Chiropractor Treatments Archives

 

Have you been suffering from tendonitis?

Have you tried multiple therapies with no success?

Tendonitis, tendonosis and tendonopathy are terms that are often misused, misunderstood and often misdiagnosed.
Tendonitis is a condition that plagues many people of all walks of life. While it is tempting to think that only athletes or even “weekend” athletes get it, that is far from the truth. While tendonitis is common in athletes, you also see it in people who perform daily repetitive tasks, some can be as mundane as driving a car or truck for a living.

Injuries that occur suddenly can also put excessive strain on a tendon and we would term that “macro trauma”. Other times, and probably more common are the “micro trauma”cases. This is where you put small amounts of stress daily or frequently and consistently. A good example of this is using a mouse and keyboard, playing a musical instrument, using tools, etc. These activities can slowly create the symptoms and condition that can be called tendonitis.

Tendinosis vs Tendonitis

Tendonosis sometimes called chronic tendinitis,  chronic  tendinopathy or chronic tendon injury, is damage to a tendon at a cellular level (the suffix “osis” implies a pathology of chronic degeneration without inflammation). It is thought to be caused by microtears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community. Classical characteristics of “tendinosis” include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity and a lack of inflammatory cells which has challenged the original misnomer “tendinitis”. For purposes of this article, we will refer to the pain experienced in a tendon region as tendonitis.

Some common names for various tendinitis problems are:

• Tennis elbow
• Golfer’s elbow
• Pitcher’s shoulder
• Swimmer’s shoulder
• Jumper’s knee

No matter what you call it, it still spells pain for most people!

What does a tendon actually do?

Essentially, it connects to a muscle on opposite ends of a muscle and performs two basic functions:

1. Stabilization
2. Motion

What are some of the symptoms associated with tendon problems?

Signs and symptoms of tendinitis occur at the point where a tendon attaches to a bone and typically include:

• Pain, often described as a dull ache
• Tenderness
• Mild swelling
• Pain with movement

Symptoms can vary from an ache or pain and stiffness to the local area of the tendon, or a burning that surrounds the whole joint around the inflamed tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day as swelling impinges on the movement of the tendon. Many patients report stressful situations in their life in correlation with the beginnings of pain which may contribute to the symptoms. Most often the pain does not stop you from moving, but the pain can hinder your movement. Sometimes even trying to pick up a coffee cup can cause arm pain. Turning a key, using a screwdriver are all activities that can increase pain when there is arm tendonitis.

Without proper care, tendinitis can increase your risk of experiencing tendon rupture – a much more serious condition that may require surgical repair.

To reduce your chance of developing tendinitis, follow these suggestions:

• Ease up. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest.
• Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
• Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
• Stretch first. Before you exercise, take time to stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember to stretch after exercise too.
• Use proper workplace ergonomics. At your workplace, get a proper ergonomic assessment. Fitting your work space to your body is essential to ensure that no tendons are continually stressed or overloaded.
• Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.
Tendinitis problems are some of the most common ailments there are. If not treated properly they can persist indefinitely. The longer your tendonitis lasts, the harder it is to get rid of and the more scar tissue your body develops fighting the injury. If you don’t heal your tendonitis quickly and completely, you may be subject to a lifetime of recurrent pain and decreased performance.
Tendons are very slow to heal if injured, and rarely regain their original strength. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendon. Recurrence of injury in the damaged region of tendon is common.

What are the traditional ways of dealing with tendonitis?

Standard treatment of tendon injuries is largely palliative. Use of non-steroidal anti-inflammatory drugs combined with Physical Therapy, rest and gradual return to exercise is a common therapy. However, there is evidence to suggest that tendinosis is not an inflammatory disorder, that anti-inflammatory drugs are not an effective treatment and that inflammation does not cause tendon dysfunction. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks About 80% of patients will fully recover with traditional treatment.

Traditional treatment of tendon injuries is largely conservative. Use of non-steroidal anti-inflammatory drugs, rest, and gradual return to exercise is a common therapy. Resting assists in the prevention of further damage to the tendon. Ice, compression and elevation are also frequently recommended. Physical therapy, orthotics or braces may also be useful. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks. As tendinosis is more common than tendinitis, and has similar symptoms, tendinitis is often initially treated the same as tendinosis. This helps reduce some of the chronic long-term risks of tendinosis, which takes longer to heal. Steroid injections have not been shown to have long term benefits and are equivalent to NSAIDs in the short term. In chronic tendinitis laser therapy has been found to be better than conservative treatment at reducing pain; however, no other outcomes were accessed
Steroid injections have not been shown to have long term benefits and are equivalent to NSAIDs in the short term. In chronic tendinitis laser therapy has been found to be better than conservative treatment at reducing pain; however, no other outcomes were accessed.

 

Now, there is a better way to treat tendonitis than the “traditional” method!

The use of cold (low level) laser and a unique patch applied to the area is a revolutionary way to actually HEAL the tendon at a radically accelerated rate!

 

For information on cold laser, please refer to the page on this web site. Below are the ingredients used in the Wei Fast Patch that are used to heal tendons:

Cortex Cannamomi
Cortex Periplocae
Fructus Chaenomelis
Myrrhax
Radix Achyranthis Bidentatae
Radix Aconiti Jusnezolfii
Radix Angelicae Pubescentis
Radix Angelicae Sinensis
Radix Dipsaci
Radix Paeoniae Rubra
Resina Ferulae
Rhizoma Alpiniae Officinarum
Rhizoma Seu Radix Notoplergyi
Lignum Sappan
Lignum Piri Nodi

The FASTT Patch is used to treat musculoskeletal system injuries such, tendonitis, sprains and strains, and bursitis. It accelerates the healing of acute and chronic injuries and injuries caused by overuse of the tendon.

The FASTT Patch is a scientifically-designed Chinese herbal mixture attached to the highest grade, waterproof surgical tape available. When placed on the injured area, the herbal ingredients migrate slowly through the skin and increase the blood flow to the injured area and accelerate the healing mechanism, which facilitate the growth of the new tissue. This proposed mechanism was supported by the observation that the skin temperature in the area with herb coverage is higher than the temperature of the surrounding skin. The herbs also help increase the lymphatic circulation and accelerate the dead  tissue break down, as we have observed that the bruises in the injured area can be cleared rapidly (within 24 hours) after the FASTT Patch was applied and noticeable pain reduction begins within a couple of hours when treating an acute condition. With a faster new tissue growth, dead tissue clear-up, and the use of cold laser therapy, you can actually speed up the healing tendons 8 to 10 times quicker.

The key to successful tendonitis treatment is patience. In almost 90% of recurring tendonitis cases the individual did not give the tendon sufficient time to recover before returning to the activity that caused the pain initially. If you do not give the tendon enough time to recover tendonitis will return, it’s a simple as that.

Please call us for a no-charge consultation regarding your specific problem.

 

 

Chiropractic has long been practiced, usually among adult patients. Some parents are also considering having their kids try the alternate treatment. You have to ensure that the approach is truly safe for the young ones to prevent unnecessary risks and dangers. Here are some details about the techniques, as well as some precautionary measures for you.

On Subluxation

Spinal bone misalignments can occur, thereby hindering the regular flow of nerve energy called subluxations. Several individuals still relate these with severe trauma. The spine is believed to be affected only after carrying very heavy items or being involved in a car accident. The truth is that daily activities among young children and infants can lead to subluxations. A lot of babies actually get subluxations before birth or during delivery.

Cesarean section is one of the modern medical techniques that create irregular strains on the vulnerable body of the baby, due to use of forceps and other materials and medications that induce delivery. On most occasions, physicians hold the baby in an upside down position, putting the tiny spine in a great deal of stress because of the stretched, twisted and tugged form. Subluxations will then ensue.

Caring for Kids

Parents are highly encouraged to have their kids visit the chiropractor’s clinic at a very young age. The strain on your kids’ spine will not end in the delivery room. Children are naturally energetic, playful and active, so they indulge in several physically straining activities like jumping, running and falling.

On the exterior, the body will only present bruises or small scratches. The interior, however, may present more serious problems because of considerable force acted upon it. Small bones that form the spinal column, can be forced to assume an unnatural position, thereby reducing the protection provided to the system.

Effects on Kids

Subluxations among kids can lead to different body problems such as disabilities, disease and other signs and symptoms. Whenever nerve flow in the body is hindered, the brain will only get distorted messages, so the body cannot work excellently. Optimum level of health cannot be achieved. Some of the manifestations that parents should watch out for to determine if their child needs to be checked by a chiropractor include hyperactivity, stomach pain, fever, bed wetting, sore throat, colds, flu and poor posture.

Treatment Measures

Spinal problems in kids can be treated by first having the chiropractor conduct a thorough evaluation of the spine. A lot of these experts are experienced and trained to view pediatric spinal problems. Spinal adjustments may be done on infants and children, using light fingertip techniques to improve spinal structures and other malfunctions.

The pressure usually does not exceed 1 pound. It is usually enough to restore spinal joint mobility. Some of the things to expect are popping sounds as joints are moved.

Chiropractic on children and infants are not painful, although kids may find the first few sessions frightening. It is normal to see kids cry during visits, because of apprehensive feelings. Children only need fewer adjustments, compared to adults, since their spine is more mobile and can be corrected more easily.

The number of treatments will depend on the duration of the current condition. Kids will need to be re-evaluated every now and then to check progress, and if other therapies are required for full recovery.

Nerve-Express is a fully automatic, non-invasive computer-based system designed for quantitative assessment of the Autonomic Nervous System (ANS) based on Heart Rate Variability (HRV) analysis. In short, it tells you how healthy your system is at the time considering your age and health habits.

For the ìTechyî, HRV analysis is based on measuring variability in heart rate; specifically, variability in intervals between R waves – ìRR intervalsî . These RR intervals are then analyzed by spectral (as in Nerve-Express) or some other form of mathematical analysis (e.g., chaos, wavelet theories). Such mathematical analysis generates multiple parameters; typically 20-30. The problem of SNS-PSNS quantification, which has remained for many years the principal dilemma of HRV analysis, is specifically in reducing all possible variations of these multiple parameters to a quantitative relationship between only two parameters: SNS and PSNS.

Nerve-Express is the first and only system to solve the problem of SNS-PSNS quantification. This technological breakthrough is heart rate variability testingachieved by using proprietary algorithms and a new approach based on one of the leading theories of Artificial Intelligence – Marvin Minsky’s Frame Theory. Nerve-Express objectively and reliably evaluates the state of ANS in “real-time” (up to 24 hours) as well as during Orthostatic test and Valsalva maneuver combined with Deep Breathing. Due to its highly sophisticated HRV analysis, Nerve-Express is the only system that enables quantification of 74 ANS states with a corresponding qualitative description for each one.

In plain language, this means that there is now a means of assessing oneís adaptability and fitness level based on the most fundamental systemÖthe human nervous system. It is also useful in predicting how one will respond to a nutritional program and can tell the doctor whether they might have ìblocked regulationî. When this condition is seen, this is the type of person who when they try to sleep, are awake and when they try to be active, they are tired. This also can explain why some people donít seem to respond to medication, weight loss, supplements and other treatments. This is breakthrough technology and is the missing link in many nutritional programs.

The procedure itself is done by placing a rubber belt around the chest, just as any other hospital heart monitor would use. Then we take a reading lying down for five minutes and another immediately standing up. The standing test relates to your sympathetic nervous system (the acceleratro) and the lying test relates the the parasympathetic nervous system (the brake). The values and the difference are extremely accurate in determining where your health status stands at the time. We can then help you with lifestyle changes and ideas to get you back on track to a healthy life.

The Low Level/Cold Laser

Light energy has been used for healing since the earliest recorded medical history, but has gone out of favor in Western medicine with the advent of the existing paradigm of a more surgical and pharmacological basis. Recently, a shift in thinking has been emerging with an explosion of research, exploration and utilization of energy medicine modalities such as micro-current stimulators, bone growth stimulators, broad-spectrum multiple frequency Tesla coil devices, and low-level or cold lasers. Despite years of research demonstrating the benefits of low-level laser therapy (LLLT) as a modality for wound healing, Western medicine, and its low level cold laser therapyadjunct professions, have been slow to adopt this technology. LLLT has been an essential part of therapy for practitioners around the world for almost 20 years, but it is only recently catching on in the United States. Still, the vast majority of students of medicine and allied health practices in this country are not being taught its efficacy and use. Itís time we opened our eyes to the light.

An Eye Opener in My Office
My first in-office awakening as to the effectiveness of cold laser was a senior citizen in his early 70ís with post-herpetic pain (shingles) that ranged from the left side of his neck into the left shoulder girdle and upper arm. After 1 Ω years of going to the pain clinic and being told that he would probably have this forever and would need to use Vicodin for pain control (he was taking 5-6/day) he consulted me for laser treatment. After the first treatment there was a definite improvement and after 5-6 times, he was almost pain free. Unfortunately the medical doctor at the pain clinic told him that peanut butter would have worked just as well. (I couldnít help wondering why he didnít prescribe that if it works so well). As you can imagine, he was extremely pleased with the results and this particular laser therapy has been a part of my practice ever since.

How It Works
The exact mechanism of action of LLLT is not completely understood; however, there are several theories based on cellular research conducted over the last two decades or more. The basic premise is that LLLT stimulates cell activation processes which, in turn, intensify physiologic activity. Healing is essentially a cellular process and light energy initiates a cascade of reactions, from the cell membrane to the cytoplasm, to the nucleus and DNA. This is called cellular amplification; a phenomenon whose demonstration earned the Nobel Prize in Physiology or Medicine in 1994. There are many biological processes that take place in tissues that have been shown to respond to LLLT in the 630-640 nanometer wavelength range. One of these processes is the enhancement of ATP production in the mitochondria, which provides more energy substrate for cellular healing and tissue recovery post injury. This wavelength has also been shown to decrease inflammatory mediators in wounds and increase endogenous endorphin release. When one considers that wounds have varying degrees of cellular and vascular damage, the wound site can be in a potentially anaerobic state. Cells deprived of oxygen or blood supply have a potential to increase lactic acidosis and therefore amplify local cellular damage. Normal physiologic healing requires growth factors and cytokines to be released at the wound site. These cell mediators call inflammatory cells to the wound which clean up damaged tissues, fight bacteria, and stimulate fibroblasts and vascular cells to grow to try to heal the zone of injury. The physiologic concept is that LLLT improves cellular metabolism and accelerates the process of debris cleaning, improves neutrophil bacterial clearing and hastens cellular division. Therefore, all stages of wound healing; hemostasis, inflammation, cell proliferation and migration, collagen synthesis, wound contraction, and wound remodeling proceed more rapidly and more efficiently. A key issue to understand is that LLLT, as a category, covers a broad range of wavelengths. Individual wavelengths have individual physiologic results. The 635 nm wavelength is the monochromatic output that has been shown to be the best wavelength for improving cellular metabolism and therefore, improving wound healing. Another important property of an effective laser is that it be a true laser, which, by definition, produces the emission of coherent light, generated at a precise, stable frequency, in a focused direction. Products that use Light Emitting Diodes (LEDs) are not true lasers. They produce non-coherent or random light, generating random frequencies. Coherent light energy is critical when treating the human body. One more consideration is the optimum power necessary for bio-stimulation. The Arndt- Schulz Law of photo-biological activity, essentially states that ìless is moreî when it comes to energy for improved cellular physiology. The ErchoniaÆ LLLT provides the best wavelength (635 nm) for cellular physiology at very low energy (2-5 mill Watts) to stimulate cells to function better. If the stimulation is too intense, there may actually be an inhibitory effect, or possibly degeneration or destruction of cells.

Healing Research
Our research with burn patients demonstrates several advantages to the 635nm LLLT in burn/wound management. The most immediate advantage is an average of 70% decrease in pain at the wound site within 5 minutes of a two-minute treatment per 4% total body surface area (TBSA). Other research has shown that LLLT increases natural endorphins in patients. This increase in endorphin release would explain why we often see decreased pain for days at a time. I believe we are also seeing an immediate decrease in sensory nerve stimulation and a decrease in sympathetic stimulation. This decrease in sympathetic tone and sensory nerve stimulation provides the decrease in pain within minutes. During our studies with burn patients we noticed that they had less swelling in their wounds, visibly improved perfusion (blood supply) to the tissues and faster healing. When patients have continued LLLT and we follow them post-healing, they have less scar formation and less purritus (itching) in their scars. Currently, we are undertaking a multi-center, double-blinded trial that will explore the potential of LLLT in healing burn injuries and decreasing their late complications. Our success with the burn-injured patient led us to apply LLLT to the management of other complex wounds. Some of the wounds we have treated include diabetic wounds, decubitus ulcers, post-orthopedic surgery wounds and skin and myocutaneous flaps. We use the laser to decrease inflammation, improve tissue perfusion and decrease pain at thewound site; each a tremendous advantage to the patient and the treating practitioner.

Complementary Advantages
The ErchoniaÆ laserís first FDA approval was obtained for the management of neck and back pain. The advantages in improving musculoskeletal pain carry over to the physical therapy and occupational therapy arenas. We have found in our clinical work that patientís stiffness and sense of tissue tightness greatly decreases after LLLT treatments. Typically, an improvement of 30-50% occurs with just one treatment. Many extremity wounds have long periods of immobilization associated with them; from splinting, surgery, or just a protective mechanism of pain control. LLLT treatments increase the patientís recovery of range of motion (ROM). This mechanism of improved ROM is separate from pain control and protective issues. Later, after a burn or wound injury, many patients will report no pain, but have problems with tightness and stiffness. Within minutes or hours of LLLT treatments they report significant (>30%) improvement in the tightness. We have also found that many patients may have a functionally normal ROM by goniometer measurements, yet feel very tight or stiff. The LLLT greatly improves their subjective assessment of tightness, however their ROM may remain the same.

Basic Mechanics
The ErchoniaÆ laser is a very portable, user-friendly, hand-held unit. Treatments take about 5 minutes total on average, so it fits easily into a clinical treatment schedule. ErchoniaÆ laser can be used with full contact with the patient if needed, but most treatments are done about 6-12 inches away from the surface area so there is no cross contamination if the patientsí wound is colonized with resistant bacteria. LLLT can beused in the setting of open wounds, burns, tissue injury, surgical recovery, neuropathy, deep tissue injury or active infection. There is no known ìtissue problemî that is a contraindication; however, I would not suggest treatment of a known active cancer until more studies are done specifically in cancer cells. To date, there is no evidence that LLLT converts normal cells to cancer cells. LLLT can be used near and over hardware such as artificial joints. Pregnancy is not a contraindication, but it is suggested that a pregnant patient not be treated due to medical/legal issues. Though there are no known problems with the use of LLLT on a patient with a pacemaker, it is not suggested that it be used directly over the pacemaker or pacemaker wires. LLLT can be applied through dressings and clothing, though, in my practice, I like to observe the areas when treated. In the physical therapy setting this is important because dressings or garments donít always have to be removed. The number of treatments depends on the problem being addressed and may be as little as one and as many as 20 spread over several months. There can often be increased exudate in an open wound for LLLT increases tissue perfusion which can increase wound fluid. Pain at the treatment site is rare, but can occur on occasion with a mild increase in pain that then significantly resolves in 1-2 hours. As a plastic surgeon in charge of a burn and wound center for many years, I have had the opportunity to assist multiple patients with pain management, wound healing and physical recovery with the use of 635 nm LLLT. This modality has been the best new technology I have had to offer my patients in the last decade. It is my hope that others will latch onto this technology and bring it forward, for it is a completely non-invasive option that provides so many physiologic advantages with no apparent side effects.

The Low Level/Cold Laser
Light energy has been used for healing since the earliest recorded medical history, but has gone out of favor in Western medicine with the advent of the existing paradigm of a more surgical and pharmacological basis. Recently, a shift in thinking has been emerging with an explosion of research, exploration and utilization of energy medicine modalities such as micro-current stimulators, bone growth stimulators, broad-spectrum multiple frequency Tesla coil devices, and low-level or cold lasers. Despite years of research demonstrating the benefits of low-level laser therapy (LLLT) as a modality for wound healing, Western medicine, and its adjunct professions, have been slow to adopt this technology. LLLT has been an essential part of therapy for practitioners around the world for almost 20 years, but it is only recently catching on in the United States. Still, the vast majority of students of medicine and allied health practices in this country are not being taught its efficacy and use. Itís time we opened our eyes to the light.

An Eye Opener in My Office
My first in-office awakening as to the effectiveness of cold laser was a senior citizen in his early 70ís with post-herpetic pain (shingles) that ranged from the left side of his neck into the left shoulder girdle and upper arm. After 1 Ω years of going to the pain clinic and being told that he would probably have this forever and would need to use Vicodin for pain control (he was taking 5-6/day) he consulted me for laser treatment. After the first treatment there was a definite improvement and after 5-6 times, he was almost pain free. Unfortunately the medical doctor at the pain clinic told him that peanut butter would have worked just as well. (I couldnít help wondering why he didnít prescribe that if it works so well). As you can imagine, he was extremely pleased with the results and this particular laser therapy has been a part of my practice ever since.

How It Works
The exact mechanism of action of LLLT is not completely understood; however, there are several theories based on cellular research conducted over the last two decades or more. The basic premise is that LLLT stimulates cell activation processes which, in turn, intensify physiologic activity. Healing is essentially a cellular process and light energy initiates a cascade of reactions, from the cell membrane to the cytoplasm, to the nucleus and DNA. This is called cellular amplification; a phenomenon whose demonstration earned the Nobel Prize in Physiology or Medicine in 1994. There are many biological processes that take place in tissues that have been shown to respond to LLLT in the 630-640 nanometer wavelength range. One of these processes is the enhancement of ATP production in the mitochondria, which provides more energy substrate for cellular healing and tissue recovery post injury. This wavelength has also been shown to decrease inflammatory mediators in wounds and increase endogenous endorphin release. When one considers that wounds have varying degrees of cellular and vascular damage, the wound site can be in a potentially anaerobic state. Cells deprived of oxygen or blood supply have a potential to increase lactic acidosis and therefore amplify local cellular damage. Normal physiologic healing requires growth factors and cytokines to be released at the wound site. These cell mediators call inflammatory cells to the wound which clean up damaged tissues, fight bacteria, and stimulate fibroblasts and vascular cells to grow to try to heal the zone of injury. The physiologic concept is that LLLT improves cellular metabolism and accelerates the process of debris cleaning, improves neutrophil bacterial clearing and hastens cellular division. Therefore, all stages of wound healing; hemostasis, inflammation, cell proliferation and migration, collagen synthesis, wound contraction, and wound remodeling proceed more rapidly and more efficiently. A key issue to understand is that LLLT, as a category, covers a broad range of wavelengths. Individual wavelengths have individual physiologic results. The 635 nm wavelength is the monochromatic output that has been shown to be the best wavelength for improving cellular metabolism and therefore, improving wound healing. Another important property of an effective laser is that it be a true laser, which, by definition, produces the emission of coherent light, generated at a precise, stable frequency, in a focused direction. Products that use Light Emitting Diodes (LEDs) are not true lasers. They produce non-coherent or random light, generating random frequencies. Coherent light energy is critical when treating the human body. One more consideration is the optimum power necessary for bio-stimulation. The Arndt- Schulz Law of photo-biological activity, essentially states that ìless is moreî when it comes to energy for improved cellular physiology. The ErchoniaÆ LLLT provides the best wavelength (635 nm) for cellular physiology at very low energy (2-5 mill Watts) to stimulate cells to function better. If the stimulation is too intense, there may actually be an inhibitory effect, or possibly degeneration or destruction of cells.

Healing Research
Our research with burn patients demonstrates several advantages to the 635nm LLLT in burn/wound management. The most immediate advantage is an average of 70% decrease in pain at the wound site within 5 minutes of a two-minute treatment per 4% total body surface area (TBSA). Other research has shown that LLLT increases natural endorphins in patients. This increase in endorphin release would explain why we often see decreased pain for days at a time. I believe we are also seeing an immediate decrease in sensory nerve stimulation and a decrease in sympathetic stimulation. This decrease in sympathetic tone and sensory nerve stimulation provides the decrease in pain within minutes. During our studies with burn patients we noticed that they had less swelling in their wounds, visibly improved perfusion (blood supply) to the tissues and faster healing. When patients have continued LLLT and we follow them post-healing, they have less scar formation and less purritus (itching) in their scars. Currently, we are undertaking a multi-center, double-blinded trial that will explore the potential of LLLT in healing burn injuries and decreasing their late complications. Our success with the burn-injured patient led us to apply LLLT to the management of other complex wounds. Some of the wounds we have treated include diabetic wounds, decubitus ulcers, post-orthopedic surgery wounds and skin and myocutaneous flaps. We use the laser to decrease inflammation, improve tissue perfusion and decrease pain at thewound site; each a tremendous advantage to the patient and the treating practitioner.

Complementary Advantages
The ErchoniaÆ laserís first FDA approval was obtained for the management of neck and back pain. The advantages in improving musculoskeletal pain carry over to the physical therapy and occupational therapy arenas. We have found in our clinical work that patientís stiffness and sense of tissue tightness greatly decreases after LLLT treatments. Typically, an improvement of 30-50% occurs with just one treatment. Many extremity wounds have long periods of immobilization associated with them; from splinting, surgery, or just a protective mechanism of pain control. LLLT treatments increase the patientís recovery of range of motion (ROM). This mechanism of improved ROM is separate from pain control and protective issues. Later, after a burn or wound injury, many patients will report no pain, but have problems with tightness and stiffness. Within minutes or hours of LLLT treatments they report significant (>30%) improvement in the tightness. We have also found that many patients may have a functionally normal ROM by goniometer measurements, yet feel very tight or stiff. The LLLT greatly improves their subjective assessment of tightness, however their ROM may remain the same.

Basic Mechanics
The ErchoniaÆ laser is a very portable, user-friendly, hand-held unit. Treatments take about 5 minutes total on average, so it fits easily into a clinical treatment schedule. ErchoniaÆ laser can be used with full contact with the patient if needed, but most treatments are done about 6-12 inches away from the surface area so there is no cross contamination if the patientsí wound is colonized with resistant bacteria. LLLT can beused in the setting of open wounds, burns, tissue injury, surgical recovery, neuropathy, deep tissue injury or active infection. There is no known ìtissue problemî that is a contraindication; however, I would not suggest treatment of a known active cancer until more studies are done specifically in cancer cells. To date, there is no evidence that LLLT converts normal cells to cancer cells. LLLT can be used near and over hardware such as artificial joints. Pregnancy is not a contraindication, but it is suggested that a pregnant patient not be treated due to medical/legal issues. Though there are no known problems with the use of LLLT on a patient with a pacemaker, it is not suggested that it be used directly over the pacemaker or pacemaker wires. LLLT can be applied through dressings and clothing, though, in my practice, I like to observe the areas when treated. In the physical therapy setting this is important because dressings or garments donít always have to be removed. The number of treatments depends on the problem being addressed and may be as little as one and as many as 20 spread over several months. There can often be increased exudate in an open wound for LLLT increases tissue perfusion which can increase wound fluid. Pain at the treatment site is rare, but can occur on occasion with a mild increase in pain that then significantly resolves in 1-2 hours. As a plastic surgeon in charge of a burn and wound center for many years, I have had the opportunity to assist multiple patients with pain management, wound healing and physical recovery with the use of 635 nm LLLT. This modality has been the best new technology I have had to offer my patients in the last decade. It is my hope that others will latch onto this technology and bring it forward, for it is a completely non-invasive option that provides so many physiologic advantages with no apparent side effects.

Many Clinical Case Studies Prove Low Level Laser Therapyís Effectiveness Treating Numerous Conditions Including:

PAIN ñ Low Level Laser Therapy has been cleared by the FDA as an adjunct treatment method for pain related to shoulder injuries.
Carpal Tunnel Syndrome ñ Low Level Laser Therapy has been cleared by the FDA as an adjunct treatment method for this condition.
Epicondylitis (Tennis Elbow) ñ Simunovic treated 324 patients . . . complete pain relief and restored functional ability were achieved in 82% of the acute patients and 66% of the chronic cases. J Clin Laser Med & Surg. 1998; 16 (3): 145-151
Fibromyalgia ñ Longo treated 846 patients with fibromyositic rheumatism during a 15 year period. About 2/3 benefited from the treatment with regard to local pain, hypomobility and phlogosis. J Clin Laser Med Surg. 1997; 15 (5): 217-220
Headache/Migraine ñ Wong treated 20 patients with migraine or symptoms resembling migraine. The pain disappeared after 1-5 minutes. Proc 9th Congress Soc Laser Surgery and Medicine, Anaheim, CA: 2-6 Nov. 1991
Low Back Pain ñSoriano performed a double-blind trial with elderly people suffering from chronic low back pain. Treatment was effective in 71% of the laser group and 36% of the sham group. The pain disappeared completely in 45% of the laser group and 15% of the sham group. Lasers Surg Med. 1998 Suppl 10, p. 6
Rheumatism/Osteoarthritis ñ Palmgren conducted a controlled double-blind study on 35 patients with rheumatoid arthritis of the hand. In the experimental group, grip strength and movement were improved while swelling, pain and morning stiffness were reduced. Lasers in Medical Science, 1989; 4: 193.
Wound Healing ñ Palmgren investigated the effect of Low Level Laser Therapy on infected abdominal wounds after surgery. Healing time to half wound size was 6.8 days in the laser group compared to 14 days in the placebo group. Lasers Surg Med 1991; Suppl 3:11

More In-Depth/Scientific Descriptionof Low Level Laser Therapy (for the techy-minded)

Although it is not very well understood many theories have been postulated about the mechanism of action for low level lasers. Much research has been done in the areas of pain management, wound healing, and nerve regeneration, but little is known about the exact mechanism of action and the physiological changes occurring at the cellular level. In the literature, the three most often encountered theories are:

Bioluminescence theory – according to Russian researchers, DNA replication emits light at 630 nm. Since this is very close to the wavelength of the He Ne-laser light, it is postulated that laser may accelerate DNA replication via photic stimulation. Laser irradiation at this frequency is said to be non mutagenic since it is not in the range to alter the genetic program by affecting chromosomal ultra structure. The latter is more likely to occur at ultra-violet light irradiation at 300 to 400 nm.

Cellular oscillation theory – the laser beam carries electromagnetic oscillations of definite frequency. When it reaches the tissues the electromagnetic oscillations gradually “swing and excite” single cells. This is thought to eventually intensify the bioenemical processes that ultimately regulate the performance of various vital organs. Soviet scientists go on to say that the cell itself begins to emit light similar to the rays of the laser, when the resonance sets in.

Biological field theory – connections between tissues and organs in the intact organism are not limited to humeral effects and nervous control mechanisms alone. Rather, there exist unique around every cell, tissue and organ and higher structural levels (organism, organ) exerting a normalizing influence on lower levels (tissue cells). The resonance effect of the low power laser is thought to restore the normal energetic status of the organism, that is, restore its normal physiological state.

All three theories share the basic premise that laser causes activation in the cell, which in turn leads to an intensification of the bionemical processes. It is within this context that the Arnat-Schulz law becomes important with respect to low power laser application. This biological law states that “weak stimuli excite physiological activity, moderately strong ones favor it, strong ones retard it and very strong ones arrest it.”

More recently, however, in the last decade or so, many advances have been made to support these observations and increase our knowledge of how low level lasers work. For example, T.Karu, H.Klima, J.Oschman, and others have recently expanded and contributed to earlier work done on cellular amplification by Nobel laureate Gilman in 1994. According to Oschman, the current understanding of the cellular signaling cascade and amplification is that the receptors on the cell surface are the primary sites of action of low frequency electromagnetic fields. It is at this receptor that cellular responses are triggered by hormones, growth factors, neurotransmitters, pheromones, antigens, or a single photon. Membrane signals closely associated with the receptors, such as adenylate cyclases and G proteins, are considered secondary messengers that couple a single molecular event at the cell surface to the influx of a huge number of calcium ions. Calcium ions entering the cell activate a variety of enzyme molecules and can produce a cascade of intracellular signals that initiate, accelerate, or inhibit biological processes. These enzymes, in turn, are catalysts and since catalysts are not consumed by reactions they can act again and again until calcium levels drop back to pre-stimulation levels. The frequency of the stimulus is also crucial. and will be discussed later. For example, separate studies of lymphocytes stimulated with a mitogen showed that a weak 3Hz pulsed magnetic field sharply reduced calcium influx, while a 60 Hz signal, under identical conditions, increased calcium influx.

In her study “Changes in absorbance of monolayer of living cells induced by laser radiation at 633, 670 and 820 nm” reported in Selected Topics in Quantum Electronics. 2001; 7 (6): 982-988.Karu’s results obtained evidence that cytochrome c oxidase becomes more oxidized (which means that the oxidative metabolism is increased) due to irradiation at all wavelengths used. The results of present experiment support the suggestion (Karu, Lasers Life Sci., 2:53, 1988) that the mechanism of low-power laser therapy at the cellular level is based on the electronic excitation of chromophores in cytochrome c oxidase which modulates a redox status of the molecule and enhances its functional activity. . A cascade of reactions connected with alteration in cellular homeostasis parameters (pHi, [Cai], cAMP, Eh, [ATP] and some others) is considered as a photosignal transduction and amplification chain in a cell (secondary mechanisms).

H.Klima further discusses the Biophysical aspects of low level laser therapy from two points of view: from the Electromagnetic and the Thermodynamical point of view. From the electromagnetic point of view, living systems are mainly governed by the electromagnetic interaction whose interacting particles are called photons. Each interaction between molecules, macromolecules or living cells is basically electromagnetic and governed by photons. For this reason, we must expect that electromagnetic influences like laser light of proper wavelength will have remarkable impact on the regulation of living processes. An impressive example of this regulating function of various wavelengths of light is found in the realm of botany, where photons of 660 nm are able to trigger the growth of plants which leads among other things to the formation of buds. On the other hand, irradiation of plants by 730 nm photons may stop the growth and the flowering. Human phagocyting cells are natively emitting light which can be detected by single photon counting methods. Singlet oxygen molecules are the main sources of this light emitted at 480, 570, 633, 760, 1060 and 1270 nm wavelengths. On the other hand, human cells (leukocytes, lymphocytes, stem cells, fibroblasts, etc) can be stimulated by low power laser light of just these wavelengths.

From the thermodynamical point of view, living systems – in contrast to dead organisms – are open systems which need metabolism in order to maintain their highly ordered state of life. Such states can only exist far from thermodynamical equilibrium thus dissipating heat in order to maintain their high order and complexity. Such nonequilibrium systems are called dissipative structures proposed by the Nobel laureat I. Prigogine. One of the main features of dissipative structures is their ability to react very sensibly on weak influences, e.g. they are able to amplify even very small stimuli. Therefore, we must expect that even weak laser light of proper wavelength and proper irradiation should be able to influence the dynamics of regulation in living systems. For example, the transition from a cell at rest to a dividing one will occur during a phase transition already influenced by the smallest fluctuations. External stimuli can induce these phase transitions which would otherwise not even take place. These phase transitions induced by light can be impressively illustrated by various chemical and physiological reactions as special kinds of dissipative systems. One of he most important biochemical reaction localized in mitochondria is the oxidation of NADH in the respiratory chain of aerobic cells. A similar reaction has been found to be a dissipative process showing oscillating and chaotic behavior capable to absorb and amplify photons of proper wavelength. A great variety of experimental and clinical results in the field of low level laser therapy supports these two biophysical points of view concerning the interaction between life and laser light. By using cytometric, photometric and radiochemical methods it is shown that the increase or decrease of cell growth depends on the applied wavelengths, on the irradiance, on the pulse sequence modulated to laser beams (constant, periodic, or random pulses), on the type of cells (leukocytes, lymphocytes, fibroblasts, normal and cancer cells) and on the density of the cells in tissue cultures.

It is our belief that by incorporating these observations and known interactions into the design mode that Erchonia Medical laser produces a unique result oriented product. The four frequency PL5 model allows the clinician to take advantage of the time saving as well as mult-functional aspect of the laser. Each frequency can activate different cell types simultaneously. Therefore the clinician can treat pain, inflammation, lymphatic, and immune system all at the same time. The easy programmable mode ensures accuracy of treatment time and protocol compliance. Armed with a functional portable device and our knowledge of clinical double blind studies allowed Erchonia Medical lasers to obtain the first FDA approved Low level laser for pain management.

We currently have two separate IRB approved clinical studies focusing on accelerated wound healing, and low level laser liposuction. These studies involved MRI and Scanning Electron Micrographs. Our preliminary data was published in the prestigious peer reviewed Cosmetic Surgery Journal and the Plastic and Reconstructive Surgery Journal earlier this year and has prompted tremendous interest in the Plastic Surgery arena. The publications dovetailed television coverage on CNN, CNBC, and Good Morning Arizona. Manipulation of scar tissue, post-op pain reduction, and accelerated wound healing are all benefits that the surgeons are experiencing with our unique laser. Typically, a surgeon may have to use more than one expensive device to obtain similar results. The fact that Erchonia Medical lasers is an ISO 9001 certified laser manufacturing facility and has research capabilities allows us to stay one step ahead of the competitor. We are well aware that it is much easier to sell a product if it is supported by sound scientific studies. As Medical Director of Erchonia Medical Lasers, I am confident that we will continue to be the leaders in low level laser therapy and set higher standards for others to follow.

Professionally,
Kevin T. Slattery M.D.

The first thing a chiropractor will do is ask you about the health complaints about which you are chiefly concerned. The DC will also ask about your family history, dietary habits, other care you may have had (chiropractic, osteopathic, medical, etc.), the nature of your work, and other questions designed to help determine the nature of your illness and the best way to go about treating the problem.You will need to fill out some paperwork. THis is mostly for general information and processing of any insurance claims, if you are using insurance.

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You may or may not receive an actual treatment on your first visit. Often times this is a fact gathering meeting only.However, If you are in severe pain and it has been determined that you should try a short course of chiropractic treatment, modalities to reduce pain may be used. An actual “adjustment,” as doctors of chiropractic use the term, means the specific manipulation of vertebrae which have abnormal movement patterns or fail to function normally. Doctors of chiropractic spend years learning motion palpation (the art of examining by movement or touch) and other forms of spinal examining procedures, so that they can administer specific and appropriate spinal adjustments.

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Lastly, if you are going to be in a working relationship with the chiropractor, you will receive a report detailing the nature of your problem, what was found and a plan to deal with it. It is important for you to be comfortable, informed and clear on what needs to be done.