What Is Laser Treatment?

The Clinical Effects of Low Level Laser Therapy (LLLT)

What is LLLT?

How does LLLT work?

The Clinical Effects of Low Level Laser Therapy (LLLT)

An appropriate dose of light can improve speed and quality of acute and chronic wound healing, soft tissue healing, pain relief improve the immune system and nerve regeneration. Applications with good RCT evidence include Venous Ulcers, Diabetic Ulcers, Osteoarthritis, tendonitis, Post Herpetic Neuralgia (PHN, shingles) & postoperative pain.

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What is LLLT?

LLLT, or Low Level Laser Therapy as it is often called, is the application of red and near infra-red light over injuries or lesions to improve wound / soft tissue healing and give relief for both acute and chronic pain. First developed in 1967, it is now commonly referred to as LLLT.

LLLT is used to: increase the speed, quality and tensile strength of tissue repair; give pain relief; resolve inflammation; improve function of damaged neurological tissue and often used as an alternative to needles for acupuncture.

The red and near infrared light (600nm-1000nm) commonly used in LLLT can be produced by laser or high intensity LED. The intensity of LLLT lasers and LED's is not high like a surgical laser. There is no heating effect.

The effects of LLLT are photochemical (like photosynthesis in plants). Red and near infrared light can affect cell membrane permeability and aid the production of ATP thereby providing the cell with more energy which in turn means the cell is in optimum condition to play it's part in a natural healing process.

LLLT devices are typically delivering 10mW - 500mW (0.2 -> 0.01 Watts). The power density typically ranges from 0.05W/Cm2 -> 5 W/Cm2.

LLLT is popularly used for soft tissue injuries; joint conditions, chronic pain, non healing wounds and ulcers, post-op pain and acupuncture.

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How does LLLT work?

Like photosynthesis - the correct wavelengths and power of light at certain intensities for an appropriate period of time can increase ATP production and cell membrane perturbation could lead to permeability changes and second messenger activity resulting in functional changes such as increased syntheses increased secretion and motility changes. Red and near infrared light seem to be the most ideal wavelengths.

Red light acts on the mitochondria and near infrared light on the mitochondria and at the cell membrane. In in-vitro and animal LLLT wound healing studies comparing wavelengths, red consistently is more effective. Shorter wavelengths are not so good, expensive to produce and with poor penetration they are a poor choice. Near infrared light whilst not quite as good do penetrate better than the red wavelengths and are available in higher powers and at low prices. According to live in-vivo experiments at Uniformed Services University Bethesda Maryland (a US military research centre) 810nm is the best penetrating wavelength. It also happens to work well in LLLT nerve regeneration studies they are doing.

Clinical Effects of LLLT

An appropriate dose of light can improve speed and quality of acute and chronic wound healing, soft tissue healing, pain relief improve the immune system and nerve regeneration. Applications with good RCT evidence include Venous Ulcers, Diabetic Ulcers, Osteoarthritis, tendonitis, Post Herpetic Neuralgia (PHN, shingles) & postoperative pain.

To paraphrase NASA research:

"Low-energy photon irradiation by light in the far-red to near-IR spectral range with low-energy (LLLT) lasers or LED arrays has been found to modulate various biological processes in cell culture and animal models. This phenomenon of photobiomodulation has been applied clinically in the treatment of soft tissue injuries and the acceleration of wound healing. The mechanism of photobiomodulation by red to near-IR light at the cellular level has been ascribed to the activation of mitochondrial respiratory chain components, resulting in initiation of a signaling cascade that promotes cellular proliferation and cytoprotection."

"A growing body of evidence suggests that cytochrome oxidase is a key photoacceptor of light in the far-red to near-IR spectral range. Cytochrome oxidase is an integral membrane protein that contains four redox active metal centers and has a strong absorbance in the far-red to near-IR spectral range detectable in vivo by near-IR spectroscopy."

"Moreover, 660-680 nm of irradiation has been shown to increase electron transfer in purified cytochrome oxidase, increase mitochondrial respiration and ATP synthesis in isolated mitochondria, and up-regulate cytochrome oxidase activity in cultured neuronal cells."

"LED photostimulation induces a cascade of signaling events initiated by the initial absorption of light by cytochrome oxidase. These signaling events may include the activation of immediate early genes, transcription factors, cytochrome oxidase subunit gene expression, and a host of other enzymes and pathways related to increased oxidative metabolism."

"In addition to increased oxidative metabolism, red to near-IR light stimulation of mitochondrial electron transfer is known to increase the generation of reactive oxygen species. These mitochondrially generated reactive oxygen species may function as signaling molecules to provide communication between mitochondria and the cytosol and nucleus."

Therapeutic photobiomodulation for methanol-induced retinal toxicity.

Proc Natl Acad Sci U S A. 2003 Mar18; 100(6): 3439-44. Epub 2003 Mar 07.

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What are the benefits of LLLT?

Below are a few Abstaracts of double blind clinical studies demonstrating the positive effects of LLLT. More abstracts can be viewed on our LLLT Research page.

Pain Scores And Side Effects In Response To Low Level Laser Therapy (LLLT) For Myofascial Trigger Points

E Liisa Laakso Carolyn Richardson, and Tess Cramond

1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, University of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.

A double-blind, placebo-controlled, random allocation study. 41 subjects, chronic myofascial trigger points in the neck and upper trunk region, five treatment sessions over a two week period, All groups demonstrated significant reductions in pain over the duration of the study.

Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, (Queensland, Australia, 4029.

6/97 Rep. US $8-10-12 copyright 1997 by LT Publishers, , U.K.' Ltd. Manuscript received:January, 1997 Accepted for publication: March, 1997

LASER THERAPY. 9: 67-72 67

Two wavelengths studied.

Best results with the higher powered infrared laser compared with the lower powered red laser.

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Diode Laser (LLLT) in Cervical Myofascial Pain: A Double-Blind Study versus Placebo

* F. Ceccherelli, * L. Altafini, * G. Lo Castro, * A. Avila, *F. Ambrosio, and * G. P. Giron

*Institute of Anesthesiology and Intensive Care, University of Padua, and the Associazione Italiana per la Ricerca e, l'Aggiornamento Scientif co, Padua, Italy

Double-blind, pulsed infrared, treatment of myofascial pain in the cervical region. 27 subjects, 12 LLLT sessions, alternate days, at each session the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated with 1J. Pain was monitored using McGill pain questionnaire andScottHuskisson visual analogue scale, pain attenuation in the treated group and a statistically significant difference between the two groups of patients, both at end of therapy and at the 3-month follow-up examination.

Address correspondence and repent requests to Dr. F. Ceccherelli at the Istituto di Anestesiologiae Rianimazione, via C. Battisti 267, 35121 Padova, Italia.

The Clinical journal of Pain 5:301-304 copyright 1989 Raven Press, Ltd., New York

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Low Level Laser Therapy (LLLT) Of Tendinitis And Myofascial Pains A Randomized, Double-Blind, Controlled Study

Mimmi Logdberg-Anderssont1, Sture Mutzell2, and Ake Hazel3

1: Akersberga Health Care Centre, 2: Danderyd University Hospital, Danderyd, and

3: Vaxholm Health Care Centre, Stockholm, Sweden.

A double-blind study, laser therapy for tendinitis and myofascial pain,176 subjects, 6 treatments during a period of 3-4 weeks.Pain estimated objectively using a pain threshold meter, and subjectively with a visual analogue scale. Laser therapy had a significant, positive effect compared with placebo. Laser treatment was most effective on acute tendinitis. 

Addressee for Correpondance, Sture Mutzell, Danderyd University Hospital 5-182 87 Danderyd, Sweden.

03/07 Rep US 10-12-14 , 1997 By LT Publishers, U.K., Ltd., LASER THERAPY, 1997:9: 79-86

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