Low Intensity Laser Therapy (LILT)

Low-Intensity Laser Therapy (LILT)

Low-Intensity Laser Therapy (LILT): Unlocking the Healing Power of Light

Introduction

Low-Intensity Laser Therapy (LILT), also known as Low-Level Laser Therapy or Photobiomodulation, is a non-invasive medical technique that utilizes low-intensity laser light to promote healing and relieve pain. LILT has gained recognition for its ability to stimulate cellular function and support tissue repair.

Understanding Low-Intensity Laser Therapy (LILT)

LILT involves the application of low-intensity laser light to targeted areas of the body. The laser emits specific wavelengths of light that interact with cellular structures, triggering various biological responses. This therapy is typically painless, non-invasive, and free from significant side effects, making it a safe and effective treatment option.

The Research Behind Low-Intensity Laser Therapy (LILT)

  1. Cellular Stimulation and Regeneration: LILT works on a cellular level by enhancing cellular metabolism and promoting the production of adenosine triphosphate (ATP), the energy currency of cells. This increase in ATP production fuels cellular processes and accelerates tissue repair and regeneration. Research suggests that LILT can stimulate the growth of new blood vessels, enhance collagen synthesis, and promote the formation of new tissue.
  2. Anti-inflammatory Effects: LILT has been found to possess anti-inflammatory properties. It can reduce the production of pro-inflammatory cytokines, decrease edema (swelling), and modulate immune responses. By mitigating inflammation, LILT helps to alleviate pain and promote the healing of injured tissues.
  3. Analgesic Effects: LILT can provide effective pain relief by interacting with nerve cells. It inhibits the transmission of pain signals by modulating nerve cell activity and reducing the release of pain mediators. This makes LILT a valuable treatment option for individuals with acute or chronic pain, including musculoskeletal conditions, neuropathies, and postoperative discomfort.

Benefits of Low-Intensity Laser Therapy (LILT) for Different Health Problems

  1. Musculoskeletal Conditions: LILT has shown significant benefits for various musculoskeletal conditions, such as arthritis, sprains, strains, and sports injuries. It can alleviate pain, reduce inflammation, improve joint mobility, and accelerate the healing of damaged tissues.
  2. Wound Healing: LILT has been utilized to promote wound healing in both acute and chronic wounds. The therapy stimulates the formation of new blood vessels, enhances tissue oxygenation, and promotes collagen synthesis. It can accelerate wound closure, reduce the risk of infection, and minimize scar formation.
  3. Neurological Disorders: LILT holds promise for various neurological conditions, including neuropathic pain, peripheral nerve injuries, and stroke rehabilitation. By stimulating nerve cell activity and promoting neuroregeneration, LILT may help improve nerve function, reduce pain, and enhance neurological recovery.
  4. Dermatological Conditions: LILT has shown benefits for several dermatological conditions, including acne, psoriasis, and dermatitis. It can reduce inflammation, promote tissue repair, and enhance the effectiveness of topical treatments. LILT may also help improve skin tone and reduce the appearance of scars.
  5. Oral Health: LILT has been utilized in dentistry to promote oral health and treat various conditions, including gum disease, oral ulcers, and temporomandibular joint disorders (TMJ). It can reduce pain and inflammation, stimulate tissue healing, and accelerate post-surgical recovery.

Light Affects Molecules

In LILT, Red (633nm) and infrared (830nm) have different effects on molecules. Red (visible) light can produce chemical changes while infrared radiation can only produce physical changes in molecules. In spite of this, both result in clinical improvement.

Visible light enhances cell proliferation through photochemical changes in the mitochondria, which then set in motion a chain of biological events that ultimately, affect cellular membranes. This, in turn, has an effect on messenger RNA synthesis, which ultimately leads to the observed enhancement of cell proliferation.

Pores in membranes open and close to let ions, such as calcium, in and out of cells as a consequence of physical changes in the membrane pore molecules. Calcium ions act as intracellular messengers in many signal-transducing pathways. The cellular calcium ion concentration can be abruptly raised for signaling purposes by transiently opening calcium channels in the plasma or intracellular membranes.

The catalytic activities of many enzymes are regulated by the calcium concentration. Since infrared radiation affects the physical state of molecules, it can affect the pore molecules directly. Thus, a similar effect on cell proliferation can occur whether the cells were irradiated with visible light at 633nm or infrared at 830nm.

Specific types of molecules absorb specific wavelengths of light, both visible and infrared. Absorbed radiation produces specific biological effects in tissue, depending upon which types of molecules absorb the light (Karu, 1998).

Trelles et al reviewed the use of local irradiation with LILT. They found this approach elicited the following types of effects: bio stimulatory, analgesic, anti exudative, antihaemorrhagic, anti-inflammatory, antineuralgic, antioedematous, antispasmodic and vasodilatory (among others).

Trelles, et al, (1989) and Muxeneder, (1988) also reviewed the effects of LILT on vertebral pain, headaches, and local immune responses. They found the main clinical uses included wound healing, pain control, soft tissue injury, arthropathy and osteopathy, and treatment of existing scars. They observed local irradiation stimulated extremely rapid healing, even of extensive indolent superficial wounds. It was considered effective and safe. Scarring was minimal.

According to Mester, et al, (1985) and Muxeneder, (1988), the effects of LILT on wound healing are dramatic. They stated, “Many irradiated septic wounds heal as if by the first intention”.

Clinical Studies

Numerous clinical studies, and this author’s experience as a team physician for a nationally ranked college hockey program, all indicate that swelling and inflammation in superficial muscles, tendons, ligaments, bursae, and sheaths can be alleviated by irradiation of the affected areas. In arthropathy and osteopathy, mid-range lasers can alleviate pain swelling, and inflammation of accessible joints, especially if the primary sites are irradiated. Initially, the effect was thought to be anti-inflammatory, but recent work has shown that LILT enhances the inflammatory process and allows the body to reach the healing stage much faster. It is also effective in pain control and resolution of osteitis and periostitis in superficial areas. It was (and still is) preferable to ultrasound in these conditions as the latter can only heat bones, potentially causing damage.

Old scars (surgical or traumatic) can act as trigger points if there are tender areas, keloid formation, and adhesions along the scar. Such scars can be associated with chronic, reflex pain, lameness, and autonomic effects. LILT of such tissue can produce dramatic clinical improvement in most cases.

The earlier lasers were “powered” by gases such as Helium and Neon (He-Ne). It was not until the 1980s that semiconductor diode systems became available. The most popular of these for clinical use is the gallium arsenide (GaAs) and the gallium aluminum arsenide (GaAlAs). These superluminous diodes are mounted into a “treatment head” for easy application. The emitted light includes far and near ultra-violet, the visual spectrum, and near, mid, and far infrared.

In LILT, nothing happens unless the tissue absorbs the photons (bundles of light). In the therapeutic near-infrared range absorption takes place in the tissue water (about 70%) and organic molecules (about 30%). For this purpose, absorption may be defined as the conversion of light into some other form of energy. Once absorbed, the photons have different effects on amino acids, nucleic acid bases, and other groups called chromophores. The former is the basis for DNA and proteins. The latter involves porphyrins, which are bio-organic molecules (hemoglobin and melanin are examples).

Another factor in the photochemical action of LILT is attenuation, or how much light is lost as it travels through tissue. This depends upon the ratio between absorption and scattering. This ratio varies according to the type of tissue irradiated and the wavelength applied. Where light absorption is low, (600 – 1200 nm), scattering predominates. In human tissue, scattering tends to be in a forward direction.

Considerable cellular research concerning laser irradiation has been done since the 1970s. At that time the focus was primarily on wound healing due to the great clinical success using LILT. For obvious reasons, the studies related to this involved observing the actions of fibroblasts, lymphocytes, monocytes/macrophages as well as epithelial and endothelial cells.

All studies exhibited positive effects on the healing mechanisms involved with the cells being tested, either by stimulation or inhibition. As a result, one could explain why wounds heal faster with LILT. However, the exact mechanism is still unknown; The effect on the patient and how it affects healing is, however, known. What remains unknown is the exact mechanism by which light causes these photochemical reactions.

Pain Relief

Of at least equal importance (more so for the practitioner) is the role of LILT in pain relief. This, more than wound healing, results in the, ”too good to be true” attitude within the American medical community. After all, EVERYONE knows the only ways to relieve pain are by medication and surgery. If these don’t work, psychotherapy is the last alternative.

However, since 1986 world-respected researchers have recommended LILT for such use (Seitz & Kleinkort 1986; Zhou Yo Cheng 1988; Woolley-Hart 1988; Kert & Rose, 1989). In addition, clinicians around the world, based on their professional experiences, confirm the analgesic effect of LILT.

Unfortunately, from a strictly scientific point of view, these reports are hardly conclusive. There has been little or no standardization in the application of LILT. The type of laser used, the wavelength, contact or non-contact mode, length of treatment as well as skin color, age of the patient, and body type are all variables that can affect outcomes. As a result, the majority of reports concerning the efficacy of LILT have been considered anecdotal. A great many of those were reported in foreign languages, which often resulted in obscuring information during the translation.

Another major obstacle involves the subjectivity of pain. The very nature of pain is such that there is no truly scientific way to measure it. Also, some people have higher or lower sensitivities. They also react differently to having it (victim vs. survivor). On almost a daily basis, pain sensitivity can vary depending on physical, chemical, and/or emotional factors.

In spite of these limitations, the number of clinicians and patients who report significant analgesia from LILT has grown dramatically. Whether or not we know exactly why, LILT is proving to be a very valuable modality in the treatment of pain. In fact, clinicians using LILT and other forms of electrotherapy consistently report the clear superiority of the former. In a growing number of instances, it is now used as the first treatment of choice for pain. Perhaps even more important is the fact that, to date, there has never been a report of a serious, long-term negative side effect attributable to this procedure.

The list of painful conditions treated with LILT is extremely impressive. In fact, clinically it would be easier to list conditions on which LILT does not work. Even then, failure is not outright. It is more appropriate to say that the percentage of success in some patients, with some conditions, is lower. These conditions include spinal stenosis, where there is direct bony pressure on a nerve(s), reflex sympathetic dystrophy, and advanced neuropathy.

In addition, a “permanent cure” is difficult to achieve if a structural component exists. A reasonable analogy is having a motor vehicle that pulls toward the right side of the road when the driver is trying to go straight. If the right front tire is not flat, there is probably a misalignment of the vehicle’s front end. The driver might not want to spend the money to get it aligned (perhaps the lease is up very shortly). Instead, they lower the air pressure in the left front tire to the point that the car drives straight. Problem solved! The symptom goes away. Unfortunately, they will have to purchase two new front tires every three thousand miles (5000km) or so. Thus, structural problems demand structural corrections. If there is a misalignment in a person’s hips, spine, or extremities, there is constant irritation to the soft tissue components of those areas. It can feel better with LILT, but permanent healing will be extremely difficult to achieve. When this is the case, concomitant structural correction (manipulation) and LILT result in rapid, complete recovery.

Following is a list of conditions that clinically and invalid research, have been treated with a very high rate of success:

  • CERVICAL PAIN FACIAL PAIN (INFLAMMATION)
  • TRIGEMINAL NEURALGIA TRIGGER/TENDER POINTS
  • HEADACHE/MIGRAINE TENDONITIS
  • SCAR TISSUE CARPAL TUNNEL SYNDROME
  • ROTATOR CUFF INJURY EPICONDYLALGIA
  • SHOULDER JOINT PROBLEMS EPICONDYLITIS
  • COSTOCHONDRITIS NEURALGIA
  • CHONDROMALACIA PATELLA HIP JOINT PROBLEMS
  • TIBIAL COMPARTMENT SYNDROME PLANTAR FASCIITIS
  • ARTHRITIS/ARTHRALGIA BURSITIS
  • CAPSULITIS FRACTURES
  • HEMATOMA HERPES ZOSTER (SHINGLES)
  • MYALGIA/FIBROMYALGIA NERVE ROOT/TRUNK PAIN
  • ACUTE AND CHRONIC LOW BACK PAIN ACROMIOCLAVICULAR JOINT DYSFUNCTION
  • TEMPOROMANDIBULAR JOINT PATHOLOGY

Included in the above list are sports-related injuries experienced by “weekend warriors”, and college and professional athletes.

After a double-blind clinical trial conducted by General Motors Corporation using LILT for Carpal Tunnel Syndrome, the company has established laser treatment facilities in all of its manufacturing plants.

While the neurophysiological effects of pain have been studied in both animals and humans, no major recent studies have been completed recently. The latest review was by Basford et al, 1990. Overall, the findings were inconsistent and even contradictory with human subjects. However, once again, there was no standardization. It does appear that the use of He-Ne lasers at low doses (less than 1 J/cm squared) would consistently have no appreciable effect on nerve conduction latency.

The Arrant-Schultz Law (Baxter, (1997); Ohshiro & Calderhead, (1988) may explain the inconsistent findings of researchers. It is to photobiological activation what the law of diminishing returns is to economics. Basically, it says there is a threshold amount of energy (laser light) that is required to effect a change in cellular activity. This amount varies with individuals. When the dosage is increased above the threshold (relatively little), the degree of cellular biological activity also increases. When the dosage increases further, above a certain level (variable), a plateau effect occurs. There is simply no increase in cellular activity. When the dosage is increased above the plateau level, there is an inhibitory effect on the cells. Using this model as justification, many experts in the field of LILT contend that it is not possible to “overdose” with laser treatment.

Low-Intensity Laser Therapy has been clinically proven to be superior to all other forms of pain therapy. In comparative applications, it has worked better than medication, ultra-sound, electrotherapy, heat, ice, etc. It also does not have some of the severe side effects, as do other forms of treatment.

LILT is not a “magic wand”. It is a medical device that promotes rapid healing and pain relief. This is a PROCESS, not an on/off switch. However, millions of patients have been helped when no other form of treatment has worked.

Laser therapy also dramatically reduces healing time when compared to other traditionally used modalities. Hospitals in Great Britain use LILT in post-surgical recovery rooms. They have found patients have much less pain, take 50% less pain medication, heal in half the time, and have significantly less scar tissue. To those of us who have been privileged to use this technology, our patients’ permanent recoveries are not only believable but also expected.

In this author’s opinion and experience, the most superior form of low-intensity laser therapy is via the BioFlex computer-driven laser instrument, produced by Meditech International, in Toronto, Canada. Besides dozens of pre-set protocols (see the partial list above), it can also accommodate customized protocols. All parameters can be altered to truly individualize each treatment. Even such things as age, skin color, and body type can be considered when choosing the appropriate amount of light exposure. Once chosen, it is calculated automatically.

Another of the unit’s most unique features is the “Flex” part of the name BioFlex. The treatment heads can wrap around joints (knee, elbow, wrist, etc.), delivering light through either 60 or 180 superluminous diodes. This author, while treating almost 4,000 patients, found that the BioFlex was clearly superior to the other laser devices he used previously.

The author expresses his deepest gratitude to Dr.G. David Baxter, Director of the School of Social and Health Sciences and Education, University of Ulster, Ireland. I relied heavily on his genius and research.

Everyone interested in adding Low-Intensity Laser Therapy to his/her practice MUST read Dr. Baxter’s book, “THERAPEUTIC LASERS, THEORY AND PRACTICE”, Churchill Livingstone, 1997. It is the most authoritative, well-documented and readable text on this subject. If this author could impose such a standard, this text would be required reading before embarking on the use of this wonderful technology.

Conclusion

Low-Intensity Laser Therapy (LILT) has emerged as a valuable therapeutic modality with wide-ranging benefits for various health problems. By stimulating cellular function, promoting tissue repair, reducing inflammation, and relieving pain, LILT offers a non-invasive and safe treatment option. Its applications span from musculoskeletal conditions and wound healing to neurological disorders and dermatological conditions. As with any medical treatment, it is essential to consult with a qualified healthcare professional experienced in LILT to determine its suitability for your specific condition and receive appropriate treatment guidance.

Videos to watch:

Introduction to Low Light Laser Therapy (LLLT)

Low-Intensity Laser Therapy

Low Laser Treatment of Sports Injuries

Low Laser Treatment of Neck Pain

Low Laser Treatment for Oral Mucositis

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