October/November 2020 - 39

Combining the Right modalities can take
the pressure off when
treating swelling
Author: Mark Callanen, PT, DPT, OCS
Director of Clinical Development,
LightForce Therapy Lasers
Acute inflammation is an issue that most
clinicians face on a daily basis. Some clinicians
still reach for an ice bag as their first modality
choice to decrease swelling. While ice has been
shown to help produce analgesic effects on
acute injuries, research has cooled on ice with
regard to its effectiveness in reducing inflammation
and promoting tissue healing.1,2,3
Health professionals are starting to become
more aware of modalities that target inflammation
with active mechanisms outside the
simple, and some argue, flawed concept of
pursuing vasoconstriction.
One modality that is showing promise in this
arena is high power therapeutic laser. These
lasers create a phenomenon known as photobiomodulation
(PBM) which can safely treat
large areas of tissue quickly. PBM occurs when
an effective dose of photons photochemically,
photomechanically, and/ or photothermally
stimulate tissue at the mitochondrial level. This
triggers several positive biochemical changes
that can decrease pain,4,5
reduce inflammation6,
and accelerate tissue healing.6,7,8
COX-2 levels9
Specifically, PBM has been shown to reduce
, bradykinin levels10
, interleukin-1
levels11, and Prostaglandin E2 (PGE2)12
.
Decreasing one or more of these factors can
significantly impact an acute injury. PBM
influences inflamed tissue via stimulating cell
metabolism and improving microcirculation
which enables it to impact multiple cytokines in
the inflammatory cascade.
A body system that is often overlooked
when treating inflammatory conditions is the
lymph system. Ingloriously referred to as " the
body's sewer system " , it is tasked with removing
extracellular fluids from the extremities via a
one-way journey to the subclavian veins.
Techniques that assist this system are wellknown
to reduce swelling. These can include
(but aren't limited to): massage, elevation,
wraps, Kinesiotaping techniques, vaso-pneumatic
devices, and more recently negative
pressure devices. Some of these techniques are
better understood than others.
Negative pressure is a treatment concept
that is usually associated with cupping, made
popular by Michael Phelps during the 2016
Olympic Games to aid in his recovery between
events. A staple of Eastern Medicine, it is just
starting to gain acceptance in Western settings.
While there are some debatable theories on
how it can impact pain, the primary mechanism
of how negative pressure impacts swelling
is straight forward. By pulling (negatively) on
the skin, superficial lymph valves are opened
and then closed when the pressure is removed,
which helps promote retrograde lymph flow.13,14
This is different from vaso-compressive devices
that squeeze tissue in order to " pump " or " milk "
fluid out.
Handheld devices have been created to
provide negative pressure in either a constant
or a pulsed fashion to more elegantly provide
this benefit. Since the pressure can be specifically
adjusted, patients can get the benefit of
improved lymph drainage without the hallmark
bruising that cupping creates by damaging
capillary beds. The mechanical assistance
these devices provide removes unwanted fluid
from the injured area which can help promote
normal interstitial pressure and circulation.13,14
Coupling modalities to impact swelling is
nothing new. However, focusing on micro and
macro approaches via laser to spark cellular
changes combined with a negative pressure
device to help improve the interstitial environment
of an acute injury might be.
While this combination may not be the most
commonly paired modalities used to address
acute inflammation, both deserve consideration
given the mounting evidence around the
concept of active healing. These innovative
devices have the potential to impact patient
outcomes in a way those cold packs in the
freezer can't.
To learn more, visit
lightforcemedical.com/lymphatouch
References
1. Reinl G. ICED! The Illusionary Treatment Option. Oct 15, 2013:
9-11.
2. Crystal NJ, Townson DH, Cook SB, LaRoche DP. Effect of cryotherapy
on muscle recovery and inflammation following a bout of
damaging exercise. Eur J Appl Physiol. 2013; 113:2577-2586.
3. H. Lu, D. Huang, N. Saederup, I. F. Charo, R. M. Ransohoff, L.
Zhou. Macrophages recruited via CCR2 produce insulin-like growth
factor-1 to repair acute skeletal muscle injury. The FASEB Journal,
2010; DOI: 10.1096/ fj.10-171579.
4. Chow R, Armati P, Laakso E, Bjordal JM, Baxter GD. Inhibitory
Effects of Laser Irradiation on Peripheral Mammalian Nerves and
Relevance to Analgesic Effects: A Systematic Review. Photomedicine
and Laser Surgery. 2011;11(10):1-17.
5. Duchesne E, Dufresne S, Dumont N. Impact of Inflammation
and Anti-inflammatory Modalities on Skeletal Muscle Healing:
From Fundamental Research to the Clinic. Physical Therapy.
2017;97(8):807-817.
6. Karu, T. (1991) " Low-Intensity Laser Light Action Upon Fibroblasts
and Lymphocytes. " Ohshiro T, Calderhead RG, eds. (1991) Progress
in Laser Therapy. (pp. 175-180) Chichester, New York: John Wiley
and Sons.
7. Stein A, Benayahu D, Maltz L, Oron, U. Low-Level Laser Irradiation
Promotes Proliferation and Differentiation of Human Osteoblasts
in Vitro. Photomedicine and Laser Surgery. 2005;23(2):161166.
8.
Mvula B, Mathope T, Moore T, Abrahamse H. The effect of low
level laser therapy on adult human adipose derived stem cells. Lasers
in Medical Science. 2008;23(3):277-252.
9. Prianti, A.C.G. et al. (2014) Low-level PBMT (LLLT) reduces the
COX-2 mRNA expression in both subplantar and total brain tissues
in the model of peripheral inflammation induced by administration
of carrageenan. Lasers Med Sci. 29(4):1397-1403.
10. Jimbo, K. et al. (1998) Suppressive effects of low-power laser
irradiation on bradykinin evoked action potentials in cultured murine
dorsal root ganglion cells. Neurosci Lett. 240(2):93-96.
11. Lopes-Martins, R.A. et al. (2005) Spontaneious effects of
low-level PBMT (650 nm) in acute inflammatory mouse pleurisy
induced by carrageenan. Photomed Laser Surg.23(4):377-381.
12. Mizutani, K. et al. (2004) A clinical study on serum prostaglandin
E2 with low-level PBMT. Photomed Laser Surg. 22(6)537-539.
13. Negative Pressure Therapy In The Management Of Lymphoedema
Gott, F. H., Ly, K., Piller, N. & Mangion, A. 2018. Journal of
Lymphoedema, 13 (1)
14. Modeling Of Interstitial Fluid Movement In Soft Tissue Under
Negative Pressure-Relevance To Treatment Of Tissue Swelling
Iivarinen, J. T., Korhonen, R. K., & Jurvelin, J. S. 2016. Computer
Methods In Biomechanics And Biomedical Engineering, 19(10),
1089-1098.
http://www.lightforcemedical.com/lymphatouch
October/November 2020

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