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Class IV laser therapy, also LLLT (low level laser therapy) is a non-invasive, painless, and  easily administered therapy by those who have been trained and certified. Our chiropractors and therapists have been trained on the physiological effects of laser therapy and the indications for its use in many diverse circumstances. The incidence of adverse effects for LLLT is very low, with no reports of serious events in the literature. LLLT is the latest and greatest in therapeutic treatments for many musculoskeletal and neurological conditions and is becoming very popular in sports medicine clinics. Laser therapy has been demonstrated to be very effective in the following conditions. This list is by no means exhaustive, however representative of the most recognized literature to date.

Reducing inflammation as brought on by tissue injury and systemic disease processes such as rheumatoid arthritis. It has been demonstrated to reduce specific inflammatory markers (prostaglandin E2, interleukin 1β, tumour necrosis factor α)

Acute, subacute, and chronic mechanical neck and back pain disorders.

  • Positive effects have been maintained for up to 3 months after laser treatment protocols.
  • Blocking  nerve conduction of A and C fibres, which convey pain (nociceptive) sensations. These effects could be mediated by disruption to fast axonal flow in neurons or inhibition of neural enzymes (for more information on pain fiber typing and mechanisms of action check themanipulative therapy page).
  • Research investigations have been shown that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. 

Myofascial triggerpoints as brought on by repetitive motion strains. These are the chronic tender spots that ache all day when you press them. 

Inhibition of transmission at the neuromuscular junction could provide yet another mechanism for LLLT effects on myofascial pain and trigger points.  Such effects could mediate the clinical finding that LLLT decreases tenderness in trigger points within 15 min of application.

Decreased range of motion (joint mobilityas is seen with frozen shoulder or post injury fibrosis in muscle bellies.

Patients with fibromyalgia have been demonstrated to show a significant improvement in pain, which has been theorized to potentially minimize the social impact related to this disease.

Osteoarthritis (aka degenerative joint disease) of the spine and extremity joints.

Tendon pathologies, formerly known as tendinitis and now more properly termed tendinosis.

It has been demonstrated that results using laser therapy contrast with those for non-steroidal anti-inflammatory drugs in arthritis and spinal disorders, for which the effect ends rapidly when drug use is discontinued. This simply means that laser therapy pain relief lasts longer. 

Increasing the tissue healing response by accelerating the initiation of reactions at the cellular membrane level by its photo-physical effect on Ca+ channels. These changes in the membrane permeability are believed to cause increase in macrophage, fibroblast, and lymphocyte activity which provide the main indication for the use of LLLT as a therapeutic agent.

At Indy Sport and Spine, class III laser therapy is used as an adjunct to your manipulative and rehabilitative therapy in order to increase healing time and decrease the pain associated with trauma and injury. Call today to see how laser therapy can increase your condition and get you out of pain. For those interested in a more detailed discussion of how laser therapy works, continue reading.

Although laser therapy developed by engineers, in the last decade the medical community has been catching up and investigating the science and therapeutic effects with many research investigations. The field of laser therapy is still in its infancy, however there has been much published to justify its use in the clinical setting. There have been many in vitro (isolated segments of an organism) and in vivo (therapy tested with segments within the organism) studies in the past decade. 

Laser is light that is generated by high-intensity electrical stimulation of a medium, which can be a gas, liquid, crystal, dye, or semiconductor. Surgical applications of laser ablate tissue by intense heat and are different from LLLT, which uses light energy to modulate cell and tissue physiology to achieve therapeutic benefit without a macroscopic thermal effect. The effectiveness of laser therapy depends on factors such as wavelength, site, duration, and dose of treatment.  Research into the dose response profile of LLLT suggests that different wavelengths have specific penetration abilities through human skin. 

Researchers have used laser devices that delivered irradiation to points in the neck identified bytenderness, local acupuncture points, or on a grid at predetermined points overlying the neck. 

The differences between commercially available laser units are wavelength, power density, pulse modulation, and aesthetics. From these parameters are derived the penetration depth, dose distribution, treatment time, and the estimated biological effect. There is no magic wavelength or setting that is the cure for any particular disease. There are, however, certain operating protocols and wavelengths that give better results than others and are more effective for particular symptoms. Since LLLT does not generate destructive heat, safety relates mainly to potential eye damage, dependent on the class of laser device (classes 1–4), which is defined by analysis of several parameters. Safety glasses are required.

Much of the research has come from in vitro studies on mammalian cells, individual bacteria, and single layers of cells on petri dishes. From these there is a clear picture where light is absorbed in cells and which processes are catalyzed by this interaction.

A very important thing to note early on is that the cell, and the body as a whole is comprised of 80% water.

Because there is not much variation in cellular structure in the body, with the exception of bone, laser therapy is highly non-selective. There are however some heavier elements in these cells (copper andiron) which act as contrast agents to water and are important targets in laser therapy.

These two elements are at the core of the most important photo acceptors in the body,  hemoglobin(an iron-containing metalloprotein responsible for oxygen transport) which is at the core of red blood cells, and cytochrome c oxidase which is in the mitochondria and responsible ultimately for ATP (energy) production. When hemoglobin reaches the cell it has to be de-oxygenated (reduced). The oxygen is then passed through the cell membranes and into the mitochondria where it is processed by a series of enzymes, the last of which is cytochrome c oxidase. Here the oxygen is again reduced as it is converted into water, this reaction is the stimulus for the enzyme ATP synthase to create ATP, the source of chemical energy in cells.

With the exception of melanin in the skin, these complexes are the principle absorbers of mammalian tissue by light in the near infrared range of the electromagnetic spectrum. Action spectra (dependence of wavelength on absorption) have been generated for these targets in vitro and the peaks have been isolated and correlated with the biologically active state of these complexes. This action spectra tells us where in the spectrum and at what rate laser radiation is absorbed by these chromophores, but we must address the biology of the cell first to understand the subsequent chain of events that lead to a beneficial, curative result.

The central goal is to stimulate the cell to perform its natural functions at an enhanced rate.

These bodily functions are extremely numerous (protein synthesis, enzyme secretion, cell signaling, physical movement) and are also cell-type dependent so any attempt to directly target one of these specific enzymes is difficult, and fundamentally unnecessary. Instead, the intended goal is tostimulate the bodies metabolism, specifically the respiratory chain which will enhance the functionality of all of its natural processes.

Both hemoglobin and cytochrome c oxidase are involved in cell metabolism and their roles in the respiration chain are linked.

The goal is to stimulate the amount of hemoglobin that reaches the cell, the rate at which it reduces its oxygen, and then the rate at which the cell can process that oxygen and  create energy. The goal then is to increase local blood circulation, stimulate the reduction of hemoglobin, and stimulate both the reduction and immediate re-oxygenation of cytochrome c oxidase so the process can start again. Cytochrome c oxidase, is the principle absorber of radiation in the entire cell and governs the rate at which oxygen is processed into ATP (energy). Unlike the one-way deoxygenation of hemoglobin, cytochrome receives and delivers its oxygen in cycles within the cell and so we need to stimulate both processes in order to maximize efficiency.

Laser also creates local temperature differences on the molecular level which create potentials along which blood cells are more likely to flow. The stronger and more numerous the gradients, the more local circulation of oxygen can be stimulated. Because the cell is more than 80% water we can target the absorption of water by a particular wavelength of radiation which can cause local resonances that reinforce themselves. In the entire near infrared region (700-1000 nm) the strongest and most distinct peak in absorption is at 965 nm. Laser therapy is interested in the absorption spectrum of oxygenated hemoglobin HbO2 whose deoxygenation can be stimulated by the absorption of a photon of radiation. 

Laser irradiation does both,  depending on the oxidation state of the enzyme and the 970 nm wavelength that coincides with a peak in water absorption

There is however a Heterogeneity of treatment protocols which might be due partly to variation in LLLT parameters and protocols, eliciting different effects. Whatever the mechanism of action, clinical benefits of LLLT occur both when LLLT is used as a single therapy intervention and also in the context of a regular exercise and stretching program. In clinical settings however a combination of laser therapy with an exercise program is preferable.

Call today to schedule your appointment with at Indianapolis Sport and Spine and see how laser therapy can decrease your pain and improve your condition.

Page citations

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1 –  Assis, L, Moretti, A.I.S, Abrahão, T.B., Cury, V., Souza, H.P., Hamblin, M.R., and Parizotto, N.A. Low-Level Laser Therapy (808 nm) Reduces Inflammatory Response and Oxidative Stress in Rat Tibialis Anterior Muscle After CryolesionLasers Surgery in Medicine, Oct 2012

2 – Dawood MS, Al-Salihi AR, Qasim AW. Laser Therapy of Muscle Injuries. Lasers Medicine and Science., Jun 20 2012

3 – Oliveira FS, Pinfildi CE, Parizoto NA, Liebano RE, Bossini PS, Garcia EB, Ferreira LM. Effect of Low Level Laser Therapy (830 nm) With Different Therapy Regimes on the Process of Tissue Repair in Partial Lesion Calcaneous Tendon. Lasers Surgical Medicine, 41(4):271-6. (2009)

4 – Daniel Knapp, DC. Class IV Laser Therapy Treatment of Multifactorial Lumbar Stenosis with Low-Back and Leg Pain: A Case Report. Journal of the American Chiropractic Association, 47(1):10-15. (2010)

5 – Roberta T Chow, Mark I Johnson, Rodrigo AB Lopes-Martins, Jan M Bjordal. Efficacy of Low-Level Laser Therapy in the Management of Neck Pain: a Systematic Review and Meta-Analysis of Randomised Placebo or Active-Treatment Controlled Trials. The Lancet, 374(9705):1897-1908. (2009)

6 – Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RA.Low-Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo-Controlled Trials. Photomed Laser Surg, 24(2):158-68. (2006)

7 – Kelly A. Larkin, Jeffrey S. Martin, Elizabeth H. Zeanah, Jerry M. True, Randy W. Braith, Paul A. Borsa. Limb Blood Flow After Class 4 Laser Therapy. J Athl Train, 47(2):178-83. (2012)

8 – Navratil L, Kymplova J. Contraindications in Noninvasive Laser Therapy: Truth and Fiction. J Clin Laser Med Surg., 20(6):341-3. (2002)

9 – da Silva JP, da Silva MA, Almeida AP, Lombardi Junior I, Matos AP. Laser therapy in the tissue repair process: a literature review. Photomed Laser Surg. 2010 Feb;28(1):17-21. doi: 10.1089/pho.2008.2372.

10 - Posten WWrone DADover JSArndt KASilapunt SAlam M. Low-level laser therapy for wound healing: mechanism and efficacy. Dermatol Surg. 2005 Mar;31(3):334-40.

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