EXPLAIN IN DETAIL THE ROLE OF LOW LEVEL LASER THERAPY IN MUSCULOSKELETAL REHABILITATION ?
A 3 INTRODUCTION
A ) The LLLT, also known as phototherapy, is a non-invasive application of non-thermal and low-powered laser light of single wavelength of classes IIIa and IIIb
B ) The protocol for laser treatment in musculoskeletal disorders is associated with better performance in wavelengths of between 632 and 1,064 nm and laser power output of less than 5 mW (class IIIa) or less than 500 mW (class IIIb)
C ) The LLLT is typically administered in a routine therapeutic treatment as either stationary in skin contact or stationary with distance from skin over a maximum of ten trigger or painful points for 90 s at 2,000 Hz , 150 s at 3,500 Hz, or 5 min at 1,000 Hz per painful point.
D ) Low level laser therapy (LLLT), also known as “cold” laser therapy, refers to a wide variety of procedures involving several laser types and treatment methods.
1 - LLLT uses red beam or near infrared nonthermal lasers with a wavelength between 600 and 1000 nanometers and from five to 500 milliwatts.
2 - In contrast, lasers used for surgery typically use 300 watts. When applied, the lasers penetrate the surface of the skin without a heating (burning) effect, produce no sensation and do not damage the skin.
3 It is believed that due to the low skin absorption and no side effects, the laser light can penetrate deeply into tissues and can reach the site of damage or injury.
E ) Low-energy lasers (also known as cold lasers or class III lasers) have been promoted as an effective way to produce analgesia and accelerate healing of a variety of clinical conditions.
F ) By definition, low energy laser therapy uses irradiation intensities that induce minimal temperature elevation (not more than 0.1 to 0.5°C), if any.
G ) For practical purposes, this restricts treatment energies to a few J/cm2 and laser powers to 500 mW or less.
H ) Examples of LLLT devices include Acculaser Pro4,Axiom BioLaser LLLT Series-3, Bioptron 2, Luminex LL Laser System, MicroLight 830, RianCorp LTU-904, Thor DDII 830 CL3 Laser System, Thor DDII IR Lamp System and TerraQuant. The TerraQuant device uses a combination of a “super pulsed” laser, pulsed infrared, red light and static magnetic field, which is purported to accelerate pain relief.
MECHANISM OF ACTION
1 The physiological mechanisms of LLLT are not well-understood and the mechanisms tend to be very broad
A ) One hypothesis is that there may be an increase in nociceptive threshold after LLLT resulting in neural blockade, specifically an inhibition of A and C neural fibers
B ) This inhibition may be mediated by altering the axonal flow or by inhibiting neural enzymes
C ) In addition, data suggests an increase in endorphin production and opioid-receptor binding via opioid-containing leukocytes with LLLT
D ) LLLT may also mimic the effects of anti-inflammatory drugs by attenuating levels of prostaglandin-2 (PGE2) and inhibiting cyclooxygenase-2 (COX-2)
E ) In addition, data have suggested that LLLT may augment levels of nitric oxide, a powerful vasodilator, which would in turn act to increase blood flow and assist with healing
F ) While the mechanisms have not been completely explained, it is clear that LLLT may have an analgesic effect.
USES
1 Bone regeneration/bone healing
2 Burning mouth syndrome
3 Cadio-protection following myocardial infarction
4 Carpal tunnel syndrome
5 Colorectal cancer
6 Dental pain
7 Dentin hypersensitivity
8 Elbow disorders
9 Fibromyalgia
10 Hair loss
11 Knee osteoarthritis
12 Lymphedema
13 Musculoskeletal dysfunction
14 Myofascial pain syndrome
15 Neurological dysfunctions
16 Oral mucositis
17 Pain relief (e.g. acute and chronic low back pain/neck pain
18 orthodontic pain
19 neuropathic pain
20 shoulder pain
21 Patella-femoral pain syndrome
22 Rheumatoid arthritis
23 Shoulder impingement syndrome
24 Temporomandibular joint disorders
25 Tinnitus
26 Traumatic brain injury
27 Wound healing (including diabetic ulcers, gingival healing, and pressure ulcers)