LOW INTENSITY LASER THERAPY – TOO GOOD TO BE TRUE OR A VALID
SCIENTIFIC FORM OF TREATMENT
Leonard W. Rudnick,
BA, BS, DC, DABDA
Among the more
notable facts of life that appears too good to be true is
PHOTOSYNTHESIS. Can
anyone honestly believe that sunlight (or any other forms of
light) mixes with some “green stuff” in plants (CHLOROPHYLL),
to form glucose and oxygen? The
plant uses the glucose to grow and gives off oxygen into the
atmosphere. Be
serious! Light
plus chlorophyll equals glucose and oxygen.
Only a fool would believe this.
What a scam!
Although studies
prove these photochemical actions and reactions, you can’t see
it happen. You can’t smell the oxygen being released.
And, if you tasted the plants, they are BITTER, not sweet
like glucose. No,
it’s absolutely too good to be true.
EXCEPT that it happens, and our planet and its inhabitants
survive solely because of this process.
In addition to
photosynthesis, there is PHOTOMORPHOGENESIS (genesis=development,
morph=form of an organism, photo=influenced by light).
An example in plants is the action of red light (633nm) on
an inactive molecule called PHYTOCHROME.
Upon absorption of this light, the phytochrome becomes
active. This induces
a cascade of enzymatic reactions that lead to such responses as
seed germination and flowering among others (Karu, 1998).
This is analogous to actions that occur within human
tissue.
It is arguable that
light is one of the most critical sources of energy for our
planet. Societies living in areas deprived of sunlight have a
significantly higher suicide rate than those where the sun shines
almost daily.
The Bible and
earliest history refer to the sun (hence light).
Please note that in the first paragraph of the first book
of the Bible, Genesis, it does NOT say “…Let there be
cortisone, surgery or ultra-sound”.
It says, ”Let there be LIGHT”.
For approximately
thirty years, light, in the form of Low Intensity Laser Therapy
(LILT) has been used to treat a myriad of conditions.
Significant advances with this technology have occurred
since the mid-eighties. However,
the available information was only sparingly disseminated to the
scientific community. Little was known by the clinician (Baxter et al, 1991) until
it was utilized, primarily in Europe and Asia, with very little
information available in North America.
When being applied
properly, LILT has proven to be tremendously effective.
Unfortunately, until recently there has been a lack of
scientific scrutiny concerning the clinical efficacy of this
procedure (Baxter et al, 1997).
This does not mean that LILT doesn’t work. Despite
the lack of scientific research, clinical results have been
outstanding. While
patients were getting better, clinicians didn’t know why or
understand the reasons for this improvement.
The “why”
appears to be important only when a new procedure/philosophy wants
to gain acceptance. To
prove this point I refer to the American edition of the Physicians
Desk Reference (any year will do).
Please note the statements under ACTIONS for each of the
following; ELAVIL (amitriptyline),
Naprosyn (naproxen) and Robaxisal (methocarbamal and asperin).
In the first it states, “…the mechanism of action in
man is not known”. In
the second, it says, “…the mode of action is not known”. The third states”…the method of action in man is
unknown”. Nevertheless,
all three are commonly prescribed medications.
This paradox is
easily explained: treating the symptoms is an accepted practice
throughout the industrialized world.
LILT, however, deals with HEALING on the cellular level,
which secondarily (and quickly) relieves the symptoms.
This is such a radically different philosophy that greater
scrutiny and proof will be required before it will be generally
accepted by mainstream medicine.
How long will this
process take? Consider
that Einstein, in 1917, published a paper which outlined the key
principles for the stimulated emission of photons. This was based
upon an earlier concept by Planck concerning quantal energies. It
has only taken about 85 years to get this far.
In the past few
years however, more and more pieces have been found to exist in
the completion of the “why puzzle”.
Dr. Kendrick C. Smith observed that the activation of an
enzyme or the induction of the synthesis of an enzyme are
excellent candidates for the biological basis for LILT, because
only a few photons are needed for these processes to begin. Once an enzyme is activated, it can catalyze thousands of
chemical reactions. There
is a large amplification factor involved. A
few photons can produce a huge biological effect.
In LILT, Red (633nm)
and infrared (830nm) have different effects on molecules.
Red (visible) light can produce chemical changes while
infrared radiation can only produce physical changes in molecules.
In spite of this, both result in clinical improvement.
Visible light
enhances cell proliferation through photochemical changes in the
mitochondria, which then set in motion a chain of biological
events that ultimately, affect cellular membranes.
This, in turn, has an effect on messenger RNA synthesis,
which ultimately leads to the observed enhancement of cell
proliferation.
Pores in membranes
open and close to let ions, such as calcium, in and out of cells
as a consequence of physical changes in the membrane pore
molecules. Calcium
ions act as intracellular messengers in many signal-transducing
pathways. The
cellular calcium ion concentration can be abruptly raised for
signaling purposes by transiently opening calcium channels in the
plasma or intracellular membranes.
The catalytic
activities of many enzymes are regulated by the calcium
concentration. Since infrared radiation affects the physical state of
molecules, they can affect the pore molecules directly.
Thus, a similar effect on cell proliferation can occur
whether the cells were irradiated with visible light at 633nm or
infrared at 830nm.
Specific types of
molecules absorb specific wavelengths of light, both visible and
infrared. Absorbed
radiation produces specific biological effects in tissue,
depending upon which types of molecules absorb the light (Karu,
1998).
Trelles et al
reviewed the use of local irradiation with LILT.
They found this approach elicited the following types of
effects: biostimulatory, analgesic, antiexudative,
antihaemorrhagic, antiinflamatory, antineuralgic, antioedematous,
antispasmotic and vasodilatory (among others).
Trelles, et al,
(1989) and Muxeneder, (1988) also reviewed the effects of LILT in
vertebral pain, headaches and local immune responses.
They found the main clinical uses included wound healing,
pain control, soft tissue injury, arthropathy and osteopathy and
treatment of existing scars.
They observed local irradiation stimulated extremely rapid
healing, even of extensive indolent superficial wounds.
It was considered effective and safe.
Scarring was minimal.
According to Mester,
et al, (1985) and Muxeneder, (1988), the effects of LILT on wound
healing are dramatic. They
stated, “many irradiated septic wounds heal as if by first
intention”.
Numerous clinical
studies, and this author’s experience as team physician for a
nationally ranked college hockey program, all indicate that
swelling and inflammation in superficial muscles, tendons,
ligaments, bursae and sheaths can be alleviated by irradiation of
the affected areas. In
arthropathy and osteopathy, mid-range lasers can alleviate pain
swelling and inflammation of accessible joints, especially if the
primary sites are irradiated.
Initially, the effect was thought to be anti-inflammatory,
but recent work has shown that LILT enhances the inflammatory
process and allows the body to reach the healing stage much
faster. It is also
effective in pain control and resolution of osteitis and
periostitis in superficial areas.
It was (and still is) preferable to ultrasound in these
conditions as the latter can only heat bones, potentially causing
damage.
Old scars (surgical
or traumatic) can act as trigger points if there are tender areas,
keloid formation and adhesions along the scar.
Such scars can be associated with chronic, reflex pain,
lameness and autonomic effects.
LILT of such tissue can produce dramatic clinical
improvement in most cases.
The earlier lasers
were “powered” by gases such as Helium and Neon (He-Ne).
It was not until the 1980s that the semiconductor diode
systems became available. The
most popular of these for clinical use are the gallium arsenide (GaAs)
and the gallium aluminum arsenide (GaAlAs).
These superluminous diodes are mounted into a “treatment
head” for easy application.
The emitted light includes far and near ultra-violet, the
visual spectrum and near, mid and far infrared.
In LILT, nothing
happens unless the tissue absorbs the photons (bundles of light).
In the therapeutic near infrared range absorption takes
place in the tissue water (about 70%) and organic molecules (about
30%). For this
purpose, absorption may be defined as the conversion of light into
some other form of energy. Once
absorbed, the photons have different effects on amino acids,
nucleic acid bases and other groups called chromophores.
The former is the basis for DNA and proteins.
The latter involves porphyrins, which are bio-organic
molecules (hemoglobin and melanin are examples).
Another factor in
the photochemical action of LILT is attenuation, or how much light
is lost as it travels through tissue.
This depends upon the ratio between absorption and
scattering. This
ratio varies according to the type of tissue irradiated and the
wavelength applied. Where
light absorption is low, (600 – 1200 nm), scattering
predominates. In
human tissue, scattering tends to be in a forward direction.
Considerable
cellular research concerning laser irradiation has been done since
the 1970s. At that
time the focus was primarily on wound healing due to the great
clinical success using LILT.
For obvious reasons, the studies related to this involved
observing the actions of fibroblasts, lymphocytes, monocytes/macrophages
as well as epithelial and endothelial cells.
All studies
exhibited the positive effects on the healing mechanisms involved
with the cells being tested, either by stimulation or inhibition.
As a result, one could explain why wounds heal faster with
LILT. However, the
exact mechanism is still unknown; The effect on the patient and
how it affects healing is however, known.
What remains unknown is the exact mechanism by which light
causes these photochemical reactions.
Of at least equal
importance (more so for the practitioner) is the role of LILT in
pain relief. This,
more than wound healing, results in the, ”too good to be true”
attitude within the American medical community.
After all, EVERYONE knows the only ways to relieve pain are
by medication and surgery. If
these don’t work, psychotherapy is the last alternative.
However, since 1986
world-respected researchers have recommended LILT for such use
(Seitz & Kleinkort 1986; Zhou Yo Cheng 1988; Woolley-Hart
1988; Kert & Rose, 1989).
In addition, clinicians around the world, based upon their
professional experiences, confirm the analgesic effect of LILT.
Unfortunately, from
a strictly scientific point of view, these reports are hardly
conclusive. There has
been little or no standardization in the application of LILT.
The type of laser used, the wavelength, contact or
non-contact mode, length of treatment as well as skin color, age
of the patient and body type are all variables that can effect
outcomes. As a
result, the majority of reports concerning the efficacy of LILT
have been considered anecdotal. A
great many of those were reported in foreign languages, which
often resulted in obscuring information during the translation.
Another major
obstacle involves the subjectivity of pain.
The very nature of pain is such that there is no truly
scientific way to measure it.
Also, some people have higher or lower sensitivities.
They also react differently to having it (victim vs.
survivor). On almost a daily basis, pain sensitivity can vary depending
upon physical, chemical and/or emotional factors.
In spite of these
limitations, the number of clinicians and patients who report
significant analgesia from LILT has grown dramatically.
Whether or not we know exactly why, LILT is proving to be a
very valuable modality in the treatment of pain.
In fact, clinicians using LILT and other forms of
electrotherapy consistently report the clear superiority of the
former. In a growing
number of instances, it is now used as the first treatment of
choice for pain. Perhaps even more important is the fact that, to
date, there has never been a report of a serious, long-term
negative side effect attributable to this procedure.
The list of painful
conditions treated with LILT is extremely impressive.
In fact, clinically it would be easier to list conditions
on which LILT does not work.
Even then, failure is not outright.
It is more appropriate to say that the percentage of
success in some patients, with some conditions, is lower.
These conditions include spinal stenosis, where there is
direct bony pressure on a nerve(s), reflex sympathetic dystrophy
and advanced neuropathy.
In addition,
“permanent cure” is difficult to achieve if a structural
component exists. A
reasonable analogy is having a motor vehicle that pulls toward the
right side of the road when the driver is trying to go straight.
If the right front tire is not flat, there is probably a
misalignment of the vehicle’s front end. The driver might not
want to spend the money to get it aligned (perhaps the lease is up
very shortly). Instead,
they lower the air pressure in the left front tire to the point
that the car drives straight.
Problem solved! The
symptom goes away. Unfortunately,
they will have to purchase two new front tires every three
thousand miles (5000km) or so.
Thus, structural problems demand structural corrections.
If there is a misalignment in a person’s hips, spine or
extremities, there is a constant irritation to the soft tissue
components of those areas. It
can feel better with LILT, but permanent healing will be extremely
difficult to achieve. When
this is the case, concomitant structural correction (manipulation)
and LILT results in rapid, complete recovery.
Following is a list
of conditions which clinically and in valid research, have been
treated with a very high rate of success.
CERVICAL PAIN
|
FACIAL PAIN
(INFLAMMATION) |
| TRIGEMINAL NEURALGIA |
TRIGGER/TENDER POINTS |
| HEADACHE/MIGRAINE |
TENDONITIS |
| SCAR TISSUE |
CARPAL TUNNEL SYNDROME |
| ROTATOR CUFF INJURY |
EPICONDYLALGIA |
| SHOULDER JOINT PROBLEMS |
EPICONDYLITIS |
| COSTOCHONDRITIS |
NEURALGIA |
| CHONDROMALACIA PATELLA |
HIP JOINT PROBLEMS |
| TIBIAL COMPARTMENT SYNDROME |
PLANTAR FASCITIS
|
| ARTHRITIS/ARTHRALGIA |
BURSITIS |
| CAPSULITIS |
FRACTURES |
HEMATOMA
|
HERPES ZOSTER (SHINGLES) |
| MYALGIA/FIBROMYALGIA |
NERVE ROOT/TRUNK PAIN |
| ACUTE AND CHRONIC LOW BACK PAIN |
ACROMIO-CLAVICULAR JOINT DYSFUNCTION |
| TEMPOROMANDIBULAR JOINT PATHOLOGY |
|
Included in the
above list are sports-related injuries experienced by “weekend
warriors”, college and professional athletes.
After a double blind
clinical trial conducted by General Motors Corporation using LILT
for Carpal Tunnel Syndrome, the company has established laser
treatment facilities in all of its manufacturing plants.
While the
neurophysiological effects of pain have been studied in both
animals and humans, no major recent studies have been completed
recently. The latest
reviewed was Basford et al, 1990. Overall, the findings were inconsistent and even
contradictory with human subjects.
However, once again, there was no standardization.
It does appear that the use of He-Ne lasers at low doses
(less than 1 J/cm squared) would consistently have no appreciable
effect on nerve conduction latency.
The Arrant-Schultz
Law (Baxter, (1997); Ohshiro & Calderhead, (1988) may explain
the inconsistent findings of researchers.
It is to photobiological activation what the law of
diminishing returns is to economics.
Basically, it says there is a threshold amount of energy
(laser light) that is required to effect a change in cellular
activity. This amount
varies with individuals. When
the dosage is increased above threshold (relatively little), the
degree of cellular biological activity also increases.
When the dosage increases further, above a certain level
(variable), a plateau effect occurs.
There is simply no increase in cellular activity.
When the dosage is increased above the plateau level, there
is an inhibitory effect upon the cells.
Using this model as justification, many experts in the
field of LILT contend that it is not possible to “overdose”
with laser treatment.
Low Intensity Laser
Therapy has been clinically proven to be superior to all other
forms of pain therapy. In
comparative applications, it has worked better than medication,
ultra-sound, electrotherapy, heat, ice, etc.
It also does not have some of the severe side effects, as
do other forms of treatment.
LILT is not a
“magic wand”. It
is a medical device which promotes rapid healing and pain relief.
This is a PROCESS, not an on/off switch.
However, millions of patients have been helped when no
other form of treatment has worked.
Laser therapy also
dramatically reduces healing time when compared to other
traditionally used modalities.
Hospitals in Great Britain use LILT in post-surgical
recovery rooms. They
have found patients have much less pain, take 50% less pain
medication, heal in half the time and have significantly less scar
tissue. To those of
us who have been privileged to use this technology, our
patients’ permanent recoveries are not only believable, but also
expected.
In this authors
opinion and experience, the most superior form of low intensity
laser therapy is via the BioFlex computer-driven laser instrument,
produced by Meditech International, in Toronto, Canada.
Besides dozens of pre-set protocols (see the partial list
above), it can also accommodate customized protocols.
All parameters can be altered to truly individualize each
treatment. Even such
things as age, skin color and body type can be considered when
choosing the appropriate amount of light exposure. Once chosen, it is calculated automatically.
Another of the
unit’s most unique features is the “Flex” part of the name
BioFlex. The treatment heads can wrap around joints (knee, elbow,
wrist, etc.), delivering light through either 60 or 180
superluminus diodes. This
author, while treating almost 4,000 patients, found that the
BioFlex was clearly superior to the other laser devices he used
previously.
The author expresses
his deepest gratitude to Dr.G. David Baxter, Director of the
School of Social and Health Sciences and Education, University of
Ulster, Ireland. I
relied heavily on his genius and research.
Everyone interested
in adding Low Intensity Laser Therapy to his/her practice MUST
read Dr. Baxter’s book, “THERAPEUTIC LASERS, THEORY AND
PRACTICE”, Churchill Livingstone, 1997.
It is the most authoritative, well-documented and readable
text on this subject. If
this author could impose such a standard, this text would be
required reading before embarking on the use of this wonderful
technology.
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R Hallman H O
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Diamantopoulos C, O’Kane S, Shields 1997 Therapeutic Lasers
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1986 The effect of laser therapy on wound contraction and
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Chichester
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