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Durolane Knee Injection vs. Laser TherapyI had a new patient referred to me for laser therapy for his ongoing knee pain due to osteoarthritis in both knees.  He is a HIGHLY active, 78 year old gentleman who still enjoys tennis, skiing and working out.  But in order to do his activities, he’s got to pop two Advils beforehand in order to lessen the pain while doing it.  Afterwards, the knees will ache for about 24 hours.  In recent months, the pain had gotten worse so he decided to go through with a series of recommended DUROLANE injections by the orthopedic surgeon.  The injections were supposed to replenish joint fluid and cushioning of his deteriorated knee joint via a substance called hyaluronic acid.  In my patient’s words: “The injections hurt like hell and I’d hobble back to the car after each visit.  They didn’t do a darned thin for my knees and it was expensive too!”.

Fast forward to present day.  This patient has had 4 laser treatments at our Richmond Hill laser therapy clinic so far.  He has already noticed improvement in pain levels during his sports.  He also had two days this week where he said the knees ‘felt amazing’ because there was practically no pain.  Why is this happening?  Because laser therapy’s effects are three fold: anti-inflammatory, analgesic (pain relieving), and curative.  Right now, he’s experiencing the first two.  As we get further along with treatment, the laser treatments will stimulate a certain level of repair to the damaged cartilage of the knee.  I make sure to say that “don’t expect to get a brand new, 20 year-old’s knee”.  That’s not going to happen.  But the laser should stimulate the regeneration of a fine new layer of cartilage to help cushion the effects of his various activities.  He is quite hopeful especially after reading one of our testimonials from another patient who had amazing results with his knee osteoarthritis and was able to continue playing hockey.

He will do about 12 treatments at which point we will re-evaluate his progress and see how much more therapy is required.  We’ll keep you posted!  And in case you are interested, I’ve included some research abstracts regarding laser therapy and knee pain.

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The Effect of Low Power Laser Therapy (Cold Laser) on Osteoarthritis of the Knee

 Basirnia A., Sadeghipoor G., Esmaeeli Djavid G. et al.   Radiol Med (Torino).1998 April; 95 (4):303-9.
…We achieved significant improvement in pain relief and quality of life in 70% of patients.

Positive Outcomes for Infrared diode laser in low reactive-level laser therapy (cold laser) for knee osteoarthritis.

M.A. Trelles, J.Rigau, P. Sala, G. Calderhead, T. Ohshiro. Laser Therapy, (1991): 3(4): 149-153.
82% reported significant removal of pain and recovery of joint mobility
.   Cold Laser Therapy is concluded to be a safe effective and noninvasive alternative to conventional surgical and medical treatment modalities for DJD patients.

The Influence Of Low Level Infra Red Laser Therapy On The Regeneration Of Cartilage Tissue.

P. Lievens, Ph. Van der Veen.Abstract from Laser Florence 2002. Laser in Medical Science. 2002:17(4).
This study concerns the influence of Laser treatment on the regeneration process of cartilage tissue.   There is no need saying that the regeneration of cartilage tissue is a very big problem in rheumatic diseases for example. The lack of blood supply is one of the most important factors involved. Lots of previous publications give us proof of the regeneration capacities of Laser Therapy.   In this study we have chosen to experiment on cartilage tissue of the ear of mice….Microscopic as well as histological evaluations were performed on the cartilage regeneration of both ears… After the second day, only in the irradiated group there is a clear activation of the perichondrium (the connective tissue surrounding cartilage).

Beneficial Effects of Laser Therapy in the early stages of Rheumatoid Arthritis onset

Ailioaie C, Lupusoru-Ailioaie LM.   Laser Therapy (1991) 11(2); 9-87
The purpose of this study was to determine the effects of laser therapy in pain reduction and /or recovery of patients at the onset of Rheumatoid Arthritis, comparatively with the traditional non-steroidal anti-inflammatory drugs (NSAIDS).   Group 1 received laser therapy, Group 2 received placebo laser therapy, Group 3 was treated with only NSAIDS…. The overall efficacy rate in these studies was 86% in the first group (who just had laser), 50% in the placebo group, and 40% in the NSAIDS treated group.   After 4 months of treatment, our investigations showed the laser therapy group promoted the restoration of function, relieved pain and limited the complications of Rheumatoid Arthritis.

Improvement of Pain and disability in elderly patients with degenerative osteoarthritis of the knee treated with low power light therapy (cold laser therapy)

Stelian J, Gil I , Beni-Habot, Rosenthal M, Abramovici I, Kutok N, Khalil A. Journal American Geriatric Society.   (January 1992) 40 (1); 23-26.
Low power light therapy (Cold laser therapy) is effective in relieving pain and disability in degenerative osteoarthritis of the knee.

Cold Lasers, Electrical Stimulation Curb Knee Pain

Boggs, Will MD. BMC Musculoskeletal Disorders. (June 22, 2007).
People with knee pain caused by osteoarthritis may find relief with… electrical nerve stimulation, (and) low-level laser therapy (cold lasers), research shows.
…Electrical stimulation and low-level laser therapy have fewer and less severe side-effects than NSAIDS, and unlike oral drugs they seem to… maintain the positive effect for some weeks after treatment has stopped…
Dr. Bjordal, MD said, “In our opinion, there is currently more short-term potential in refining these safe treatment methods for osteoarthritis than there are for drugs.”

Laser Therapy More Effective than Medication?

…From the findings of a recent Norwegian Health Technology Assessment Report, laser therapy was given the potential of becoming at least twice as effective as NSAIDS(non-steroidal anti-inflammatory drugs), if applied with optimal dose and energy… Although the number of laser trials is still smaller than for NSAIDS, the unequivocal scientific findings so far, has earned cold laser therapy a top spot in levels of evidence and treatment recommendations for knee osteoarthritis issued by the Norwegian Drug Agency.

Cancer sucks…and anyone who has suffered through it or knows a loved one who as will surely agree.   But my patient, A.S. is a 73 year old, female colorectal cancer SURVIVOR.  She is an upbeat, positive woman who underwent chemotherapy back in 2008.  At her last CT scan and blood work in November last year, the doctor told her she was clear of any evidence of cancer.  GREAT NEWS!  However, ever since she completed the chemotherapy, she’s had neuropathy in both legs and feet.

Her symptoms were primarily sensory: constant numbness & tingling in both feet and toes, pain in the calves, some loss of coordination and balance.  Fortunately, she had no loss in muscle function or strength.

After explaining to her how low intensity laser can help with nerve cell regeneration (there is ongoing current research into laser therapy for peripheral nerve and spinal cord injuries), we agreed to start a trial of 12 sessions.  My plan was to use both my BIOFLEX laser as well as the THOR laser so that I could cover a large area of both legs.  I used the flexible BIOFLEX arrays on the bottoms of her feet while I applied the THOR “showerhead” over known acupuncture points that coincided with major nerves innervating the lower leg and foot.

By the 6th session, she was already reporting that she no longer had any pain, numbness or tingling in her legs and feet!  At the end of the 12 sessions, she continued to remain asymptomatic!  Suffice it to say, she was extremely happy.

Whether it be neuropathy, radiculopathy, carpal tunnel syndrome, sciatica, bell’s palsy, shingles or any other nerve related problem, laser therapy has a crucial role in the healing process!

Iliotibial (IT) band injuries are commonplace for runners, cyclists and jumping athletes and usually manifests as pain or tightness on the outside/lateral part of the knee at or just above the level of the knee cap.  It can also move all the way up the outside of the leg to the hip. Symptoms are typically worse with activity and better with rest, and swelling can occur at the lower tendon if the inflammation is severe enough.

The ITB is a thick fibrous band that runs from the outside of the hip, all the way down the outside of the thigh to insert just below the knee joint on the tibia.

Typically, IT bands injuries result when it becomes overly tight and causes the band to a) be pulled tightly over the femur (your big upper leg bone), and b) repeatedly be dragged back and forth over the bone as it helps bend and straighten the knee. So if you are involved in repetitive activities such as running or biking, the IT band becomes constantly irritated and the injury progressively worsens.

I won’t go into the biomechanical reasons why the tightening occurs because if you are reading this, you probably just want to know how to get rid of the pain so that you can start training again!

Enter, the FOAM ROLLER.  If you’ve never seen, heard of, or tried one of these before, then you need to.  It may be the single most effective thing you can do to fix your IT band problem (well, short of laser therapy).  This blue cylinder is made of high density foam which you lay your body weight on and roll back and forth on your IT band.

The foam roller not only stretches muscles and tendons but it also breaks down soft tissue adhesions and scar tissue.  The benefit of doing this it that you can perform a self-massage or myofascial release, break up trigger points, and soothe tight fascia while increasing blood flow and circulation to the soft tissues.

Using the foam roller is not only good for the IT band, but also for pretty much any other part of your body.  Quads, calves, hamstrings, upper and lower back…you get a lot of bang for your buck with this simple tool.

A word of warning though and I’m not going to sugar coat it.  IT HURTS!  Especially if you’ve got alot scar tissue or trigger points in whatever area you are working on.  But it does get better as you regularly roll away at the dysfunctional muscles and fascia.  Most importantly the pain that you normally experience should gradually improve and you should notice an overall improvement in flexibity and range of motion.  Trying to do some rolling everyday in the privacy of your home will reap the most benefit.

What does it cost you ask?  About $40-$50.  Something you can use for a lifetime.  Something your spouse can use also.  A small investment for a lifetime of benefit.  If you live anywhere near our Oak Ridges/Richmond Hill clinic, you can pick one up from one  of the following places:

1) The Treadmill Factory

2) Fitness Source

3) Fitness Depot

As an active taekwondo student at All Star Taekwondo in Richmond Hill, a common injury experienced by myself and my fellow TKD students is the ubiquitous hamstring pull/strain.  Typically, I’ve found it occurs in the mid belly of the muscle but it certainly can occur higher or lower near the tendon attachment sites.  Usually you’ll feel like you tweaked it a bit during your activity (hamstring injuries are also common in sports like hockey, soccer, running, baseball, etc.) and then it becomes progressively more sore and stiff later that day.  For a more serious tear in the hamstring, you’ll feel that intense burning pain right away and be unable to walk without some assistance.  Any of this sound familiar?

So what should you do if you have a fresh hamstring injury, or worse, a chronic hamstring injury that just won’t seem to go away?  Here are some good guidelines:

Acute hamstring pull/strain

  1. You’ve heard it before, RICE it: Rest, Ice, Compression, Elevation.  Essentially, during the 1st 48-72 hours you want to control the inflammation and swelling.  This is your tried and true method.  However, rest should be relative rest.  Not ‘don’t-move-it-at-all’ type rest.  Light muscle activation will help reduce progressive stiffness.  Either do some hamstring curls (leg only, no weights) or at least some isometric exercise (where you try to curl your leg against a resistance without actually bending your knee).
  2. Depending on the severity, plan to take at least 1 week off from the activity that caused the hamstring pull.  This may be the toughest guideline to follow!  But it’s better than retweaking it some more and prolonging the injury and recovery time further.
  3. Perform some light massage over the injured area to improve in and outgoing circulation.  Try to do it yourself or enlist the help of your spouse or friend.  You can also use The Stick.  This great tool for self-massage is wonderful for to use even if you DON’T have any injuries.  Use it on any or all your muscles!  Click here to watch a video on how to work your legs.
  4. After the third day, switch to using heat on your injured hamstring. You want to use heat because it will improve blood flow to the tissue that will assist with healing as well as promote better tissue flexibility.
  5. Now you should also start massaging the hamstring more deeply whether your use your hands or the Stick.  You want to break down any scar tissue, knots or adhesions developing in the muscle tissue and promote healthy, flexible tissue development.
  6. Add a bit more resistance to your leg curl exercise.   Consider adding astiff-legged deadlift exercise as well with little to no weight.
  7. Start stretching your hamstring.  Hold the stretch for 20 seconds (no bouncing), relax for 10 seconds, repeat 3 times.  Try to do this regularly through the day.
  8. Get some moderate activity in: try going for a jog, do some jumping jacks, take a bike ride.  Do things that get the muscles and blood flowing without aggravating the hamstring.  If you feel any pain, stop right away.  Fighting through the pain isn’t a good idea.
  9. If after a few days of doing #8, your hamstring has suffered no setbacks, try doing things related to your sport lightly.
  10. If you follow these steps methodically, you should be good to return to your sport in about 2-3 weeks.

Chronic hamstring pull/strain

If you’ve had a hamstring injury linger for more than 2 months and you keep re-injuring it any time you participate in your sport, you’ll need some professional help.  In all likelihood, the hamstring has not been healing properly because you returned to your activity too soon, have inadequate hamstring flexibility, insufficiently rehabbed the muscle and/or developed excessive, scar tissue or adhesions within the muscle and fascia.  At the Laser Pain Solution clinic, I’d likely do the following:

  1. Perform a functional and postural assessment to determine areas of muscle tightness and weakness in the kinetic chain.
  2. Aggressively work to reduce the scar tissue using either myofascial release techniques or Graston Technique.
  3. Perform PNF stretching with you.
  4. Apply low intensity laser therapy to assist with healing and pain.
  5. Instruct you on appropriate sport-specific rehab exercises to not only the hamstring but other surrounding muscle groups that may be contributing to the problem.
  6. Insist that you take a few weeks off from your activity until rehab is complete (yes, I know you will be ENTIRELY RESISTANT to this!..but do you want to get back to your sport or not???).

Most people tend to want to deal with their injuries on their own which is why I provided the instructions above.  However, it’s always best to seek professional help from the get-go.  The worst thing you could do is simply ‘rest’ for a few weeks and hope it will go away on its own.   The pain might go away (temporarily) but the tissue will not have healed properly and you’ll just be setting yourself for re-injury in the near future.  You need to be actively treating it either yourself or with the aid of a knowledgeable chiropractor, physiotherapist or trainer.

OK so my 4.5 year old daughter Calleigh, has a mouthful of cavities already and one of her bottom molars was so bad that it had eroded down to the dental pulp and was causing inflammation along that side of the dental bed.  We went to Aurora Kids Dentistry last week and consulted with Dr. Peltoniemi.  She needed to have that one tooth extracted ASAP!  And so two days ago, we took Calleigh in at 7:30am to have the procedure done.  They gave her a sedative to drink when we got there and then she got into the dental chair about 30 minutes later.  Next was what every parent hates going through…seeing their child in pain and crying.

The crying first started when the local anesthetic was injected.  Even just looking at that LONG needle they used made ME want to cry (that was one seriously long and scary needle)!  After that, Dr. P performed the extraction.  It’s one of those times when you wish you could be the one suffering instead of your child.  Calleigh was a trooper though.  And after receiving a couple of prizes from the prize bucket, she was in better spirit again.

Of course, being the laser therapy proponent that I am, I had brought my THOR laser therapy system home the night before because I knew it would help with the post-extraction pain and healing.  I’ve never actually used the laser for this purpose before but in the past I’ve seen many research abstracts like these related to its use for dental conditions.  What better opportunity to give it a whirl than with my own kid as the guinea pig.  After all, the worse thing that could happen would be NOTHING!

Around 11 am, the effects of the anaesthetic began to wear off as Calleigh started complaining that her mouth was hurting.  I took out the piece of gauze that she was instructed to bite on to help stop the bleeding.  The spot where the tooth was removed was still bleeding a bit.  So I did a short 3 min treatment on her and then gave her a fresh piece of gauze.  She then fell asleep in my lap until 1 pm!  When she awoke, I asked her how she was feeling and she said there wasn’t any pain.  I checked her mouth again and the bleeding seemed to have stopped completely.  Her grandmother then proceeded to feed her a big bowl of mushy rice which she consumed heartily.  I left for work and when I came home later, I was told that Calleigh had ate another half bowl of mushy rice, a bowl of watermelon AND had demanded that my mother give her some breakfast cereal with milk (she wasn’t supposed to have any hard food grandma!!!).

I checked her mouth again and the area of the tooth extraction looked very good.  Wound was closed significantly and very minimal swelling.  I proceeded to give her another 5 mins of laser therapy.  Half an hour later we had dinner…soft food for Calleigh…no pain, no complaints.

The next morning, Calleigh was her normal self.  Like she hadn’t gone through a tooth extraction just 24 hours earlier.  No pain, no swelling.  The wound had closed and shrunk further.  Another quick 3 min laser treatment before school.  No pain, no complaints.  She ate ‘normal’ food.  Even the gingerbread cookies her mom had packed her (no wonder she’s got a mouthful of cavities)!

Did the laser therapy help with her post-extraction pain and healing?  I like to think so.  Of course this is not a double-blinded, randomized control study that is the gold standard for medical research.  But if my 4 year old can recover from a pretty significant dental procedure in about 24 hours, as a parent I’m happy with a therapy that helps alleviate my kid’s suffering.

I don’t plan on making dental conditions a major focus of the Laser Pain Solution clinic but it’s great to see laser therapy’s potential for treating a variety of soft tissue injuries…even those related to the mouth!

If you’ve begun researching the use of low intensity laser therapy for your injury or pain problem, you’ve probably come across a variety of clinics all using a variety of different laser systems.  I can imagine that it can be quite confusing with all those options out there!  First, let me state unequivocally that laser therapy WORKS!  For the past 8 years, I’ve seen it work on my own injuries and on my patients’ problems.  Medical research is continually be produced showing how effective it is for a variety of conditions such as neck and back pain, carpal tunnel syndrome, tendonitis, osteoarthritis, ulcers, wound healing, etc, etc.  However, for a laser device to work it must meet some basic criteria:

  1. it must use proper wavelengths of light
  2. it must have sufficient power output
  3. it must be applied with the correct dosage

Based on current laser research, there are 3 wavelength ranges that have been shown to be most useful: 630 nm range, 840 nm range and 905 nm range.  The longer the wavelength, the deeper the penetration.  Different wavelengths also cause different cellular responses that stimulate healing and pain reduction.

Power output determines to a certain extent on the depth of penetration of the laser.  This is important as we want to make sure the laser energy gets down to the problem area.  However, keep in mind that while a laser may only penetrate to say 1 inch deep, it’s EFFECT can be much further into the tissue based on the trigger of cell signalling and a cascade of reactions that occur that promote healing.  Basically, I’m saying that more power can be better to a certain limit but is not a necessity.  Minimum power output per beam 50mW, maximum 500 mW.  See why it’s called low intensity laser?…less than 1 watt of power generated.

In the same way that you are prescribed medication (ie. take two capsules, twice a day after meals, until finished), laser dosage refers to the fact that you need to bombard the affected area of injury with sufficient light energy (photons) to have a therapeutic effect.  The dosage is dependant on the power output and the amount of time the laser is applied.   If you aren’t getting any better initially with laser therapy, it could be that the treatment time needs to be lengthened each time, or that you need more days of treatment per week to get the desired result.

Now to our Top 5 laser therapy systems in the GTA…

>> Meditech BIOFLEX – used here at the Laser Pain Solution and many clinics in Canada and worldwide.  Main features are the infinite customization of parameters to suit each unique patient and his particular problem and the use of flexible arrays of light that can appropriately surround and bathe the injured area with photon energy.

>> Theralase TLC-1000 – another Canadian product and I have many colleagues who use this device.  It is also quite popular in Canada.  Main feature is the use of ‘super-pulsing’ technology that drives the a 904 nm laser beam up to 4 inches deep!  Also treatment times are significantly shorter.

 

 

>> LiteCure LCT-1000 – made in the U.S., this device is just breaking into the Canadian marketplace.  It features the use of a Class IV laser that produces more power output and hence supposedly very deep penetration.  At the moment, there is little scientific research that shows Class IV lasers are more effective than Class III.  It’s greatest usefulness may be for really deep problems like an arthritic hip or low back disc herniations.

 

 

 

>> THOR laser – manufactured across the pond in the United Kingdom and very popular in Europe.  We use this device also at the Laser Pain Solution and there are a limited number of clinics across Canada who have it.  We chose to implement this device as a secondary option to the BIOFLEX because it is portable and it uses research proven wavelengths of light.  For us, we’ve primarily used it for more superficial injuries or conditions with consistent success.

 

>> MedX laser- another CDN product also very popular in clinics around the GTA. I believe they’ve been around the longest in Canada.  But other manufacturers have more features to offer in their laser systems and clinics are adopting the other devices instead.

 

 

 

 

I consider these to be the top 5 laser systems available in Toronto because the companies that make them are reputable and/or are leaders in the laser research and manufacturing community.  Many clinics are using these devices on patients with great efficacy.  Which is the best laser therapy device? My bias of course, is for the BIOFLEX laser mainly because of the flexible arrays and true protocol customization it offers.  But the true answer is: none of them. There is no “one size fits all” laser. Each one has its limitation. Success with laser therapy is heavily dependant on the therapist’s understanding of the injury, palpation of the affected tissue, patient feedback with therapy and the therapist’s experience.

Finally, some general guidelines I’ve observed through experience and available research are:

  1. very high powered lasers are useful for treating large areas in short time and to obtain pain inhibition, but seemingly less effective for basic cell stimulation.
  2. for healing processes, low power over longer time duration is more effective than high power over short time, even if the total energy is the same.
  3. All types of medical lasers are useful within their own limitations, but the very high powered lasers are still lacking scientific documentation

Like I said earlier, laser therapy works and I am confident that you will get some measure of relief with any of them.  My hope is simply that more and more people become aware of this simple, safe and non-invasive laser treatment that can help them be pain-free and resume an active lifestyle once again!

It’s common knowledge that having a strong mid-section equates to a healthy back, right?  I had an interesting conversation with an older, gray haired man at a local Richmond Hill Tim Horton’s yesterday.  Apparently, he watched me park my SUV with the Laser Pain Solution full body decal on it and he asked me while I was in line waiting to order: “So what’s this Laser Pain Solution thing?”.  I smiled and gave him a brief blurb on how I use low intensity laser to help with pain and to heal a variety of injuries including conditions like back pain, tendonitis, arthritis and carpal tunnel syndrome.  To which he responded: “I’ve never had a single problem with back pain in all 65 years of my life.  You know why?  I’ve been doing 100 situps everyday since I was 15 years old.

I told him how great it was that he wasn’t one of the many people out there who’s ever suffered low back pain (80% of the population has at least one bad episode in their lifetime) and applauded him for his diligent ab work for the past 50 years.  However, in the back of my head I also knew he was VERY LUCKY!  Why you ask?  Because while developing a strong core is certainly a key ingredient to preventing low back pain, there a good abdominal exercises and bad abdominal exercises.  And the regular situp that most people have grown up doing in phys ed class are definitely one of the BAD ONES!

According to recent spinal biomechanics research (again, I quote Dr. Stuart McGill’s work because he is the man!), any activity that causes spinal loading with trunk flexion places large compression forces on the spine and discs.  If done repeatedly, this will weaken the integrity of the lumbar discs and set you up for back pain and possibly a herniated disc.  Let’s compare the results of various common abdominal exercises:

From this list, you can see that the top 4 exercises that cause the greatest amount of spinal compression are also the same exercises you most frequently see people doing at your local gym or health club!

If your desire is to develop core strength, improve spinal stability and trim your waistline, there are much better spine sparing exercises that you can do.  It’s something we teach here at the clinic to help people maintain their pain-free back after their laser treatments are done.

100 SITUPS per day???!!!  Forget about it!!

If you have carpal tunnel syndrome, you might experience tingling of the thumb, the index, middle, and ring fingers.  At night, it might waken you from your slumber but you can usually relieve it somewhat by shaking, hanging, or rubbing your hand.  If you’ve got a particularly bad case of carpal tunnel, there might be numbness and loss of manual dexterity due to weakness of the hand causing difficulty with pinching and grasping. You might even find that you drop objects frequently or have difficulty using keys with the affected hand.

If this sounds familiar to you at all, your in luck because some recent research confirms what I see regularly at the Laser Pain Solution clinic!  That laser therapy is an effective treatment for carpal tunnel syndrome!

You can refer to this abstract available on PubMed (the science community’s database of all published research studies around the world):

Comparison of splinting and splinting plus low-level laser therapy in idiopathic carpal tunnel syndrome.

Basically, this study shows that 81% of the study participants who underwent 10 sessions of laser therapy in addition to wearing a splint at night got partial to full recovery.  Most importantly, when compared to the control group that only wore the night splint, the laser therapy participants exhibited better grip strength scores and improved nerve test scores at the 3 month follow up.

I’m glad to see that there’s an abundance of ongoing research out there giving laser therapy its ‘props’ as an effective clinic treatment for various nerve, muscle and joint problems!

Laser Therapy GuaranteeIt’s a common question that I get from new patients during their free initial consultation at the Laser Pain Solution.  After all, we all want to ensure that our time and money is well spent right?  Well, as the saying goes there’s nothing guaranteed in life except death and taxes!  However, we can proudly say that on average 80% of the time, patients do experience improvement for their various injuries and problems.

Your likelihood for a successful outcome will depend on certain factors that for the most part, can largely be controlled by YOU!

  1. Sticking with the treatment frequency – it’s amazing how people try to implement their own treatment frequency plan rather than what we tell them.  If we say two times per week is necessary for optimal healing and recovery but the patient decides he only wants to come once a week or even worse, whenever his schedule allows him, what do you think will happen?  This is like being told that you need to take your blood pressure medications 3x/day by your family doc, but you elect to only take it whenever you remember to.
  2. Sticking with the home recommendations - when we work with you, it’s based on a team approach.  This means we do what is necessary while you are here at the clinic but you also have to do your part.  You are an ACTIVE participant in this healing process.  So when we provide rehab exercises for you to do at home, you actually need to do them!  Or if we say you need to stop playing hockey, or working out, or lifting heavy things, you really do need to STOP doing those things that can aggravate the problem.
  3. Your innate healing potential – we see this phenomenon in our family members, friends and co-workers.  Some people who rarely get sick or injured and who recover quickly from their ailments.  Unfortunately, this is something that we have limited control over.  It’s determined largely by your genetics.  That said, sometimes your healing potential is adversely affected by lifestyle factors.  Maybe you are a smoker, a Type-A high stress personality, overweight, nutritionally challenged (ie. bad diet), a poor sleeper, etc.  You can drastically improve your chance for healing if you address these personal issues.
  4. The chronicity of the problem – fresh injuries respond quickly to laser therapy while injuries or problems that you’ve had in excess of 6 months will take longer.  Sometimes much longer depending on how long you’ve been dealing with it.  On average, most problems are fixed in about 12 treatments.  We have treated some tougher chronic problems with 20+ sessions.  So the bottom line is if you do not stay the course, then laser therapy will not ‘work’ for you.

While we can’t offer a 100% guarantee or a money back, risk-free offer with laser therapy (sorry, we aren’t an infomercial or Internet marketing business!), an 80% success rate is nothing to scoff at.  We will provide all the therapy and education necessary to assist you on the road to healing.  Your role is to accept it.

I think it’s wonderful that more and more clinics and therapists are starting to use low intensity laser therapy with patients to treat a wide variety of soft issue injuries.  There is a significant amount of good scientific research being produced that shows laser therapy’s efficacy in treating neck pain, back pain, tendonitis and arthritis to name a few.  And where there used to be only a handful of manufacturers 10 years ago, there are a lot more companies out there selling laser devices today.  However, I see more and more that the issue of LASER POWER is confusing both therapists and patients alike.  Does more power mean better penetration and better efficacy?  Is there an ideal laser out there that will fix and cure everything under the sun?

First and foremost, let’s be honest…there is:

  1. NO TREATMENT AVAILABLE THAT WILL CURE EVERYONE 100% OF THE TIME.
  2. NO TREATMENT AVAILABLE THAT WILL FIX ALL PROBLEMS.

And if anyone tries to tell you otherwise, I suggest you walk out the door.  Medications don’t always work.  Surgery doesn’t always work.  Massage works sometimes.  Acupuncture works other times.  Even my beloved laser doesn’t fix everyone’s problem every time.  I’m just being honest.  But I am happy that at least 75-80% of the time, my patients get good to excellent outcomes as a result of using laser therapy for the problem.

There are a variety of reasons as to why someone might not get better after undergoing a number of laser treatments (which will be the topic of a future post)…but it’s not likely due to an INSUFFICIENTLY POWERED LASER as some patients, therapists and laser manufacturers might suggest.

For anyone serious about laser therapy, or more appropriately called these days PHOTOMEDICINE, the best resource for info on the Internet is found at www.laser.nu.

Anyone who is a true proponent of laser therapy will know of Jan Tuner and Lars Hode, two members of the medical and science community who specialize in low intensity laser and photomedicine research.  They’ve written the golden textbook on laser therapy and recently published a great article entitled: “How Not To Promote Laser Therapy”.  It is an excellent read for clinician and consumers and talks about the many misconceptions related to laser therapy devices and laser therapy claims in the market today.

Class IV laser

The supposed superiority of a Class IV laser

One of those misconceptions is about how higher powered Class 4 lasers are “better” because they allow for increased tissue penetration and shorter treatment times than Class 3 lasers.  Then there’s another camp that says very low powered lasers (less than 10mW) are better…and will even penetrate through clothes!  What are we to believe???!!!  I suggest we listen to the true laser experts, Tuner & Hode, and not some marketing claim by a clinic or laser manufacturer:

“For example, some manufacturers claim that their Class IV lasers (e.g. 10-60 W, 980 nm laser) offer superb penetration through tissue (from 6-to-9 inches according to one manufacturer), and that the so-called “weak” class IIIB lasers (e.g. 500 mW, 808 nm laser) hardly penetrate the surface skin barrier at all. However, in the chosen example below, the very opposite is the truth! Due primarily to its absorption by water in the tissue, 980 nm penetrates less than 808 nm, and this is not compensated by the higher power. At around 808 nm we actually have the best penetration into tissue, and increasing power only increases the depth of penetration marginally. With the higher superficial absorbance of the 980 nm laser there will be considerable heating, and, while heat is fine for many conditions, it is not of what photomedicine is constituted.”

So basically don’t worry about (high) power…the wavelength of the laser is most important.  Also explained by our two laser gurus:

“There are two extremes on the market – those promoting very low power output and those promoting very high power output. Which is best? The answer is: none of them. There is no “one size fits all” laser. Each one has its limitation. There is an increased awareness about the necessity to deliver fairly low doses over longer time to optimize anti-inflammatory results (Castano et al 2007, http://www.ncbi.nlm.nih.gov/pubmed/17659584 as one example). This means that, at least for healing processes, low power over long time is more effective than high power over short time, even if the total energy is the same. The same goes for stimulation of cell proliferation. For temporary analgesia of painful conditions, high power over short time can give a better momentary effect, subject to certain minimum-time and maximum-power thresholds. The optimal dose windows for musculo-skeletal indications, based upon the current scientific evidence, can be found at www.walt.nu. Conclusion: very high powered lasers are useful for treating large areas in short time and to obtain pain inhibition, but seemingly less effective for basic cell stimulation. And they do not penetrate much deeper due to the high output – in fact, the very act of making a high power laser ‘safe’ for long-duration exposures may make it less capable of penetrating as deeply as a lower-powered laser that can e.g. be applied in contact and with slight pressure to the skin. All types of medical lasers are useful within their own limitations, but the very high powered lasers are still lacking scientific documentation in spite of their increasing popularity with salesmen and their lessinformed customers.”

So don’t believe the hype!  Less is MORE!  But as with most things in life, we are so conditioned to think that more is always better.  In the case of laser therapy, slow and steady wins the race.

As is often problematic with quoting sources, I recommend that you read the entire article to make sure I didn’t misquote…and more importantly  for you to gain a better understanding of the whole power issue as well as other dubious claims that can potentially be made.  Make no mistake, laser therapy and photomedicine does work and there are plenty of patients who can testify of it…just realize that some of the hype isn’t necessarily supported by the science.

If laser therapy has worked for you back, knee, hip, elbow or other problem in the past, GREAT!!  If laser therapy has not worked for you, don’t write it off completely yet…maybe it was simply the wrong device to use.

Until next time!

Dr. Keith

P.S.  I recently saw an infomercial on Sunday afternoon for a light therapy device to treat pain…one word for you: GARBAGE

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The Solution Blog provides insights into the use of laser therapy for the treatment of acute and chronic pain problems. With an 80% success rate in treating a variety of musculoskeletal conditions, the Laser Pain Solution may be the answer you have been looking for. Call today for a FREE CONSULTATION...905-773-5794

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