Low Level Laser Research

"HEALTH" - Sebastian Sun, October 9, 2003
By Rachael Jackson, staff writer

Cold, hard facts: New laser treats various illsFor years, the pain was so great Pat Ground couldn't stand on her tiptoes. There were times when she could hardly walk.
The Sebastian banker tried doctor after doctor, endured several types of treatments, but nothing seemed to make a real lasting difference in the swollen nerves in her feet.

But now, after only a month of a new laser treatment by chiropractor Jeff Stepanek at Sebastian Chiropractic, Ground, 58, happily reports she can retrieve items from a top shelf without enduring tremendous pain from a condition called Morton's Neuroma.

Stepanek recently obtained the Microlight cold laser, which can treat a wide range of ailments. The laser offers a non-invasive treatment alternative for soft and connective tissue disorders such as athletic injuries, Morton's Neuroma and Carpal Tunnel Syndrome, a stress injury caused by repetitive movements such as typing or working on an assembly line that can cause progressive loss of function in the hand.

MicrolightLaser®, the company that manufactures the handheld, battery-operated device claims its laser can make the difference between partial and full recovery in Carpal Tunnel sufferers.

"It's been wonderful with my patients," Stepanek said. "Every single person has responded."

Although hot lasers are used for procedures such as correcting vision and removing tumors, the heat can destroy tissue as the laser penetrates. Stepanek said the cold lasers work by using frequencies of energy that are the same frequencies the body uses when healing. The laser, which has been approved by the Food and Drug Administration, stimulates parts of the cell to accelerate healing in injuries that do not seem to respond to other treatments.

Stepanek 35, who lives in Sebastian, even tested the laser on his girlfriend when she accidentally cut herself with a kitchen knife. Stepanek said the cut, which went through to the muscle, normally would have taken at least three weeks to heal. After four days of laser treatments the wound was reduced to a red line. After a week it had healed completely.

The schedule of laser treatments varies for different conditions, but Stepanek said most people require three 15-minute visits a week for two to four weeks. A daily regime of laser treatments can accelerate healing and minimize scarring from post-surgical wounds.
He has also used the laser to treat arthritis, chronic joint pain and ankle sprains. Stepanek learned about the cold laser from his brother, Chris Stepanek, a Vero Beach chiropractor.

Jeff Stepanek said research on the laser suggests it speeds healing by 30 to 50 percent. After using the laser for about a month, and very positive responses from his patients, he said that seems like a conservative estimate.

"With the laser I noticed a difference in the pain the day after the first treatment," Ground said. "It definitely was a marked difference from the other things I tried."
Ground said she is waiting to see how long the laser’s effects will last.
- Rachael.jackson@scripps.com

AT A GLANCE

A new cold laser treatment can provide a surgery alternative for sufferers of Carpal Tunnel Syndrome, athletic injuries; and other soft and connective tissue disorders. The treatment is painless and non-invasive and, according to MicrolightLaser®, its manufacturer, it can make the difference in full and partial recovery for Carpal Tunnel patients.

Jeff Stepanek of Sebastian Chiropractic reported extremely positive results after using the laser for about a month. Sebastian Chiropractic is at 13250 U.S. 1 and can be reached at 772-388-1148.Please call Rick Martin at 775-884-1615 for more information.

"How laser light helps cells repair themselves CAN gentle doses of laser light help cells to heal?" - THE NEW SCIENTIST, October 11-15, 2003

How laser light helps cells repair themselves CAN gentle doses of laser light help cells to heal? The technique is sometimes used to treat problems such as tinnitus and joint pain, but with no explanation for how these therapies work, there is scepticism over whether the effect is real. Now a physicist has come up with evidence that the physical forces generated by low-energy laser beams may switch on cells' repair mechanisms.

This will support the growing body of evidence that laser therapy is beneficial. At the Joint International Laser Conference in Edinburgh, UK, last month, researchers reported promising results for fields as diverse as IVF and spinal injury. For example, rats with damaged spinal cords made a better recovery if their wound was illuminated with near-infrared laser light, reported Kimberly Byrnes of the Uniformed Services University of Health Sciences in Bethesda, Maryland.

Her team found that in light- treated rats, levels of interleukin-6, which is involved in inflammation, were only 1 per cent of the levels in a control group of rats. But Byrnes does not know how to explain the result. .'There are a million different theories," she says.
One popular idea is that molecules within cells absorb the light, and the extra energy drives chemical reactions. Although this may be part of the answer, it does not explain why some studies have shown effects that are specific to laser light.

Anatoly Rubinov of the Stepanov Institute of Physics in Minsk, Belarus, is convinced that the unique properties of lasers offer an explanation. Unlike ordinary light, laser light is strongly ordered: its electromagnetic waves oscillate in step, with the peaks and troughs aligned. When a laser beam passes through a layer of cells, it splits into many components, which interfere with each other as they bounce about, creating a mottled pattern of light and dark regions.

To show the physical effect this might have on cells, Rubinov illuminated some cell-sized plastic beads with various interference patterns (Journal of Physics D: Applied Physics, vol 36, p 2317). The beads were moved around by the light, and became trapped in the bright regions. Rubinov says cells should be affected in the same way. It is well known that light can exert significant forces on small objects, but the effect of these forces in laser therapy has not been considered before.

Rubinov believes it is these forces that trigger a biological effect within the cells. When he exposed human white blood cells to uniform laser radiation, the number of cells that underwent apoptosis -a form of programmed death that eliminates mutated cells -increased with exposure time. When he used an interference pattern of the same laser light, the number of cells undergoing apoptosis also rose for a few minutes, but then dropped off sharply.

Rubinov concludes that while radiation itself can damage DNA, the forces exerted by the interference pattern trigger a repair mechanism within the cells. In another set of experiments, he showed that cells exposed to certain interference patterns showed fewer signs of DNA damage than those exposed to uniform radiation. "The gradient forces activate the repair system of the cell and increase the resistance of its genome to external factors and increase the resistance of its genome to external factors," he says.

Harry Mosely, president of the British Medical Laser Association, says Rubinov's work represents an important first step towards understanding the potential medical effects of lasers. "It is moving us on in our thinking, which is excellent," he says.
Jenny Hogan .
www.newscientist.com

Lightwave of the Future The low-power laser for the treatment of carpal tunnel syndrome is safe, painless, and completely noninvasive.
By John S. Soet
REHAB MANAGEMENT; JANUARY/FEBRUARY 2005; PP. 24-30.
(click here to download a pdf version of this article)

It was the late 1960s. The Beatles were still the rage, the Vietnam War was in full swing, and Star Wars was a decade away. Theodore Maiman, utilizing a technique of concentrating and amplifying monochromatic light originally developed by two teams of researchers, produced a device known as LASER, light amplification by stimulated emission of radiation. Immediately, the term “ray gun” came to mind. The development of weapons-grade lasers became a priority. Because the beam could be concentrated to cut a minute surface area, surgical applications were also developed.

But while governments and researchers were concentrating on military applications, a Hungarian physician named Endre Mester suspected that the laser might have a more humane application—the destruction of malignant tumors. Malignancies were traditionally treated with the cut/burn/poison strategy—surgery, chemotherapy, and radiation. If, indeed, the new addition to the scientific arsenal could destroy carcinomas with a minimum of damage to surrounding tissue, it would be an incredible breakthrough in cancer treatment. However, Mester concluded his research with good news and bad news.

LASER SERENDIPITY
The bad news was that his treatment was ineffective against malignancies. The good news was a curious observation in the test animals. He observed that in many cases the skin incisions he made to implant malignant cells in test animals appeared to heal faster in treated animals compared to the incisions of control animals that were not treated with light. Curious about this unexpected and unanticipated result, he designed many follow up experiments on skin defects, diabetic ulcers, burns, infections, and decubiti. He was baffled by the discovery that they all healed more quickly when exposed to the light of his laser. Eventually, Mester discovered that his laser was underpowered, which was why it did not have a destructive effect on cancerous tissue. This led him to conclude that, just as sunlight is destructive in high amounts but beneficial in small amounts, the laser, at low power, stimulated healing in tissue.

In the decades that followed, Mester’s work was adapted to numerous benign laser applications the world over. However, one of the fields where the laser is one of the most beneficial, yet noninvasive, treatments available is also one of the slowest to capitalize on its advantages. This is the field of physical therapy. Chukuka Enwemeka, PhD, PT, is one of the world’s foremost authorities on and advocates of low-power laser therapy. The former chair of the University of Kansas Department of Physical Therapy and Rehabilitation and current dean of the School of Health Professions, Behavioral and Life Sciences at the New York Institute of Technology, Enwemeka is also former president of the World Association for Laser Therapy. “Almost every other field of the healing professions is picking up on laser technology faster than PTs,” he says. “Chiropractors, oriental medicine doctors, everyone except orthopedic surgeons, who are even slower.”

Enwemeka expands his comments to include the fact that the United States, in general, is “last on the block” as far as utilization of laser therapy. “It’s been utilized much longer just about everywhere,” he states, “Europe, South America, Asia … processes are much slower to catch on here. Part of this is because the approval process takes so long, and part of it is that we PTs seem to be skeptical about anything new. The other problem is that there are so many innovations being developed in the United States, anything developed here gets priority in the approval process and anything developed in other countries gets moved to the back of the line.”

Ironically, a staple of the physical therapy profession is one single area where the laser has proven to be highly effective: the treatment of carpal tunnel syndrome (CTS). “It was the first physical therapy protocol for which the low-power laser, or ‘cold’ laser, was approved by the FDA,” Enwemeka says. “In fact, it’s one of the most effective interventions in the PT’s arsenal. In many cases, lower power laser treatment has been effective when even surgery has failed.

HEALING MECHANISM
“ All cells, or should I say most cells, have chromophores,” says Enwemeka, “which are like chlorophyll. They absorb light and transform it to ATP, which can be used, for example, to create more collagen or induce homeostasis to reduce inflammation. The light, basically, supplies energy to the cells. Cells absorbing light stimulate the metabolic process on the cellular level.

“ ATP is used to power many metabolic processes; synthesize DNA, RNA, proteins, enzymes, and other
biological materials needed to repair or regenerate cell and tissue components; enhance mitosis or cell proliferation;
and/or restore homeostasis. The result is that the absorbed energy is used to repair the tissue, reduce pain, and/or restore normalcy to an otherwise impaired biological process. We experience this ourselves. When it is overcast or dark, you don’t feel as good as you do when the day is bright and sunny. If you are out of the light for a while, you feel lethargic and depressed. It demonstrates the role light plays in stimulating ATP production.

“ An additional benefit for employing the cold laser in treating carpal tunnel is pain relief. Reports indicate that light therapy can modulate pain through its direct effect on peripheral nerves as evidenced by measurements of nerve conduction velocity and somatosensory evoked potential. Other reports indicate that light therapy modulates the levels of prostaglandin in inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and soft tissue trauma.”

Additionally, other forms of light therapy have been found to be extremely effective in carpal tunnel treatment. “Light
technology continues to advance. Other monochromatic light sources with narrow spectra and the same therapeutic value as lasers are now available. These include light-emitting diodes (LEDs) and superluminous diodes (SLDs). As the name suggests, SLDs are generally brighter than LEDs; they are increasingly becoming the light source of choice for manufacturers and researchers alike. The light source does not necessarily have to be a laser in order to have a therapeutic effect. It does have to be light of the right wavelength. It has been demonstrated that lasers, LEDs,
SLDs and other monochromatic light sources all produce beneficial effects. Preferences vary from therapist to therapist. However, it is the dose and wavelengths that are critical. At present, it is believed that appropriate doses of 600 to 1,000 nm light promote tissue repair and modulate pain,” Enwemeka says.

CARPAL TUNNEL PROCEDURES
“ It should be pointed out that, while it certainly is one of the most exciting advances in the history of physical therapy,
light therapy is not a panacea,” says Enwemeka. “Certain cases of CTS do not respond. However, the most common
forms of repetitive strain injuries are very responsive to light therapy. Because it is completely noninvasive, clinically, the PT really should give serious consideration to this procedure.” Enwemeka also believes light therapy is contraindicated in certain cases, including the following:

• The presence of any malignancies.
• Irradiation of the eyes.
• Patients with a high degree of light sensitivity.
• Patients who have been pre-treated with photosensitivity-enhancing agents, for example, patients undergoing photodynamic therapy.
• Patients on medications that may enhance photosensitivity or patients using the herb Saint-John’s-wort.
• Irradiation over the uterus during pregnancy.
• Irradiation of the thyroid gland.
  

Since light is destructive at high doses but very therapeutic at appropriately low doses, it is important to use the right dose (fluence or energy per unit area treated), and frequency of treatment appropriate for each condition. The dosage is, of course, determined by a ratio of power to duration. Generally, according to Enwemeka, the dosage is at 3 J/cm2 to 5 J/cm2 two to three times a week. Often, patients begin to note rapid improvement within three to five visits. The entire course of treatment ranges from eight to 10 visits.

TIME TO SEE THE LIGHT
Many practitioners in Europe believe that light therapy will eventually replace most other forms of carpal tunnel treatment. However, as previously stated, Enwemeka still believes many American PTs need some urging to move in this direction. “A mind-set has developed in our profession that is what I can best describe as a resistance to anything new.

There is a certain skepticism about newer treatment protocols. While this is good in the fact that it has helped physical therapists avoid quackery and maintain a reputation as the most reliable rehabilitation specialists, it’s a double-edged sword because it also allows other countries and practitioners to get a head start on us.

“ The low-power laser has received a lot of press and news coverage. It has established a reputation with the public for being quick and painless, so a patient who is able to make his or her own determinations might seek out a rehab specialist who uses light therapy. The PT who does not utilize light therapy may soon, if not already, be losing business to chiropractors and acupuncturists. Aside from a business standpoint, the treatments really are in the patient’s best interest for the same reasons.

“ A lot of PTs also balk at the thought that they have to purchase the equipment. But the truth is that while the equipment can be over $20,000, the light equipment used in physical therapy begins at around $5,000 or $6,000. And there’s almost never a problem with insurance providers as long as the treatments are coded properly.

“ The low-power laser could revolutionize treatment of carpal tunnel syndrome,” concludes Enwemeka. “It would be a shame if PTs continue to take a ‘wait-and-see’ attitude toward this therapy and allow other professionals to continue to take the lead.” _
John S. Soet is a contributing writer for Rehab Management.

Source: www.microlightlaser.com