23rd Sep 2015
Clinical Applications of Low-Level Laser Therapy in Physical Therapy
Chronic pain is the most common cause of long-term disability in the United States. As a result most conditions that result in a visit to physical therapy involve a degree of inflammation and pain. These symptoms typically result in functional limitations, decreased strength and impaired mobility. Physical therapists create treatment plans with efficiency and maximum benefits in mind using a combination of manual therapy, activity-based procedures, patient education and physical modalities. When considering using a modality, many factors are considered: ease of use, efficiency of time, whether it’s non-invasive, and the speed in which it can benefit. Low-Level Laser Therapy (LLLT) is one of the most popular treatment modalities in physical therapy. Physical therapists use laser light therapy to great
effect with a multitude of chronic pain diagnoses including arthritis, neuropathy, muscle strains, fractures, pain reduction and TMJ.
How Laser Light Therapy Works
Laser Light therapy uses very short wavelengths of light (600-1000 nm) to penetrate human tissue which facilitates the healing of tissue, reduces pain and swelling. Particles called photons assemble in waveforms to make light. The light transmits through the skin's layers (the dermis, epidermis and the subcutaneous tissue or tissue fat under the skin) at all wavelengths within the visible range. However, light waves in the near infrared ranges penetrate the deepest of all light waves in the visible spectrum. When low level laser light waves penetrate deeply into the skin, they optimize the body’s immune responses in the blood. This creates both anti-inflammatory and immunosuppressive effects. Research has found that light transmitted to the blood through light therapy has positive effective through-out the whole body because it supplies vital oxygen and energy to every cell.
The type of light utilized in Laser Light Therapy is most commonly red or near infrared light. These forms of light are found on the electromagnetic spectrum just above visible light. Numerous studies have found that the photons, especially those found in the red or near infrared spectrum, have healing properties at the cellular level, which means the cells are able to absorb the photons. The cell then uses these photons to make additional adenosine triphosphate (ATP), which creates the body’s energy. Being able to create this additional energy helps accelerate the body’s natural healing processes.
Additionally, Laser Light Therapy is a popular treatment modality, aside from its therapeutic benefits, is treatments usually last 5 minutes or less are non-invasive and are pain-free. And while light therapy treatments are usually performed two to three times a week, most people have noticed improvements with their first or second treatment, making it fast acting too.
LLLT has been shown to hasten the inflammatory process through mitochondrial chromophore stimulation. This is important because this stimulation increases respiratory chain activity, which in turn enhances ATP synthesis, cellular repair and reproduction.
With these broad-ranging benefits, LLLT is appropriate for a lot of treatment plans. Let’s discuss where LLLT may be a productive tool in physical therapy treatment.
Laser Light Therapy Devices in Physical Therapy
- General Chronic Pain: Chronic pain is the most common cause of long-term disability. According to the National Center for Health Statistics, approximately 76.2 million suffers from acute pain lasting longer than 24 hours. Chronic pain is comprised of pain associated with muscle spasms, tension, inflammation, stiffness, etc. LLLT is effective for treating chronic pain and its side effects on many levels. LLLT helps relieve muscle tension, spasms, inflammation, fluid retention, aches, stiffness, and pain. Other benefits include improved circulation (blood and lymph), general flexibility, range of motion, and increased tissue elasticity (ex: scar tissue). The laser is placed directly over the injured area for 30 seconds to several minutes, depending on the size of the area being treated and the dose provided by the cold laser unit. When cells absorb this light energy, it initiates a series of events in the cell that is theorized to eventually result in normalizing damaged or injured tissue, a reduction in pain, inflammation, edema and an overall reduction in healing time by increasing intracellular metabolism.
- Pelvic Dysfunction: Pelvic floor dysfunction refers to a wide range of problems that occur when the muscles of the pelvic floor are weak, tight, or there is an impairment of the sacroiliac joint, low back, coccyx and/or hip joint. The tissues surrounding the pelvic organs may have increased or decreased sensitivity and/or irritation resulting in pelvic pain. Cold laser applies low-intensity laser light to the tissue and may help with pain, inflammation, and wound healing. LLLT is able to relieve minor muscle aches, joint pain and stiffness, and for relaxation of muscle spasm, and increased local blood flow where they are trapped or pinched by muscles.
- Arthritis: Arthritis currently affects 1 in 5 Americans. The primary advised treatment for arthritis sufferers include anti-inflammatory drugs and painkillers which carry the risks of potential heart attack, stroke, liver and kidney problems and stomach bleeding. These drugs are recommended for short term use, but for anyone suffering from Arthritis that’s not possible, which means taking these drugs for the long term and increasing the risk of long term side effects. The low level lasers of LLLT are able to alter cellular function and have been found to be effective in the treatment of Rheumatoid and Osteoarthritis. In a recent study published in The Journal of Rheumatology, LLLT reduced pain in Rheumatoid Arthritis patients by 70% relative to the placebo and reduced morning stiffness by 27.5% min, and increased flexibility of the hand by 1.3 cm. A British study at the University of Dundee shows laser therapy used to stimulate the same pressure points used in acupuncture significantly reduced pain in patients suffering from Osteoarthritis. Patients measured their pain on a scale of one to 10. The results, published in The Journal Physiotherapy showed pain scores for those who received the treatment dropped an average of 1.3 points and in some cases falling as much as 2.4 points.
- Achilles tendonitis: Achilles tendonitis is a common sports injury. It affects about 11% of all running injuries. Achilles tendonitis can be quite debilitating, preventing the sufferer from running and causing great difficulty walking, especially when the pain is acute. Achilles tendonitis tends to occur more in middle-aged recreational athletes than other age groups. This is because the Achilles tendons, like other body tissues become more rigid, less flexible, and more susceptible to injury as we age. Achilles tendonitis is usually caused from overuse and associated with over-pronation of the foot or changes in footwear or running routine. The primary presenting symptom of Achilles tendonitis is posterior heel pain. Research suggests LLLT can provide relief from pain and faster healing of tendonitis than conventional treatments, which rely primarily on resting the injured tendon and using ice to reduce inflammation. Additionally a study published in Lasers in Surgery and Medicine found, combining ultrasound with LLLT helped accelerate healing and increase tendon tensile strength.
- Lateral Elbow Tendinopathy or Tennis Elbow: Lateral pain in the elbow also known as Tennis elbow affects up to 3% of the population, and is usually an overload injury that often follows minor trauma to extensor forearm muscles. Unfortunately pain and symptoms of Tennis Elbow may persist for over 18 months to 2 years in up to 20% of people. In a review of studies published in BMC Musculoskeletal Disorders that included patients with poor prognosis caused by failed steroid injections or other treatment failures, or long symptom duration or severe baseline pain, it showed that LLLT has an anti-inflammatory effect in 21 out of 24 controlled laboratory trials and a bio-stimulatory effect on collagen production in 31 out of 36 trials. According to research, both of these effects were dose-dependent and could be induced by all wavelengths between 630 and 1064 nm with slight variations in therapeutic dose-ranges according to the wavelength used. What this means is the anti-inflammatory effect and increase in collagen fiber production is seen in higher therapeutic doses of LLLT.
- Carpal Tunnel Syndrome: Carpal Tunnel Syndrome (CTS) develops from nerve problems in the wrist, which cause persistent pain, numbness and tingling. These symptoms of CTS progress gradually and can become debilitating, leading to work disability and the need for surgery. It is estimated 260,000 carpal tunnel surgeries are performed each year in the U.S. However, if caught early and treated CTS is reversible. Unfortunately, if not treated, the insulation on the nerves may wear away, and permanent nerve damage may develop resulting in the need for surgery. A recent study published with The National Center for Biotechnology showed that low level laser therapy significantly improved grip strength, functionality and lowered pain in carpal tunnel patients.
- Temporomandibular joint (TMJ): Temporomandibular joint (TMJ) pain can be a significant problem. More than 10 million Americans complain of jaw pain. The temporomandibular joint (TMJ) guides jaw movement. Problems with the TMJ are known as temporomandibular joint disorder or dysfunction (TMD). TMD has a number of causes: bad posture, chronic clenching, poor teeth alignment, fracture, surgery or what is called “lockjaw”. TMD can cause a whole host of other problems, as the pain radiates to other areas of the body. TMD can not only cause jaw pain, but also fatigue, difficulty opening the mouth, ringing in the ears. By using LLLT in the treatment of TMJ, the low level lasers of LLLT are able to alter cellular function, reduce pain, inflammation and increase the flexibility of the jaw joint. In a meta-analysis of studies including those using a double-blind and placebo-controlled trial, showed that LLLT seemed to be effective in reducing pain, providing an anti-inflammatory, healing and analgesic effect in TMJ as well as in the masticatory muscle painful area. However, it must be noted that reducing pain levels is dose-specific when using LLLT.
- Diabetic Neuropathy: Diabetic neuropathy is the most common diabetes-related comorbidity. Diabetic neuropathy impacts between 60 to 70 percent of all patients with diabetes. Neuropathy can have serious detrimental effects on a patient’s quality of life. Patients with diabetic neuropathy have a 1.7-fold greater risk of amputation and a 25 to 50 percent higher mortality rate in comparison to those diabetic patients without neuropathy. Current therapy for Diabetic Neuropathy is purely symptomatic, aiming to relieve the pain through the administration of various analgesic drugs. These drugs are effective, but no more than 40–60% of patients show adequate symptomatic relief. However, research has shown that LLLT is an effective treatment option for Diabetic Neuropathy. According to a study published in The Journal of Advanced Research patients receiving LLLT had a 26.4% decrease of pain level through four weeks of treatment. The reduction in pain is thought to be due to increased ATP production by the mitochondria, and increased cellular oxygen consumption, increased serotonin and endorphins, anti-inflammatory effects and improved blood circulation in some cases.
The diversity of pain conditions in patients requires a diversity of research and treatment approaches. The costs of unrelieved pain can result in longer hospital stays, increased rates of re-hospitalization, increased outpatient visits, and decreased ability to function fully which leads to loss of income and insurance coverage. According to a recent Institute of Medicine report: “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research”, pain is a significant public health problem that costs society at least $560-$635 billion annually, an amount equal to about $2,000.00 for everyone living in the U.S. This includes the total incremental cost of health care due to pain from ranging between $261 to $300 billion and $297-$336 billion due to lost productivity (based on days of work missed, hours of work lost). These costs don’t even take into account the psychological cost of living with chronic pain.
In physical therapy, treatment regimens for pain are a combination of hands-on therapy, therapeutic exercise and treatment modalities. As we’ve discussed, studies have shown time and again that Low Level Laser Therapy is an effective partner in physical therapy treatment especially when LLLT was combined with ultrasound therapy. LLLT is effective not only in pain reduction, but is also non-invasive, cost and time-efficient. The benefits of LLLT over a broad-range of diagnoses make it an important tool in any physical therapy practice.