11/19/2014 David Zuckerman, DPM
Musculoskeletal Laser Recommendations (Joe Grillo, DPM)
Here are some important facts with
references. Power density as well as substained
delivery of energy determines the therapeutic
outccome both short-term and most importantly
long-term. My personal experience as well as
observing thousands of podiatric cases has shown
the following detailed information below.
Facts:
1. Not all lasers are the same. The laser
mentioned in this article is a CLASS 3 laser,
commonly referred to as a "cold laser", or a "low
level therapy laser"; or a "low power laser".
Laser Classifications come from the FDA and are
determined by power level and eye safety,
FDA website link: http://www.fda.gov/radiation-
emittingproducts/radiationemittingproductsandproce
dures/homebusinessandentertainment/laserproductsan
dinstruments/default.htm
2. The Current Trend in Laser Therapy
The authors of "Laser Therapy- Clinical Practice
and Scientific Background" a book considered
worldwide to be the authority on laser therapy,
Dr. Jan Tun’er and Lars Hode, have performed an
analysis of a number of frequently cited studies
on the effects of low-power-laser therapy.
Selected Quotes:
In many of these studies, analysis uncovered one
or more reasons for the negative findings
reported, the most common being the use of
extremely low doses.
The trend in laser therapy for the past 10 years
has been to increase power density and dose, since
this has been shown to improve therapeutic
outcomes considerably.
There is no point in increasing the dose if the
wavelength has a low penetration factor; the
penetration of the particular wavelength must be
taken into account.
For the moment, we must rely on our own clinical
experience. That experience, however, is so
encouraging that it cannot be ignored, even with
lack of scientific support. It would appear that
“high powered” therapeutic lasers will be able to
further expand the scope of laser therapy.
I can see two alternatives: to speak up and start
a conflict within the laser community, maybe
discrediting the therapy itself in the eyes of the
general public or to keep quiet and let U.S.
practitioners pay a lot of money for very low-
powered lasers, leaving us with dissatisfied
customers and discredit from those who are
supposed to use laser therapy in medicine.
3. Insurance Determination: CLASS 3 Therapy Lasers
Are Not Effective
While the FDA has approved the marketing of the
device, many payers have declined to provide
recognize LLLT as effective treatment.Results of
treatment have not been consistent so that it is
difficult to state that such treatment would be
necessary. Last, given the reported number of
visits required to be nine to 12 visits, the cost
of such treatment would be approximately $1000 to
$1500. These costs appear to be somewhat
unreasonable for a treatment that has not been
demonstrated in the medical literature to be
effective.
Source: Position Paper on Low Level Laser Therapy
(LLLT) 12 pages
Ohio Bureau of Workers’ Compensation Website Link
-
https://www.bwc.ohio.gov/downloads/blankpdf/Positi
onLaserTherapy.pdf
Aetna considers cold laser therapy experimental
and investigational because there is inadequate
evidence of the effectiveness of low-energy (cold)
lasers in wound healing, pain relief, or for other
indications such as musculoskeletal dysfunction,
arthritis, and neurological dysfunctions.
Source: Aetna: Clinical Policy Bulletins, Number
0363, Subject: Cold Laser Therapy
4. Class IV Therapy Lasers: The Next Generation
of Laser Therapy
The laws of laser physics have demonstrated that
the higher the wavelength, the deeper the
penetration. Penetration is paramount in order to
stimulate deep musculoskeletal, vascular,
lymphatic, and neurological structures.
If Class III lasers are therapeutically
ineffective, it is because of insufficient energy
or dosage, combined with poor penetration.
Characteristics of Class IV Therapy Lasers.
Class IV lasers offers better therapeutic outcome,
based on six characteristics of this new
technology:
Larger dosages of therapeutic energy
Class IV lasers can deliver up to 1,500 times more
energy than Class III and consequently reduce
treatment time.
Deeper penetration into the body
Leading Class III lasers only penetrate 0.5-2.0
cm2. Class IV can penetrate up to 10 cm2.
Larger treatment surface area
Class III cover a treatment area of 0.3-5.0 cm2,
depending on the model and manufacturer. Class IV
cover up to 77 cm2. This is important when
treating large regions, such as the lumbar spine,
quadriceps or hips.
Greater power density
Power density indicates the degree of
concentration of the power output. This property
has been shown to play a major role in therapeutic
outcomes.
Continuous power supply
In Class III lasers, the power is pulsed or
modulated approximately 50 percent of the time. In
other words, light is permitted to pass through
the probe for only 50 percent of the total
operating time.
In most cases, Class IV lasers deliver a
consistent amount of energy over a given time.
Their power can be adjusted for acute and chronic
conditions.
Superior fiber optic cables
Fiber optic cables transmit laser energy from the
laser to the treatment probe (wand) at the end of
the cable. Several studies reveal that as much as
50 percent of the light energy generated by a
Class III laser may be lost by the time it reaches
the end of the probe.
Not all lasers are equal. Opening a laser therapy
Center can change the way you practice, but you
get what you pay for and in order to get the best
outcomes for MS conditions, you need a Class four
laser with high power out put.
David Zuckerman, DPM, Cherry Hill, NJ
