Photobiomodulation - healing through light.
Low Level Laser Light Therapy
Colin of Weston, Stafford.
Lyn of Cheltenham.
Low Level or Low Intensity Laser Therapy uses low power laser light (often called ‘soft’ or ‘cold’ Laser) to aid the body’s natural healing processes safely and effectively.
LLLT, Low Intensity Laser or cold laser therapy helps the body's natural healing process by the safe application of red and infrared light. It helps restore normal function, whether muscle, tendon or ligament. Low Level Laser Therapy is used to help many conditions like wounds and ulcers, deep tissue problems, trigger points, fibromyalgia, pain relief, peripheral nerve regeneration, skin conditions and tendinitis.
Many ailments are helped to resolve using low level laser light therapy.
It is used in the medical field for the treatment of pain, wound healing and musculoskeletal problems. Low level lasers should not be confused with surgical lasers, which are a different classification of laser. Low level laser cannot harm the skin, cut or burn because it is low intensity laser; its effects are photo-biomechanical, not thermal.
This treatment has been used widely for over thirty years for Sports Injuries, Veterinary, Podiatry, NHS and Dental practice. Improved outcomes have been reported for:
How it works
The physiological effects of laser therapy have been extensively researched and the details of the mechanisims are increasingly becoming understood. The chemistry of this topic is fascinating – I owe a deep debt of gratitude to both Omega Lasers and to a book by Volkmar Kreisel and Michael Weber: “A Practical Handbook - Laser Acupuncture - Successful treatment Concepts” – most of what follows I attribute to these gentlemen and Jessica Nelson of Omega Lasers (errors in my interpretation of their work are mine alone).
Particular wavelengths of light stimulate the body to heal itself by being absorbed by the body's healing cells. Initial absorption by mitochondria leads to an increased fibroblast cell proliferation and migration, with modulation of cytokine levels (synthesis and expression of cytokines), growth factor response, inflammatory mediators, increased ATP synthesis and increased tissue oxygenation - all part of the natural healing process. Photons of light excite dysfunctional cells to function.
It is the appropriate wavelength of light (nm) and power over area and time or energy density (J/cm²) and the pulsing frequency (Hz) that gives the safe healing dose of energy over small intervals of time that have beneficial physiological effects. Low Level Laser therapy or LLLT is also now known as PhotoBioModulation or photobiostimulation- its action involves the modulation of the biological activity of the body through the controlled delivery of light. It gets a number of healing processes working at the cellular level.
Light heals but too much and it can damage – a sunbather can get 1000 jules per minute over the entire body. LLLT delivers doses of red and infrared light delivers very small doses for moments.
LLLT works with small doses of light stimuli. It triggers enhancement effects in the body by “a precisely directed communication with essential control centres for processes that take place within the body.”
LLLT works by the “interactions between the photons and molecules in the intracellular space...very low energy densities are sufficient for photobiostimulation.”
Our cells and particularly the mitochondria in our cells absorb light. This increases ATP production beneficial to our mitochondrial metabolism (our cellular respiration –giving our cells more energy), which improves our cells’ functions. Our cells having more energy can better synthesize proteins and enzymes and perform their individual functions better. Damaged and weakened cells perform poorly and this leads to disease. Take pain for example. We sense painful stimuli by our nociceptor cells (pain perception cells). When damaged or weakened these depolarize more easily lowering our pain threshold and increasing our sensitivity to painful stimuli. LLLT improves the electrochemical potential of protons so our nociceptors do not depolarize so easily, so pain signals are reduced. This positively impacts on many painful ailments – even headaches. LLLT stimulates mitochondria to better produce ATP for cellular respiration and leads to better cellular performance. Many ailments and diseases are actually mitochondriopathies and LLLT restores mitochondrial health, better protein and RNA synthesis, boosted oxygen consumption, better cellular health and so better bodily health.
LLLT has an antiphlogistic or anti oedematous effect. It inhibits mast cell degranulation and the synthesis of pro-inflammatory prostaglandins – part of the inflammatory reaction. It promotes micro-circulation through vascular dilation by reducing the effect of vasoactive amines. It activates the immune cells through increased leukocyte mobilization. The migration of our repair and immune cells (macrophages, leukocytes and fibroblasts) from tissue increases as does the phagocytosis rate. The removal of necrotic tissue parts, inflammation mediators and pathogenic germs is accelerated. Inflammatory swelling is reduced, lymphatic flow is stimulated. A bacteriostatic effect is promoted by the oxidative metabolism.
LLLT alleviates pain in different ways. It slows down the degranulation of mast cells and thus the release of vasoactive amines and inflammation mediators. The concentration of prostaglandins, which cause inflammation and pain, and the interstitial tissue pressure decrease – as does the pain as a result (general pain relief).
The increased ATP production in the pain receptor increases its capacity for hyperpolarization, in consequence raising the pain threshold by up to 50% (local pain relief). At the sub-cellular level it improves mitochondrial metabolism, disorder of which is involved in many ailments. Relieving pain by reducing the depolarization of nociceptors (our pain receptor cells) so raising the pain threshold -
desensitization where pain signals to the brain are reduced in frequency and intensity. Reduced pain and so restoring function leads in turn to a better Range of Movement. A better range of movement leads to better pain relief.
Larger amounts of opioid peptides (enkephalins, endorphins and dynorphins) which inhibit, for example, the release of central neurotransmitters in the mesencephalon (central alleviation of pain) may collect in the little myelinated nerve fibres responsible for transmitting stimuli. The threshold for nerve pressure pain is increased: pain reduced. Substance P pain mediator is reduced. Musculature is relaxed – the activity of trigger and tender points in muscles reduced, giving more pain relief. Reduced swelling itself gives pain relief. Add to that the pain relief achieved from stimulation of selective acupuncture points (without needles) and one can see that LLLT is a good therapy for pain relief in many conditions: Carpal and tarsal tunnel syndrome, sciatica, trigeminal neuralgia, muscular and arthrosis (joint) pain, trigger point and referred pain, peripheral polyneuropathy.
During wound healing phase 1 (stage of inflammation and necrosis) LLLT promotes anti inflammatory effects. During phase 2 (stage of proliferation) and 3 (stage of epithelisation) LLLT enhances the oxygen supply to the cell and the proliferation rate of the fibroblasts to increase the formation of collagen and elastin: elasticity of tissue is improved and the remodelling process stabilized. Keloid formation is reduced; scar tissue reduces and fixes. Intracellular growth hormone is activated. Nerve fibre regeneration is possible and peripheral nerve regenerated after injury. This leads to improved wound healing: ulcers, burns, trauma and post-operative. Fibroblasts and chondrocytes are activated leading to improved tendon, muscle, and cartilage repair; osteocytes for damaged bone, impaired osteosynthesis and fracture repair.
Circulation improving effect
In cases of traumas, inflammations, degenerative processes, as well as vegetative and other disorders, the regulation of the blood supply to organs and tissue may be disrupted. Low-level laser therapy influences this regulation in many ways. For example it lowers adrenergic stimuli, thus promoting peripheral micro-circulation. It stimulates the neuroreceptors, inducing them to release more neuropeptides for increased vasodilation. At the same time it activates the lymphatic circulation and thus the reduction of edemas, which results in lower tissue pressure and less obstructed blood circulation. After injuries it promotes revascularization.
LLLT - A powerful healing tool
LLLT reduces edema: swelling. It promotes micro-circulation, intravasal filtration and interstitial tissue pressure decrease. Tissues are better supplied with oxygen and wastes removed. The back resorption of transudates into the vascular system and hence their washout is facilitated. Since mast cell degranulation is reduced, fewer vascular amines are released and vascular permeability is reduced as well. LLLT boosts the fibrinolysis and phagocytosis rate of the macrophages, speeding up the dissolution of paravasal exudates. Reduced interstitial pressure, improved lymphatic circulation, revascularization, increased resorption reduces tissue ischemia and promotes wound healing and tissue repair. Pain relief and better function and mobility in turn give more pain relief. Better cellular function leads to tissue repair and better healing.
All this makes LLLT a powerful healing tool.
Acute and chronic injury
In acute cases it influences the concentration of prostaglandins thus reducing pain associated with inflammation and reduces oedema improving Range of Movement and optimising recovery. It is uniquely useful with chronic injuries or conditions, often able to restart a 'stalled' healing process where other approaches have failed and to give relief where neuralgia or neuropathic pain is involved.
The immediate pain-relieving effects, which can occur within minutes of application, are brought about by three responses: neural blockage in peripheral and sympathetic nerves, particularly nociceptors; reduction of muscle spasm; and reduction in local oedema, especially in acute injury. (Omega Lasers)
Pain relief - Analgesic effect
"Weak or inhibited mitochondrial respiration in the respiratory chain leads to a lack of energy in the cell which inhibits all cellular functions. Protein and enzyme synthesis is weak, and the cellular metabolism is impaired: the cell has insufficient energy to maintain the cellular pump function." (Volkmar Kreisel and Michael Weber - 'Laser Acupuncture, a practical handbook. Successful Treatment Concepts 2012.') Thus raising the pain threshold by improving the action of the cellular sodium pumps, reducing the influx of sodium ions into the cytoplasm, inhibiting depolarisation of the nociceptors thus raising the pain threshold. "It slows down the degranulation of the mast cells and thus the release of vasoactive amines and inflammation mediators." It mediates excess inflammatory cells. Prostaglandins cause pain and their concentrations are reduced as is interstitial tissue pressure, which contributes to a reduction in pain.
In addition to local cellular effects, research on low level laser therapy has demonstrated both enhanced / elevated beta endorphine levels and endorphine release (opioid peptides) and the suppression of pain messages previously sent to the brain - it inhibits nociceptor C and Aδ fibres. It does not increase blood flow nor stimulate the larger A fibres. (Omega Lasers)
Longer-term effects are achieved through modulation of the inflammatory response and the stimulation of tissue healing. These occur within days to weeks and last months to years and are key to limiting the progression of acute to chronic pain. Coupled with acu-point work LLLT can ameliorate diabetic painful neuropathy.
Combining these effects with those from its use in stimulating acupuncture and "trigger" points, low level laser is an excellent therapy for treating pain.
Low Level Laser Therapy (LLLT) has been shown to accelerate bone healing, particularly in the early stages of repair when high cellular proliferation occurs. It is also demonstrated to improve the strength of bone tissue during the healing process. Using mostly infra-red wavelengths to irradiate the bone, the therapy increases the activity in bone cells around the site of the repair. It prompts increased osteoblast proliferation, collagen deposition, and bone neo-formation when compared to non-irradiated bone. LLLT/PBM can inhibit calcification, like rotator cuff calcification, disperse bone spurs like painful heel spurs.
Influencing all three phases of wound healing: the inflammatory, proliferative and remodelling phases, photobiomodulation promotes ATP synthesis, induces cell proliferation, accelerates collagen synthesis, increases tensile strength and influences the concentration of prostaglandins thus reducing pain associated with inflammation. For post-surgical healing, the cell proliferation, the promotion of angiogenesis (the growth of new networks of blood vessels) - ischaemic areas improve through small vessel renewal and the proliferation and migration of keratinocytes enables a wound site to close more quickly and it is especially useful for treatment of immune-compromised patients with chronic non-healing wounds. PBM increases proliferation of macrophages and lymphocytes, the body's immune and healing response. (Omega Lasers)
There is an increasing body of research showing that laser phototherapy can regenerate peripheral nerves in both neurosensory and neuromotor deficits. Current nerve repair treatment focuses on trigeminal neuralgia, neuropathy, low back pain with sciatica, herpes zoster and Bell's Palsy.
Appropriate low level laser irradiation produces both local and systemic effects that have been shown to enhance the nerve regeneration process. It results in increased functional activity of the injured peripheral nerve, prevents or decreases degeneration in corresponding motor neurons of the spinal cord, and improves the axonal growth and myelinisation.
As a non-invasive and painless therapeutic treatment that can be used for almost any type of patient, including those who cannot use corticosteroids, such as diabetic and hypertensive patients, it has clear potential in this field.
Skin benefits: Skin is rejuvenated: matrix remodelling is enhanced and an increase in collagen and elastin production means a consequent strengthening of the skin and fascia . It helps the skin resist U.V. The red light LED cluster probe is particularly useful here.
PBM is able to assist the Lymphatic system in its fluid drainage, immune response to infection and biological/ pathogen filtration capabilities. Lymph treatments can reduce and disperse oedema (swelling).
Low level laser optimizes wound healing. Patients can benefit from resolution of chronic wounds and pain syndromes without the discomfort and side effects of many other forms of treatment.
Musculoskeletal conditions which have previously been managed with orthotics are regularly brought to resolution when laser therapy is introduced.
Patients respond quickly when treating soft tissue conditions and pain, with results usually evident in the first 1-2 treatments. Other conditions vary, some needing 5-10 treatments. Treatment times per session are relatively short so overall treatment time shows no significant increase against that of most traditional treatments.
Over and above reductions in dressings and drugs, laser therapy is associated with reduced infection rates and post surgical scarring presenting real benefits for the patient.
Low level laser therapy offers non-invasive, drug-free augmentation of the healing processes, being useful for wounds, scars, tears, sprains, strains and tendinopathies. It can also help regenerate damaged peripheral nerves. In addition to its direct healing applications, low level lasers also provide a needle-free acupuncture medium. It is suitable for treating addictions and to relieve pain in addition to direct area treatment enhancing the therapy without needles. See Acu Laser
Rapid, effective, non-invasive and extensively researched, laser therapy is long-established but currently one of the fastest growing therapies in the podiatry field. It is extremely safe - used to treat a wide variety of conditions in medical organisations across the world. (Omega Lasers)
Safe with fewer side effects
Most people are suitable for the therapy. There are some contraindications: irradiation into the eye (laser goggles are worn as a precautionary eye protection), pregnancy, organ transplant patients and overactive neoplasm (tumor). There are some cautions - cross infection and tattoos. It is safe over pins, metal plates, implants - even pacemakers. (Omega Lasers)
Treatment is quick, non-invasive, pain free, effective and has few side-effects. The laser probe is placed on the skin at particular points on or relating to the damaged area and light, which is controlled for wavelength, power, pulsing rate and duration passes into the tissue. As the laser is portable, treatments can be given in your own home. After an initial medical history consultation, appointments can take about 30 minutes. I advise that it is best to undertake a course of therapy optimally of once or twice a week. The total number of treatments depends on the condition to be treated.
Laser Acupuncture or Acu-laser
Aculaser therapy is using the red and near infra red light at very low dose and pulse to activate the acupuncture points. LLLT is a valuable acupuncture treatment without invasive needles. Many ailments and conditions can be treated including addictions.
Low level laser light directly applied to the affected area has a healing effect. Remote treatment of an ailment away from the point of treatment is also possible: this is laser acupuncture. Points on the Chinese medicine meridians - acupuncture points influence distant connected places, tissues and organs. This is laser acupuncture or Acu-Laser: acupuncture therapy without needles. It can place a stimulus as precisely as a needle and as effectively. An active acupuncture point that is in physiological imbalance will be impacted positively - the harmonization of the reflexive expression of a disordered pattern has an additional positive impact beyond simple biostimulation. This is of particular importance in the case of ailments involving inflammation, nerve irritation, pain and degenerative tissue changes. Studies show that pain reduction can be better achieved with laser than needle. In laser stimulation the De Qi sensation (needed for a successful treatment) builds slowly without the manipulation of a needle.
Advantages of laser acupuncture:
No complications or side effects – traumas to skin are impossible
Laser can treat areas not traditionally needled e.g. REN 8 - Shenque
Laser acupuncture has a positive impact on degenerative tissue processes at the neuro-vascular bundles of acupuncture points. It has a relative impact on the pattern of disharmony that correlates to the acupuncture point. This effect goes beyond the stimulation effect and supports the therapeutic goal.
Laser acupuncture reaches points which a needle must ignore – such as points in inflamed, swollen or very painful tissue. The direct detumescence effect and the circulation-promoting, bacteriostatic and virostatic impact in the local area makes its application doubly effective in these cases.
More precise diagnosis – Active points on the body show with the trigger point finder which uses the conductivity of the skin: those points needing treatment are disclosed. Especially when it comes to finding acupuncture points on the ear that are relevant for therapy (the entire body is imaged in the ear), point testing with laser light is very useful.
So laser acupuncture synergistically blends traditional acupuncture with modern laser therapy - focused treatments that are fast, efficient, and highly effective. Laser therapy can be the primary treatment method, enhanced by the addition of carefully selected acupuncture points treated by laser light not needles. Phototherapy or biostimulation is enhanced through the use of LLLT stimulation of acupuncture points.
A wide variety of ailments and conditions can be treated including for example diabetes, painful neuropathy, fibromyalgia, smoking addiction. (Volkmar and Kreisel and Omega Lasers)
Free first consultation without obligation
I can attend you to answer any questions you may have and to work out whether low level laser therapy is a viable treatment option for you.
The Charge is £60 per treatment. Because a course of treatment is usually needed to have a positive impact and a successful outcome, a discount is given for multiple treatments. Often an improvement can be sensed after only up to six treatments, but often conditions and traumas or addictions need a longer course of treatment. LLLT has a better chance of success if treatments are delivered at least once or better twice a week.
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