How do therapeutic lasers work?

A: Therapeutic medical lasers heal tissue ailments by injecting billions of photons of visible and /or invisible laser light deep into tissue structures. Tissue naturally contains protein strands called chromophores and cytochromes located in the mitochrondria of a cell, which have the unique ability to absorb laser light energy and transform it into chemical energy for the cell. This chemical energy is utilized by the tissue to significantly accelerate the healing process and reduce pain in the body naturally.

What conditions can be treated with cold laser therapy/LLLT?

A: Theralase therapeutic lasers have been cleared by Health Canada and the FDA to treat chronic knee pain. Over 4,000 clinical studies have been conducted worldwide validating the effectiveness of low-level laser therapy on over 100 treatment conditions, including arthritis, wound healing, addiction rehabilitation, weight loss, anti-aging, (any others that should be highlighted here?), headaches/migraines, and carpal tunnel, among many others. Ultimately, it is at the discretion of the practitioner to determine based on the best available clinical evidence which areas and conditions can be treated with low-level laser therapy systems.

What scientific documentation is there on Low Level Therapy (LLT)?

A: There are thousands of published studies that describe the positive effects of laser therapy. These studies range from studies on individual cell types to in vivo double blind control studies. The areas of study range from wound healing to muscular skeletal conditions and have been conducted on different types of laser devices. Medicine is a very good medical database search engine that can provide abstracts and can sell literature. There are also many books on the subject. One very good text is "Low Level Laser Therapy - Clinical Practice and Scientific Background", written by Jan Turner & Lars Hode.

How deep into tissue can a laser penetrate?

A: The depth of penetration of laser light depends on many parameters such as the laser's wavelength, the power, the type of device driver (pulse or continuous wave mode) and lastly the technique used. The higher the wavelength typically, the deeper the penetration; however, with wavelengths greater than 950nm the water in the tissue absorbs light and the depth of penetration is drastically reduced in addition to causing heat. Secondly, devices of greater power can provide better penetration. Thirdly, the peak power of the unit is the most critical factor in providing depth of penetration. Thus, devices which are true pulsed have better penetration versus continuous wave devices because they have greater peak power densities for superior photon concentrations at depth. *The TLC-1000 series of Therapeutic Medical Lasers can provide a direct penetration of tissue 5 cm into tissue and an indirect penetration up to 10 cm.

What is the relationship between peak power and average power?

A: Typically, clinicians calculate the Energy Density (E.D.) in J/cm2 for a specific treatment using the following equation:

E.D. (J/cm2) = (Average Power (Watts) x Time (seconds)) / Surface Area (cm2)

Hence;

Time (seconds) = (E.D. (J/cm2) x Surface Area (cm2)) / Average Power (Watts)

The surface area is the beam spot size of the laser device used. Since the beam spot size in true lasers is usually quite small, typical E.D.'s for treatment protocols are in the hundreds of J/cm2. Some manufacturers of weaker power devices will advertise use of E.D's less than 10 in order to advertise shorter treatment times.

Since many clinicians use the grid technique and direct contact on the skin, the surface area in the above equation should be 1 cm2. This makes calculating treatment time very straightforward. It also becomes evident that devices with higher average powers will take less time to obtain the same density.

How do I compute the dosage for a laser treatment?

A: Since laser energy is absorbed by water, hemoglobin and melanin, different people will require different dosages so that the target tissue of interest obtains the desired energy density. The depths of the target will also play a major part in this decision. Since light energy will be absorbed by other tissues that lie between the target tissue and the skin surface, one should increase the dose to obtain the desired dosage at the target site. In order to bio-stimulate the tissue, light must reach the target in a sufficient dose otherwise bio-stimulation will not occur.

Are there any harmful side effects or contraindication?

A: No, although one must never shine the laser directly into the eye. Otherwise, we recommend that laser devices not be used on the abdomen of a pregnant woman, in the presence of photosensitive compounds or directly on any cancerous tissue.

What is the difference between normal light and laser light?

A: The major difference between laser light and normal light is the laser beam's ability to travel long distances without being dispersed. This is known as coherence, and it enables the laser to focus its power within a small circumference. Pulsated laser light has been shown to have a strong therapeutic effect on cells and muscle tissue. A Theralase cold laser, for instance, doesn't produce heat or cut organic tissue like industrial lasers or surgical lasers. Instead, it pulses a focused or culminated light beam at body tissue (bone, skin, muscle, etc.) which in turn has profound beneficial effects on the functioning of human cells the building blocks of the body.

How does cold laser help in the treatment of Rheumatoid Arthritis?

A: Rheumatoid Arthritis (RA) is an autoimmune disorder that attacks the joints causing swelling and tissue damage. RA is different than non-inflammatory problems of the joints and often mistaken for Osteoarthritis, which is inflammation caused by wear and tear on the joints.

Cold laser treatment works by reducing the pain and inflammation caused by Rheumatoid Arthritis. The initial treatment schedule can vary dependent upon the severity of the condition and the length of onset, though the average patient will receive 2-3 treatments per week for a duration of 10-25 treatments. Since RA is an autoimmune disorder and is non-curable, in order to maintain quality of life a patient is placed on a maintenance program of one to two treatments per month thereafter to maintain pain reduction, inflammation and increased range of motion.

What is photon dosage?

A: Photon dosage is defined as the amount of light at tissue depth determined by the amount of light delivered to the tissue surface, affected by both power and time.

Why is photon dosage at tissue depth important?

A: The attenuation or diminishment of light through tissue follows a 1/e formula significantly reducing the amount of light at tissue depth. To provide better treatment outcomes a practitioner needs to maximize the amount of photon light at the tissue surface by increasing the power of the laser and time of the treatment. The limiting factor with laser is the amount of light that tissue can absorb non-thermally, this is known as the Maximize Permissible Exposure or MPE. To date, a super-pulsed laser, flickering off and on, delivers the most amount of photonic energy without exceeding the MPE.

Why is cold laser dosage important?

A: Laser irradiation is dose dependent. In a recent clinical study by our clinical researchers 100mW of power with the Theralase TLC-1000 was too much power for a mouse knee joint and only increased the iNOS expression 200%, but 25mW of power, which was more suitable for a mouse knee joint, increased the iNOS expression 700%. This is startling evidence that can now help us further fine tune our laser protocols.

 

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Laser Buying Guide

Here are some tips to help determine which instrument is a good value for your money:

"Laser instruments" have been sold which do not even contain a laser, but LEDs and sometimes even ordinary light bulbs. These instruments have been sold for between US $3,000 - $10,000. Ask for proof that the instrument really does contain a laser.

In a number of products, laser diodes have been combined with LED's. This is often not mentioned. Check that all light sources in the apparatus (except guide lights and warning lights) are real lasers.

For oral work and wound healing HeNe and GaAIAs are the most common types and GaAIAs as the most versatile. Sterilizable probes are normally only available for GaAIAs lasers. For injuries to joints, vertebrae, the back, and muscles, that is, for the treatment of more deep-lying problems, the GAAs laser is the best documented. For veterinary work, laser designed so that the light can pass through the coat, and penetrate to the desired depth is best. For superficial tendon and muscle attachments, the required depth can be reached with the GaAIAs laser. Many companies have only one type of laser, such as a GaAIAs, and the salesman will naturally tell you that it is the best model for everything, and that it is irrelevant which type of laser is used. However, research tells quite a different story.

Size, colour, shape, appearance and price vary a great deal from manufacturer to manufacturer. Because a piece of equipment is large, it does not necessarily follow that its medical efficacy is high, or vice versa. The most important factor is the dosage that enters the tissue. Make sure the laser you buy is designed so that the light actually enters the tissue. Ask the salesman: How is the dosage measured? What kind of dosage is too high, and what is too low?

Many companies which import lasers have deficient knowledge in terms of medicine, laser physics, and technology. In fact, there are many examples of companies that have gone bankrupt. If a piece of equipment is faulty, it may have to be sent to the country of manufacture for repair. How long would you be without your equipment in such a case, and what would it cost to repair? Can the importer document his expertise? Who can you speak to who has used the apparatus in question for a long period of time? Is there a well-known professional who uses this make? What does it cost to change the laser diode or laser tube, for example, after the guarantee has expired? Can you get written confirmation of this? Try to get a list of references.

The difference between a colourful brochure and reality is often considerable. There are examples of brochures which describe the output ten times that which the equipment actually provides. How can you find out the real performance of the equipment (e.g. its output)? Are the measurement results from an independent authority? Is it possible to borrow an apparatus in order to measure its performance? Is there an intensity meter on the apparatus which can measure what is emitted and show it in figures? It is not enough simply to have a light indicator.

Some dealers know that their products are sub-standard. This can often be seen by the fact that they are anxious to get the customer to sign a contract. If a product is good, the dealer will have no doubts about selling it on sale-or-return basis, with written confirmation of this. What happens if the medical effects are not as promised? Is it possible to get a written guarantee of sale-or-return? In most countries, therapy lasers must be approved. The approval certificate shows the laser type and the class to which the instrument belongs, e.g. laser class 3B. There is also a certificate number. A laser which is not approved is either not a laser, or is being sold illegally.

Many companies organize courses and "training" events of markedly varying quality. A serious importer or manufacturer takes pains to ensure that his equipment is used in a qualified way, and makes sure that the customer receives some training in its use. What are the instructor's background and qualifications? Has he or she published anything? Is there a course description? What does the training material cost? Is a training course included in the cost of the equipment? Is the training material included? Is it possible to buy the training material only?

Development is going on at a fast pace. Suddenly, you have out-of-date laser equipment and a new and perhaps more efficient type of laser comes onto the market. What happens if your laser becomes outmoded? Do you have to buy a new laser, or can your equipment be updated with future components lasers?