Cold Laser Therapy

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 therapy 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.

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.

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.

Cold Laser Therapy

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