As any of my long term clients will tell you, I am constantly learning new techniques. One of my most recent new “toys” is a Celluma FDA approved LED device. I just completed a training on working with Photobiomodulation devices, the current term being used in research with Low Level Laser Therapy or Light Emitting Diodes. It so fascination that for the first time since graduate school I was able to voluntarily sit through 3 straight hours of lecture. Perhaps it is kismet that I am so excited about this form of therapy since one of the leading providers of research and education on this therapy in the United States is Wellman Center for Photomedicine, a part of Harvard Medical School.
I learned so much in this training that I want to share. I am going to break this down into multiple blog posts centered on a central theme, this one being pain. It treats almost every kind of pain, and in some cases, such as tendon inflammation and tears it is listed as one of the leading modalities for treatment. Its primary modes of action include its immune modulating function, the ability to increase the body’s production of stem cells, increase local vascularization, increase collagen production, increase ATP, and increase neurogenesis. Results are tertiary: initial treatments will work on the cellular level. Accumulative treatments will build upon each other so that over time this will result in noticeable outcomes like reduced pain, increased range of motion, and increased strength. The essentials that you need to know is that to see results you need to come in for NO LESS then 2 times a week for multiple weeks. For acute issues you want treatment almost daily. Contraindications include: this cannot be done in many locations for someone who is pregnant, those with photosensitivity, over malignant tissue, directly over the unprotected eyes, and with caution on those susceptible to seizures. You will notice that most of these studies are done with low level laser therapy, which is more concentrated than LED. Effectiveness of outcomes is dependent on the amount of power of your device; most devices that offer enough power are $1000 and up. LLLT have so much concentrated power that a therapeutic session may not last longer than 10 minutes. LED devices are better for working on broader areas and they are left on the individual for up to 30 minutes.
From here I will provide a list of studies completed on different types of pain along with frequency of treatment and outcomes as they were provided to me. This research has been compiled by David Kunashko in his training on Photobiomodulation in the Clinic.
Summary of Research
Osteoarthritis: Inflammation of the synovial membrane results in damage to the joint cartilage. Reducing the inflammation of the synovial tissue can slow damage and repair the joint.
Research on low level laser therapy on osteoarthritis shows significant reduction in inflammatory cells in the synovial membrane.
Meniscal Cartilage Tears: Increased microcirculation helped to repair the cartilage, increased synthesis of collagen and chondrocyte cells that form into cartilage.
Research: Grade 3 tears were treated 2x/week for 3 weeks, then once per week for 3 weeks. Pain went from 74 (higher level of pain) to 26. 6 months after treatment pain was at 25. 1 year after treatment it was at 27. In the placebo group pain was 58 post treatment, 75 at 6 months later, and 76 at 1 year later.
Chronic Low Back Pain was treated 2x a week for 6 weeks
Those receiving low level laser therapy had initial pain of 7.3 that reduced to 4.4. They had initial disability of 33 that reduced to 20.8. Those receiving low level laser therapy with exercise had starting pain at 6.2 that reduced to 2.4 and their level of disability reduced to 16.8. The Placebo low level laser therapy with exercise started out with a pain of 6.3 that reduced to 4.3 and disability level of 31.8 that reduced to 24.1
Fractures : Fractures can be treated if it is possible for the low light therapy device to contact the skin directly over the fracture.
A study of closed bone fracture of wrist using near infrared, 60 mw, 9.7 J/cm2 for 2 weeks at 5x/week.
In the LLLT (photobiomodulation) group: level of pain before: 6.6, after: 3.8, 2 week follow-up: 1.28.
In the nonLLLT placebo group: Level of pain before: 6, after: 5, at 2 week follow-up: 3.2
Disability measurements for the LLLT group: 39 before treatment, 20 after 2 weeks of treatment, 11 at 2 week follow-up
Disability measurements for the placebo group: 40 before treatment, 34 after 2 weeks of treatment, 28 at 2 weeks follow-up
Hand grip with laser treatment before: 2.4, after: 4.6, 2 week follow-up: 8
Placebo hand grip level before: 2.3, after: 2.5, 2 week follow-up: 3
Osteoporosis: There is limited human trials but some evidence that it might be beneficial. Findings show that LED can reduce osteoclast activity; the action of the body breaking down bone.
Ankylosing spondylitis is a chronic inflammatory disease that progressively deteriorates the spine. It is characterized by increased activity of T-lymphocytes. Low level laser therapy decreases the secretions of these immune factors.
Laser therapy group received 2x/week weeks 1-4, and 1x/week weeks 5-8
Pain of laser therapy group at 4 wks: 53, at 8 wks: 33, at 8 week follow-up: 27
Placebo pain levels at 4 weeks: 66, at 8 weeks: 66, at 8 week follow-up: 68.
Primary dysmenorrhea: It is believed low level laser therapy promotes relaxation of smooth muscle through nitric oxide release, which relieves pain. Red light therapy also has an immunomodulation effect on blood.
Treatment was 20 minutes daily for 5 days before onset of menstrual cycle at acupuncture points ren 4 and 6.
Low level laser therapy results: Pain at visit 1: 8.34, at visit 2: 8.22, at visit 3: 5.8, at visit 4:4.63, at visit 5: 3.88
Placebo results: Pain at visit 1 8.26, at visit 2: 8.05, at visit 3: 6.66, at visit 4: 6.37, at visit 5: 6.26
Resources
Contraindications and Precautions: An Evidence-Based Approach to Clinical Decision Making in Physical Therapy. Volume 62 Number 5 Special issue 2010.
J Bodyw Mov Ther. 2016 Oct;20(4):748-750. Low level light therapy and tattoos: A case report. Ingenito T 1 .
Lasers Med Sci. 2014 Jul;29(4):1449-52. Laser therapy and photosensitive medication: a review of the evidence. Kerstein RL, Lister T, Cole R.
Chow et al. Annals of Internal Medicine: Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practtice Guideline, February 14, 2017.
Alves et al. Arthritis Research & Therapy, Treatment Time and Power Considerations, 2013, 15:R116. http://arthritis-research.com/content/15/5/R116.
Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial. Lasers Med Sci (2013) 28:1183-1188.
Gholamreza Esmaeeli Djavid et al. In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomized trial.
Wen-Dien Chang et al. Therapeutic Outcomes of Low-Level Laser Therapy for Closed Bone Fracture in the Human Wrist and Hand.
HongMoon Sohn et al. Effects of Light-Emitting Diode Irradiation on RANKL-Induced Osteoclastogenesis.
Stasinopoulos et al. Lasers Med Sci. LLLT for the management of patients with ankylosing spondylitis. 12 January 2016.
Gi-Youn Hong et al. Randomized controlled trial of the efficacy and safety of self-adhesive low-level light therapy in women with primary dysmenorrhea.
pauseandlisten.org 