LOW INTENSITY LASER/LIGHT THERAPY

 

FEBRUARY 10, 2017 BLOG

At: lenrudnick.com

Dear Readers,

I have rewritten this article several times. The problem is that the information is a “tweener.” It is in between too easy for health care professionals and scientific types and a bit of a stretch for those without such backgrounds.

My advice is, when you find some material that is too technical for you, skim over it and get to the stuff you can understand. I do the same thing when reading an adventure novel. I skim over the flowery descriptions and get back to the plot.

The plot here is about using light to treat myriad conditions. In my previous blog, I mentioned using light in conjunction with a photo reactive drug to INSTANTLY KILL CANCEROUS TUMORS. This article is about the various conditions successfully treated using just light and the mechanisms behind the success.

Do not be disheartened if you don’t understand the scientific mechanisms. In the Physician’s Desk Reference, a publication listing and describing everything about all medications made in the world, there are the following entries. For the drugs Amitriptyline, Naproxen, and Robaxin (antidepressant, anti-inflammatory and muscle relaxant, respectively), under the heading, Mechanisms of Action, you will find, “The exact mechanism in man is unknown.”

So, if you don’t understand the exact mechanism of action when using light (more is known about how it works than is known about how the above mentioned drugs work), don’t fret. Just skip over it and get back to the plot. It is worth the wait.

 

LOW INTENSITY LASER THERAPY (LILT) – TOO GOOD TO BE TRUE OR A VALID SCIENTIFIC FORM OF TREATMENT

Leonard W. Rudnick, BA, BSc, DC (ret.), DABDA

Among the more notable facts of life that appear too good to be true is PHOTOSYNTHESIS.  Can anyone honestly believe that sunlight (or any other form of light) combines with some “green stuff” in plants (CHLOROPHYLL), to form glucose and oxygen?  The plant then uses the glucose to grow and gives off oxygen into the atmosphere. Really?

Although studies prove these photo-chemical actions and reactions, you can’t see it happen.  You can’t smell the oxygen being released.  Holding a match near the leaves will not result in an increased flame.  If you tasted the plants, they are likely bitter, not sweet like glucose. Obviously, we can’t prove photosynthesis exists.  Therefore, it is not true.  EXCEPT it actually happens and our planet and its inhabitants survive solely because of this process. This is a critical reason that we should not cut down all our trees and “black top” our planet.

In addition to photosynthesis, there exists PHOTOMORPHOGENESIS (photo=influenced by light, morph=form of an organism, genesis=development).  An example in plants is the action of red light (+/-633 nm) on an inactive molecule called PHYTOCHROME.  Upon absorption of this light, the phytochrome becomes active.  This induces a cascade of enzymatic reactions that lead to such responses as seed germination and flowering, among others (Karu, 1998).  This is analogous to actions that occur within human tissue.

It is arguable that light is the most critical sources of energy for our planet.  Societies living in areas deprived of sunlight have significantly higher suicide rate than those where the sun shines almost daily.  Please note that, in the first book of the Bible, Genesis, it does NOT say, “….Let there be cortisone, surgery or ultra-sound”.  IT says, “Let there be LIGHT”.  Without it, there is no replenishment of atmospheric oxygen, no food chain and no evaporation leading to rain.

For approximately 50 years, light, in the form of Low Intensity Laser Therapy (LILT) has been used to treat myriad conditions.  Significant advances with this technology have occurred since the mid-eighties.  Most recently, Michael Hamblin, PhD has been conducting research at the Wellman Photo Medicine Center at Massachusetts General Hospital.  This is in conjunction with Harvard Medical School and the MIT Division of Health Science and Technology.  He is a member of the affiliated faculty and principal investigator.  His research will be listed with the conditions that have been successfully treated using LILT.

It has been proven that visible light enhances cell proliferation through photo-chemical changes in the mitochondria (the chemical factories of the cell), which then set in motion a chain reaction of biological events that ultimately affect cellular membranes.  This, in turn, has an effect on messenger RNA synthesis, which ultimately leads to the observed enhancement of cell proliferation.

Pores in membranes open and close to let ions, such as calcium, sodium and potassium in and out of cells.  This results in physical changes in the membrane.  Calcium ions act as intracellular messengers in many signal transducing pathways.  The cellular calcium ion concentration can be abruptly raised for signaling purposes by transiently opening calcium channels in the plasma or intracellular membranes.

The catalytic activities of many enzymes are regulated by calcium concentration.  Since infrared radiation affects the physical state of molecules, it can affect the pore molecules directly.  Thus, a similar effect on cell proliferation can occur whether the cells are irradiated with visible light at +/-633 nm or infrared at +/-830 nm.

Specific types of molecules absorb specific wavelengths of light, both visible and infrared.  Absorbed radiation produces specific biological effects in tissue, depending upon which types of molecules absorb the light (Karu, 1998).  Red light (+/-633 nm) has a primary effect on the Cytochrome-C-Oxidase portion of the respiratory chain of the Mitochondria (also known as the vitamin C cycle).  In this process, Nitric Oxide (NO) is produced.  This is used along with infrared light to mechanically alter the permeability of the cell membrane.  Nitric oxide, combined with macrophages (one of the body’s white blood cells), vascular endothelial growth factor (VEGF) found in all tissue and red light produce new blood vessels in the form of arterioles (the smallest or arteries) (Karu, 1998).  This explains the remarkable healing effects of LILT on severe wounds.

According to Mester, et.al. (1985) and Muxeneder (1998), the effects of LILT on wound healing are dramatic.  They stated, “Many irradiated septic wounds heal as if by first intention” (like a paper cut).

Trelles, et al (1989) reviewed the use of local irradiation with LILT.  They found this approach elicited the following types of effects:  bio-stimulatory, analgesic, anti-exudative, anti-hemorrhagic, anti-inflammatory, anti-neuralgic, anti-edematous, anti-spasmodic and vasodilatory, among others.

Trelles, et al (1989) and Muxeneder, (1988) also reviewed the effects of LILT on vertebral pain, headaches and local immune responses.   They found the main clinical uses included wound healing, pain control, soft tissue injury, arthropathy (abnormal joint condition), osteopathy and treatment of existing scars.  They observed local irradiation stimulated extremely rapid healing, even of extensive indolent (not healing) superficial wounds.  It was considered effective and safe.  Scarring was minimal.

Numerous clinical studies, and this author’s experience as team physician for a nationally ranked college hockey program, all indicate that swelling/inflammation in superficial muscles, tendons, ligaments, bursa and sheaths can be alleviated by irradiation of the affected areas.  In arthropathy and osteopathy, mid-range lasers can alleviate pain and inflammation of accessible joints, especially if the primary sites are irradiated.  Initially, the effect was thought to be anti-inflammatory.  However, recent studies have shown that LILT enhances the inflammatory process and allows the body to reach the healing stage much faster.  It is also effective in pain control and resolution of osteitis and periostitis in superficial areas.  It was, and still is preferable to ultrasound in these conditions as the latter can heat bones, potentially causing damage.

Old scars (surgical or traumatic) can act as trigger points if there are tender areas, keloid formation and adhesions along the scar.  Such scars can be associated with chronic pain, reflex pain, lameness and autonomic effects.  LILT of such tissue can produce dramatic clinical improvement in most cases.

The earlier lasers were “powered” by gasses such as Helium and Neon (He, Ne).  It was not until the 1980’s that the semiconductor diode system became available.  The most popular of these for clinical use were gallium arsenide (GaAs) and gallium aluminum arsenide (GaAlAs).  These super luminous diodes are mounted into a “treatment head” for easy application.  The emitted light includes far and near ultra-violet, the visual spectrum and near, mid and far infrared.  Since then, studies have conclusively found that the use of Light Emitting Diodes (LED) have the same clinical effects as the more expensive GaAs and GaAlAs diodes (NASA, 2001).

In LILT, nothing happens unless the tissue absorbs the photons (bundles of light).  In the therapeutic near infrared range, absorption takes place in the tissue water (about 70%) and organic molecules (about 30%).  For this purpose, absorption may be defined as the conversion of light into some other form of energy.  Once absorbed, the photons have different effects on amino acids, nucleic acid and other groups called chromophores.  The former is the basis for DNA and proteins.  The latter involves porphyrins, which are bio-organic molecules (hemoglobin and melanin are examples).

Another factor in the photo-chemical action of LILT is attenuation, or how much light is lost as it travels through tissue.  This depends upon the ratio between absorption and scattering.  This ratio varies according to the type of tissue irradiated and the wavelength applied.  Where light absorption is low, (600 nm – 1200 nm), scattering predominates.  In human tissue, scattering tends to be in a forward direction.

Considerable cellular research concerning laser irradiation has been done since the 1970s.  At that time the focus was primarily on wound healing due to the great clinical success using LILT.  For obvious reasons, the studies related to this involved observing the actions of fibroblasts, lymphocytes, monocytes, macrophages as well as epithelial and endothelial cells.

All studies exhibited the positive effects on healing mechanisms involved with the cells being treated either by stimulation or inhibition.  As a result, one could explain why wounds heal faster with LILT.  However, the exact mechanism by which light causes these photochemical reactions is still unknown.  This should not be cause to discount the efficacy of Low Intensity Laser Therapy.  If one were to read the Physician’s Desk Reference for the drugs Amitriptyline, Robaxin and Naprosyn (to name a few), under the heading of Actions, it says, “The exact mechanism in man is unknown”.  The effect on a patient and how it affects healing is, however, known.

Of at least equal importance, especially for the practitioner, is the role of LILT in pain relief.  This, more than wound healing, results in the, “too good to be true” attitude within the American medical community.  After all, EVERYONE knows the only ways to relieve pain are by medication and surgery.  If those don’t work, patients are referred for psychotherapy.

However, since 1986 world respected researchers have recommended LILT for such use (Seitz & Kleinkort, 1986; Zhou Yo Cheng, 1988,; Woolley-Hart, 1988; Jert & Rose, 1989).  In addition, clinicians around the world, based upon their professional experiences, confirm the analgesic effects of LILT.

Unfortunately, from a strictly scientific point of view, these reports are hardly conclusive.  There has been little or no standardization in the application of LILT. The type of laser, the wavelength, contact or non-contact mode, length of treatment as well as skin color, age of the patient and body types are all variables that can affect outcomes.  As a result, the majority of reports concerning the efficacy of LILT have been considered anecdotal.  A great many of the older reports were in foreign languages, which resulted in obscuring information during translation.

The Arrant-Schultz Law (Baxter, 1997); Oshiro & Calderhead (1988) may help explain some of the inconsistent findings of researchers.  It is to photo biological activation that the law of diminishing returns is to economics.  Basically, it says there is a threshold amount of energy (light) that is required to affect a change in cellular activity.  This amount varies with individuals.  When the dosage is increased above threshold (relatively little), the degree of cellular biological activity also increases.  When the dosage increases further, above a certain level (variable), a plateau effect occurs.  There is simply no increase in cellular activity.  When dosage is increased above plateau level, there is an inhibitory effect upon the cells.

These issues were resolved with the research and testing of the BioFlex Professional Laser System by Meditech, International, Inc. in Toronto, Canada.  In more than 25 years of exacting collection of data and constant upgrading of the laser equipment, Fred Kahn, MD, FRCS(C) has produced a LILT unit that can eliminate the above listed variables.  His publications, “Low Intensity Laser Therapy-The Definitive Texts” (three volumes) have documented the standardizations for application of LILT that were previously missing.

Another major obstacle to pain relief using LILT involves the subjectivity of pain.  The very nature of pain is such that there is no truly scientific way to measure it.  Also, some people have higher or lower sensitivities.  They also react differently to having it (victim vs. survivor).  On almost a daily basis, pain sensitivity can vary depending upon physical, chemical and/or emotional factors.

In spite of these limitations, the number of clinicians and patients who report significant analgesia from LILT has grown dramatically.  Whether or not we know exactly why, LILT is proving to be a very valuable modality in the treatment of pain.  In fact, clinicians using LILT and other forms of electrotherapy consistently report the clear superiority of the former.  In a growing number of instances, it is now used as the first treatment of choice for pain.  Professional teams and players use it as a first choice for “itis” conditions (Miami Heat, Toronto Raptors and others).  Perhaps of greatest importance is that, in more than 50 years worldwide, there has never been a single report of a significant long term negative side effect attributed to this procedure.

The list of conditions treated by LILT is extremely impressive.  It transcends just pain.  In fact, it would be easier to list conditions on which LILT does not work.  Even then, failure is not outright.  It would be more appropriate to say that the percentage of success in some patients, with some conditions, is lower than usual.

It is essential to note that, because LILT returns cells to normal function, and that the normal function of cells is to HEAL and not to hurt, this procedure is curative rather than simply getting rid of symptoms.  The healing can be inhibited if a structural component exists.  A reasonable analogy is having a motor vehicle that pulls toward the right side of the road.  If the right front tire is not flat, there is a probability that a misalignment of the front end of that vehicle exists.  The driver might not want to spend the money to get it aligned (perhaps the lease is up shortly).  Instead, they lower the air pressure in the left front tire to the point that the car drives straight.  Problem solved!  The symptom goes away.  Unfortunately, they will have to purchase two new front tires every 3,000 miles (5,000 km) or so.  Thus, structural problems demand structural corrections.

If a patient has a misalignment in the hips, spine or extremities, there is constant irritation to the soft tissue components of those areas.  It can feel better with LILT, but permanent healing will be extremely difficult to achieve.  When this is the case, concomitant structural correction (manipulation by a Chiropractor or Osteopath) and LILT results in rapid, complete recovery.  Considering the 10,000 patients treated in my office with LILT, this author has found that 30 patients have ever returned for treatment of the same problem.  The common denominator was structural issues that were not corrected or has once again become an issue.

Following is a partial list of conditions which clinically and in more scientific research, have been successfully treated.  This list is not all-inclusive.

CERVICAL PAIN                                                       FACIAL PAIN (INFLAMMATION)

TRIGEMINAL NEURALGIA                                  TRIGGER/TENDER POINTS

HEADACHE/MIGRAINE                                       TENDONITIS

SCAR TISSUE                                                            CARPAL TUNNEL SYNDROME

ROTATOR CUFF INJURY                                      EPICONDYLAGIA

SHOULDER JOINT INJURIES                             EPICONDYLITIS

COSTOCHONDRITIS                                              NEURALGIA

CHONDROMALACIA PATELLA                           HIP JOINT PAIN

TIBIAL COMPARTMENT SYNDROME               PLANTAR FASCITIS

ARTHRITIS/ARTHRALGIA                                   BURSITIS

CAPSULITIS                                                               FRACTURES

HEMATOMA                                                              HERPES ZOSTER

MYALGIA/FIBROMYALGIA                                  NERVE ROOT/TRUNK PAIN

DIABETIC LESIONS                                                 BED SORES

GANGRENE                                                                COPD

CYSTIC FIBROSIS                                                     STROKE

CLOSED HEAD INJURIES                                     DEPRESSION

PTSD                                                                            ADHD

SPINAL CORD INJURIES                                      PERIPHERAL NERVE REGENERATION

BELL’S PALSEY                                                        TRIGEMINAL NEURALGIA

ACUTE/CHRONIC LOW BACK PAIN                 TMJ PATHOLOGY

PARKINSON’S DISEASE                                        WOUNDS

ACROMIO-CLAVICULAR JOINT DYSFUNCTION

REFLEX SYMPATHY DYSTROPHY/COMPLEX REGIONAL PAIN SYNDROME

Included in the above list are sports related injuries experienced by ‘weekend warriors”, college and professional athletes.

After a double blind clinical trial conducted by General Motors Corporation using LILT for treating Carpal Tunnel Syndrome on workers disabled at least two years (40% went back to work), the company had established laser treatment facilities in all of its manufacturing plants.

Low Intensity Laser Therapy has been clinically proven to be superior to other forms of pain therapy.  In comparative applications, it has worked better than medication (that just masks the pain), ultra-sound, electrotherapy, heat, ice, etc.  It also does not have the side effects as do other forms of treatment.

LILT is not a “magic wand”.  It uses a device which promotes rapid healing and pain relief.  This is a PROCESS, not an on/off switch.  However, millions of patients have been helped when no other form of treatment has worked.  Of +/-10,000 patients treated by this author and in the BioFlex Laser Therapy Clinics in Toronto and Etobicoke, Canada (+/-200,000 patients), about 98% have tried every other possible form of treatment and failed to get better.  In both facilities, the LILT success rate has been more than 90%.

Success is measured by how the patient feels, if they experience better sleep, if they take less medication, spend more time every day not being aware of the pain, participate in more of life’s daily activities without limit due to pain, and other considerations patients believe to be important.

Laser/Light therapy also dramatically reduces healing time when compared to other traditionally used modalities.  Hospitals in Great Britain have used LILT in post-surgical recovery rooms.  They have found patients have much less pain, take 50% less pain medication, heal in half the time and have significantly less scar tissue.  To those of us who have been privileged to use this technology, our patients’ permanent recoveries are not only believable, but are expected.

As a lecturer at international conferences dealing with LILT, I include a reminder to all of us who treat patients, regardless of profession.  Oliver Wendell Holmes, an American author, lawyer and Supreme Court Justice was also a medical doctor (unknown to most people).  He is quoted as saying, “The body does the healing but the doctor pockets the fee”.  Ultimately, the body, not the doctor, does the healing.  Those of us privileged to work with patients are mediators who hopefully provide something a body needs in order to recover.  This author believes LILT is the best and safest way to assist the body, human or otherwise.

Having been a principal investigator for two FDA Clinical Trials involving Low Intensity Laser Devices, and having used several other such devices, it is the author’s opinion that the most superior form of LILT is via the BioFlex computer driven laser instrument.  This device is produced by Meditech International, Inc. in Toronto, Canada.  Besides dozens of pre-set protocols, it can also accommodate customized protocols.  All parameters can be altered to truly individualize each treatment.  Even such things as age, skin color and body type can be considered when choosing the appropriate amount of light exposure.  Once chosen, the dosage is calculated automatically.

Another of the unit’s most unique features is the “Flex” part of the name BioFlex.  The treatment heads can wrap around joints (knee, elbow wrist, etc.), delivering light through as many as 240 LEDs. In addition, there are laser probes with single diodes using red (100 mw) and infrared (200 mw). The flexibility of the treatment heads in application and choices as well as almost unlimited settings create a treatment device second to none.

Dr. Fred Kahn is founder of Meditech International, Inc., Toronto, Canada.  He has tirelessly worked to create the most complete LILT device based on research at the Meditech Clinics in Etobicoke and Toronto. The most detailed, complete records have been kept on more than 200,000 patients for over 25 years. Based upon the findings of these patient treatments, the equipment and protocols have been constantly updated.

Now, available for the first time, are two Personal Therapy Systems. They are the BioFlex 120 and the BioFlex 180. The numbers represent the number of Red and Infrared LED diodes in the respective treatment heads. There are 12 body areas pictured on the control unit. There are also four stage settings which actually gives you forty-eight treatment options. They are remarkable advances in treatments available for home use. Information about these units can be found at BioFlexlaser.com. If you have additional questions, you can reach me by writing a comment/question in response to this blog.

Dr. Kahn’s trilogy of books, “In Clinical Practice”, “The New Therapeutic Dimension” and “Clinical User’s Manual” (Meditech International, Inc. 2006), are the platinum standards for those who treat patients with LILT.

For those of you who are interested, I am not an employee of Meditech International, Inc. Toronto, Canada. I get no commission for selling any of their equipment. I have just entered my 22nd year of using LILT, having experience with many different manufacturers and their equipment. I have made it clear that, should I find a superior LILT device, I would tell doctors and patients about it. I have never found this to be the case. The BioFlex equipment has been and continues to be the most superior LILT equipment based on research, design, field testing and results.

Several years ago, I read in a medical journal that, on average, it takes twenty years for a new medical procedure to be generally accepted by the majority of medical professionals. Unfortunately, this has been the case with Low Intensity Laser Therapy or, as now called, Light Therapy or Photo Medicine. Sadly, the medical profession (AMA) has yet to assign LILT a reasonable CPT (Current Procedural Terminology) code used to bill outpatient and office procedures. Until this is corrected, there will either not be insurance reimbursement or the reimbursement will be so low that doctors cannot afford to provide this type of care. Of course, with the current trend toward very high deductibles and co-pays, paying out of pocket for LILT is cheaper than having to constantly return for follow-up office visits and paying for medication that will only, at best, temporarily hide the symptoms.

I want to make it clear that I would not want to live in a world where there were no medications or surgery. As with everything in life, with the good comes the potential for negative outcomes. The only exception appears to be LILT. It should be used first and fall back on the other two if necessary, not the other way around.

 

REFERENCES

 

Basford J R, Daude J R, Hallman HO et al 1990.  Does low-intensity Helium-Neon laser irradiation alter sensory nerve action potentials or distal latencies?  Lasers in Surgery and Medicine 10:  35-39

Baxter G D, Bell A J, Allen J M et al 1991   Low Level Laser Therapy – Current clinical practice in Northern Ireland.  Physiotherapy 77:  171-178

Baxter G D, Diamantopoulos C, O’Kane S, Sheilds, 1997.  Therapeutic Lasers Theory and Practice, Churchill Livingston, New York, NY

Dyson M, Young S 1986, The effect of laser therapy on wound contraction and cellularity in mice.  Lasers in Medical Science 1:  125-130

Kahn, F 2006, Low Intensity Laser Therapy-the definitive texts (In Clinical Practice, The New Therapeutic Dimension and Clinical User’s Manual) Meditech International, Inc., 415 Horner Ave. Etobicoke, Ontario, Canada m8w 4w3

Kert J, Rose L 1989 Clinical laser therapy: low level laser therapy.  Scandinavian Medical Laser Technology, Copenhagen

Mester E, Mester A F, Mester A 1985 The biomedical effects of laser application.  Lasers in Surgery and Medicine 5:  31-39

Muxeneder R, 1988 The conservative treatment of chronic skin alterations of the horse via laser acupuncture.  Praktische Tierarzt Vol 69 Iss 1

Oshiro T, Calderhead R G 1988 Low level therapy: a practical introduction.  Wiley, Chichester

Seitz L, Kleinkort J A 1986 Low-power laser: its applications in physical therapy.  In: Michlovits S L, Wolf S L, Thermal agents in rehabilitation, F A Davis, Philadelphia

Smith K C Professor Emeritus, Radiation Oncology, Stanford University School of Medicine, Founder and First President of the American Society for Photobiology, Karu T In: The Science of Low-Power Laser Therapy, Gordon and Breach, Amsterdam, The Netherlands

Trelles M A, Mayayo E, Miro L et al 1989 The action of Low reactive Level Laser Therapy on mast cells: a possible relief mechanism examined.  Laser Therapy 1: 27-30

Wolley-Hart A 1988 A handbook for low-power lasers and their medical application.  East Asia, London

Ahou Yo Cheng, Ohshiro T, Calderhead R G  1988 Laser acupuncture anesthesia  In: Laser acupuncture anesthesia, Low-level laser therapy: a practical introduction  Wiley, Chichester

 

 

 

 

 

 

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