April 2006

Laser Therapy's Evolution

By C.A. Wolski

A growing number of clinicians are discovering the benefits of laser therapy as a modality for pain management.

Mano Borg-Pappas, PT, has used lasers for a number of therapeutic purposes for more than 20 years. Over this time, she has seen the evolution of lasers in therapy gain wider acceptance. Borg-Pappas is a physical therapist at Scottsdale Physical Therapy, Scottsdale, Ariz. She recently discussed why she uses laser therapy, its history, and talked about some recommendations to therapists looking to add the modality to their practice.

Rehab Management (RM): Why did you start using laser therapy?

Mano Borg-Pappas: I first got interested in "cold" [or low level] laser for pain management in relation to scar tissue, edema, pain control, and wound healing, because lasers are a noninvasive form of acupuncture. The other factor that contributed to the purchase of [my first] laser—and its continued use—is the fact that there have been no adverse side effects found, and patient response has been positive. Pain relief is immediate and longer lasting with a single treatment compared to more traditional modalities.

RM: What are the most common conditions for the use of the laser?

Borg-Pappas: In my practice, I find the laser effective in treating acute and/or chronic pain. It tends to work faster on the more acute injury, but is still effective on chronic pain and/or scar tissue. I have used it for wound healing, and know of other therapists who have used it in neurological rehabilitation. However, I do not treat neurological patients in my practice, and I have not used it for this purpose.

RM: How do you determine which frequency is best for the patient?

Borg-Pappas: In the early 1980s, I was limited to using just one frequency on all types of injuries, but with the development of new lasers, I can now use four frequencies simultaneously. Researchers have determined that different cells within the body respond to different photonics. That is why I can treat an acute sprain and visibly see edema and pain decrease and the patient's range of motion and strength increase. I rely on researchers to provide the protocol that they have found to be the most effective for different pathologies.

RM: How does laser therapy work, and why is it efficacious?

Borg-Pappas: The laser affects the mitochondria, parts of cells that enhances the production and synthesis of adenosine triphosphate, and releases endorphins. Much of today's research revolves around finding why the laser works [to heal tissue].

RM: How was it determined that the laser would be a good modality for rehabilitation and medical conditions?

Borg-Pappas: When you can do a muscle test and change the strength within 30 seconds to a couple of minutes while decreasing pain, it makes one a believer. As I have already stated, you can see a decrease in edema in a matter of minutes. Wound healing is another condition that has dramatically changed between visits, and immediate results by increasing circulation are evident. Europeans have been utilizing the cold laser for healing diabetic ulcers since the 1960s. The key to success is to keep the wound debrided so that it heals from the inside out.

RM: Laser therapy was originally reviewed not to be effective. Why the change?

Borg-Pappas: In the 1970s, researchers were overenthusiastic and undercontrolled, according to the articles I have read. The laser is not a magic wand and should not be used on just the area of injury. The practitioner should also treat the myotomes to help reestablish the nerve pathways and muscle memory.

RM: Is there any reason you would not recommend laser therapy?

Borg-Pappas: The only reason would be pregnancy. Guidelines have not yet been established as to whether there would be any effect on the developing fetus. The other questionable area has been treatment for those with a cancer diagnosis, yet I have used the laser to help control pain from chemotherapy with good results.

RM: Do you see the laser as an adjunct or primary therapy for the conditions it does treat?

Borg-Pappas: In the case of acute pain from a sprain, I think it is primary. Wound care is also primary. In the case of chronic pain/scar tissue pain, the patient will have developed postural deviations to accommodate the pain, plus tight/weak muscles. In these cases, it is an adjunct to exercise.

RM: How has the equipment changed over the years? Is it more compact, better quality, more diverse?

Borg-Pappas: You can purchase lasers in all sizes, shapes, and wave lengths, so I do not feel it has changed much in this regard. The big change I have seen in the past 20 years is the ability to use different frequencies simultaneously, plus research has shown specific wavelengths to be more beneficial in healing.

RM: Please describe the equipment that is used.

Borg-Pappas: The piece of equipment that I use is battery operated, and weighs a little more than 3 pounds.

RM: Can you describe a typical treatment?

Borg-Pappas: Treatment protocol depends on whether the pain is acute and/or chronic, and if, upon evaluation, it is determined whether the patient has gait deviations and/or balance issues. I also evaluate the patient to determine the source of pain/weakness, and treat the myotome for the affected area as well as the area of injury. I have also found the use of auricular therapy to be beneficial. Treatment time varies from 30 seconds to 15-20 minutes, depending on the involvement.

RM: What are some of the new conditions you see laser therapy treating in the coming months or years?

Borg-Pappas: Dermatologists, dentists, and orthopedic surgeons are using the cold laser to control edema and pain, as well as promoting healing pre- and post-operatively. I [think it would be interesting to study] what laser could do for acute spinal cord injuries to decrease edema.

RM: How do you think the equipment will change in the next decade or so?

Borg-Pappas: I do not know how the equipment will change unless it would be to make it smaller, as well as lighter, but I hope with more research we will have new protocols for treating other diseases. Some therapists have experienced good results in improving the Parkinson's gait, with the results lasting for 1 week following one treatment.

RM: What is the biggest stumbling block in acceptance of the laser by clinicians?

Borg-Pappas: The fact that you feel nothing during the treatment as it does not heat [the affected area] nor does it cause a muscle contraction. I actually had a patient—who is also a physician—comment that the treatment was "voodoo," as he could feel nothing except his pain go away. Needless to say, the [he still] comes to my office [for laser therapy] after he [sustains an injury].

RM: If you were recommending equipment to a department that could afford only one laser therapy device, what would you tell them?

Borg-Pappas: I think a hospital or rehabilitation unit would be interested in portability, so a battery-operated laser would be ideal. For frequency requirements, I would recommend a unit that has more than one diode so that you can use different frequencies simultaneously, which will cut down on treatment time. I think it is also important to remember that different tissues absorb photonic energy differently.

The advances made in the past 20 years, especially in the United States, in the development of the low level laser have made this modality a very effective tool in pain management, wound care, and rehabilitation. If you are a clinician who can see outside of the box, I highly recommend you do the research necessary to make an informed decision to add this piece of equipment to your practice.

C.A. Wolski is a contributing writer for Rehab Management.

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