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There are a variety of therapeutic modalities that are used to help reduce pain or inflammation or to enhance tissue regeneration in the promotion of healing of musculoskeletal pathologies. The scientific evidence-based conclusions for the use of Low Level Laser (Light) Therapy (LLLT) have shown in numerous peer review journal study articles to support its use for pain management (both nociceptive and neuropathic types of pain), reduction in inflammation and edema, and to promote tissue healing for a wide range of musculoskeletal injuries and conditions. Further, these beneficial therapeutic effects are delivered without the many potential side-effects of traditional therapies used to treat pain and inflammation.
The effect of the LLLT, also known as Photobiomodulation, is photochemical not thermal. The application of the low level light therapy (power range of 10m W-500m W, wavelength 660nm-905nm) has the ability to penetrate skin, and soft/hard tissues and stimulates biochemical changes within the cells of the affected tissues that reduce pain signaling and inflammation and stimulate the release of growth factors associated with tissue repair, proliferation and healing. The power density (irradiance) is typically between 5 W/cm2 and is applied to the site of an injury or pain for 30-60 seconds a few times a week for up to several weeks depending in the type and extent of pathology. The primary clinical targets for LLLT are:
- Site of injury or damaged tissue to promote healing, proliferation, and remodeling, and to reduce inflammation (Note: the mechanism for tissue repair is thought to be associated with enhanced neovascularization, promotion of angiogenesis, and increased collagen synthesis)
- Lymph nodes to reduce inflammation and edema (Note: a reduction in pro-inflammatory cytokines is consistently seen in burn and muscle lesions when treated with LLLT)
- Nerves to reduce pain signaling (Note: there are several potential mechanisms attributing to pain relief including the inhabitation of nerve impulses creating a neural blockade and suppressed sympathetic activity in second order neurons so that cortical areas of the pain matrix are not activated, and a release of neuromuscular contractions producing a reduction in muscle spasm)
- Trigger points to reduce tenderness and facilitation muscle relaxation
Application of LLLT with a laser (Light Amplification by Stimulated Emission of Radiation) that emits a divergent beam (not focused) is indicated for use in the treatment of acute (lasts less than 30 days) and chronic (lasts more than six months “or” is pain that continues beyond the expected period of healing) pain associated with:
- Sprains
- Strains
- Post-operative pain
- Muscular neck and back pain
- Tendinopathies
- Cervical and lumbar disc radiculopathy
- Osteoarthritis
- Rheumatoid arthritis
- Frozen shoulder
- Epicondylitis
- Carpel tunnel syndrome
- Fibromyalgia
- Plantar fasciitis
- TMJ syndrome
- Chronic regional pain syndrome
- Trigeminal neuralgia
- Diabetic neuropathy
LLLT therapy is most effective when used as an adjunct therapy with other physical therapy therapeutic interventions.
Safety and Contraindications for Laser Therapy
The North American Association for Laser Therapy gives these main recommendations for precaution and contraindication in the use of laser or LLLT Therapy:
- Eyes: Do not aim laser beam into eyes and everyone present should wear appropriate safety spectacles.
- Cancer: Do not treat over the site of any known primary carcinoma or secondary metastasis unless the patient is undergoing chemotherapy when LLLT can be used to reduce side effects such as mucositis. LLLT however can be considered in terminally ill cancer patients for palliative relief.
- Pregnancy: Do not treat directly over a developing or gravid uterus.
- Epileptics: Be aware that low frequency pulsed visible light (<30Hz) might trigger a seizure in photosensitive, epileptic patients.
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