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LLLT (Low Level Laser Therapy) is the application of red and near infra-red light over
injuries or lesions to improve wound / soft tissue healing and give relief for both acute and
chronic pain. First developed in 1967, it is now commonly referred to as LLLT.

LLLT is used to: increase the speed, quality and tensile strength of tissue repair; give pain
relief; resolve inflammation; improve function of damaged neurological tissue and often used
as an alternative to needles for acupuncture.

The red and near infrared light (600nm-1000nm) commonly used in LLLT can be produced
by laser or high intensity LED. The intensity of LLLT lasers and LED's is not high like a
surgical laser. There is no heating effect.

The effects of LLLT are photochemical (like photosynthesis in plants). Red and near infrared
light can affect cell membrane permeability and aid the production of ATP thereby providing
the cell with more energy which in turn means the cell is in optimum condition to play its part
in a natural healing process.

LLLT devices are typically delivering 10mW - 500mW (0.2 -> 0.01 Watts). The power
density typically ranges from 0.05W/Cm2 -> 5 W/Cm2.

LLLT is popularly used for soft tissue injuries, joint conditions, chronic pain, non-healing
wounds and ulcers, post-op pain and acupuncture.

NEWS The Lancet publishes landmark review of LLLT for neck pain read more and listen to
interview here



 

Like photosynthesis - the correct wavelengths and power of light at certain intensities for an
appropriate period of time can increase ATP production and cell membrane perturbation
could lead to permeability changes and second messenger activity resulting in functional
changes such as increased syntheses, increased secretion and motility changes. Red and near
infrared light seem to be the most ideal wavelengths.

Red light acts on the mitochondria and near infrared light on the mitochondria and at the cell
membrane. In in-vitro and animal LLLT wound healing studies comparing wavelengths, red
consistently is more effective. Shorter wavelengths are not so good, expensive to produce and
with poor penetration they are a poor choice. Near infrared light whilst not quite as good do
penetrate better than the red wavelengths and are available in higher powers and at low
prices. According to live in-vivo experiments at Uniformed Services University Bethesda
Maryland (a US military research centre) 810nm is the best penetrating wavelength. It also
happens to work well in LLLT nerve regeneration studies they are doing.

Clinical Effects of LLLT

An appropriate dose of light can improve speed and quality of acute and chronic wound
healing, soft tissue healing, pain relief, improve the immune system and nerve regeneration.
Applications with good RCT evidence include Venous Ulcers, Diabetic Ulcers,
Osteoarthritis, tendonitis, Post Herpetic Neuralgia (PHN, shingles) & postoperative pain.

To paraphrase NASA research:

³Low-energy photon irradiation by light in the far-red to near-IR spectral range with low-
energy (LLLT) lasers or LED arrays has been found to modulate various biological processes
in cell culture and animal models. This phenomenon of photobiomodulat ion has been applied
clinically in the treatment of soft tissue injuries and the acceleration of wound healing. The
mechanism of photobiomodulation by red to near-IR light at the cellular level has been
ascribed to the activation of mitochondrial respiratory chain components, resulting in
initiation of a signaling cascade that promotes cellular proliferation and cytoprotection.´

³A growing body of evidence suggests that cytochrome oxidase is a key photoacceptor of

light in the far-red to near-IR spectral range. Cytochrome oxidase is an integral membrane
protein that contains four redox active metal centers and has a strong absorbance in the far-
red to near-IR spectral range detectable in vivo by near-IR spectroscopy.´

³Moreover, 660±680 nm of irradiation has been shown to increase electron transfer in

purified cytochrome oxidase, increase mitochondrial respiration and ATP synthesis in
isolated mitochondria, and up-regulate cytochrome oxidase activity in cultured neuronal
cells.´

³LED photostimulation induces a cascade of signaling events initiated by the initial

absorption of light by cytochrome oxidase. These signaling events may include the activation
of immediate early genes, transcription factors, cytochrome oxidase subunit gene expression,
and a host of other enzymes and pathways related to increased oxidative metabolism.´
³In addition to increased oxidative metabolism, red to near-IR light stimulation of
mitochondrial electron transfer is known to increase the generation of reactive oxygen
species. These mitochondrially generated reactive oxygen species may function as signaling
molecules to provide communication between mitochondria and the cytosol and nucleus.´

Therapeutic photobiomodulation for methanol-induced retinal toxicity.

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Below are a few Abstaracts of double blind clinical studies demonstrating the positive effects
of LLLT. More abstracts can be viewed on our LLLT Research page.

Pain Scores And Side Effects In Response To Low Level Laser Therapy (LLLT) For
Myofascial Trigger Points

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy

Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane
Hospital, Brisbane, Queensland, Australia.

A double-blind, placebo-controlled, random allocation study. 41 subjects, chronic myofascial

trigger points in the neck and upper trunk region, five treatment sessions over a two week
period, All groups demonstrated significant reductions in pain over the duration of the study.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department,

Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.

6/97 Rep. US $8-10-12 copyright 1997 by LT Publishers, , U.K.' Ltd. Manuscript

received:January, 1997 Accepted for publication: March, 1997

LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red
laser.

Wave- Average Energy Power Energy Pulses Time Beam

length Power Density Density Spot size
0.89
820 25mW 5 J/Cm2 0.14 J 5,000Hz 5.62 secs 0.89Cm2
W/Cm2

 
 
 





   


 F. Ceccherelli,  L. Altafini,  G. Lo Castro,  A. Avila, F. Ambrosio, and  G. P. Giron

Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione
Italiana per la Ricerca e, l'Aggiornamento Scientif co, Padua, Italy

Double-blind, pulsed infrared, treatment of myofascial pain in the cervical region. 27

subjects, 12 LLLT sessions, alternate days, at each session the four most painful muscular
trigger points and five bilateral homometameric acupuncture points were irradiated with 1J.
Pain was monitored using McGill pain questionnaire andScottHuskisson visual analogue
scale, pain attenuation in the treated group and a statistically significant difference between
the two groups of patients, both at end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to Dr. F. Ceccherelli at the Istituto di

Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

The Clinical journal of Pain 5:301-304 copyright 1989 Raven Press, Ltd., New York

Wave- Energy Power Energy

Power Pulses
length Density Density per point
5mW av 1KHz
904nm (not given) (not given) 1 J
(25Wpeak) x 200nS

Low Level Laser Therapy (LLLT) Of Tendinitis And Myofascial Pains A Randomized,
Double-Blind, Controlled Study

Mimmi Logdberg-Anderssont1, Sture Mutzell2, and Ake Hazel3

1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and

3: Vaxholm Health Care Centre, Stockholm, Sweden.

A double-blind study, laser therapy for tendinitis and myofascial pain,176 subjects, 6
treatments during a period of 3-4 weeks.Pain estimated objectively using a pain threshold
meter, and subjectively with a visual analogue scale. Laser therapy had a significant, positive
effect compared with placebo. Laser treatment was most effective on acute tendinitis.

Addressee for Correpondance, Sture Mutzell, Danderyd University Hospital 5-182 87

Danderyd, Sweden.

03/07 Rep US 10-12-14 , 1997 By LT Publishers, U.K., Ltd., LAS ER THERAPY, 1997:9:
79-86

Wave- Power Energy Power Energy Pulses Treatment

length Density Density per point Time
904nm 8mW av 0.5-1.0 (not given) 1J 4KHz x 2 mins
(10Wpeak) J/Cm2 180nS
- 
  
Manual therapy is the treatment of choice, but often an electrotherapy is used to augment a
hands on approach to aid tissue repair and give pain relief.

Ultrasound is the most commonly used electrotherapy, it is however limited in its

effectiveness and limited in its range of applications (ultrasound should not be used over
bony prominences, pins, plates and very acute injuries).

Physiotherapists are now turning to LLLT (low level laser therapy) which can be used safely
in these areas and finding they are using it more and more. Says Sue Bunn, MCSP, SRP,
physio to the British Paragliding Team, " I would not like to be faced with all the acute
injuries we see without a laser. Since I've had a laser I can not be bothered with ultrasound
and all that gel".This is a comment heard from many physios who find laser easy to learn and
simple to use.

LLLT works differently from ultrasound, it works quickly from within the cell and often
resolves conditions that have not responded to manual therapy or ultrasound treatments.

Matt Jevon, Chief Executive of The British Association of Sports Trainers and visiting
lecturer in Sports Rehabilitation at the University of Salford is very excited about this
modality. "Laser therapy (LLLT) is our most commonly used electrotherapy apparatus,
particularly in acute cases. We have used it in our support of over 300 players in the Student
Rugby League World Cup with considerable success when compared against other
electrotherapy and mechanical modalities."

LLLT is used as an adjunct to many of the manual therapies practised by our

physiotherapists, all of whom appreciate the benefits of accuracy in application. We currently
have two laser units and it will be first on our purchasing list after plinths as we expand into
new clinics."

With modern higher power laser components, modern LLLT systems are more effective than
in the past. Simpler laser treatment protocols have now been developed that enable users to
give fast, effective treatments for both acute injuries and difficult conditions.

Says Sarah Cooper, physio to the British Athletic Team "I use laser immediately on acute
injuries, it is a very useful adjunct to have at major sporting games, treating acute and chronic
injuries alongside manual therapy for pain relief and reduction of inflammation.".

LLLT is considered to be one of the safest forms of electrotherapy and has more published
research evidence supporting it than any other electrotherapy. It is used by physiotherapists
for pain relief, resolution of inflammation and tissue repair. A 1991 survey showed it to be
the most effective electrotherapy for pain relief and wound healing - since then many
ultrasound users have become laser enthusiasts.

Is Laser Therapy overtaking ultrasound? Seems likely!



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Myofascial trigger points - tendinitis - strains - sprains

Simple LLLT Treatment Technique

Example shown here is for a THOR LLLT system with 200mW laser probe and cluster
probe.

u Having thoroughly palpated and assessed the area, set the timer to 20 seconds
u Set the Pulse frequency to one of the following settings:
› 2.5 Hz - for acute injuries;
› 5 KHz - for chronic injuries and non-healing or infected wounds.
u Treat the top of the neck/occiput atlas for 20 seconds
u Then treat the nerve exits at C7 / T1 for 20 seconds
u Then treat the nerve root exit related to injury for 20 seconds, and continue to treat
several points along the course of the nerve towards the injury at 20 second intervals.
u Treat each tender point for 20 seconds with the THOR 200mW laser probe. Palpate
for any changes (eg: reduction in pain, change in tissue texture, relaxation of muscle,
etc). If there is no response, then treat the tender points again. Palpate for any changes
and repeat once more if necessary.
u Finally treat the surrounding soft tissue with the cluster probe for 2 mins per area

Times are approximate and can be varied according to the dept of the injury / build of the
patient.

Be accurate during treatment, gapping and positioning joints appropriately to gain maximum
exposure of the joint, treating 'around' tendons where possible and be as thorough as time
permits. Use LLLT as soon as possible after injury, treating daily for acute conditions and
less frequently as resolution occurs. Treat chronic inflammatory conditions twice weekly and
osteo-arthritis weekly or fortnightly. Treat as many points as necessary during one session; do
not move the probe during each application. Treat with single, then cluster probe during one
session.

There are normally no adverse effects from LLLT, however, patients occasionally experience
mild discomfort / ache after treatment. This is due to a restimulation of the inflammatory
phase and should settle down after 24 - 48 hours.

Myofascial trigger points - tendinitis - strains - sprains

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Direct Irradiation Of The Eyes

Class 3b lasers are potentially harmful to the retina - though retinal damage is highly
unlikely. Safety goggles must, however, be worn by both patient and practitioner.

Pregnancy

Laser is contra-indicated for use over the pregnant uterus. It may be used on the pregnant
woman as an adjunct to the other modalities being used for the treatment of back pain or
other complaints.


 

Do not use laser over any known primary or secondary lesions. Laser treatment may be given
for pain relief during the terminal stages of the illness - we recommend this be done only with
the full consent of both patient and consultant involved.

   
Laser should not be used over the thyroid gland.


 


It is conceivable that laser-mediated vasodilation may worsen the haemorrhage.

-  
 

Laser Therapy is contra-indicated for patients on these drugs

Treatment Over Sympathetic Ganglia, The Vagus Nerves & Cardiac Region In Patients With
Heart Disease

Laser therapy may significantly alter neural function, and is therefore contra-indicated over
these regions in patients with heart disease.


 
 


There has been a lot of discussion about the best method to quantify LLLT dosage.
However, it is my opinion that:

1. There is no agreed method of defining beam area

2. Dosage expressed as J/cm2 is inadequate
No agreed method for measuring LLLT dosage

So beam area is hard to define and there is no agreement in our industry for defining it. [I
propose 1/e2 - will explain this soon].

Dosage expressed as J/cm2 is inadequate

³Dosage´ is usually calculated as Power / Beam Area x Time = J/cm2. However, to consider
that dosage should equal J/cm2 is, in my opinion, inadequate.

 


Assume there is a well-defined beam area and thus a quantifiable dosage.

u A 500mW laser with a beam area of 0.25Cm2 used for 20 seconds

delivers 40 J/cm2
u A 200mW laser with a beam area of 0.1Cm2 used for 20 seconds
delivers 40 J/cm2
u A 30mW laser with a beam area of 0.015Cm2 used for 20 seconds
also delivers 40 J/cm2

Each of these probes apparently apply the same "dosage". However, the total energy
delivered is clearly different [10 Joules, 4 Joules and 0.6 Joules respectively].While dosage
appears consistent using J/cm2, I suggest that the clinical results would be quite diverse. So I
say that J/cm2 is an inadequate method of expressing dosage.


 
 

 





 




  
  
 

Area of a circle = r2 Area of a circle = r1r2

  




       





   

Where is the edge of the beam? What is the

beam area?