Cold Laser Therapy

Cold laser (also referred to as low level laser) provides a non-addicting treatment that eliminates the complications of long-term drug treatment programs. Cold laser are widely use for treatment of:

  • Acute and chronic pain
  • Ligament sprains
  • Muscle strain
  • Soft tissue injuries
  • Tendonitis
  • Arthritis
  • Tennis elbow
  • Back pain
  • Bursitis
  • Carpal Tunnel Syndrome
  • Fibromyalgia

The cold laser Dr. Carter uses at Beyond Chiropractic is the ML830®. The ML830® received the first FDA clearance ever for a Class IIIb laser.

Benefit of Cold Lasers

  • Easy to apply
  • Extremely safe
  • Non-Toxic
  • Non-Invasive
  • No side effects or pain
  • Highly effective in treating ailments (more than 90% efficacy)
  • Superior alternative to analgesics, NSAID’s and other medications
  • Reduces the need for surgery
  • Works synergistically with other modalities like Chiropractic, and Physical Therapy

General Therapeutic Laser Biological Effects

  • Increased Cell Growth: Laser photons accelerates cellular reproduction and growth.
  • Increased Metabolic Activity: Photons initiate a higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
  • Faster Wound Healing: Cold laser photons stimulates fibroblast development and accelerates collagen synthesis in damaged tissue. (See research study below)
  • Anti-Inflammatory Action: Laser photons reduce swelling caused by bruising or inflammation of joints resulting in enhanced joint mobility. (See research study below)
  • Increased Vascular Activity: Laser photons induce temporary vasodilation that increases blood flow to effected areas.
  • Reduced Fibrous Tissue Formation:Laser photons reduce the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
  • Stimulated Nerve Function: Laser photon exposure speeds the process of nerve cell reconnect ion to bring the numb areas back to life.
  • Pain Reduction: Almost all systems have a mode of operation specifically designed to reduce pain.


Laser Accelerated Inflammation/Pain Reduction and Healing

Martin, Richard BS, CLT. Practical Pain Management, Nov/Dec 2003

Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the author separates those processes categorically for identification.

Acute Inflammation Reduction (flowchart provided in the original article) – After injury, tissues initiate a series of biological responses and cellular membrane reactions which manifest in a combination of edema, inflammation, pain and functional debility.LLLT mediates by: (1) Stabilizing cellular membranes; (2) Enhancing molecule ATP production and synthesis; (3) Stimulating vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4) Accelerating leukocytic activity; (5) Increasing Prostaglandin synthesis; (6) Reducing Interleukin-1; (7) Enhancing lymphocyte response; (8) Increasing angiogenesis; (9) Modulation temperature; (10) Enhancing superoxide dismutase levels; and (11) Decreasing C-reactive protein and neopterin levels.

Pain Reduction (flowchart provided in the original article) – Evidence justifies a conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2) Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4) Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6) Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel normalization.

Tissue Healing – LLLT enhances wound healing by: (1) Enhanced leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4) Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7) Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed wound tensile strength.


A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow)

Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI.
Institute of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College, Moellendalsvn, 6, 5009 Bergen, Norway. BMC Musculoskelet Disord. 2008 May 29;9:75. [PMID: 18510742]

BACKGROUND: Recent reviews have indicated that low level level laser therapy (LLLT) is ineffective in lateral elbow tendinopathy (LET) without assessing validity of treatment procedures and doses or the influence of prior steroid injections.

METHODS: Systematic review with meta-analysis, with primary outcome measures of pain relief and/or global improvement and subgroup analyses of methodological quality, wavelengths and treatment procedures.

RESULTS: 18 randomised placebo-controlled trials (RCTs) were identified with 13 RCTs (730 patients) meeting the criteria for meta-analysis. 12 RCTs satisfied half or more of the methodological criteria. Publication bias was detected by Egger’s graphical test, which showed a negative direction of bias. Ten of the trials included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain. The weighted mean difference (WMD) for pain relief was 10.2 mm [95% CI: 3.0 to 17.5] and the RR for global improvement was 1.36 [1.16 to 1.60]. Trials which targeted acupuncture points reported negative results, as did trials with wavelengths 820, 830 and 1064 nm. In a subgroup of five trials with 904 nm lasers and one trial with 632 nm wavelength where the lateral elbow tendon insertions were directly irradiated,WMD for pain relief was 17.2 mm [95% CI: 8.5 to 25.9] and 14.0 mm [95% CI: 7.4 to 20.6] respectively, while RR for global pain improvement was only reported for 904 nm at 1.53 [95% CI: 1.28 to 1.83]. LLLT doses in this subgroup ranged between 0.5 and 7.2 Joules. Secondary outcome measures of painfree grip strength, pain pressure threshold, sick leave and follow-up data from 3 to 8 weeks after the end of treatment, showed consistently significant results in favour of the same LLLT subgroup (p < 0.02). No serious side-effects were reported.

CONCLUSION: LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.


Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD. METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

Carpal Tunnel Syndrome (CTS)

Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament

Chang WD, Wu JH, Jiang JA, Yeh CY, Tsai CT.
Department of Bio-Industrial Mechatronics Engineering, National Taiwan University, Taipei, Taiwan. Photomed Laser Surg. 2008 Dec;26(6):551-7. [PMID: 19025407]

OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS).

BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. MATERIALS AND METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up.

RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). TheVAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings ofNCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up.

CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.


The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial

Hegedus B, Viharos L, Gervain M, Gálfi M.
Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. Photomed Laser Surg. 2009 Aug;27(4):577-84. [PMID: 19530911]

INTRODUCTION: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).

MATERIALS AND METHODS: Patients with mild or moderate KOA were randomized to receive either LLLT or placeboLLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded.

RESULTS: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature—and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur.

CONCLUSION: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

Wound Healing

Dose and wavelength of laser light have influence on the repair of cutaneous wounds

Mendez TM, Pinheiro AL, Pacheco MT, Nascimento PM, Ramalho LM.
IP&D, Univap & School of Dentistry, Universidade do Vale do Paraíba, São José dos Campos, São Paulo, Brazil. J Clin Laser Med Surg. 2004 Feb;22(1):19-25. [PMID: 15117483]

OBJECTIVE: The objective of the present study was to compare histologically the effect of GaAlAs (lambda 830 nm, phi approximately 2 mm(2), 35 mW) and InGaAlP (lambda 685 nm, phi approximately 2 mm(2), 35 mW) lasers, alone or in association with doses of 20 or 50 J/cm(2) on cutaneous wounds in the dorsum of the Wistar rat. Background Data: The healing time of surgical wounds is of extreme importance and it is usually associated with a post-operative period free of infection and with less pain and inflammation.

MATERIALS AND METHODS: Sixty Wistar rats were divided into seven groups: Group I – control (non-irradiated); Group II – lambda 685 nm, 20 J/cm(2); Group III – lambda 830 nm, 20 J/cm(2); Group IV – lambda 685 nm and lambda 830 nm, 20 J/cm(2); Group V – lambda 685 nm, 50 J/cm(2)); Group VI – lambda 830 nm, 50 J/cm(2); and Group VII – lambda 685 nm and 830 nm, 50 J/cm(2). The animals were sacrificed 3, 5, and 7 days after surgery.

RESULTS: Light microscopic analysis using H&E and Picrosírius stains showed that, at the end of the experimental period, irradiated subjects showed increased collagen production and organization when compared to non-irradiated controls. Inflammation was still present in all groups at this time.

CONCLUSION: Group IV (lambda 830 nm and lambda 685 nm, 20 J/cm(2)) presented better results at the end of the experimental period. It is concluded that low-level light therapy (LLLT) can have a positive biomodulatory effect on the repair of cutaneous wounds.

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