Application of low-level laser therapy has been shown to help alleviate pain in a variety of patient conditions.

By Ryan Whelton, MSPT, DPT

The use of laser therapy in physical therapy clinics has been growing exponentially over the past decade. Low-level laser therapy is clinically called LLLT. LLLT is FDA approved, safe and extremely effective for pain relief and when used as an adjunct to classical physical therapy methods when applied correctly. As the owner of Sport and Spine Physical Therapy and Wellness Center and a licensed PT for seven years, laser therapy was integrated into my Tampa, Florida practice four years ago. LLLT has benefited my patients ever since.

As a wellness center owner, I have had the opportunity to learn about and apply some of the most cutting-edge medical technologies on the market. Because LLLT is a relatively new technology compared to legacy ice treatment techniques, laser therapy was not available for use in my previous employment positions. In retrospect, this treatment option could have expedited patient healing and increased the rate athletes returned to competition.

In the past, I served on the New England Patriots medical staff for four years, one of which was when we won Super Bowl XXXVIII. I also worked for the Boston Celtics as well as trained and rehabilitated players for the NFL combine/draft in New Orleans, LA. After relocating to sunny Tampa, I helped rehabilitate our nation's active duty soldiers and veterans returning from war.

How It Works
LLLT is a unique technology because, unlike other methods on the market such as therapeutic ultrasound, the laser emitted passes 2 inches to 3 inches through the skin. This is possible because the laser's wavelength is between 820 nm to 840 nm, where lesser wavelengths would simply absorb/stop at the skin's surface. Essentially, laser therapy works in two ways; the treatment decreases edema and increases angiogenesis, or the creation of new capillaries, at the microcapillary bed. After the human body suffers an injury, laser therapy can decrease swelling and increase the healing rate by 50% to 60%. Often I have observed that a patient's swelling decreased markedly right in front of my eyes.

Immediate and Long-Term Benefits
During the last four years I have frequently applied laser therapy in addition to classical PT methods. The patient benefits and results of laser therapy have been dramatic. From my experience, LLLT has been effective for treating arthritis, carpal tunnel, temporomandibular joint (TMJ) disorders, headaches, herniated discs, sprains/strains, fibromyalgia and all other inflammatory conditions. Recently, I applied laser therapy for patients who had neurological diseases such as multiple sclerosis, Parkinson's disease, and hereditary spastic plegia (HSP), and found only positive results. The greatest benefit of LLLT to the patient is that they experience immediate relief.

About a year ago I treated a patient who sought me out as a last-ditch effort before she had to decide if her left kidney was to be removed. Her nephrologist sent her to my center because he had a feeling that the low-back pain she was experiencing might not have been caused by her kidney. I performed traditional physical therapy methods with the ML830 laser as an adjunct. After three weeks of therapy, the patient reported that her back pain was gone. She returned to her nephrologist and was elated to learn she was able to keep her kidney. LLLT was effective when applied with classical physical therapy methods and had positive long-lasting results for the patient.

A little more than 10 years ago, the ML830 laser was approved by the U.S. Food and Drug Administration (FDA) and was the first laser therapy marketed in the U.S. In 2011, when I began using this laser in my practice, I stopped using most all other modalities because of the benefits I observed firsthand. My patients had immediate pain relief, observable increased function, and were truly healing at a faster rate than what I had experienced before I applied laser therapy.

Because the results of laser therapy were significant, I reduced my application of hot packs, cold packs, ultrasound and electrical stimulation methods. I have always found with most all other modalities the patient feels better usually for a few hours and then reports the pain returns. This response is commonly associated with the gate control theory of pain and because the area treated on the patient is numb when they leave the office. Laser therapy has helped revolutionize how I can help others.

To date, laser therapy has been featured on shows and networks such as The Doctors, Dr. Oz, CNN, NBC and numerous other media outlets. The increasing popularity of this treatment is due to its demonstrated effectiveness in the doctor's office. Media reports and patients consistently calling their insurance companies demanding this treatment be covered by insurance has also increased the visibility of this technology. Despite this increased popularity, a vast majority of insurance companies do not cover laser therapy. In fact, my experience demonstrates that insurance claims will be denied solely because laser therapy was billed. The answer I give my patients when asked why their insurance does not cover this treatment is this simple. Drug therapy for pain relief is a multi-billion dollar industry, and this particular laser is so effective it has potential to threaten the drug company's bottom line.

Is This Therapy Appropriate?
Often I use the laser on muscle strains and tears and find great results. Based on my observations and experience, those patients who undergo laser therapy will likely heal 50%-60% faster and experience less pain. Patients are usually elated after one 15 minute treatment because they recover their range of motion, strength and overall better functional movement. My experience is that patients who present with herniated discs or any issues associated with the nervous system will require more treatments to heal. However, muscular pathology pain is usually decreased immediately and their range of motion increases. During the last couple of years I have used the ML830 laser technology for patients with neurological diseases and found good results. I have one patient with HSP which is a rare neurological disease affecting the corticospinal tract leading to debilitating lower extremity weakness. I spend approximately 5 minutes on the motor points located in each mid quadracep and five minutes at each Vastus Medialis Oblique (VMO). After treatment, the patient explained to me that their legs feel more "alive" and their gait clearly had noticeable improvements.

Treatment Requirements
People often ask me "How many treatments are required?" and the answer depends on a few factors. Most importantly, this question is answered by understanding the source of the issue as well as the patient's willingness to allow their body to heal. During the first session, the source of the pain should be determined: Is the source of the pain related to the musculoskeletal or nervous system? Patients' willingness to remove the destructive forces that caused or exacerbated their problem is equally important. For injured athletes, I frequently request that they allow their body to heal during treatment and slightly reduce the stress they place on the injured areas. For athletes who choose not to reduce the stressors on their body, they will require a greater number of laser treatments to remove the pain than those people who reduce the stressors. Flare-ups or "fires" as I call them are acute injuries caused by their activities and can occur if the injured area is under too much stress. From firsthand observations, if pain is musculoskeletal in origin, and the patient reduces stress upon their body, I prescribe 8 to 10 sessions. If the nervous system is involved 12 to 15 sessions typically will be optimal.

All Patients, All Conditions?
Based on my experience, there are some conditions LLLT has been ineffective at treating. These include pain stemming from the central nervous system, neuropathic pain from brain injury, spinal cord injury, complex regional pain syndrome (CRPS) and any other central nervous system pathology. When communicating with dentists and doctors I have been able to help direct them to a diagnosis based on whether the LLLT reduced their pain and/or inflammation. I explain to them that the laser usually works on every inflammatory condition I have treated. The fact that their patient did not experience any relief tells me that the pain etiology may not be related to the peripheral nervous system.

LLLT has been effective in treating a number of different injuries and disorders in my practice when used as an adjunct to classical PT methods. This technology has only been available in the US for a little more than 10 years and additional case studies will undoubtedly be published in the coming years. With an aging population and desire by medical professionals to more quickly, safely, and effectively reduce pain experienced by patients, laser therapy will continue to revolutionize the way physical therapists address the needs of their patients.

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