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June 2005

Joe Kleinkort

Rehab Management recently spoke with Joe Kleinkort about low-level laser therapy (LLLT). Kleinkort is executive vice president of WorkSTEPS Inc, Austin, Tex; senior rehabilitation consultant for Lockheed Martin, Bethesda, Md; and president of the pain management special interest group of the orthopedic section of the American Physical Therapy Association.

Q: Tell us about some recent developments in LLLT.
A: The FDA is finally approving certain types of LLLT. I started using it and writing about it in the late 70s, and it’s taken until now for the FDA to approve it; it’s a big step in the right direction. Most therapists still aren’t very aware of it because it’s not being taught much in school since it wasn’t FDA-approved until now. With the approval, it might be taught again. Most therapists do not know anything about it even though they are licensed to do it.

Q: What are some of the benefits of LLLT?
A: Laser is efficacious, simple, and quick. It produces rapid results so that you can move on to other rehabilitation needs. First, users should know that there is laser, then there is LED, and photostimulation, which are all slightly different. Laser has colimitation and divergence, and is a specific waveform, whereas LED does not have colimitation so there are some different properties that happen physiologically with the tissue.

One of the most interesting things that certain types of laser do is that it can laser muscle tissue, and one of the biggest side effects of that is the stimulation of mitochondria to increase production of ATP—you can take a grade 3 or 4 muscle, and immediately in 30 to 90 seconds, turn it into a grade 5 muscle strength. You can significantly alter muscle strength, unless you have an orthopedic condition that hampers that from happening.

Q: What industry challenges does LLLT face?
A: Reimbursement issues. Some insurance companies don’t pay for it, some do. Because there are different types of laser therapy, there are different types of results and outcomes. For example, there is one laser type that is in the 630 nm range, and there is another laser in the 830 nm range. In the FDA studies, the 630 took about 3 minutes to get results of significance, whereas the other took three times a week for 5 weeks to get results. So, there’s a lot of confusion within insurance companies, because in some cases you can solve a problem in as little as four or five treatments, but other cases may take weeks and weeks.

Q: What is the future for LLLT?
A: I think that LLLT will be widely accepted and it will become a commonly used modality. It will significantly alter the amount of time that people have to experience certain pains, and it will certainly be one of the main choices in wound healing. With more work being done on frequencies, pulsing, and various wavelengths, we’ll get even better results than today.

Laser is just another tool, not a panacea, but it’s one of the most powerful tools that a therapist can possibly ever utilize to modulate pain and return people to activities of daily living quickly. It is a must for any physical therapist doing wound healing or pain management.

—By Arati Murti

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