March/April 2020 - 14

Ever wish you had a magic wand
to help treat injured tissue?
Header
Explaining how therapeutic laser can
accelerate a plan of care.
Author: Mark Callanen, PT, DPT, OCS
Director of Clinical Development, LightForce Therapy Lasers
Progressing plans of care (POC) is a careful
dance between identifying the current
stage of healing, balancing subjective pain
complaints, and appropriately increasing
therapeutic activity levels. Incorporating
high power laser to create temporary analgesic
effects and spur on tissue healing via
photobiomodulation (PBM) may make this
task easier for clinicians.
Treating acute injuries usually focuses
on controlling symptoms associated with
pain and inflammation; which can include
multiple techniques and modalities that will
ultimately allow ROM and function to be restored
later in the POC. This can be a trying
time for athletes as their overall activity levels
are reduced while their injury heals.
WHAT IF?
What if you could wave a magic wand over
the injured area to reduce pain complaints
(in minutes) and promote better ROM earlier
in the POC? High power therapeutic lasers
may be a modality that helps make this
wish become a reality.
Laser therapy promotes photobiomodulation
(PBM) which is the mechanism by
which photons elicit photophysical and photochemical
events in tissues leading to physiological
changes and therapeutic effects1
.
Recent PBM research has shown that
treating afferent nerves with higher power
densities (irradiance) signifi cantly impacts
pain perception2,3
. When laser is applied in
higher doses, it can slow down conduc tion
rates and decrease the size of compound
action potentials in both C and A delta afferent
nerves2,3
. This can result in quick
changes in patients' pain complaints via true
analgesia.
THE RESULTS
While getting quick pain relief is a desirable
benefit when using high power laser, most
clinicians want to achieve lasting results. The
good news is that you don't have to sacrifice
one for the other. High power laser has the
potential to help with both short term pain
blocking and improved long-term function.
A 2018 study out of The University of
Cairo looked at patients with rotator cuff
tendinopathy that underwent exercise programs
combined with either high intensity
laser (HILT) or sham laser treatments,
performed 3 x week for 4 weeks. The HILT
group had significant improvements in
pain, ROM, and Shoulder Pain and Disability
Index (SPADI) scores compared to the
sham group. Significant differences were
still noted at 3 and 6 months4
.
Laser can be used for a variety of diagnoses.
In 2017 The American College of
Physicians endorsed Low Level Laser Therapy
(LLLT) as the only passive modality in
its treatment recommendations for chronic
low back pain5
. The Journal of Orthopedic
and Sports Physical Therapy (JOSPT) similarly
recommended laser in its 2014 Clinical
Practice Guidelines for the treatment of
heel pain and plantar fasciitis6
as well as
its 2017 Revision of Neck Pain Treatment
Guidelines, where it recommended laser in
two subcategories7
.
CONSISTENT OUTCOMES
The key to getting consistent outcomes with
any laser device is understanding how power,
time, and wavelength impact dosing,
while knowing the specifications of the device
being used is imperative.
With correct dosing and adequate irradiance,
PBM should open the door in the
early phases of a POC to progress exercise
programs and provide treatment options
that would otherwise be delayed due
to pain. This factor combined with the fact
that PBM has been shown to help improve
tissue healing through all phases of tissue
healing, could result in athletes magically
getting back on the field ahead of schedule.
12 | Training & Conditioning | March/April 2020
References
1. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/
laser therapy versus photobiomodulation therapy. Photomed
Laser Surg 2015;33:183-184.
2. Chow et al. Inhibitory Effects of Laser Irradiation on Peripheral
Mammalian Nerves and Relevance to Analgesic
Effects: A Systematic Review. Photomedicine and Laser
Surgery Volume X, Number X, 2011ª Mary Ann Liebert,
Inc. Pp. 1-17.
3. Holanda, V.M. et al. (2017) The Mechanistic Basis
for Photobiomodulation Therapy of Neuropathic Pain
by Near Infrared Laser Light. Lasers Surg Med. 2017
Jul;49(5):516-524.
4. Elsodany, A. et al. Long-Term Effect of Pulsed Nd:YAG
Laser in the Treatment of Patients with Rotator Cuff Tendinopathy:
A Randomized Controlled Trial. Photomedicine
and Laser Surgery, Vol 36 (9), 2018, pp. 506-513.
5. Qaseem A, Wilt TJ, McLean RM, et al, for the Clinical
Guidelines Committee of the American College of
Physicians. Noninvasive Treatments for Acute, Subacute,
and Chronic Low Back Pain: A Clinical Practice Guideline
From the American College of Physicians. Ann Intern Med.
2017;166:514-530.
https://annals.org/aim/fullarticle/2603228/
noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice?_ga=2.94313501.1892251386.15743640661113658412.1572282428
6.
Martin, R, et al. Heel Pain-Plantar Fasciitis: Revision
2014 Clinical Practice Guidelines Linked to the International
Classification of Functioning, Disability and
Health From the Orthopaedic Section of the American
Physical Therapy Association. J Orthop Sports Phys Ther.
2014;44(11): A1-A23.
7. Blanpied, P, et al. Neck Pain: Revision 2017 Clinical
Practice Guidelines Linked to the International Classification
of Functioning, Disability and Health From the
Orthopaedic Section of the American Physical Therapy
Association. J Orthop Sports Phys Ther. 2017;47(7):
A1-A83.
Watch a FREE on-demand webinar to
learn more about Deep Tissue Laser
Therapy™ and how professional sports
teams are using it in their plans of care.
https://learn.lightforcemedical.com/
treatliketheproswebinar

https://www.annals.org/aim/fullarticle/2603228/ https://learn.lightforcemedical.com/

March/April 2020

Table of Contents for the Digital Edition of March/April 2020