By Jeffrey Tucker, DC, DACRB
Therapeutic lasers are used for three primary indications: eliminating pain, reducing inflammation and accelerating tissue healing. There are different types of light forces such as LED’s, low powered lasers and high powered lasers or “super-pulsed” lasers.
I have more than five years of experience using a Class IV laser and, more recently, decided to add the Class IIIB in my practice. My choice to add a Class IIIB laser had to do with the depth of penetration and the ability to use laser without having to move the handle around on the patient’s dermis without fear of it getting too hot and burning the patient.
We are all familiar with going to the market, buying a light bulb, usually anywhere from 25 to 100 Watts. We’ve placed that bulb in the socket and felt the heat it generates. I’m sure your fingers have experienced the burn by that heat. Laser light is a type and source of energy that can generate heat. The light must be absorbed in order for a photo chemical reaction to take place. For my practice, I need a device that can penetrate this light source deep into the hips, shoulders, knees, low back, etc. The Class IIIB is able to penetrate four inches of tissue, whereas other light products with the low powered LED do not have the power in order to penetrate sufficient depth of tissue. If you are dealing with more acute injuries or superficial injuries, these systems would be fine, but if you are dealing with deeper tissues or more chronic conditions, you are going to need more powerful systems.
There are two methodologies used to increase power. One is the Watts. There are lasers that use a “super-pulsed” technology with a very high impulse function of 50 Watts across the laser diode. Remember what a 50 Watt light bulb would feel like on your fingers once it’s in the socket! So, for a fraction of a second there is 50 Watts of power at that tissue surface. This “super-pulsed” function is what allows the practitioner to hold the handle of the laser in one place without a hot burning sensation and for the light to penetrate up to four inches into tissues. We cannot leave 50 Watts of continuous power on the same spot of tissue because it would burn a hole through the patient. The “super-pulsed” delivery method provides an average power of 100 mWatts. The maximum permissible tissue exposure is 500 mW depending on the wavelength.
The second important method to increase power is getting light of the right color. Photochemists typically work in only a few sections of the electromagnetic spectrum. Some of the most widely used sections, and their wavelengths, are the following: Ultraviolet: 100–400nm; Visible Light: 400–700nm; Near infrared: 700–2500nm.
The class IV laser companies try to increase the power because they feel that more power is better. They are right up to a certain extent, once they go above 500 mWatt (half of watt), they now exceed the maximum tissue exposure and the Class IV lasers will deliver heat to tissues which is why they have to defocus the beams or use the roller tract ball at the end of the laser handle. The advantage of a roller ball or tract ball is that you can perform fascial release during the laser treatment. Again, the disadvantage to the class IV laser is that the practitioner has to keep the light moving otherwise if they hold it in one place it will burn the patient. The important thing about how lasers work is to get the right light wavelength down into the tissues.
All lasers (class I, class III, class IV), are tools that emit light and work on the ATP pathway. It is the emitted light from the laser that produces photochemistry and therefore photobiology. For the basic functions of the body (metabolism), we need food and we have to have oxygen, water and glucose. The glucose or the sugar molecule goes into the cell and gets transported into the mitochondria. Between the inner and outer membrane of the cell, the glucose molecule is transformed through a process called phosphorylation, which is known as Adenosine tri-phosphate which gets converted to the basic energy source of cells called ATP. The last source of the Krebs cycle or the citric acid cycle forms ADP to ATP and involves a Cytochrome which is a light sensitive protein. Our eyes see from 400 to 700 nanometers of light. At four hundred nanometers (400nm), we see violet, then blue, green, orange and yellow. Red is the widest bandwidth, the peak is at 660nm.
Lasers also use two other pathways to help the healing process. One is the nitric oxide pathway. Nitric oxide is a very powerful molecule but it has a very short term life. It causes endothelial cells to relax or become flaccid which causes temporary vasodilation in capillaries. Vasodilation causes more blood, more oxygen and more fuel molecules to the tissues and kicks off the lymphatic system to drain off more interstitial fluids. Some molecules are too big to go through the circulatory system and need to go through the lymphatic system. The nitric oxide causes the lymphatic system to become more leaky and allow more absorption of interstitial fluids. You can take a person with osteoarthritic knees or an inflamed knee and measure the circumference of the knee with a cloth tape measure. After you laser them for 10 to 15 minutes, including the lateral and medial joint lines, you will see a reduction in the measurement of the knee circumference. The lymphatic system is a very important system for the body. It drains fluid, swelling and facilitates the natural fluid flow in order to be healthy. By activating both the cardiovascular system and the lymphatic system you can affect healing at a much faster rate.
The most common reason patients seek our professional help is because of pain. No matter how hard I try to create a practice with patients coming in for diet, nutrition and exercise therapy, I am still known for helping people get out of pain, especially chronic pain. I have a lot of first hand experience using laser to help many people go on their happy way after seeking help and not getting full satisfaction from acupuncture, physical therapy, drug therapy,and surgery. Pain is a biochemical process and laser helps relieve pain.
A nerve cell receives a stimulus of pain, trauma, heat, cold or whatever type. The receptors force sodium outside of the cell wall and create a potential difference of 80 milli-Volt. When the sodium is outside, its very hard for it reintegrate back into the nerve cells. It has to go through a sodium- potassium pump. The peak absorption of lipids is 900 nanometers, so if you look at the lipid membrane of a cell it’s a bi-lipid membrane. By using 905nm light with the “super-pulse” technology we can make the lipid membrane more porous and allow faster integration into nearby channels. This promotes removal of noxious pain chemicals when patients are treated. After a laser treatment the patient will say my injury “feels different,” “my pain is less,” “it dropped from an 8 to a 4 out of 10,” “it feels like I have greater range of motion.” Why? Because we have rebalanced the sodium potassium, we produce a lot of nitric oxide and we took away the inflammation and accelerated the tissue healing by ATP.
I have been impressed with the many conditions that laser can affect: TMJ, traumatic brain injuries, neck pain, shoulder pain, low back pain, knee osteoarthritis, rheumatoid arthritis, epicondylitis, iliotibial band, chondromalacia patella, plantar fasciitis, achilles tendinitis and muscle stiffness. There are hundreds if not thousands of conditions to treat but only a few contraindications of laser light.
Because laser light is so powerful, on a square inch basis, it is 100 times more powerful than the sun. This light would be damaging to the eyes. We make sure we wear special glasses and don’t point laser into the eyes. If the light goes into the optical path, the cornea of the lens focuses 30,000 times onto the retina and you would cause permanent damage to the retina if it was a sustained dose. Luckily, we have a blink reflex, but having laser into the eye is one of the main contraindications. If you are working around the periphery of the face, you have to wear glasses. If they are face down on a table and I am working on the back, I ask them to close there eyes, and in this case they don’t need to have laser glasses. Another contraindication is cancer. We do not treat somebody who has cancer if they have not been clear for five years. We are also cautious not to treat the abdomen of a pregnant woman.
Laser is effective for nerve action growth, wound healing, damage to nerves either through surgery or trauma, diabetic ulcers, diabetic polyneuropathy, venous stasis, improving oxygenation and myofascial pain. Laser is noninvasive, has little known side-effects and is safe. In conjunction with exercise therapy, nutrition and our hands-on skills, it is a highly effective treatment. Compared to drugs like NSAIDs and Cox 2 inhibitors, there are no contraindications.
Self-Controlled Energy Neuro-Adaptive Regulator (SCENAR): It was first invented in Russia in the mid 80s under space and military research programs. SCENAR device generates electrical impulses that are physiologically similar to our own bodies neurological impulses. SCENAR impulses get applied to your skin, then the body uses its own reflexes, in a biofeedback process at real time and biological speed. By continuously using biofeedback, the SCENAR modifies each successive input signal to either amplify or dampen the form of the pathological signals that exist in the body.
Pain is the most common complaint to be dealt with the SCENAR therapy by blocking transmission of the pain impulses in the nerve endings.
I use SCENAR to send a signal along peripheral nerve fibers, allowing suppression of pain that occurs in the brain cortex. By rubbing the SCENAR impulses over an inflammed or restricted fascial area, there is reduction of the swelling/edema around the nerve fibers leading to reduction of pressure effects on the nerves.
When I looked to purchase a new Laser for my practice, I really did my research. I picked a Laser that I could use while performing deep tissue massage. The Laser plus massage provides pain relief faster than Laser alone.
Here is what I am seeing after using the laser in my day-to-day practice…
Patients like the soothing warm feeling of the Laser with deep tissue massage better than hands-on only.
Laser is best known for healing and anti-inflammatory effects. I am not disappointed by the results.
For an acute injury, the sooner you get in for the Laser treatment the quicker the healing process.
Patients like when I apply the Rock Tape after the Laser.
For long term chronic pain problems, combining the Deep Muscle Stimulator, Radial Pulse Therapy, exercise, and nutrition are getting the best results.
The Laser is useful for treating large painful areas like the low back, and in a short time obtains pain relief.
The laser is solving difficult knee, shoulder, ankle and foot pain.
Typical Laser sessions can last from 5 – 15 minutes.
The current price of a laser session in my office is approximately $40. Other Doctors are charging $60-90 for Laser treatments and they are using less quality devices.
Laser treatments are safe, they last, they are effective for analgesia of painful conditions, they penetrate deeply.
Call the office at 310-444-9393 to try the Laser with massage.
I work every day with chronic pain clients and I am often not satisfied with the results. I search for educated answers and I look for innovative therapy for clients to improve there problems. This has led me to use many cutting edge modalities early on in my practice, such as being in a multi-disiplinary practice, laser, kettlebells, ropes, suspension training, vibration and percussion, radial shock wave therapy, instrument-assisted soft tissue tools and SCENAR therapy…
I stopped using the Biolase and am now testing out a new Laser device/system. Class IV Laser Therapy for pain relief are becoming more and more mainstream. I started using laser more than 5 years ago. I have more experience with warm laser than most practitioners. Laser therapy reduce pain associated with inflammation and swelling.
Sometimes I use the laser as a stand alone treatment and with other clients they require laser in conjuction with Radial Shock Wave Therapy, the Deep Muscle Stimulator (DMS), SCENAR or hands-on therapy. I continue to recommend stretching, corrective exercise and diet recommendations.
I also look at clients shoe wear and arch supports(or lack of support) – sometimes wearing better or different shoes with inserts helps make a big difference in low back pain. I discuss sitting and standing posture. Prolonged sitting without taking a break is a major contributor of back and neck pain. The new recommendation for taking a break from sitting is stand-up every 20 minutes for at least two minutes– don’t let your muscles tighten up in the first place. Reduce the time spent sitting!
Please come in and feel the new Laser. Call 310-444-9393
Staying innovative as always! Best, Jeff
Everyone with chronic pain can safely start the Anti-inflammatory diet – no sugar, alcohol, gluten, dairy, preservatives, & chemicals. The minimum supplements I recommend you should be taking are high amounts of EPA/DHA (EPA-DHA 720, three softgels up to three times daily with food), Vitamin D3 (IsoD3 5,000 i.u. daily) and digestive enzymes (Metazyme, one tablet during each meal). Order from Metagenics 800-692-9400.
Additional Supplements for chronic pain:
Quercetin (Resveratin Plus 12 capsules daily). Order from XYMOGEN 1-800-647-6100
UltraInflamX Plus 360 medical food is a shake that contains Turmeric, Ginger, Rosemary extract, as well as other vitamins and minerals plus 15 grams of protein. Two scoops in water or juice 1 – 2 times daily. Order from Metagenics 800-692-9400
Kaprex is for joint relief and contains hops, iso-alpha acids, Olive Leaf extract and Rosemary Leaf extract. Dose is two softgels three times daily. Order from Metagenics 800-692-9400.
Chronic pain depletes serotonin, GABA and dopamine and other catecholamines (which in turn amplify pain perception); so nutrients that address serotonin (such as Tryptophan, 5HTP, and vitamin D) and dopamine and catecholamines are useful. Trancor and Symphora (4 each per day). Order from Metagenics 800-692-9400
Acute Trauma: Traumeel tablets – take 1 tablet every 15 minutes for 3 hours then cut back to 1 every hour for day 1; 1 every 2 hours on day 2 and 1 3 per day until you come in for a visit. This is easily purchased in health food stores.
Peripheral neuropathy, including diabetic neuropathy:
Take Insinase which contains Alpha Lipoic Acid 540 mg BID and Acetyl-L-Carnitine HCL 400 mg BID. Order from Metagenics 800-692-9400.
Osteoarthrits & RA:
Combinations of Magnesium, Calcium, Valerian root and Hops are essential. See my list for chronic pain and include UltraInflamX 360.
Capsaicin (Capsicum frutescens) cream:
Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the surface of the skin, it is believed to deplete stores of a substance that contributes to inflammation and pain in arthritis. Several studies have shown that capsaicin cream provided much better pain relief than a placebo but no improvement in joint swelling, grip strength, or function for people with OA. Pain reduction generally begins 3 to 7 days after applying the capsaicin cream to the skin. Apply the cream 4 times daily.
This is another topical pain reliever used in pain management. This is especially good for sore or strained muscles; shoulderand arm pain; neck, hip, and leg pain; back pain; arthritis pain; painful joints; diabetic neuropathy; tendonitis; and bursitis. Biofreeze needs to be applied 4 times daily.
KinesioTaping procedures are an invaluable aide in everything from chronic edema (swelling) reduction to reduction of muscle tension/pain.
My two favorite modalities for chronic pain continue to be the Deep Muscle Stimulator (DMS) and warm laser.
Antinociceptive effects of docosahexaenoic acid against various pain stimuli in mice.
Nakamoto K, Nishinaka T, Mankura M, Fujita-Hamabe W, Tokuyama S.
Department of Clinical Pharmacy, Kobe Gakuin University, School of Pharmaceutical Sciences, Kobe, Japan.
Docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid (n-3 PUFAs), is an essential polyunsaturated fatty acid in the central nervous system, and possesses many physiological functions in neurodegenerative diseases. Previously, there are some reports that n-3 PUFAs contribute to pain relief. As the antinociceptive effect of DHA alone has not been reported, this study examined the antinociceptive effect of DHA on various pain stimuli. To evaluate the antinociceptive effect of DHA on thermal and chemical nociception, we employed the tail flick test, acetic acid writhing test and formalin test in mice. DHA was orally administrated at 5, 15 and 25 mmol/kg at 30 min before measurement. DHA administration dose-dependently exerted an antinociceptive effect against thermal and chemical stimulation in comparison to the control olive oil administration. These effects of DHA were abolished when mice were pretreated with naloxone, an opioid receptor antagonist. These findings suggest that DHA has opiod receptor-mediated pain control activities, and may provide valuable information towards an advanced therapeutic approach for pain control.
OmegaPure 820 from XYMOGEN (phone # to order 1-800-647-6100) has independent third party assays that document freshness and purity of every DHA batch.
I use High Power Laser Therapy (7.5 watts). Laser stimulation has been shown to increase blood flow and lymphatic drainage while, at the same time, stimulating endorphin and enkephalin release for pain management. Stimulation with laser reduces inflammation, and promotes nerve regeneration.
High Power Laser Therapy has the ability to reach deep within the body when compared to Low Level Laser Therapy. Laser energy apperas to also biostimulate collagen and fibroblast growth.
I usually use the laser in combination with hands-on therapy and I often use the Deep Muscle Stimulator (DMS) as well. Exercises are taught based on the Functional Movement Screen (FMS) and squat evaluation.