Using electromagnetic energy to heat tissues and promote tissue healing

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Laser therapy can be used to increase tissue healing, assist with pain relief and decreased inflammation with rheumatoid arthritis, lymphedema management, carpal tunnel syndrome, and pain reduction.  When applied appropriately, asers have been found to increase the rate of wound closure, increase tensile strength of wounds, and decrease perception of pain.



Lasers are:

​Monochromatic- contains one wavelength of light (one color), determined by the amount of energy released when the electron drops to a lower orbit

​Coherent- it is organized, in that each photon moves in step with the others.  This means that all of the photons have wave forms that launch in unison

​Directional- the laser beam has a tight beam, making it strong and concentrated (as compared to a flashlight, where the light is released in many directions, causing a weak and diffuse light beam)



*LED light is not coherent or monochromatic, but it is cheaper and easier to produce compared to laser. LED also has a lower wattage, meaning treatment time must increase in order to get the same effect. 



Lasers are thought to work by promoting ATP production within the cells.  Secondarily, lasers may also promote collagen production, modulate inflammation, inhibit bacterial growth, promote vasodilation, and change nerve conduction velocity and regeneration. 

 

 

Contraindications

Eyes, malignancy, within 4-6 months following radiation therapy, hemorrhaging areas, or locally to thyroid or other endocrine glands



Precautions

Epilepsy, fever, pregnancy, gonads, epiphyseal lines, decreased sensation, infected tissue, sympathetic ganglia, vagus nerves, or the cardiac region

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To apply laser therapy, position the patient in a relaxed posture, sitting with the target tissue exposed.  Explain that they should not feel any heat, and the treatment should not last very long (approximately 30 seconds to a minute). Inspect the areas for sensation, range of motion, open wounds or cuts, and be sure to remove any gels or lotions with an alcohol swab.  Plug in and power on the machine, select "Light Therapy", and adjust the intensity (since the power level of the machine is fixed, the treatment time will adjust to achieve the desired intensity).  Then press start and the power button on the wand, and hold it in place for the duration of the treatment.  Be sure to document the location and surface area treated, dosage (J/cm2), frequency and type of laser, patient response, and outcome measures (including pain scales, functional scales, etc)



Different machines have different power levels, as well as safety parameters.  Make sure you know these guidelines for your machine.  here are some safety recommendations based on class of machine



Safety:

Class I – exempt.  Invisible lasers average power of 1mW or less.  Includes GaAs lasers (820-910 nm)
Class II- “low power”.  Visible lasers up to 1mW.  Do not stare directly into source, risk of damage.  Safety glasses recommended not required.  Includes HeNe laser
Class III – moderate risk.  Operator and pnt need protective eyewear.  Cannot cause serious skin injury under normal use
Class IV – high power.  Capable of thermal injury.  Used in surgery