The use of cold lasers also know as low level lasers can be approached from an
Acupuncture perspective as well as from a “site of injury” or anatomical
perspective. Personally I prefer a blend of the two and I change the mix depending
on the patient. Whether you choose to use one, the other, or both is up to you.
I believe it is imperative that once we are comfortable with the laser that we
use a simple method to communicate our cold laser treatment plan to a capable
CA, just like we might with ultrasound, etc. I use a full-page blank human line
drawing for that purpose. Most of the time I use the laser wand with five true
pulsed lasers (three 635nm 5mw Class 3A and two 808nm 150mw Class 3B) set at
12hz. with a 30 second timer so I write a small number (1, 2, etc) in the
location I want treated, the number = the number of times to push the button
and a line under the number (1, 2, etc) means to leave a
little air gap between the laser and the skin, this lowers the “dose” for the
more sensitive patient.
Laser Dosage is measured in Joules and there are two dosages to consider. One
is “Total Body Dose” and two is dosage to a specific joint or body area. The
World Association of Laser Therapy states that between 100 and 200 J is the total
body dose we don’t want to exceed in one treatment or it could exacerbate our
patient’s condition. In about 6 hours you can treat again. Skin color and type
is an important factor to consider in treatment. Older or very frail or thin
skinned patients and also really light skinned sensitive patients could max out
at as little as 30% of the stated numbers, inversely a very dark skinned person
could need double the stated treatment, err on the side of caution. The frail
and light skinned can experience a form of burn from a powerful laser. Another
consideration is prescription meds that are “photo reactive”, they will cause
the patient to “burn” very easily. I have no list of these drugs but if they
are advised to stay out of the sun because of some RX med then assume that a
635nm 5mw is the only laser to use on them. The five true pulsed lasers (three
635nm 5mw Class 3A and two 808nm 150mw Class 3B) set at 12hz. puts out about
9.45 J per button push (30 sec), that’s 5-10 button pushes (30 seconds each) or
2.5 to 5 minutes for a total body dose treatment. Really you can do a bit more,
the large area of any wand style applicator actually decreases the laser power
density (mW/cm2) but that’s more than were trying to cover here and 3-5 minutes
should be plenty of time with the wand, you would double that if using a single
808nm 150mw laser tip.
Now that all that is out of the way lets discuss the use of the “laser wand” on
general tissues, and some acupuncture points used for different conditions.
Remember, the single 808nm 150mw laser or the single 635nm 5mw laser can also
be used in the same ways as I discuss about the wand type laser, just double
the times provided. You want to do the math (on the human line drawing sheet is
a good place) and document the dose you treat a patient with and include it in
the patients file. Another thing is the WALT
Chart , it should be printed and in your files so you can point to it in
case you ever run into a problem with over “dosing” or “burning” a patient.
I make it a practice to keep a box of fold top sandwich bags in each treatment
room and use them to cover any laser tip or wand for sanitary purposes and I
usually put the wand or tip against the patients skin to maximize the effect on
the tissue plus it makes reflection less of an issue. Patients usually present
with spinal subluxation/degeneration, I believe that when combined with the
adjustment the laser helps the subluxation heal faster. I often find myofascial
restrictions and/or trigger points as well. You can use the laser before or
after you adjust but if you’re doing soft tissue work laser AFTER you’re done.
GENERAL TX and SPINE TX:
When the complaint is of pain I begin by treating the lower cervical ganglia
that is anterior to the C7 TVP on the side of the complaint for 30 sec to 1
minute, if there are multiple complaints I might treat both sides for 30 sec or
even a minute. Stay away from the thyroid gland please! Now if the problem is
joint pain like a knee, shoulder or hip I would likely go to that joint next
and treat it as shown on this chart
http://www.walt.nu/images/stories/files/dosage-table-780-860nm.pdf
I then do the laser treatment at the involved spinal level (posterior aspect)
and treat with the wand for 30 sec - 1 minute in the center of the spine then
move out toward the involved side (or treat bilaterally) about the width of the
laser wand out so that I’m over the spinal nerve root area/facet and treat that
for an additional 30 sec to 1 min per side. This basic treatment is for a
primary subluxated level that I’ve reported to the patient, the same type
treatment can be applied to any/all levels of the spine. Keep in mind the Total
Body Dose per visit. If there is a broad problem area I will treat the levels
just above and below in a similar way and possibly even the opposite side also.
Then I will move out to the involved extremity for problem areas like muscle
spasm or trigger points and treat them.
MUSCLE/TENDON/LIGAMENT/NERVE:
When dealing with sprains/strains and/or nerve irritation keep the laser moving
rather than letting it sit still. Covering the entire involved area slowly in a
“spray painting” sort of fashion, while still against the skin. You can just
rotate the wand within the baggie so it moves around a little. This applies the
anti-inflammatory effect of the laser (therefore it decreases pain) Keeping the
laser stopped on one spot could possibly begin to generate heat in the soft
tissues and overtreatment of one specific spot could decrease its
effectiveness. This “spray painting” method is also used for neuropathy and
phantom limb pain, just “spray paint” the nerve pathways for 30 sec to 2
minutes depending on the size of the area. For both neuropathy and phantom limb
pain please also treat the corresponding auricular points. As for trigger
points, treatment should be 1-4 J per trigger point and you probably need a single
808nm 150mw to get to a small area.
JOINTS:
The WALT
Chart gives specific dosages and the number of points to treat according to
the World Association of Laser Therapy. Generally you’re still thinking along
the same lines. Treat the involved joint, treat the pathway of the involved
nerve(s), treat the involved spinal level and treat the auricular point(s)
related to the condition.
ACU-POINTS:
As we discuss treatment of a “point” we are now talking about using either an
808nm 150mw a 635nm 5mw or possibly a 650nm 50mw. When treating acu-points I
usually begin at the spine by treating the general area of the spine where the
nerve roots exit that possibly have a relationship to the complaint. In the
neck or low back I commonly treat between each spinous process (Du Meridian)
for 2-3 levels above and below the level I believe to be the culprit, then I
treat the Hua To Points (1/2 tsun out from center and between each spinous)
again treat 2-3 levels above and below the offending, subluxated area. Finally
I treat any Associated Points on the Bladder meridian that are within a few
levels up or down. I treat each level regardless of whether I’ve seen it in an
acupuncture point manual. I learned this concept from Dr. Amaro a long time ago
and it works! You want to apply between 0.5 - 2 J per acupuncture point.
OTHER POINTS:
I find LI 4, ST 44, & ST 43 seem to help reduce pain in general. To relax
the stressed out, decrease headaches and sometimes even blood pressure I use GV
20, the Four Points located 1 tsun anterior, posterior and lateral to GV 20 on
top of the head, HT 7, BL 62, & Auricular - Shen Men, Tranquilizer Point
and Muscle Relaxing Point. To increase the energy levels of “lethargic”
patients I’ve had success with CV 6, CV 8, ST 36, & SP 6.
OTHER CONDITIONS:
We see patients with every condition known and most neuro-musculo-skeletal
complaints will respond to the low level laser. Most conditions are treated
with a “common sense” approach. For example it makes sense that you would treat
a fibromyalgia patient by using the laser on the tender “fibro” points. But If
you think about it you will also recognize fibromyalgia as a condition that
also requires you to cut the dose down to 30% of normal in the beginning of
treatment so with only 30-60 Joules to “spend” where will you treat and for how
long? If the wand is your only laser you might think about an air gap to
decrease the dose and you could count 1 Mississippi, 2 Mississippi in your head
and adjust the time down to 5-10 seconds per tender point then remove the laser
or move it quickly to the next point so it isn’t overtreating the patient. By
my calculation I could now treat all 18 points and still have a little time left
for the anterior C7 ganglia before reaching 50 J, but that might still be a
little to much. You could also simply use the 635nm 5mw laser and “spray paint”
each point for a minute or so. That keeps the dosage down so you see how the
patient responds to care and you’re sure not to exacerbate the fibro. Then you
can use the wand for the Ant C7 spot.
That’s the way I approach any condition so you don’t need a manual a foot thick
with pictures and exact cook book like recipes - you’re the doctor and you know
things like, the referred pain patterns trigger points present with and where
the trigger points are that refer, treat the trigger point and the referred
pain will likely respond.
Neuropathy is another one but it has another aspect. Obviously you would think
of “spray painting” the entire affected limb, right? Now follow the nerves
pathway and “spray” it all the way up the limb to the cord level. Then go to
the ear and treat the auricular point for the area. If you don’t have a small
laser tip for auricular points (you could call and get one) or you can use an
inexpensive microcurrent type point locator/stimulator. To summarize: we
treated the area of the complaint, the pathway of the involved nerve, the
involved cord level and I usually include the entire spine protocol here - Du
points, Hua To points & Associated points for about 5 levels, involved + 2
above and 2 below.
For something like TMJ dysfunction do whatever you do other than laser then
treat the Tempomandibular joint inself, the general jaw muscle area and the
temporalis muscle above the ear. Here is an example of a time it is good to
have more than just the laser wand because the TMJ is a tiny joint and a small
treatment area sometimes calls for a small treatment tool. Apply according to the
TMJ on the WALT
Chart but treat the muscles too in addition to the TMJ.
Do NOT overtreat at the base of the skull with the wand. The occipital nerves
are very sensitive.
One final thought for patients with multiple complaints. Just like in
Chiropractic care, treating the primary problem is most likely to offer relief
and give the patient relief for a longer period of time. With that said don’t
overlook what appears to be a secondary condition because sometimes that’s
really the problem. Be careful not to get caught up in treating so many things
you end up overtreating one of the more sensitive conditions and making it
worse. Remember any laser treatment affects the WHOLE BODY.
As a starting point try this chart from the website of the World Association of
Laser Therapy http://www.walt.nu/images/stories/files/dosage-table-780-860nm.pdf
As you can tell that chart offers you a guideline for muscles/tendons as well
as specific recommendations for most joints and you have a standardized guide
to determine your own treatment plans. As far as maximum doses are concerned
the two 808nm 150mw's in the wand are 300 mW total whereas the three 635nm
5mw's lasers total 15 mW. So with the wand you are really treating two of the
points with a lot of energy every time you push the button; for this reason, I
recommend you mark your wand so you know where the two infrared lasers are
located without looking at it during operation. You want to aim into the
“openings” of the joint, then you can move the laser wand around during
treatment so as to continue to aim into joint, while you simultaneously have
the patient moving the joint through its ranges of motion the best they can,
this allows you to get to all different angles to treat the joints. You can
also rotate the wand head while it is still against the skin in the plastic bag
if necessary.
With the single 808nm 150mw you can direct your treatment a little more
specifically to the “openings” and that can really make a difference on small
joints where you have to get the treatment done with a really low number of
Joules. Finally, if you need to decrease the density (mW/cm2) of the treatment
you can just use “air”. Just like x-rays need more MAS at 72 FFD the laser
loses density if it isn’t against the skin. Where it says max 100mW/cm2 you
could lower the density of your laser wand or single 808nm 150mw laser tip by
simply holding it where it is just a millimeter or two from touching the skin.
Thank you for reading this far down, your patients will benefit and pay you
well!
Sincerely,
Charles Dixon, DC, FASA, Chandler, TX
Disclaimer:
This document represents treatments “I’ve” done in practice but you are
completely responsible for any treatment you decide to offer, as well as your
compliance with your state laws and your treatment decisions for patients. I have
no knowledge about the exact building or marketing processes of any cold laser
product and I make no representations that I do. I use the cold lasers I bought
from http://ColdLaserTherapy.us in
practice every day and with great results, how you use it is your own
responsibility. Obviously everyone in any treatment room must wear laser
goggles approved for the wavelength of the laser being used.