L.A.S.E.R. stands for Light Amplification by Stimulated Emission of Radiation. Laser Therapy involves the application of low-intensity laser light to relieve pain caused due to the damage of soft tissue. It facilitates tissue repair and restores normal cell function. It is used by experts to heal wounds and pain. The level of light is quite low as compared to other forms of Laser Therapy, such as those used to destroy tumors and coagulate tissues.
CLASSIFICATION BASED ON AEL (Accessible Emission Light)
· Class1- incapable of producing damaging radiation levels
· Class2- power visible lasers (400-700nm wavelength,1nW)
· Class3- medium-power lasers need eye protection
· Class4- high power lasers(more than 500nW)
· Surgical lasers
· Hard lasers
· Thermal lasers
· Energy (3000-10000 Mw) lasers
· Medical lasers
· Soft lasers
· Sub thermal lasers
· Energy 1-500 mW lasers
· Therapeutic (cold) lasers produce a maximum output of 90mW or less
· 600- 1000nm light
High power lasers
High-power lasers are known as hot lasers because of the thermal response they generate. They are used in surgical cutting, coagulation conditions, destroy tumors and coagulate tissues.
Low power lasers(Cold LASER)
Low power lasers act according to the Arndt-Schulz principle which states that if a stimulus is too weak, no effect is seen. Increased stimulation and optimal dose lead to the optimal effect, while further dose increase leads to a decreased effect and furthermore increase leads to inhibition of stimulation is also known as photobiomodulation, used in wound healing and pain management. Low laser is a pain-free, non-invasive method. It has the properties of monochromaticity (same color), collimation (all rays are parallel to each other and do not diverge significantly even over long distances) and coherence (all the light waves are in phase both spatially and temporally).
This procedure is generally safe, effective and non-invasive to use. Although you will feel the laser device touching your skin but the procedure is painless, no vibration or heat is felt. The non-thermal photons of light that are emitted from the Laser, pass through the skin layers. Once the light passes through the layers of the skin and reaches the target area. The body tissue then absorbs the light and initiates a series of events in the cell resulting in the healing of damaged or injured tissue, reduction in pain and inflammation, and an overall reduction in healing time by increasing intracellular metabolism.
The laser has therapeutic effects which help to:
· Reduce pain
· Increases ATP (Adenosine Triphosphate) which accelerates the repair process of the cell. Some molecules that increase inflammation are reduced and beneficial antioxidants are increased.
· Faster wound healing. Laser Therapy is effective on open wounds also.
· Recovery from nerve injury Reduces aches and pains by decreasing nerve sensitivity.
· It reduces the formation of Fibrous/Scar tissue. It also improves the vascular activity in the body.
· Promotes bone and cartilage formation
Most commonly used lasers
Helium-neon (He-Ne) In this laser, a mixture of helium gas and neon is used in a pressurized tube. This creates a laser in the red portion of the electromagnetic spectrum with a wavelength of 632.8nm.
Gallium arsenide (Ga-As) It uses a diode to produce an infrared invisible laser at a wavelength of 904nm. Diode lasers are composed of semiconductor silicon that is cut and layered. An electrical source is applied to each side and lasing action is produced at the junction of the two surfaces. The surfaces function as partially reflecting surfaces that produce coherent light. This laser is given in pulsed form because of the heat produced by it.
Preparation of the patient skin
The skin to be treated is cleaned to lower the skin resistance. Gels sprays or water is applied to the skin to lower the resistance
Calculation of doses
The tissue dose is expressed by energy density measured in Joules per cm2. Produced energy is obtained by multiplying the laser output power in milliwatts by exposition time in seconds. For e.g. irradiation area is 0.5cm2, 2 J is divided by 0.5cm2. The time of exposure and the dose becomes 4J/CM2.
The dose is most affected by the size of the laser probe, a slim probe will result in high doses of joules per cm2, but this does not mean that energy applied on the tissue is high, although the intensity of the light the energy emitted at the end of the slim probe is high, but not the dose in the depth
Depth of penetration
He-Ne laser energy: Absorbed rapidly in the superficial structures, especially within the first 2-5mm of tissue. The He-Ne has an indirect effect on the tissues up to 8-10mm.
GaAs laser energy: Ga-As laser which has a longer wavelength is directly absorbed in tissues at depths of 1-2cm and has an indirect effect up to 5cm.
Contact technique: Gas is only given for trigger points and around wounds
Non-contact technique: For He-Ne and Ga-As for healing of wounds and for stimulation of wound beds.
With broad-ranging benefits, LASER Therapy is appropriate for a lot of treatment plans. Some of them are:
· General Chronic Pain
· Shoulder impingement
· Pelvic Dysfunction
· Osteoarthritis of the knee, hip, and ankle
· Hip or shouder bursitis
· Eye: Laser beams should not reach the eyes, therefore use of spectacles is necessary
· Cancer: Do not use it over the cancerous part of the body.
· Epileptics: Do not use in epileptic patients.
· Pregnancy: The laser rays should not reach the fetus.
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