Chapter Title Section

The Science of Laser Therapy and

Clinical ApplicationsMay 2012

Greg Bewsh

GENERAL HYPOTHESIS FOR LOW LEVEL LIGHT THERAPY

Laser Light is able to excite molecules, thus,

� is directly able to stimulate or amplify cellular pathways

or mechanisms that support healing

�can re-activate systems or processes that have been de-

activated as a result of injury or pathology.

WHY LASER?

� Increased treatment efficacy over other modalities

� Increase clinic revenue by adding valuable new clinic

service

�Ability to penetrate tissue = effective to treat deep

seated injuries

� Fulfill patients’ requests for laser therapy

� Excellent adjunct to chiropractic treatment

� Effective and fast- no gels or pads to apply

� Staying competitive, value added service

HUMAN CELLS

“Engine of the Cell”

KEY CELLULAR PATHWAY 1

1.ATP Pathway:

Activated by 630-670 nm, Visible Red Light

Light sensitive molecules within the

mitochondrial membrane are activated by red

light. These molecules are integral components

of the electron transport chain and their

activation leads to increased production of ATP.

Cytochrome c oxidase has been identified as a

key integral membrane protein activated by

laser light.

BEST TO ACTIVATE 3 KEY CELLULAR PATHWAYS TO STIMULATE RAPID HEALING

KEY CELLULAR PATHWAY 2

2. Nitric Oxide Pathway:

Activated by 905 nm, Near Infrared Light

Nitric oxide signals endothelial cells to relax, leading to

increased dilation of blood vessels and lymphatic vessels.

Dilation of blood vessels inc. blood flow

Dilation of lymph vessels inc. drainage/dec. swelling

905 super pulsed light increases nitric oxide levels by

700% compared to other wavelengths and technologies.*

(*Published in Lasers in Surgery and Medicine 03/2009)

KEY CELLULAR PATHWAY 3

3. Lipid Absorption Pathway:

Peak activation in the 900 nm range, Near Infrared

Light

•Light receptors in bi-lipid membrane of cells are

activated by near infrared light.

•Activation of these receptors opens channels within

the membrane, altering the flow of Na+ and K+ ions

across the membrane.

•This change in electron gradient across a nerve cell

can stop the propogation of impulses across the cell

and remove pain signals.

900 nm range laser light are able to remove pain

signals emitted at source of pain.

0

20000

40000

60000

620 720 820 920 1020

Wavelength (nm)

Molar Extinction Coefficient (cmM^-1)

Water Lipids

LASER DRIVE TECHNOLOGIES

Super Pulsed: High peak power (50 W) laser diodes delivered in bursts of very short duration (200 nanoseconds) at high frequencies (10 kHz). Provides high number of photons without any heat.

Pulsed, Chopped or Pseudo Wave:Continuous wave laser diodes or LEDs which are either electronically (pulse train) or mechanically (shutter) to pulse at low frequencies (100 Hz to 1 kHz). Usually delivered at 50 / 50 duty cycles effectively cutting average power in half.

Continuous Wave: Continuous wave laser diodes or LEDs which have a set output power.

LASERS VERSUS LIGHT EMITTING DIODES

THERAPEUTIC WINDOW

THERAPEUTIC LASER PARAMETERS

WAVELENGTH: Wavelengths between 600-950 nanometers can create therapeutic (biostimulation) effects.

Wavelength and power determine how deep the light will effectively penetrate into the tissues

660 nm red light penetrates up to 0.25” per penetration depth into tissue

905 nm infrared light penetrates up to 0.42” per penetration depth into tissue

Combine 2 wavelengths of light for increased tissue healing & activation of multiple cellular pathways required for healing.

POWER: Power of the laser determines the rate at which photons travel into tissue. Higher power delivers a larger quantity of photons to tissue over time, thus achieving the required energy in a shorter period of time.

High peak powers are able to deliver high doses of photons to the tissue surface without exceeding the Maximum Permissible Exposure (MPE) of tissue.

Conditions Treated

ACUTE INJURIES

• sports injuries

• motor vehicle accidents

• tendon tears, muscle tears

• ligament sprains

• fractures

• meniscus tears

• labrum tears

• contusions/hematomas

Conditions Treated

CHRONIC INJURIES

• RSIs: Carpal Tunnel

• Nerve Root Irritation

• Facet/capsular irritation

• Compartment syndrome

• Myofascial syndromes

• Chronic Inflammatory Conditions: tendonitis

• Bursitis, myositis, synovitis

DEGENERATIVE CONDITIONS

• Osteoarthritis• Chondromalacia• Degenerative Disc Disease• Disc herniation

WOUND MANAGEMENT

• Ulcers: diabetic,

pressure

• Venous insufficiency

• Post-operative

wounds/scars

WHO IS USING COLD LASER THERAPY AND WHERE?

Therapeutic lasers are used by various healthcare providers in

outpatient clinics across North America and Europe, including:

�Medical Doctors and Specialists

�Pain Clinics

�Chiropractors

�Physical Therapists

�Dentists

�Podiatrists

�Naturopaths

�Nurses

�Veterinarians

HOW OFTEN DO I NEED TO TREAT?

The latency period of light into tissue is 24 to 72 hours; therefore, the most often you

would treat is every day and the least often is once every four days.

The number of treatments depends on the chronicity of the condition, typically:

Acute Injury: 4-6 treatments (Average 5 treatments)

Subacute injury : 8-12 treatments (Average 10 treatments)

Chronic Injury: 15-25 treatments (Average 20 treatments)

Frequency : 3 days in a row, then 3 times per week for the first 3 weeks,

followed by 2 times per week thereafter dependent on the

number of treatments

BENEFITS OF THERAPEUTIC LASER THERAPY

• Decrease / eliminate pain

• Reduce inflammation

• Stimulate new tissue growth (muscle/tendon

tears)

• Promote new blood vessels (angiogenesis)

• Promote nerve axon growth (neuropathies)

• Faster wound healing and closure

• Non-Invasive / No Side Effects

• Extremely Safe / Drug Free

• Few contraindications – eyes, cancer, pregnant abdomen, thyroid gland.

• Safe over implants, pacemakers, growth plates.

TREATMENT-LATERAL EPICONDYLITISLaser Settings 60 mW, 2.5 minutes per point

Treatment Points Treatment with multiple probe over extensor tendon and extensor muscles

(2-3 treatment points).

Patient Position Seated with arm extended

# Treatments Depends on chronicity

Acute Injury: 4-6 treatments

Subacute injury : 8-12 treatments

Chronic Injury: 15-25 treatments

Frequency 3 days in a row, then 3 times per week

Treatment Goals Eliminate pain

Remove inflammation

Reduce healing time by up to 50%

OSTEOARTHRITIS OF THE KNEES

Laser Settings 50 mW, 3 minutes per point

Treatment Points Treatment with multiple probe over 4

locations around the knee. Treat over

painful areas and arthritic locations:

medial/lateral joint lines, peripatellar,

posterior knee.

Patient Position Seated with knee at 30 degrees flexion

(open joint position)

#Treatments 15-25 treatments (chronic injury)

Frequency 3 days in a row, then 3 times per week

Treatment Goals Reduce Pain

Stimulate tissue repair

Increase activity level/function

OSTEOARTHRITIS OF THE KNEES

Knee @ 30 deg. flexion to open joint space

SCIATICA Laser Settings Settings change with treatment

location (due to depth of injury):

Lumbar Spine 90 mW, 3 minutes

Buttock 80 mW, 3 minutes

Posterior Thigh 70 mW, 2 minutes

Posterior leg 70 mW, 1 minutes

Treatment Points Treatment with multiple probe

over involved Spinal level then

distal points in buttocks and lower

extremities (chase the pain).

Patient Position Side or prone with flexed lumbar

spine (open joint position)

Treatment Goals Eliminate pain / Inflammation

Repair Injured nerves

Stimulate repair of paraspinal

muscles and discal tissue.

MARKETING FOR LASER SERVICES

• In office marketing, handouts, talking about new treatments in the office,

patient brochures, posters, video streaming in reception area

• Patient newsletter announcing new laser technology in clinic

• Offer a free treatment

External:

• Community lectures, paper or radio advertising, sporting events (i.e. set up

treatment booth at marathons, races)

• Word of mouth referrals from satisfied patients

• Have a social media presence

Internal :

BILLING FOR LASER

1. Average Billing Fees for Laser ($30 to $140 per 10 minute treatment)

2. Sample CPT codes:

97026 Infrared

97026-22 Attended Infrared

97039 Attended Infrared/Attended laser (include 1 page description)

97110 Therapeutic Exercise : In patients who are unable to perform therapeutic exercise due to pain, use the laser 7 - 10 min. then have the patient perform therapeutic exercises minimum 8 minutes (minimum to bill CPT 97110).

i.e. Bill $0 for the laser and $30 to $40 per unit of therapeutic exercise (dependent on insurance provider) where 1 unit = 8 to 22 minutes, 2 units = 23 to 37 minutes

3. Many clinics charge cash only for laser treatments.

4. Extended Health Insurance

RETURN ON INVESTMENT

Practitioners bill $30 to $140 per 10 min. treatment

($3 to $14 per minute, Average of $4.50 per minute)

Practitioner assistants administer 100 to 300 patients treatments per month

(Average of 200 laser treatments per month)

Average Monthly Revenue: $9,000 incremental

Cost of Equipment: $10,000 TO $18,000

ROI (annual): 514 %

Payback Period: 2 to 6 months (depending on the laser configuration)

RETURN ON INVESTMENT

WHAT TO LOOK FOR IN A LASER MANUFACTURER

Evidence based: Look for a laser manufacturer which uses technology and protocols

based on solid clinical research by a team of clinical and scientific researchers and the

feedback of thousands of health care clinics worldwide.

Clinical Research: Look for a laser manufacturer who uses on-going, cutting-edge clinical

research from major teaching hospitals, universities and research institutions.

Advisory Board: Look for a laser manufacturer with a medical and scientific advisory

board chaired by renowned medical practitioners and scientific researchers .

Results Driven: Look for a laser manufacturer with 100,000’s patients successfully treated,

with 1000’s of therapeutic lasers in the field to ensure protocols deliver efficacy, safety

and quality

World Class Manufacturer: Look for a laser manufacturer with FDA, Health Canada, CE,

ISO-13485 and CSA-601 regulatory approvals to ensure efficacy, safety and quality in

manufacture.

THERALASE THERAPEUTIC MEDICAL LASER

• Dual wavelength 660nm & 905nm super

pulsed laser system

• High peak power - up to 4” depth

• Short Treatment Times (10 minutes)

• Class 3B Laser – extremely safe

• FDA , Health Canada and CE cleared -

chronic knee pain & neural muscular skeletal

conditions

• Clinically supported and used by thousands

of practitioners Portable / battery operated /

Hands free

• 72 Pre-Programmed Treatment Protocols

• 3 different probes available

THERALASE TLC-1000 TESTIMONIALS“The Theralase laser is the most effective technology we have ever used. Our players now

rely on Theralase to keep them healthy and playing at their peak.”

George Poulis and Dave Abraham, Toronto Blue Jays, Athletic Trainers

“The Theralase laser is now a standard of care treatment methodology within our rehab

clinics and is a great tool in helping our athletes return to competition.”

James Andrews, MD, Andrews Institute, Orthopedics and Sports Medicine, Florida

“I love the Theralase medical laser system and use it in our clinic at least 20 times per day.”

Kevin Wilk, DPT, Champion Sports Medicine, Sports Medicine, Alabama

“As a chronic pain specialist, the most advanced laser I have used is the Theralase

therapeutic laser system, with which I have treated over 1000 patients.”

Dr. Laurence Altshuler MD, Balanced Healing Medical Center, Oklahoma

“I use the Theralase laser to keep my throwing arm healthy. It reduces fatigue and allows

me to play at my peak, game after game.”

Roy Halladay, Cy Young Award, Toronto Blue Jays, 2003, Philadelphia Phillies, 2010

CONCLUSION

� Increase efficacy of your chiropractic care. Spinal adjustments have longer lasting effects with laser enhanced tissue repair.

� Expand your range of treatment services.

� Offer a non-invasive, safe and comfortable treatment option to patients.

� Increase your revenue stream .

� Choose a technology with the optimal wavelengths, power, and ease of operation .

� Choose a treatment that patients are asking for.

� Practice Growth - Laser patients often become chiropractic patients or refer others.

� Sports injuries are having great success with laser. High profile athletes using laser has increased exposure of the modality.

Questions?

THANK YOU FOR ATTENDING

www.theralase.com