Understanding LLLT

Low Level Laser therapy is also now known as PhotoBioModulation (PBM) and perhaps more helpfully so, since its action involves the modulation of the biological activity of the body through the controlled delivery of light which is monochromatic and usually but not always coherent laser light.

Laser treatment 

Supraspinatus Muscle Inflammation

Laser therapy, specifically low-level laser therapy (LLLT) and high-intensity laser therapy (HILT), is a potential treatment option for supraspinatus tendonitis, a common condition affecting the shoulder. These therapies can help reduce pain, improve function, and accelerate healing by stimulating the body's natural healing processes.

 

 

Types of laser class and function

Medical Low-Level Laser Therapy (LLLT) devices are primarily classified by their power output into Class 2, Class 3, and Class 4 lasers. Class 3 lasers are further divided into 3R and 3B, with 3B being the most commonly used in LLLT. Class 4 lasers have the highest power output and are used for deeper tissue penetration and faster treatment times, but require more safety precautions.

Class 2 Lasers:

These lasers, typically found in laser pointers, have a very low power output (less than 1 milliwatt) and are generally considered safe for normal use.

Class 3R Lasers: 

Emit less than 5 milliwatts and are generally considered safe for diffuse reflections, but may pose a hazard under direct or specular reflection.

 

Class 3B Lasers: 

Have a power output between 5 and 500 milliwatts (0.005 - 0.5W) and are the most commonly used in LLLT. They require safety glasses due to the potential for eye damage.

Class 4 Lasers:

These lasers have a power output above 500 milliwatts (0.5W) and are capable of causing tissue damage if not used properly. They offer the ability to penetrate deeper into tissues and potentially provide faster treatment times, but require specialized training and safety precautions.

  • Class 2 and 3R lasers are generally considered safe for normal use, but Class 3B and Class 4 lasers require safety precautions due to their higher power output and potential for eye and tissue damage. 
 
  • Class 4 lasers offer the advantage of deeper tissue penetration and faster treatment times, but come with more stringent safety requirement

How it works

1. Healing growth factor response through:

  • Increased ATP and protein synthesis
  • Improved cell proliferation
  • Change in cell membrane permeability to calcium up-take

 2. Pain relief through:

  • Increased endorphin release
  • Increased serotonin
  • Suppression of nociceptor action 

 3. Immune system support through:

  • Increasing levels of lymphocyte activity
  • Photomodulation of blood

L.A.S.E.R.

Light Amplification by Stimulated Emission of Radiation

Laser Physics 101 In order to clarify how low-level laser therapy affects the body, it is necessary to review basic laser physics and developmental anatomy. LASER means Light Amplification by Stimulated Emission of Radiation and was first theorized by Einstein. In 1960 Miaman developed the first laser, a ruby laser. This was a tube laser with a metal chamber, which contained the element ruby. When an electrical current excites the enclosed element, the atoms give off photons or packets of light energy. The photons bounced off a solid mirror on one end of the tube and out holes in the mirror on the other end of the tube. This light beam is unlike regular light in that it is coherent i.e., the photons are well ordered and synchronized. Laser light is also monochromatic, meaning it is of one pure color. Power density is a key to laser energy. Power Density (PD), or light concentration is measured in watts per centimeter squared (W/cm2). The problem with most DC battery driven lasers is that the battery bleeds off and does not maintain a standard PD, which negatively affects low-level laser therapy (LLLT) results. Recent developments in miniature computers have enabled the patenting of techniques that maintain a standard PD as well as to control energy frequency. Wavelengths are measured in nanometers. The most beneficial wavelengths are in the visible and near infrared ranges. These ranges are very safe ranges, far away from the damaging ultraviolet, x-rays, gamma and cosmic rays. Although the longer waves such as microwaves and radio waves are usually considered safe, there are some that think they might be damaging to the very sensitive individual. All wavelengths used in low-level lasers are safely divided from these potentially damaging waves. Many people only think of lasers as cutting lasers. In order to cut with lasers, it is necessary to increase the PD from 300 to 10,000 W/cm2. Cold Lasers do not even have a warming affect unless they are operated above 5 W/cm2. We only offer cold lasers that produce no warming effect and are perfectly safe.

Key Parameters:

The important parameters which need to be considered for clinicians to achieve the best possible therapeutic effects when using low level laser are:

  1. Wavelength
  2. Energy Density from Power Density and Time
  3. Pulsing

Wavelength:

Wavelength is measured in nanometers. In Omega’s equipment it is set in the probe and is changed by using different probes. Our lasers are produced with wavelengths under 1000nm and fall into two classes with different characteristics – the visible red light range from 600nm to 780nm and the invisible Infrared over 780nm:

Red Light (Visible) from 600nm to 780nm

  • Readily absorbed by the mitochondria and therefore potentially stimulatory
  • Excellent source of stimulation of a range of growth factors
  • Red Light does not penetrate very effectively below the skin surface and into the tissue below
  • Red light is optimal for wound healing or superficial conditions but is not the most effective way to treat deeper injury.

Infrared (Invisible) over 780nm

  • Absorbed through the cell walls (acting differently between cells) and therefore cell response is more wavelength specific in the infrared range, responding differently to different wavelengths
  • More penetrative through the tissue, especially the 800nm to 900nm range, therefore this range is selected for treatment through intact skin and pain relief.
  • Synergistic effects are achievable through combining selected wavelengths in both the infrared and red light ranges - see multi-wavelength cluster probes.