laser ii nd bpt_3rd class

8/13/2019 Laser II Nd BPT_3rd Class

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Laser :

Clinical Applications in Physiotherapy

Amitesh NarayanProfessor

Dept. of Physiotherapy

KMC Mangalore


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Difference between Laser and Ordinary Light


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Types of Lasers

Based on the intensity the laser is divided into 2 types

- Hot Lasers (High intensity):

Generates heat and destroys the selected tissue and

used for making surgical incisions and cauterize duringsurgical procedures.

- Cold Lasers (Low intensity , PD =50mW/cm,ED


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Low Level Laser and Surgical Laser:Comparision


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Laser: Penetration in Tissues


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When a laser beam projected to tissue

reflection,

transmission,

scattering,

re-emission,

absorption.

Five phenomena takesplace:

Laser light interacts with tissue

and transfers energy of photons

to tissue because absorption

occurs.


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Laser: Tissue absorption and Penetration


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Impact of Laser on the Tissues


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Low Level Laser and Surgical Laser:Comparision


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Laser: Thermal Effects

Temperature Biological effect 37C Normal 45C Hyperthermia 50C Reduction in enzyme activity,

cell immobility 60C Denaturation of proteins and,

collagen,coagulation 80C Permeabilization of membranes 100C Vaporization thermal

decomposition ablation) > 100C Carbonization > 300C Melting.


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How Laser Works?


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Laser: Biostimulativeeffects


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Physiological Effects of Low Level Laser Therapy

Improved blood circulation & vasodilation: Increases blood supply.

Increase collagen production: Develops collagen & muscle tissue

Increase macrophage activity: Stimulates immune system

Alter nerve conduction velocity: Stimulates nerve function.


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Increases ATP production

Bio stimulation: Improved metabolism, increase in cell metabolism-

Increases speed, quality & tensile strength of tissue repair.

Analgesic effect- Relieves acute/chronic pain.

Anti-inflammatory & anti-edematous effects- Reduces inflammation.


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Stimulation of wound healing:

Promotes faster wound healing/clot formation

Helps generate new & healthy cells & tissue.


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Laser: Short Term Effects

Production and release of beta-endorphins: (morphine like substances

produced by various cells in the body that inhibit the sensation of pain).

Cortisol production is increased (cortisol is the precursor of cortisone):

This enables the body to combat the stress associated with trauma or the

disease process.

Short-term effect is significant in 5-10% of cases during or after the conclusion of the

initial treatment, but is not as important as the long term or cumulative effect.


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Laser: Long Term or Cumulative Effect

ATP (adenosine triphosphate) production: increases

resulting in improved cellular Metabolism.

DNA (deoxyribo-nucleic acid) production; protein building block of

tissue is substantially increased.

Facilitation of Neurotransmission: due to elevated levels of

serotonin and acetylcholine.


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Stimulation of Mitochondrial activity: resulting in cell replication

etc. (i.e. replacement, regeneration and repair of abnormal cells).

Modulation of macrophages, fibroblasts and other cells .

Angiogenesis(formation of new blood vessels).


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Regulates cell membrane potential: essential in Na, Cl and K ion

transfer (electrolyte balance).

Release of Cytokines and other chemicals: enhancing cellular

communications.


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Laser: Other Effects

Stimulation of immune responses.

Improved Lymphatic drainage.

Histamine response is positively altered.

Production of growth hormone is increased.

Enhances bodys natural healing processes areenhanced.


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Laser: Tissue healing


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Orthopedic Application of

Laser: No operative

Pain management.

Fractures: enhancement of union.

Burn healing

Wound care.

Healing Heel fissures.

Plantar fascitis management.

Fungal nail correction.

Arthroscopy (all types)


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Orthopedic Application of Laser:No operative

Neurogenic Pain

Herpes Zoster

(Shingles)

Fibromyalgia

Post Traumatic Injury

Diabetic Neuropathy

Trigeminal Neuralgia

Radiculitis

Sciatica

Management of gout.


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Orthopedic Application of

Laser: No operative Acute & Chronic Joint Problems:

Osteoarthritis

Rheumatoid Arthritis

Ligament & Tendon injuries

Chondromalacia Patella.


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Orthopedic Application of Laser:No operative

Chronic Back & Neck Pain

Reduction of Inflammation:

Metatarsalgia.

Brachial Neuralgia.

Plantar Fascitis.

Frozen Shoulder.

Carpal Tunnel syndrome.


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Treatment Techniques

Gridding Technique Divide treatment areas into grids of square centimeters

Scanning Technique No contact between laser tip in skin; tip is held 5-10

mm from wound

Wandering Technique A grid area is bathed with the laser in an oscillating

fashion; distance should be no farther than 1 cm from

skin

Point Application (Acupuncture point)


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During the treatment..,

Maintain laser perpendicular

to treatment surface

Firm contact unless open

wound

Clean area prior to treatment

Begin with minimal treatment

and gradually increase

Check for pre/post-treatment

changes

10 minute max. treatment or 60

Joules

Place probe on treatment area.

Maintain constant contact with

the skin.

Do not bathe the area with the

probe


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Dosage

Dosage (D)

Amount of energy

applied per unit area

Measured inJoules/square cm (J/cm2)

Jouleunit of energy

1 Joule = 1 W/sec

Dosage is dependent on:

Output of laser in mW

Time of exposure in

seconds Beam surface area of laser

in cm2

Various dosage ranges

per site (1-9 J/cm2


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Recommended Dosage

Therapeutic response = 0.001-10 J/cm2

Minimal window threshold to elicit response

Too much

suppressive effect

Open wounds0.5-1.0 J/cm2

Intact skin

2.0-4.0 J/cm2

Average treatment6J /cm2


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Laser: Contraindications

Do not radiate the eye directly

During pregnancy

Photosensitive subjects

Direct irradiation to the eyes

Within 4 to 6 months after radiotherapy

Hemorrhaging regions

Locally to the endocrine glands


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Precautions

Epilepsy

Fever

Malignancy

To the lower back of

abdomen during pregnancy

or mensuration

Embryo or fetus

Confused or disoriented

patients

Areas of decreased sensation

Epiphyseal lines of children

Infected tissue

Sympathetic ganglia, vagus

nerves or cardiac region in

patients with heart disease


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Considerations

Better to underexpose than to overexpose

May experience a syncope episode during treatment

during chronic pain, but very rare If icinguse BEFORE phototherapy

Enhances light penetration

If using heat therapy

use AFTERphototherapy

Decreases light penetration

laser ii nd bpt_3rd class

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