Laser Therapy

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LIPOSUCTION RESEARCH - FAT LIQUEFACTION

Figure 1 -- SEM Picture. The adipocytes have round shape; contours are regular having a grape-cluster shape. Picture magnification of 190X. This figure has received tumescent solution.

Figure 2A -- SEM picture. Application of the laser beam for 4 minutes Only few adipocytes are liquefied, there is preservation of some cell membrane, some has lost its original shape 190X magnification. Arrows point out fat particles coming from inside to outside of the adipose cell.

Figure 2B -- SEM picture. Adipocyte exposure to the laser beam for 4 minutes, adipocytes have lost its round shape some have a star and oval shape. 130X magnification.

Figure 3A -- SEM picture. Application of the laser beam for 6 minutes shows that there are not round adipocytes; you only see fat liquefied 190X magnification. Arrows point out fat coming out of the adipose cell

Figure 3B -- SEM picture. Application of the laser beam for 6 minutes shows that there are not round adipocytes; you only see fat liquefied 190X magnification. Arrows point out fat coming out of the adipose cell

Figure 4 -- SEM picture. Application of the laser beam for 6 minutes without tumescence shows that some adipocytes are intact, but some are disrupted. 450X magnification. Single arrow points out an intact cell, double arrows point out the disrupted cells.

Figure 5 shows the adipose membrane at 40000X magnification - The membrane remains intact when the laser has not been applied.

Figure 6 - TEM picture. Shows the cell membrane at 60000X magnification. After 6 minutes of laser exposure, the membrane is temporarily disrupted creating a transitory pore (see single arrow) that allows the liquefied fat to come out of the cell and be released into the interstitial space. Double arrow points out the fat particles released from inside the cell.

Figure 7 -- SEM picture. No laser exposure. Adipocyte intact, several collagenic fibers can be seen surrounding the adipose tissue. 200X magnification. Arrows point out collagenic fibers.

Figure 8 -- SEM picture. 4 minutes laser exposure. No tumescence has been applied. Only a few adipocytes have been liquefied. 190X magnification. Arrows point out intact adipose cells.

Figure 9 -- TEM pictures. The adipocytes are completely saturated with fat and close to one another. 20000X magnification.

Figure 10 -- TEM picture. 4 minutes laser exposure. There is partial loss of the intracellular fat and the membrane has became flexed since has lost part of its fat content. 20000X magnification.

Figure 11 -- TEM picture 4 minutes laser exposure. The adipose membrane is flexed and deformed. Capillaries remain intact in the intercellular space. 20000X magnification. Arrows show an intact capillary.

Figure 12 -- TEM picture. Recorded after 6 minutes laser exposure there is almost total disruption of the adipocyte membrane. The adipose cell has lost almost completely its fat content. 20000X magnification.

Article

Healed by the Light
By Jeffrey M. Nelson, MD and Karen P. Nelson, MA

The cell is a machine driven by energy…In every medical tradition before ours, healing was accomplished by moving energy.

Albert von Szent-Györgyi (1967)

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. It’s time we opened our eyes to the light.

One of my first eye-opening experiences with LLLT in wound recovery was with a burn patient. As a plastic surgeon and medical director of a burn and wound center, I see large numbers of acute and chronic burn injuries as well as wounds of various etiologies. One particular gentleman had a home fire that melted his carpet and he was forced to walk across it in bare feet to get out of his home. He presented with very deep foot burns and severe pain. He was on chronic narcotics due to an old back injury, so I knew his pain would be difficult to manage. At presentation his pain was exceptionally severe and the bottoms of his feet were purple, swollen and sloughing skin. Within two minutes of treatment with the 635nm Erchonia?? cold-diode laser his pain decreased by a self-reported 75%, and his skin went from blue and purple to pink right before our eyes! As you can imagine, our jaws dropped 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 “less is more” when it comes to energy for improved cellular physiology. The Erchonia?? 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 the wound site; each a tremendous advantage to the patient and the treating practitioner.

Complementary Advantages
The Erchonia?? laser’s 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 patient’s 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 patient’s 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 Erchonia?? 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. Erchonia?? 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 patients’ wound is colonized with resistant bacteria. LLLT can be used in the setting of open wounds, burns, tissue injury, surgical recovery, neuropathy, deep tissue injury or active infection. There is no known “tissue problem” 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 don’t 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.

Dr. Jeffrey Nelson is a plastic surgeon who has been involved in wound healing for more than 20 years and is currently the Medical Director of the burn and wound center at St. Mary’s Hospital in Tucson, Arizona.

Karen Nelson has an advanced degree in physiology and is working as a medical writer in Tucson, Arizona

Janus Jongbloed Research Centre, University of Utecht, 3521 GG (H.H.F.I.v.B.)
Research Laboratory, Department of Neurology, University Hospital Utrecht,
3508 GA (P.R.D.B.), Utrecht, The Netherlands

The absorption spectrum of human fibroblast monolayers showed several absorption peaks, among them one at a wavelength of 630nm. Cultures of these fibroblasts were subjected to He-Ne laser (632.8nm) irradiation of various energy doses by varying power density and exposure time. On three consecutive days the cell monolayers were irradiated for periods between 0.5 and 10 min. Laser power varied from 0.55 to 5.98mW. Both cell number and collagen type I production were determined for each irradiation condition within one experiment. Results show that laser power below 2.91mW could enhance cell proliferation (as determined by cell counting), whereas higher laser power (5.98mW) had no effect. Stimulatory effects were most pronounced at irradiation times between 0.5 and 2 min. Collagen type I production (as determined by an ELISA) was affected in the opposite direction to cell proliferation: when the cell proliferation was increased, collagen type I production was decreased. From these experiments it is clear that exposure time and power density determine the effects of laser irradiation. Both stimulation and inhibition of the observed cell properties can be obtained with the same laser on the same cells. © 1992 Wiley-Liss, Inc.

Key words: collagen, ELISA, light absorption, power-detection

Information Application:

• Supports use of low levels of energy at a high density
  

Research

THE BIOLOGICAL EFFECTS OF LASER THERAPY AND OTHER PHYSICAL MODALITIES ON CONNECTIVE TISSUE REPAIR PROCESSES

Chukuka S. Enwemeka, P.T., Ph.D., FACSM, G. Kesava Reddy, Ph.D.,

Department of Physical Therapy and Rehabilitation Sciences,
University of Kansas Medical Center,
Kansas City, KS 66160-7601, USA

Connective tissue injuries, such as tendon rupture and ligamentous strains, are common. Unlike most soft tissues that require 7-10 days to heal, primary healing of tendons and other dense connective tissues take as much as 6 - 8 weeks during which they are inevitably protected in immobilization casts to avoid re-injury. Such long periods of immobilization impair functional rehabilitation and predispose a multitude of complications that could be minimized if healing is quickened and the duration of cast immobilization reduced.

In separate studies, we tested the hypothesis that early function, ultrasound, 632.8 nm He-Ne laser, and 904 nm Ga-As laser, when used singly or in combination, promote healing of experimentally severed and repaired rabbit Achilles tendons as evidenced by biochemical, biomechanical, and morphological indices of healing. Our results demonstrate that: (1) appropriate doses of each modality, i.e., early functional activities, ultrasound, He-Ne and Ga-As laser therapy augment collagen synthesis, modulate maturation of newly synthesized collagen, and overall, enhance the biomechanical characteristics of the repaired tendons. (2) Combinations of either of the two lasers with early function and either ultrasound or electrical stimulation further promote collagen synthesis when compared to functional activities alone. However, the biomechanical effects measured in tendons receiving the multi-therapy were similar, i.e., not better than the earlier single modality trials.

Although tissue repair processes in humans may differ from that of rabbits, these findings suggest that human cases of connective tissue injuries, e.g., Achilles tendon rupture, may benefit from appropriate doses of He-Ne laser, Ga-As laser, and other therapeutic modalities, when used singly or in combination. Our recent meta-analysis of the laser therapy literature further corroborate these findings.

Source:

Laser Therapy Vol. 12 Special Millennium Edition, 2000