Laser : Clinical Applications in Physiotherapy

Amitesh Narayan
Professor Dept. of Physiotherapy KMC Mangalore

Difference between Laser and Ordinary Light

Types of Lasers
Based on the intensity the laser is divided into 2 types - Hot Lasers (High intensity): Generates heat and destroys the selected tissue and used for making surgical incisions and cauterize during surgical procedures. - Cold Lasers (Low intensity , PD =50mW/cm,ED<35J/cm , P<500mW) used for rehabilitation purposes and is Biostimulative and facilitate healing.

Low Level Laser and Surgical Laser:

Comparision

Laser: Penetration in Tissues

When a laser beam projected to tissue

Five phenomena takes place:
reflection, transmission, scattering,

re-emission,
absorption. Laser light interacts with tissue and transfers energy of photons to tissue because absorption occurs.

Laser: Tissue absorption and Penetration

Impact of Laser on the Tissues

Low Level Laser and Surgical Laser:

Comparision

Laser: Thermal Effects

Temperature
37C 45C 50C
60C 80C 100C > 100C > 300C

Biological effect
Normal Hyperthermia Reduction in enzyme activity, cell immobility Denaturation of proteins and, collagen,coagulation Permeabilization of membranes Vaporization thermal decomposition (ablation) Carbonization Melting.

How Laser Works?

Laser: Biostimulative
effects

Physiological Effects of Low Level Laser Therapy

Improved blood circulation & vasodilation: Increases blood supply.

Increase collagen production: Develops collagen & muscle tissue

Increase macrophage activity: Stimulates immune system

Alter nerve conduction velocity: Stimulates nerve function.

Physiological Effects of Low Level Laser Therapy

Increases ATP production

Bio stimulation: Improved metabolism, increase in cell metabolismIncreases speed, quality & tensile strength of tissue repair.

Analgesic effect- Relieves acute/chronic pain.

Anti-inflammatory & anti-edematous effects- Reduces inflammation.

Physiological Effects of Low Level Laser Therapy

Stimulation of wound healing:
Promotes faster wound healing/clot formation
Helps generate new & healthy cells & tissue.

Laser: Short Term Effects

Production and release of beta-endorphins: (morphine like substances
produced by various cells in the body that inhibit the sensation of pain).

Cortisol production is increased (cortisol is the precursor of cortisone):

This enables the body to combat the stress associated with trauma or the disease process.

Short-term effect is significant in 5-10% of cases during or after the conclusion of the
initial treatment, but is not as important as the long term or cumulative effect.

Laser: Long Term or Cumulative Effect

ATP (adenosine triphosphate) production:
increases

resulting in improved cellular Metabolism.

DNA (deoxyribo-nucleic acid) production; protein building block of

tissue is substantially increased.

Facilitation of Neurotransmission: due to elevated levels of

serotonin and acetylcholine.

Laser: Long Term or Cumulative Effect

Stimulation of Mitochondrial activity: resulting in cell replication
etc. (i.e. replacement, regeneration and repair of abnormal cells).

Modulation of macrophages, fibroblasts and other cells .

Angiogenesis (formation of new blood vessels).

Laser: Long Term or Cumulative Effect

Regulates cell membrane potential: essential in Na, Cl and K ion
transfer (electrolyte balance).

Release of Cytokines and other chemicals: enhancing cellular

communications.

Laser: Other Effects

Stimulation of immune responses. Improved Lymphatic drainage. Histamine response is positively altered. Production of growth hormone is increased.

Enhances bodys natural healing processes are enhanced.

Laser: Tissue healing

Orthopedic Application of Laser: No operative

Pain management.

Fractures: enhancement of union.

Burn healing Wound care. Healing Heel fissures. Plantar fascitis management.

Fungal nail correction.

Arthroscopy (all types)

Orthopedic Application of Laser:

No operative
Neurogenic Pain Diabetic Neuropathy

Herpes Zoster
(Shingles) Fibromyalgia Post Traumatic Injury

Trigeminal Neuralgia
Radiculitis Sciatica Management of gout.

Orthopedic Application of Laser: No operative

Acute & Chronic Joint Problems:
Osteoarthritis Rheumatoid Arthritis

Ligament & Tendon injuries

Chondromalacia Patella.

Orthopedic Application of Laser:

No operative

Chronic Back & Neck Pain

Reduction of Inflammation: Metatarsalgia. Brachial Neuralgia. Plantar Fascitis. Frozen Shoulder. Carpal Tunnel syndrome.

Treatment Techniques
Gridding Technique
Divide treatment areas into grids of square centimeters

Scanning Technique
No contact between laser tip in skin; tip is held 5-10 mm from wound

Wandering Technique
A grid area is bathed with the laser in an oscillating fashion; distance should be no farther than 1 cm from skin

Point Application (Acupuncture point)

During the treatment..,

Maintain laser perpendicular Check for pre/post-treatment

to treatment surface
Firm contact unless open wound

changes
10 minute max. treatment or 60 Joules

Clean area prior to treatment Place probe on treatment area. Maintain constant contact with Begin with minimal treatment the skin. and gradually increase Do not bathe the area with the probe

Dosage
Dosage (D) Amount of energy applied per unit area Measured in Joules/square cm (J/cm2)
Joule unit of energy 1 Joule = 1 W/sec

Dosage is dependent on:

Output of laser in mW Time of exposure in seconds Beam surface area of laser in cm2

Various dosage ranges per site (1-9 J/cm2

Recommended Dosage
Therapeutic response = 0.001-10 J/cm2

Minimal window threshold to elicit response

Too much suppressive effect

Open wounds 0.5-1.0 J/cm2

Intact skin 2.0-4.0 J/cm2

Average treatment 6J /cm2

Laser: Contraindications
Do not radiate the eye directly During pregnancy Photosensitive subjects Direct irradiation to the eyes Within 4 to 6 months after radiotherapy Hemorrhaging regions Locally to the endocrine glands

Precautions
Epilepsy Confused or disoriented

Fever
Malignancy To the lower back of abdomen during pregnancy or mensuration

patients
Areas of decreased sensation Epiphyseal lines of children

Infected tissue
Sympathetic ganglia, vagus nerves or cardiac region in patients with heart disease

Embryo or fetus

Considerations
Better to underexpose than to overexpose

May experience a syncope episode during treatment

during chronic pain, but very rare

If icing use BEFORE phototherapy

Enhances light penetration

If using heat therapy use AFTER phototherapy

Decreases light penetration