레이저와 침

[보은사덕(報恩師德)]

Note

There is currently little doubt that the light emitted by LEDs (non-coherent, monochromatic light; spontaneous emission) is effective in generating a biomodulatory response within living tissue, and therefore has a therapeutic role if used correctly. Tiina Karu (1998: The Science of Low-Power Laser Therapy) states that "...the coherence of light is of no importance in low-power laser clinical effects", which does appear to hold true for in vitro experiments and the treatment of open wounds and superficial tissues.

Karu also states that "[t]he primary difference between lasers and LEDs is that the laser's coherent beam produces 'speckles' of relatively high power density which can cause local heating of inhomogeneous tissues". Coherence is maintained as the laser beam penetrates the tissue and, along with polarisation, may be an important factor in allowing laser to effectively treat deeper tissues.

To date, the majority of published research has been conducted using LASERs (coherent, monochromatic light, stimulated emission). Due to the differing properties of LED and LASER generated light, and the relative lack of LED-specific research, it is misleading to suggest that meaningful information about practical LED therapy can be simply derived from LASER therapy research. Until more research is carried out and the mechanisms of photobiomodulation are better understood, this will remain the case.

The following discussion of Low-Level Laser Therapy is based primarily on research conducted with true lasers and, therefore, cannot be directly applied to LED therapy.

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Introduction

Laser Therapy is a form of phototherapy which involves the application of monochromatic light over biological tissue to elicit a biomodulative effect within that tissue.

Low-level Laser Therapy (LLLT) - the most widely-used name given to this form of photobiomodulation - can have both a photobiostimulative effect and a photobioinhibitive effect within the irradiated tissue - each of which can be used in a number of therapeutic applications.

LLLT is gaining increasing acceptance in conventional medical, physiotherapy, acupuncture, dental, and veterinary practice - and refers to the "reaction between laser and the irradiated biological tissue" (Baxter, 1994).

LLLT is a complementary form of treatment and, therefore, is not intended to replace other electrotherapeutic modalities, such as ultrasound, interferential therapy, and magnetic therapy. In a number of therapeutic applications, however, LLLT has been rated more highly in its effectiveness than these other modalities (Baxter et al, 1991).

The following information has been compiled in order to raise practitioners' awareness of LLLT, its uses and potential benefits, and to enable the accurate assessment of laser therapy equipment which may be currently available or in use. Spectra-Medics trusts that this information will assist you to make informed decisions when purchasing and using any LLLT system, and to do so economically.

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Low-Level Laser Therapy

Laser Therapy works on the principle of inducing a biological response through energy transfer, in that the photonic energy delivered into the tissue by the laser modulates the biological processes within that tissue, and those within the biological system of which that tissue is a part. The Arndt-Schultz Law of Biomodulation infers that low dosages of photonic energy will stimulate those biological processes, and higher dosages will inhibit them.

The wavelength at which the laser emits determines the effective depth of penetration, within the tissue, of the laser energy delivered. Far-red to infra-red wavelengths (longer than 800nm) will penetrate deeper, and so are indicated for deeper acupuncture points and trigger points, and deeper tissue injuries. Visible red wavelengths (shorter than 800nm) do not penetrate as far, and are therefore more applicable to superficial tissue and treatment points. Photons emitted at shorter wavelengths do, however, have greater energy/mass which is measured in electron-volts (eV).

In clinical applications the effects of Visible Red laser are of use in, but not limited to, the treatment of open and post-operative wounds, decubitus & venous ulcers, acne, and other dermatological conditions. Visible Red laser has also been effective in the tonification and sedation of superficial acupuncture points.

The therapeutic effects of Visible Red laser are, however, also elicited by Infra-Red wavelengths. For example, research conducted by Sugrue et al (1990) indicated that Infra-Red lasers cause significant decreases in the size of venous ulcers, and corresponding decreases in pain. Infra-red wavelengths have the added benefit of deeper penetration into the tissue, which enhances the healing effect by stimulating micro-circulation and lymphatic drainage.

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Clinical Uses of LLLT

There are a number of potential clinical uses for LLLT, such as those in medical, dental, podiatric, chiropractic, osteopathic, and cosmetic applications. Some of the most popular applications of LLLT currently, however, are in physiotherapy, veterinary, and acupuncture practice.

The portability and diversity of battery and mains-powered diode laser systems allows treatment to be carried out in various clinical, hospital, and field locations. This opens up possibilities for the immediate (and thereby more effective) and on-going treatment of sporting and athletic injuries, such as muscle tears, haematomas and tendinopathies (Baxter, 1994).

It is an attractive modality for the treatment of athletes, especially those involved in professional sports, due to the prospect of shorter recovery and lay-off times. Treatment of chronic and acute musculoskeletal disorders is the most common clinical application of LLLT, due to the effectiveness of laser in treating these types of conditions, and the short treatment times required.

Due to its pain-relieving and wound-healing properties, LLLT has many uses in hospitals and aged-care homes, such as for the treatment of pressure sores in bed-ridden patients, and for enhanced post-operative wound healing and pain relief. The effect of LLLT is such that it can accelerate remodelling of scar tissue, and "give a more cosmetically-acceptable result" (Baxter, 1994) to post-operative scarring.

Trelles et al (1987) reviewed the use of local irradiation with Low-Level Laser in therapy. The stimulus was applied mainly to local lesions to elicit the following types of effect:

• biostimulatory effects in ulcers, granulomas, burns, septic wounds and trauma to superficial tissues;
• stimulation of local cell metabolism in damaged tissues in vivo and in vitro;
• stimulated activity of local tissue enzymes;
• enhanced scar formation and tissue regeneration, mitogenic activity, and osteogenic activity.

Trelles et al (1987) and Muxeneder (1987) also reviewed the effects of LLLT in vertebral pain, headaches and local immune responses. Other recorded therapeutic effects of LLLT (Illarionov et al, 1993) are:

• analgesic, antiexudative, antihaemorrhagic;
• anti-inflammatory;
• antineuralgic, antioedematous, antiseptic;
• antispasmodic;
• vasodilatory.

According to Laakso et al (1994), the "...analgesic response to phototherapy may be mediated through hormonal/opoid mechanisms...and...responses to LLLT are dose and wavelength dependent."

Research being carried out around the world is constantly adding to the ever-expanding body of knowledge and understanding of the mechanisms and effects of LLLT.

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Calculating Laser and Treatment Parameters

Laser diodes are generally operated at or below the laser diode manufacturer's recommended maximum optical output power rating of, say, 100mW, to ensure maximum stability and long diode life. It is this rating which is usually used to state the output power of a laser therapy unit. It is necessary, for accurate dosage control, to know the actual optical output power emitted from the laser probe at the aperture. Check with the manufacturer or use an output power meter suitable for the wavelength of the laser in question.

Laser Therapy devices are generally specified in terms of the average output power (milliwatts) of the laser diode, and the wavelength (nanometres) of light they emit. This is necessary information, but not enough with which to accurately define the parameters of the laser system. To do this, one must also know the area of the laser beam (cm²) at the treatment surface (usually the tip of the handpiece when in contact with the skin).

If the output power (mW) and beam area (cm²) are known, it is a reasonably straight-forward exercise to calculate the remaining parameters which allow the precise dosage measurement and delivery.

The output power of a laser, measured in milliwatts, refers to the number of photons emitted at the particular wavelength of the laser diode.

Power Density measures the potential thermal effect of those photons at the treatment area. It is a function of Laser Output Power and Beam area, and is calculated as:

1) Power Density (W/cm2) =

Laser Output Power (W) Beam area (cm2)

Beam area can be calculated by either:

2) Beam Area (cm2) =	Diameter(cm)2 x 0.7854
or: Beam Area (cm2) =	Pi x Radius(cm)2

The total photonic energy delivered into the tissue by a laser diode operating at a particular output power over a certain period is measured in Joules, and is calculated as follows:

3) Energy (Joules) =

Laser Output Power (Watts) x Time (Secs)

It is important to know the distribution of the total energy over the treatment area, in order to accurately measure dosage. This distribution is measured as Energy Density (Joules/cm²). "For a given wavelength of light, energy density is the most important factor in determining the tissue reaction"(Baxter, 1994). Energy Density is a function of Power Density and Time in seconds, and is calculated as:

4) Energy Density (Joule/cm2) =	Laser Output Power (Watts) x Time (Secs) Beam Area (cm2)
OR: Energy Density (Joule/cm2) =	Power Density (W/cm2) x Time (Secs)

To calculate the treatment time for a particular dosage, you will need to know either the Energy Density (J/cm²) or Energy (J), as well as the Output Power (mW), and Beam Area (cm²). First, calculate the Output Power Density (mW/cm²) as per Equation 1, then:

5) Treatment Time (Seconds) =	Energy Density (Joules/cm2) Output Power Density (W/cm2)
or: Treatment Time (Seconds) =	Energy (Joules) Laser Output Power (Watts)

Finally:

Laser Output Power (Watts) =

Laser Output Power (mW) 1000

중요한 조건임

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Laser Parameters for Effective Treatment

"For a given wavelength of light, energy density is the most important factor in determining the tissue reaction" (Baxter, 1994). Research indicates that Energy Densities in the range 0.5 to 4 Joules/cm² are most effective in triggering a photobiological response in tissue (e.g. Mester & Jaszagi-Nagy, 1973; Mester & Mester, 1989; Mashiko et al, 1983; Haina, 1982), with 4 Joules/cm² having the greatest effect on wound healing (Mester et al, 1973; Mester et al, 1989).

Australian research suggests that this 'therapeutic window' of biostimulation may be extended to include 5 Joules/cm² (Laakso et al, 1994), and has applications in other areas of practice, such as Myofascial Trigger Point therapy and pain control. Dosages of 8 - 12 J/cm² and higher, and the resulting bioinhibition, may also have therapeutic applications, such as in the treatment of keloid scarring and pain management.

Many practitioners have found straight Joules dosages - up to 20 J/point in some cases - to be effective in the treatment of a number of common musculoskeletal disorders. This is possibly due to the combined action of the pain attenuating properties of laser bioinhibition at high dosages, and the biostimulatory effect of the lower-powered 'halo' around the target treatment point. However, the same effect may not be elicited from a different laser unit, due to differences in laser parameters (esp. Power Density) and configuration.

It is the Output Power Density which determines the time required to deliver a particular Energy Density (Joules/cm²) dosage, and the Output Power which determines the corresponding Energy (Joules) delivered during that time.

Results obtained from particular dosages and treatments are likely to vary between individual practitioners and patients, therefore, practitioner discretion is recommended in determining the applicable wavelength and dosage parameters for each patient. It is important to note that the appropriate configuration of a laser unit will depend primarily upon the types of conditions most commonly treated, and so specific requirements will generally differ between practitioners.

Table 1. illustrates the difference in Joules and Joules/cm² dosages for differing output parameters. The calculation of these parameters is explained above.

Output Power (mW)	Beam Spot Size (cm2)	Treatment Time (Secs)	Energy (Joules)	Energy Density (Joules/cm2)
5	0.1	8.0	0.04	0.4
50	0.1	8.0	0.4	4.0
125	0.2	8.0	1.0	5.0
250	0.2	8.0	2.0	10.0
500	0.2	8.0	4.0	20.0

Table 1. Various Laser Parameters v Dosage/Time

Please note that treatment times for Joules/cm² dosages are the same for a laser unit with any output power, eg: a 100mW diode or a 50mW diode, if the output is collimated to achieve the same Power Density, however the resultant biological effects may differ.

Baxter (1994) recommends a number of treatment parameters for common musculoskeletal disorders in terms of both Joules and Joules/cm² dosages, such as 1 - 2 Joules (8 - 16 J/cm²) for ligament strains (pp205-207). The energy and energy density combination in this case can only be achieved with a specific laser beam power to spot size ratio of 1:8. Not all laser devices will incorporate this specific ratio, and so a generalised representation of dosage parameters in this way is limited in its usefulness.

However, it can be seen that knowing and understanding the relationship between the Joules dosage and its corresponding Joules/cm² dosage (per your lasers specific configuration), and the resultant biomodulative effect, allows more accurate specification and delivery of a particular treatment dosage. It also makes a successful treatment easier to replicate, and to share results with other practitioners and researchers.

Of course, individual results may vary between patients, so practitioner discretion is advised at all times.

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The Need for Accurate Specification of Laser Parameters

The general lack of understanding of laser dosimetry has, in part, led to the current reliance on dosages only being measured in straight Joules (Output [Watts] x Time [Seconds]). 'Joules' on its own is essentially a meaningless dosimetric unit in the delivery and recording of LLLT treatment parameters in research, as it does not take into account the treatment area across which laser beam is dispersed, and leads to recorded treatment results which are ambiguous and difficult to replicate (Stuck, 1993; Baxter, 1994). However, it is still a useful dosimetric unit in clinical practice.

Imprecise or inadequate recording of laser and dosage paramenters can lead to over-stimulation of the treatment point, which potentially generates negative or undesired results through the inhibition of desired photobiological responses, or understimulation with little or no therapeutic effect. At higher Power Densities there is also potential for the laser to generate a thermal effect in the tissue. This is undesirable for Low-Level Laser Therapy, and is potentially unsafe.

One can also see that laser units which allow the user to increase or decrease the output power of the treatment probe (for example, a 100mW probe may be switched between 25, 50, 75, & 100mW settings; or a 40mW probe between 10, 20, 30 & 40mW) will offer no control over the power density, as the beam diameter will remain constant. It is more accurate from a therapeutic perspective to effect dosages changes by maintaining a fixed output power and altering the emission time.

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LLLT & Acupuncture

Laser Acupuncture relies upon similar dosage principles as needling, and a knowledge of acupuncture theory and practice is required.

According to one school of thought, very low powered lasers can be used with great finesse to effect stimulation of acupuncture points. Within this paradigm, dosage is determined by way of the intended effect, which is generally characterised as to TONIFY or SEDATE Acupuncture Points (APs) and Ah-Shi Points. Basing dosage selection upon the Arndt-Schultz Law, it can be seen that low dosages will TONIFY, whereas higher dosages will SEDATE. Dosages of 0.5 to 2.5 J/cm² are reported to be effective in the stimulation (tonification) of superficial Acupuncture Points, with 2.5 to 5.0 J/cm² being effective for deeper APs. Higher dosages (8 - 12 J/cm²) are effective for the sedation of APs.

A second, more common belief is that laser is unable to offer the practitioner the ability to finesse an acupuncture point, in the way that a practised acupuncture clinician may do so with a needle, and that laser simply acts as a force applied to a switch: once the appropriate force (dosage) is applied, the switch is thrown. A dosage lower than that required to throw the switch is insufficient to create any effect, and a dosage greater is simply wasted.

Active acupuncture points are typically painful upon palpation. This appears to concur with the observation by a number of authors that there is a 70-75% correlation between acupuncture points and known myofascial trigger points. Thus, the application of a sufficiently high dosage would 'release' that point. Typically, visible or infrared lasers with output powers exceeding 100mW are used to quickly and effectively release an active acupuncture point, with infrared being especially useful for the deeper Ah-Shi points.

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LLLT & Physiotherapy

Electrotherapy and low-level laser are used in physiotherapy to assist in the attenuation of pain and to stimulate tissue repair. As such, their application is also bound by the Arndt-Schultz Law of Biomodulation, as described above. Thus, it can be seen that the dosage delivered by the practitioner during a laser treatment is determined by the condition being treated, and the desired therapeutic effect. For example, if the desired effect of an initial treatment is that of pain attenuation, an inhibitory dosage (8.0 to 16.0 Joules/cm²) would be indicated.

Australian research has also shown that dosages of between 0.5 and 5 Joules/cm² (Laakso et al, 1994) applied to Myofascial Trigger Points will effect an analgesic response through the body's hormonal/opoid mechanisms. If the desired effect is that of tissue repair, then the required dosage per treatment point will generally fall within the optimal therapeutic window between 0.5 and 5 Joules/cm².

Available laser Output Power may range from 5mW to 500mW per laser emitter, with the higher powers indicated for larger muscle groups and treatment of the back. Near-infrared lasers penetrate further into the tissue. Multi-diode cluster probes may be effective in reducing overall treatment times where large tissue areas are to be treated. However, it must be noted that multi-diode LED and LED+Laser cluster probes often contain multiple wavelengths, which can lead to a degredation of the effectiveness of laser therapy (Karu, 1998).

Treatment will be effected by application of the laser probe to points along tendons and ligaments, and at the origins and insertions of muscles. Larger muscles can be treated by application of the laser in a grid pattern to a series of points across the body of the muscle, or by scanning or painting the laser head across the affected area.

Joint conditions, such as osteoarthritis, can be treated by applying the laser probe to a series of points along the joint line, aiming the probe tip at the articular surface where possible, and to the origins and insertions of muscles around the joint.

Open wound healing can be accelerated through laser therapy, by the application of 1-to-4 Joules/cm² to a series of points in a 1cm square grid pattern across the surface of the wound, or by scaning or painting the wound surface with the laser.

As a gereral rule, optimal biostimulation is effected by the application of smaller dosages-per-point to more points at the treatment site.

Optimal bioinhibition is achieved through applying higher dosages-per-point, but to fewer treatment points.

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Treatment Protocol, Frequency, and Response

To maximise irradiance at the target tissue, the laser probe should be held in contact with, and perpendicular to, the tissue surface.

When treating open wounds, the probe should be held slightly away from the tissue surface, whilst still maintaining a 90^o angle. The probe tip may be covered with plastic cling film, in order to reduce the likelihood of cross-contamination.

In treating musculoskeletal conditions, laser therapy should be carried out following cryotherapy as the vasoconstriction caused by cooling the tissue will increase the penetration depth of the laser irradiation. Laser therapy helps to relax muscles, and so manipulations should be carried out following laser irradiation. Heat therapies and various creams and lotions can be applied after laser therapy.

Laser treatments can be carried out by irradiating daily for the first week, then gradually increasing the interval between treatments over successive weeks, according to the progression of the condition being treated. The total dosage should not exceed 100-200 J in any single treatment session. Laser dosage is cumulative, and so overtreatment causing a degredation of LLLT effectiveness can come from overly-high dosages in one treatment session, or too many treatment sessions in close succession. Individual practitioner discretion is to be used to determine the appropriate maximum session dosage, and the frequency of treatment, for each particular patient.

Patients may report a number of sensations, such as localised feelings of warmth, tingling, or an increase or decrease in symptoms, within the period immediately following laser therapy. Other sensations that may be experienced in response to laser therapy are nausea or dizziness. It is good practice to advise patients of this possibility.

Treatment reactions, if they occur, are often reported after initial laser treatments, however, they generally diminish after the second or third treatment. If a severe reaction is experienced during treatment, stop immediately.

To reiterate, optimal biostimulation is effected by the application of smaller dosages-per-point to more points at the treatment site.

Optimal bioinhibition is achieved through applying higher dosages-per-point, but to less treatment points.

When treating acute musculoskeletal injuries, the initial desired outcome of laser therapy is the reduction of pain and inflammation. It is very effective when used in conjunction with cryotherapy, rest and elevation of the injury site. Ideally treatment will begin as soon as possible after the injury occcurs, with relatively high, inhibitory dosages (8-12 Joules per point, up to 10 points) being used to attenuate the pain and reduce the initial inflammatory response. A treatment frequency of 1-2 sessions per day may be used for the first 2-4 days post-injury.

As the time post-injury progresses, dosages and treatment frequency may be reduced. In the period 5-10 days post-injury, dosages of 6-8 Joules per point may be useful in promoting the rate of the inflammatory process and in clearing its products from the injury site, thus allowing healing to begin sooner.

Moving into the healing phase, dosages are lowered and treatment frequency is reduced further. Throughout the healing and rehabilitation phase of an injury, biostimulatory dosages (1-4 Joules per point) are used to promote tissue repair and reduce scarring and adhesions. Higher doses may be used as required to alleviate any pain that results from over-working the injured body part during rehabilitation.

When treating chronic injuries or pain, it is best to start with lower doses and then work up to the most effective dose for that particular patient, as a high initial dose may cause an unpleasant exacerbation of symptomatic pain.

Please note that these are very general guidelines. Many factors affect the selection of the appropriate dosage and treatment frequency for each condition and patient. One must take into account the body mass of the patient, their age and general health, the depth of the injury, the tissue type, skin colour and so on.

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Contraindications and Safety

Irradiation Of The Eyes Class 3b lasers are potentially harmful to the retina. Although accidental retinal damage is highly unlikely, it is recommended that laser protective eyewear, with the correct filter for the wavelength and power being used, be worn.

Pregnancy Laser is NOT contra-indicated for use over the pregnant uterus, however it should be used with caution. It is ideal as an adjunct to other modalities used for the treatment of back pain or other complaints.

Carcinoma Do not use the laser over any known primary or secondary lesions.

Thyroid Laser should not be used over the thyroid gland.

Haemorrhage It is conceivable that laser-mediated vasodilatation may worsen the haemorrhage.

Steroid Injections Patients may suffer an exacerbation of symptoms after laser therapy in conjunction with a recent steroid injection. For this reason laser should be used with caution following a steroid injection on or near the same site. We recommend one or two treatment points only at the minimum recommended dosage for that probe.

Anti-Coagulants It is possible that probe pressure may cause slight bruising after treatment.

Anti-Inflammatories Patients taking anti-inflammatories for acute soft tissue injuries may not respond as quickly to laser therapy as those who are not. Ideally, we would suggest a combination of ice and laser therapy without the use of an anti-inflammatory.

Pins, Metal Plates and Plastics are Not Contraindicated Laser may be safely used over stitches, as well as pacemakers, metal implants, pins, plates and plastics.

Tattoos and Other Pigmented Tissues Dark pigments, such as tattoos and melanin, may absorb light at the wavelengths used in laser therapy. Where probes with high power densities are in use, the absorption of laser energy by these pigments may cause localised heating, and subsequent discomfort or injury, of the irradiated tissue. We recommend conducting patch-tests on darker-pigmented tissues.

General Hygeine Clinical hygiene standards and protocols should be applied.

Legal and Regulatory Requirements Practitioners should be aware of local regulations governing the use of low-level laser therapy equipment.

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Criticisms of LLLT

Some devices, sold as lasers, do not emit laser light. These devices are based on light emitting diodes (LEDs), which emit non-coherent light. Whilst most research has been conducted using coherent light sources, it has been shown that it is the wavelength and dosage - not coherence of light - that has the most effect on biomodulation. The primary difference between lasers and LEDs is that the laser's coherent beam produces 'speckles' of relatively high power density which can cause local heating of inhomogeneous tissues (Letokhov, 1991).

Laser does have a number of other benefits. A wider range of wavelengths are generally available, and therefore it is easier to find an available wavelength in close proximity to the peak wavelength in a particular action spectra. There is usually a significant price difference between laser diodes and LEDs. However, lasers with significantly higher output powers are becoming a lot more affordable.

One of the major criticisms of low-level laser therapy to date has been the inability of practitioners and researchers to reliably replicate results obtained by other individuals. This is invariably due to the imprecise and incomplete recording of laser and treatment parameters (Stuck, 1993), and of dosages used to obtain these results. It is very difficult to develop an informed opinion about the efficacy of LLLT in these circumstances.

With laser treatment parameters recorded in terms of Output Power, Beam Spot Size, Treatment Time, and Wavelength (Grosman, 1976; Stuck, 1993; Baxter, 1994), a particular treatment can usually be replicated, in vivo and in vitro, not only with the same laser unit but with any laser configured appropriately. This is essential for further research purposes, and offers the potential to add significantly to the overall body of knowledge in the field of low-level laser therapy (especially that derived from human in vivo studies which, due to the imprecise recording of laser and treatment parameters, have in many cases been less than useful).

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Summary

Low-Level Laser Therapy, by definition, has no appreciable thermal effect in irradiated tissue; it works by modulating the biological processes within the tissue through application of photonic energy at specific wavelengths;

Laser's coherent beam produces 'speckles' of relatively high power density which can cause local heating of inhomogeneous tissues;

LEDs and LASERs both generate biomodulatory effects within living tissue, however, most published research relates to LASER;

Therapeutic effects of laser are both wavelength and dosage dependent;

Low dosages stimulate, high dosages inhibit (ref: Arndt-Schultz Law of Biomodulation) - both have therapeutic applications;

Optimal therapeutic window for photobiostimulation - 0.5 to 5.0 Joules/cm²;

Optimal Biostimulation: lower dosages per point - more treatment points;

Optimal Bioinhibition: higher dosages per point - less treatment points;

Visible red wavelengths (~620-690 nanometers) - shallow penetration - superficial tissue treatment, eg. wound healing, superficial APs, acne, etc.;

Infra-red wavelengths (~760-1260 nanometers) - deeper penetration - deeper tissue treatment, eg. musculoskeletal injuries, sports therapy, deeper APs and myofascial TPs, also wound healing,etc;

High Output Power + Infrared Wavelength + Safe Power Density = Maximum Effective Penetration

Treatment parameters to be recorded in minimum terms of Output Power (mW), Beam Spot Size (cm²), Treatment Duration (Seconds), and, Wavelength (nm);

Do not irradiate cancerous tissue;

Be aware of optical safety at all times.

 

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Treatable Conditions:

Low-Level Laser has been shown to be effective in, but not limited to, treating the following indications:

Infra-Red Wavelengths:

Soft Tissue Injuries such as:

• Capsulitis, Bursitis
• Sprains & Strains
• Haematomas
• Tendonitis, Tenosynovitis
• Myofascial Trigger Points, AhShi Points, & Deep APs

Acute & Chronic Joint problems including:

• Osteoarthritis
• Rheumatoid Arthritis
• Ligament & Tendon injuries
• Chrondomalacial Patella

Chronic Pain such as:

• Post Herpetic Neuralgia
• Chronic Back & Neck Pain
• Metatarsalgia
• Trigeminal Neuralgia
• Brachial Neuralgia
• Plantar Fasciitis
• Frozen Shoulder
• Carpal Tunnel

Fractures such as:

• Non Union
• Small bone

Visible Red Wavelengths:

• Herpes
• Apthous Ulcers
• Leg Ulcers
• Dermatitis
• Wound Healing
• Burns
• Acute Epididymitis
• Otorhinolaryngology
• Gynaecology
• Obstetrics
• Superficial AP Stimulation and Tonification
• Cosmetic
• Acne

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Bibliography and References

Airaksinen,O., Rantanen,P., Kolari,P.J. and Pontinen,P.J. (1988) Effects of IR (904nm) and He-Ne (632.8nm) laser irradiation on pressure algometry at TPs. Paper to Nordic AP Society Annual Congress, Laugarvatn, Iceland, August 26th. Scand. J. of Acupuncture and Electrotherapy, 3,56-61.

Baxter, G. D. (1994) Therapeutic Lasers: Theory and Practice. Churchill Livingstone: Edinburgh

Baxter, G.D., Bell, A.J., Allen, J.M., et al (1991) Low Level Laser Therapy: current clinical practice in Northern Ireland. Physiotherapy 77: 171-178

Dyson,M. and Yang,S. (1986) Effect of laser therapy on wound contraction and cellularity in mice. Lasers in med. science 1/2,125-130.

Grosman. Z. (1976) Effect of laser irradiation on different cell structures. SB Omik Vedeckych Praci Lekarske 19:3-4

Illarionov, V.E, & Priezzhev, A.V Current Status of Low-Energy Laser Therapy in Russia: Search for Mechanisms, Clinical Applications and Equipment Development in Low Energy Laser Effects on Biological Systems, Michal Schwartz, Michael Belkin, (eds), (1993) Proc. SPIE 1883, pp8-13

Karu, T. (1998) The Science of Low-Power Laser Therapy. Gordon & Breach Science Publishers, p.xv

Kolari,P.J., Hietanen,M., v. Nandelstad,P., Airaksinen,O. and Pontinen,P.J. (1988) Lasers in physical therapy-measurement of optical output power. Scand. J. Acupuncture and Electrotherapy.

Laakso, E.L., Cramond, T., Richardson, C., & Galligan, J.P. (1994) Plasma ACTH and b-Endorphin Levels in Response to Low-Level-Laser Therapy (LLLT) for Myofascial Trigger Points. Laser Therapy 6: 133-142

Mester,E., Mester,A.E. and Mester,A. (1985) The biomedical effect of laser application. Lasers in surgery and medicine 5, 31-39.

Mester & Mester, (1989) Wound Healing. Laser Therapy 1: 7-15

Muxeneder,R. (1987). Soft laser in the conservative treatment of chronic skin lesions in the horse. Der Prakt. Tierarzt, 68, No. 1, 12-21.

Pontinen,P.J. (1987) Mid-laser and TNS in back pain. Nordic AP Society Annual Meeting: Seminar on back pain. Oslo, September 26.

Pontinen,P.J. (1995) Low Level Laser Therapy (LLLT) and laser acupuncture: a manual for physicians, dentists, physiotherapists and veterinary surgeons.

Rogers,P.A.M., Janssens,L.A.A. & Jagger,D. (1987) The efficacy of cold laser: A survey of members of the International Veterinary Acupuncture Society. Unpublished.

Rogers P.A.M (1996) Clinical Uses of Low Level Laser Therapy. Medical Acupuncture Web Page.

Stuck, B.E Measuring and reporting physical parameters in laser biomodulation research in Low Energy Laser Effects on Biological Systems, Michal Schwartz, Michael Belkin, (eds), (1993) Proc. SPIE 1883, pp21-26

Sumano,H.L., & Casaulon,T. (1987) Eval‎uation of electro-AP and TENS effects on wound- and burn-healing. Personal Communication, Veterinary School, Mexico City.

Trelles,M.A., Mayayo,E., Mester,A. & Rigau,J. (1987) Low power laser-therapy: Experimental and clinical data. Scandinavian Journal of Acupuncture & Electrotherapy, 2, 80-100.

Tunér, J & Hode, L (1996) 'Laser Therapy in Dentistry and Medicine'. Prima Books

Tunér, J & Hode, L (1999) 'Low Level Laser Therapy - Clinical Practice and Scientific Background'. Prima Books

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All rights reserved. No part of this publication may be reproduced, stored in a retreival system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the author (Peter Jenkins, c/- SpectraMedics Pty Ltd, 248 Onkaparinga Valley Road, Oakbank, SA, Australia 5243)

Disclaimer: This information is provided as a guide only. Spectra-Medics makes no claim that Low-Level Laser Therapy will be effective in treating any conditions listed above. Individual practitioner discretion is essential in determining an appropriate form of treatment.

The information included in this document is of a general nature only, and does not specifically relate to any particular laser manufacturer or the use of any specific piece of laser therapy equipment, unless stated. Please read any information included with your laser therapy unit carefully.

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