TheraLase Therapeutic Laser

 

TheralaseTM Inc. designs and manufactures high quality therapeutic medical laser systems for the safe and effective treatment of acute and chronic pain, musculo-skeletal conditions and wounds.
Theralase has designed and manufactured therapeutic medical lasers in conjunction with our European facility since 1975. Theralase has sold thousands of therapeutic medical laser systems to medical practitioners around the world over the last 30 years.
Patients suffering from a wide range of musculo-skeletal conditions, such as acute and chronic pain, work related injuries, strains, sprains, sports injuries and wounds can all benefit from the safe and effective Theralase laser treatment.
TheralaseTM provides Healing at the Speed of LightTM
 
NOW FDA APPROVED.

 

FDA Approval

Low Level Laser Therapy (LLLT) has been in use for over 30 years in Europe and other countries with high levels of success. 
The FDA has now recognized the safety and efficacy of the Theralase TLC-1000 high power therapeutic laser system for commercial distribution into the US market by granting Theralase Inc. FDA approval under 510(k) number K050342. The indications for use, "The Theralase TLC-1000 Therapeutic Medical Laser System is indicated for adjunctive use in the temporary relief of pain associated with knee disorders with standard chiropractic practice." marks the first time that the FDA have approved a high powered laser in the NHN (non-heating lamp or biostimulative laser category) and the first therapeutic laser system that has been FDA approved for knee pain. 
Recognized healthcare practitioners, such as: doctors of medicine (MD), doctors of chiropractic (DC), doctors of osteopathy (DO), doctors of podiatry medicine (DPM), doctors of dental science (DDS), certified athletic trainers (ATC), physical therapists (PT), physician assistants (PA), chiropractic assistants (CA), occupational therapists (OTC), registered nurses (RN) and licenced acupuncturists (L.Ac) are all eligible to purchase and utilize the Theralase TLC-1000 high power therapeutic laser system, who are licenced to practice in their state of residence and in compliance with their scope of practice. 

Applications

Therapeutic lasers work by supplying energy to the body in the form of photons of light and allowing the body to effect its own repairs. Generally speaking, the biostimulating effect of laser therapy is in its anti-inflammatory, analgesic and anti-edematous effect on tissues. There is absolute increase in microcirculation, higher rates of ATP, RNA and DNA synthesis, and thus better tissue oxygenation and nutrition. There is also an increase in the absorption of interstitial fluid, better tissue regeneration and stimulation of the analgesic effect.
Treatable Conditions
Low Back Pain, Neck Pain, Arthritis, Heel Pain, TMJ, Tendonitis, and Chronic Pain Syndromes. A partial list of medical conditions which have responded well to LLLT include:
  • Sports Injuries:
    • Tennis Elbow (lateral epicondylitis)
    • Golfer's Elbow (medial epicondylitis)
    • Runner's Knee (patello-femoral syndrome)
    • Jumper's Knee (patello-tendinitis)
    • Achilles Tendonitis
    • Heel Cushion Pain (plantar fasciitis)
    • Sprains, Strains, Tendinitis
  • Work Related Injuries:
    • Carpal Tunnel Syndrome
    • Back Pain (cervical, thoacic, lumbar, sacral, sacroiliac, bursitis, fibromyositis)
  • Pain Control:
    • Sciatica
    • Radiculopathy
    • Neuralgia
  • Arthritis:
    • Rheumatoid Arthritis
    • Osteoarthritis
Therapeutic lasers have the ability to treat an extensive list of ailments that include but are not limited to:
1.       Ankylosing Spondylitis (inflammation between the vertebrae of the spine and sacroiliac joints)
2.       Buerger's Disease (inflammation of the arteries, nerves and veins in the legs or arms)
3.       Bursitis (inflammation of a bursa (fluid filled pad that acts as a cushion at a pressure point in the body)
4.       Cervical Vertebral Syndrome (pain in the neck joints)
5.       Chondromalacia Patellae (inflammation of the cartilage directly behind the kneecap)
6.       Contusions (bruises)
7.       Diabetic Neuropathy (inflammation of the peripheral nerves between the central nervous system and other organs
8.       Fibromyositis (muscular pain)
9.       Fracture Pain
10.   Frozen Shoulder
11.   Golfer's Elbow (inflammation of the epicondyle (bony prominence) on the medial side of the elbow)
12.   Ischial Pain
13.   Lumbago (lower back pain)
14.   Morton's Metatarsalgia (pain in the metatarsal bones in the foot)
15.   Neuralgia (pain associated by the irritation or damage of a nerve)
16.   Occipital and Trigeminal Neuralgia (severe pain of the trigeminal nerve)
17.   Osteoarthritis (degeneration of the cartilage that lines joints or formation of osteophytes (bony outgrowths)
18.   Otitis Media (inflammation of the middle ear)
19.   Plantar Fasciitis (heel spurs or inflammation of the fibrous connective tissue of the foot)
20.   Post-Operative Pain
21.   Prostatitis (inflammation of the prostate gland)
22.   Radiculopathy (damage to the nerve roots that enter or leave the spinal cord)
23.   Rheumatic Pain and Rheumatoid Arthritis
24.   Sciatica (pain that radiates along the sciatic nerve in the leg)
25.   Sinusitis (inflammation of the sinuses)
26.   Sore Heel Cushion (Heel Spurs)
27.   Sprains
28.   Strains
29.   Tendinitis (inflammation of a tendon)
30.   Tennis Elbow (inflammation in the tendon that attaches the extensor muscles to the humerus)
31.   Tenosynovitis (inflammation of the thin inner lining of the sheath that surrounds a tendon)
32.   Tietze's Syndrome (inflammation of the rib cartilage).
Treatable Conditions
Low Back Pain, Neck Pain, Arthritis, Heel Pain, TMJ, Tendonitis, and Chronic Pain Syndromes.
1.       Cervical Arthrosis
2.       Torticollis
3.       Shoulder pain - posterior
4.       Shoulder pain - anterior
5.       Shoulder Arthrosis
6.       Scapulo-humeral Arthrosis
7.       Frozen shoulder
8.       Post herpetic neuralgia
9.       Dorsal Arthrosis
10.   Lumbar Arthrosis
11.   Tietze syndrome
12.   Intercostal myalgia
13.   Tendonitis
14.   Elbow Arthrosis
15.   Lateral and medial epicondylitis
16.   Raynaud syndrome
17.   Carpal tunnel syndrome
18.   Finger arthrosis

Benefits

Therapeutic Laser Biological Effects
 
  • Rapid Cell Growth - Laser light accelerates cellular reproduction and growth.
  • Faster Wound Healing - Laser light stimulates fibroblast development and accelerates collagen synthesis in damaged tissue.
  • Increased Metabolic Activity - Higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and thus greater production of the basic food source for cells, Adenosine Tri-Phosphate (ATP).
  • Reduced Fibrous Tissue Formation - Laser light reduces the formation of scar tissue following tissue damage from: cuts, scratches, burns or post surgery.
  • Anti-Inflammatory Action - Laser light reduces swelling caused by bruising or inflammation of joints to give enhanced joint mobility.
  • Increased Vascular Activity - Laser light induces temporary vasodilation increasing blood flow to damaged areas.
  • Stimulated Nerve Function - Slow recovery of nerve function in damaged tissue can result in "dead" limbs or numb areas. Laser light speeds the process of nerve cell reconnection to bring the numb areas back to life.
Current Search / Relevant Findings Specific to the Effects of Low Level Laser
Cellular Effects:
  • enhances mast cell degradation (C. Diamantopoulos '94)
  • increased DNA synthesis (Mester et al., '85)
  • enhanced RNA production (Gam '77)
  • increased ATP synthesis within mitochondria (Passarella, '94, Baxter, '94)
  • stimulates phagocytic activity of neutrophils (Piller & Thelander '98)
  • increases macrophage activity (Kitchen & Partridge '91)
  • increase in cell proliferation (Baxter & Diamantopoulos '94)
  • increase in number and degranulation of mast cells (El Sayed & Dyson '94)
  • release of growth factor from mononuclear leukocytes (Shields et al, '92)
  • T-cell and B-cell inhibition (Mester et al, '85)

Tissue Effects:
  • accelerates fibroblast proliferation (Lam '96)
  • increase in fibroplasia (Baxter '94)
  • conversion of fibroblasts into myofibroblasts (Baxter,'94)
  • increase in angiogenesis (Ghali & Dyson, '92, Baxter '94)
  • increased collagen synthesis and deposition (Enwermeka '88, '90)
  • increased lymph vessel diameter (Piller & Thelander '98)
  • accelerates angiogenesis (Ghali & Dyson '92)
  • reduced inflammatory cell infiltration of synovium

Systemic Effects:
  • prevention of traumatic nerve degeneration (Schwartz et al '94)
  • increased in nerve conduction latency, promoting analgesic effect (Baxter et al, '90)
  • reduced formation of scar, hyperkeratotic lesions (Abergel et al, '84)
  • stimulating effect on the formation of callous at fracture site (Kokino et al, '85)
  • accelerates oedema resorption (Piller & Thelander '94)
  • regeneration of capillaries (Maier et al, '90)
  • enhanced collagen synthesis and matrix / tissue remodeling ((Lam '86)
  • reduced response to painful stimuli (Baxter '92)
  • regulator of local tissue inflammation (Palma et al, '91)
  • enhanced tissue repair (Lasers in science and medicine-supplement '92)
  • fracture consolidation accelerated (Trelles & Mayayo, 81)
  • enhances lymphatic and vascular regeneration (Piller & Thelander '94)

Author: Elizabeth Reid, P.T., CAWC, 2002.
Short Term Effects
  • Production and release of beta-endorphins (these are 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
  • The 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.

Long Term or Cumulative Effect
  • ATP (adenosine triphosphate) production is increased resulting in improved cellular metabolism
  • DNA (desoxyribosenucleicacid) production, the protein building block of tissue is substantially increased
  • Neurotransmission is facilitated due to elevated levels of serotonin and aceytylecholine
  • Mitochondrial activity is stimulated resulting in cell replication etc.
  • Modulation of macrophages, fibroblasts and other cells
  • Angiogenesis formation of new blood vessels)
  • Regulates cell membrane potential, essential in NA+, CL and K+ ion transfer (electrolyte balance)
  • Cytokines and other chemicals enhancing cellular communications are released

Other Effects
  • The immune response is stimulated. Higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells and a more effective immune system are induced by laser light.
  • Laser light stimulates fibroblast development in damaged tissue
  • Lymphatic drainage is improved. Laser light activates lymph vessels to allow the affected tissue to drain interstitial fluids, reducing the inflammatory process.
  • Vasodilatation of the circulatory system results in greater oxygen and fuel delivery to the affected area
  • Laser light reduces the formation of scar tissue following tissue damage from cuts, scratches, burns or following surgery
  • Laser light reduces swelling caused by bruising or inflammation of joints to give improved joint mobility.
  • Slow recovery of nerve function in damaged tissue can result in "dead" limbs or numb areas. Laser light will speed the process of nerve cell reconnection to bring the numb areas back to life. Laser light also increases the amplitude of action potentials to optimize muscle action.
  • The histamine response is positively altered. Stimulation of the healing process is accompanied by relief of symptoms
  • Production of growth hormones is increased. Laser light accelerates cellular reproduction and growth.
  • It should be noted that many other positive physiological activities are modulated and extensive research is currently in progress to fully explore these changes.
 

Patient Testimonials

Johnny Grey
Four time Olympian and Medalist (800 meter track and field event)
"The laser helped my pulled quad before racing. Not having the Theralase therapeutic medical laser system for treatment is like Superman forgetting to put on his cape."
Joe Douglas
Santa Monica Track Club Coach
"The Theralase therapeutic medical laser system is one of the best therapies for rehabilitation of athletes that I have ever used. It has helped a lot of my athletes."
Claudette Groenendaul
Two time National US Champion (800 meter track and field event)
"My lower back felt like a big block and I used to hobble around, now with the TheralaseTM therapeutic medical laser system treatments, my back feels so good that I forget about it."
Glen Telfer
Investment Advisor
"Twelve years ago, I was rear ended in a car accident. The whiplash that resulted caused my neck to stiffen over time. I found it difficult to turn my neck from side to side when I drove my car and to look up at the ball when I served in tennis. A business associate gave me the TheralaseTM patient pamphlet, which described: the conditions that the TheralaseTM  laser can treat,  how safe the TheralaseTM laser is and how effective the TheralaseTM laser is. When I read the pamphlet, I learned that not only could I get my injured neck treated, but also the pain from arthritis that was starting in my fingers and knees. From the time that I was treated with the TheralaseTM laser, the pain in my fingers has subsided. After the second or third treatment, turning my neck became more supple and workable. By the sixth treatment, I had no trouble looking up at the tennis ball when I served and most importantly, I felt a lot safer when I drove, because I could turn my neck from side to side. I would strongly recommend the TheralaseTM laser treatments to someone who is suffering from pain, stiffness and restricted movement as a result of  whiplash, arthritis or strenuous activity. "
Randy Bruder
Business Manager
"During a snowmobile accident in December 2002, I fractured my scaphoid (wrist) bone. Initially, my wrist was wrapped in tensors. After 6 weeks, the wrist continued to be very sore and was put in a cast for another 6 weeks. Following the removal of the cast, X-rays showed that the bone had healed beautifully, but the pain had not subsided. Light exercises did not help much. I had lost mobility of the hand and I could not do a single push-up. When accidentally, I put my hand under my pillow, in my sleep, I awoke from excruciating pain. The prognosis I got from the doctors was that it normally takes one year for the scaphoid bone to heal.
In September 2003, a friend suggested that I speak to Theralase, who use a low level laser therapy in their clinic to reduce pain and promote the healing of fractured bones. Even though, I had to drive from Brampton to Markham (60 km), I decided to try this non-invasive, non-thermal treatment. After the 3rd or 4th treatment I started to be able to bend my wrist back. After the 10th treatment, I had regained 90% of the mobility of my wrist. Each treatment was not longer than 5 to 10 minutes and there was absolutely no sensation of heat or discomfort, while I was being treated.
It is now 3 months since I completed the treatments. I have started my regular activities including my push ups. I wish I had started the treatments sooner, because I would not have suffered the pain and lack of mobility of my wrist for so long. I am also told that the healing would have been faster if I had my laser treatments started sooner after the cast was removed. I fully recommend the Theralase low level laser treatment to anyone who has suffered a bone fracture and who continues to be in pain and loss of mobility after the cast has done its job." 
John A. Murphy
"About 12 years ago I fell coming down some steps. As a result of the fall, I dislocated my left shoulder and fractured my lower humerus. The shoulder was splinted from the top of the fingers to the top of the shoulder. After the splint was removed, I had a great amount of physiotherapy and even acupuncture, but the shoulder continued to be achy. I found it difficult to rest my weight on my arm when I sat at my desk. I constantly felt like I carried a 100 lb. weight on my shoulder. I endured the pain and discomfort for 12 years, until recently.
A few months ago, a friend suggested I should try Theralase low level laser therapy. After a consultation by their Chiropractor and Physiotherapist, I received 6 treatments with the 905 nm, 100 mW near infrared laser at the Theralase Pain and Arthritis Centre. By the 6th treatment, my shoulder felt normal. There was absolutely no heat sensation or discomfort during the treatments and the treatments were only a few minutes long.
It has been a couple of months since my last treatment and my shoulder continues to feel just fine. The experience has been like a miracle."

Clinical Abstracts

Low Level Laser Therapy - Positive Outcome Clinical Studies
1.       Wong E. et al. Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality - application of low level laser. Int J Clin Pharmacol Ther. 1995; 33 (4): 208-211.
"The 100 mW GaAlAs laser rapidly alleviated pain and tingling in the arms, hands and fingers."
2.       Sugrue M E et al. The use of infrared laser therapy in the treatment of venous ulceration. AnnVas Surg. 1990; 4 (2): 179-181.
"Infrared laser therapy used in a groupof patients with chronic venous ulcers unresponsive to conservative measures produced a 44% ulcer reduction. The most dramatic effect of LLLT was the reduction of ulcer pain, from 7.5 to 3.5 on a VAS scale."
3.       Simunovic Z, Trobonjaca Z. Treatment of medical and lateral epicondylitis - tennis and golfer's elbow. J Clin Laser Med & Surg. 1998; 16 (3): 145-151. In Low level laser therapy: a multicenter double blind, placebo-controlled clinical study on 324 patients.
"All 324 patients had previously been treated with various methods such as TENS, supersonic vibrations, drugs, and surgery. 82% of the acute patients experienced complete relief of pain and restored functional ability."
4.       Longo L et al. Laser therapy for fibromyositic rheumatism. J Clin Med Surg. 1997; 15 (5): 217-220.
"During a 15-year period 846 patients with fibromyositic rheumatism were treated with LLLT. 66% of the patients benefited from the treatment with regard to local pain, hypomobility and phlogosis."
5.       Wong E et al. Efficacy of low power laser therapy in the pain relief of migraine headaches. Proc Ninth Congress Soc Laser Surgery and Medicine, Anaheim, California, USA: 2-6 November 1991.
"20 patients suffering with migraine or symptoms resembling migraine were treated with a GaAlAs laser. The pain dissapeared after 1-5 minutes."
6.       Gruszka M et al. Low intensity laser therapy on herniated lumbar discs. Laser Surg Med. 1998; Suppl. 10: 6.
"GaAs laser therapy was used on 15 patients with one or more protruded lumbar disc herniations. 100% of the patients were free from pain at the end of the treatment program. Gait and neurological signs improved in all patients. EMGs and CAT scans showed less protrusion of the herniated discs."
7.       Soriano F et al. Low level laser therapy response in patients with chronic low back pain. A double blind study. Laser Surg Med. 1998. Suppl. 10, p.6.
"Ten consecutive LLLT treatment were administered to elderly patients suffering from chronic low back pain. The treatment was effective in 71% of the patients. The pain disappeared completely in 45% of the patients."
8.       Landau Z. Topical hyperbaric oxygen and low energy laser for treatment of diabetic foot ulcer. Archives of Orthpaedic & Trauma surgery. 1998; 117 (3): 156-158.
"Fifty patients with chronic diabetes foot ulcers were treated with topical hyperbaric oxygen alone (15 patients) or in combination with LLLT. 86% of the patients were cured."
9.       Bernal G Helium Neon and Diode Laser Therapy is an effective adjunctive therapy for facial paralysis. Laser Therapy. 1993; 5 (2): 79-87.
"If the laser treatment was begun within two days of the occurance of the injury, treatment with LTTT was successful in 100% of cases, and a maximum of 15 treatments was required."
10.   Laakso E L et al. Plasma ACTH and Beta-endorphin levels in response to low level lasertherapy (LLLT) for myofascial trigger points. Laser Therapy. 1994; 6: 133-142.
"In a double-blind study, 56 patients with chronic pain conditions were treated using LLLT and LED therapies. ACTH and beta-endorphin levels were significantly elevated in the LLLT group but not in the LED group."
11.   Shiroto C et al. Retrospective study of diode laser therapy for pain attenuation in 3,635 patients: Detailed analysis by questionnaire. Laser Therapy. 1989; 1 (1): 41.
"Of the 3,635 patients treated over a period of 46 months, 82.8% regarded the treatment as effective."
12.   Ortutay J et al. Psoriatic arthritis treatment with low power laser irridation. A double blind clinical study. Lasermedizin - Laser in Med Surg. 1998: 13 (3-4): 140.
"87% of the patients in the treatment group had a remission of clinical activity: increased range of movement, decreased joint stiffness and tenderness. In the placebo group, only 20% of the patients improved."
Double Blind Therapeutic Laser Clinical Studies
Diode Laser in Cervical Myofascial Pain: A Double Blind Study Versus Placebo
Ceccherelli F, Altafini L, Lo Castro G, Avila A, Ambrosia F, Giron GP
Institute of Anesthesiology and Intensive Care, University of Padua, Italy.
We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myfascial pain in the cervical region. The patients were submitted to 12 sessions on alternate days to a total energy dose of 5 J each. At each session, the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irridated. Those in the placebo group submitted to the same number of sessions following an identical procedure, the only difference being that the laser apparatus was nonoperational. Pain was monitored using the Italian version of the McGill pain questinnaire and the Scott-Huskisson visual analogue scale. The results show a pain attenuation in the treated group and a statistically significant difference between the two gruops of patients, both at the end of therapy and at the 3-month follow-up.
Pain Scores and Side Effects in Responce to Low Level Laser Therapy (LLLT) for Myofascial Trigger Points
E Liisa Laakso Carolyn Richardson, and Tess Cramond 1: Physiotherapy Department, Royal Brisbane Hospital, Brisbane; 2: Physiotherapy Department, Univeristy of Queensland, Brisbane; and 3: Pain Clinic, Royal Brisbane Hospital, Brisbane, Queensland, Australia.
Clinically, Low Level Laser Therapy - LLLT has been used successfully in the treatment of chronic pain but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled. A double-blind, placebo-controlled, random allocation study was designed to analyse the effect of second daily infrared (JR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mW) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded. All groups demonstrated significant reductions in pain over the duration of the study with those groups, which received infrared (829 nm) laser at 1 J/cm2 and 5 J/cm2, demonstrating the most significant effects (p<0.001). Only those subjects who had active laser treatment experienced side effects. Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependent on power output, dose and /or wavelength.
Addressee for Correspondence: E Liisa Laakso BPhty PhD, Physiotherapy Department, Royal Brisbane Hospital, Herston, Queensland, Australia, 4029. 6/97 Rep. US $8-10-12 copyright 1997 by LT Publishers, U.K. Ltd. Manuscript received: January, 1997 Accepted for publication: March 1997 LASER THERAPY. 9: 67-72 67
Successful Management of Female Office Workers with "Repetitive Stress Injury" or "Carpal Tunnel Symdrome" by a New Treatment Modality - Application of Low Level Laser
E Wong G LEE J. Zu CHERMAN and D. P. MASON
Western Heart Institute and St. Mary's Spine Center St. Mary's Medical Center San Franscisco. CA USA and Head and Neck Pain Center, Honolulu HL. USA
Abstract. Female office workers with desk jobs who are incapacitated by pain and tingling in the hands and fingers are often diagnosed by physicians as "repetitive stress injury" (RSI) or "carpal tunnel syndrome" (CTS). These patients usually have poor posture with their head and neck stooped forward and shoulders rounded; upon palpatation thay have pain and tenderness at the spinous processes C5 - T1 and the medical angle of the scapula. In 35 such patients we focused the treatment primarily at the posterior neck area and not the wrists and hands. A low level laser (100 mW) was used and directed at the tips of the spinous processes C5 - T1. The laser rapidly alleviated the pain and tingling in the arms, hands and fingers and diminished tenderness at the involved spinous processes. Thereby, it has become apparent that many patients labeled as having RSI or CTS have predominantly cervical radicular dysfunction resulting in pain to the upper extremeties which can be managed by low level laser. Successful long-term management involves treating the soft tissue lesions in the neck combined with correcting abnormal head, neck and shoulder posture by taping, cervial collars, and clavicle harnesses as well as improved work ergonomics.
Manuscript received: July 1997 Accepted for publication: September 1997 LASER THERAPY, 1997:9: 1997 131-136 09/97 Rep. US $10-12-14 Copyright 1997 by LT Publishers, UK., Ltd.

Laser Theory

Laser Theory
The word "laser" stands for "light amplification by stimulated emission of radiation."
Lasers are possible because of the way light interacts with electrons. Electrons exist at specific energy levels or states characteristic of that particular atom or molecule. The energy levels can be imagined as rings or orbits around a nucleus. Electrons in outer rings are at higher energy levels compared to those in the inner rings. Electrons can be bumped up to higher energy levels by the injection of energy-for example, by a flash of light. When an electron drops from an outer to an inner level, "excess" energy is given off as light.
The wavelength or color of the emitted light is precisely related to the amount of energy released. Depending on the particular lasing material being used, specific wavelengths of light are absorbed (to energize or excite the electrons) and specific wavelengths are emitted (when the electrons fall back to their initial level).
The First Laser
The ruby laser was the first laser invented in 1960. Ruby is an aluminum oxide crystal in which some of the aluminum atoms have been replaced with chromium atoms. Chromium gives ruby its characteristic red color and is responsible for the lasing behavior of the crystal. Chromium atoms absorb green and blue light and emit or reflect only red light.
For a ruby laser, a crystal of ruby is formed into a cylinder. A fully reflecting mirror is placed on one end and a partially reflecting mirror on the other. A high-intensity lamp is spiraled around the ruby cylinder to provide a flash of white light that triggers the laser action. The green and blue wavelengths in the flash excite electrons in the chromium atoms to a higher energy level. Upon returning to their normal state, the electrons emit their characteristic ruby-red light. The mirrors reflect some of this light back and forth inside the ruby crystal, stimulating other excited chromium atoms to produce more red light, until the light pulse builds up to high power and drains the energy stored in the crystal.
The laser flash that escapes through the partially reflecting mirror lasts for only about 300 millionths of a second-but very intense. Early lasers could produce peak powers of some ten thousand watts. Modern lasers can produce pulses that are billions of times more powerful.
Another characteristic of laser light is that it is coherent. That is, the emitted light waves are in phase with one another and are so nearly parallel that they can travel for long distances without spreading. (In contrast, incoherent light from a light bulb diffuses in all directions.) Coherence means that laser light can be focused with great precision.
Many different materials can be used as lasers. Some, like the ruby laser, emit short pulses of laser light. Helium-neon gas lasers or liquid dye lasers, on the other hand, emit a continuous beam of light.
How does a therapeutic laser system work?
Laser therapy has been increasingly used in medicine over the last few years as a nonsurgical means of effecting cures for a variety of pains and ailments, for assisting normal healing processes to occur earlier and better, and as prophylaxis against the occurrence of undesirable side effects. Let us look concisely at what laser therapy is, how it works, and why it is used.
Light energy consists of small packets of energy, called photons, which travel in a wave-like pattern. The number, or density, of photons in a beam of light energy, combined with the wavelength, or colour, of the light will determine what reaction will occur when the energy is incident on tissue. When incident photon densities are not high enough to cause any rise in tissue temperature, the energy is transferred directly to the target cells, which changes their level of activity. It only takes one photon, in theory, to achieve a photoresponse in a target cell. The wavelength of the laser energy will determine how deeply the beam penetrates: infrared lasers have the best penetration, thus achieving deeper absorption which is of great importance in treating muscle and joint pain types. Depending on the condition of the cells and their surrounding tissue the reaction may be photoactivation, such as induced wound healing, or photo retardation, such as the slowing down of pain transmission to give pain attenuation. These opposite sides of the same therapeutic coin are collectively referred to as photoactivation or photomodulation.
In laser surgery, the level of laser-tissue reaction is higher than the survival threshold of the target cells, and the target cells are damaged or destroyed. In laser therapy, on the other hand, the level of reaction is lower than the survival threshold, and the cells are activated. Thus a common term seen in reports is low level laser therapy, or LLLT. All our tissues consist of cells, and so all tissues are potential targets for laser therapy, from skin to bone. The energized cells communicate with each other, and with non-irradiated cells, through increased levels of intra- and extracellular chemicals. If the cells are in a normal condition, then the level of activity remains higher for a short period, and then drops down to normal. Even in a 'normal' patient, an almost immediate flood of endorphins, our body's naturally-occurring opiate, occurs after laser therapy, but as they are not required for any specific pain control mechanism, they are quickly dispersed throughout the body, and naturally disappear. In other words, laser therapy assists the natural healing processes of the body: if there is a need for these processes, such as in the relief of a painful condition, or repair of damaged tissues, then the normal healing mechanisms occur more efficiently. 'Normalization' is the keystone of laser therapy, and so LLLT can be used to remove pain or to cure numbness; to remove abnormal colour from, or restore pigment to depigmented skin; to increase blood flow in blood-starved tissues, or decrease blood flow in certain birthmarks such as 'strawberry marks'; and to control both hypotension and essential hypertension. Just as some patients do not respond to a particular medication but will respond to a different one, so some patients will not respond to LLLT, or will respond poorly. Similarly, some patients need a combination of medications: thus some patients will need LLLT used in combination with other therapeutic modalities. From a study of the many papers on LLLT published in the international medical literature, we can confidently say in pain attenuation, for example, which is the largest application of LLLT, we can guarantee more than 76% pain relief in over 80% of patients. Laser therapy is not a magic wand!
What is Laser Therapy?
Lasers have been used in surgery since the early 1960's following the development of the first successful laser in 1960. Ophthalmology and then dermatology were the first medical specialities to use the intense photon density of the pure beam of laser energy to induce photothermal effects which were capable of welding detached retinae, selectively coagulating small blood vessels on the retina, and removing abnormally coloured cutaneous lesions without damaging surrounding normal tissues. This was the birth of laser surgery.
In 1968 a Hungarian clinician and scientist, Professor Endré Mester, published a paper on a nonsurgical application of laser, the induced healing in weeks of non-healing leg ulcers, some of which had a history of years of unsuccessful conventional therapies. This was the birth of laser therapy.
Laser therapy is the application of low incident levels of laser energy to achieve an ever-increasing number of clinical indications. These include: pain attenuation in a large variety of acute and chronic pain entities including pain related to abnormalities in the nerves, soft tissue, muscles, tendons, joints and bone; improved wound healing in soft tissues, tendons and bone including the induction of healing in slow-to-heal or nonhealing wounds; improved local and systemic blood circulation, very useful in blood-related conditions such as Buerger's and Raynaud's diseases and torpid leg ulcers; increased lymphatic circulation and drainage which improves the early inflammation and swelling associated with acute injuries; enhanced autoimmune response in immune-deficient conditions such as psoriasis, rheumatoid arthritis and atopic dermatitis; and in more specific indications such as the control of hypertension and the restoration of normal pigment in selected abnormally coloured cutaneous lesions.
Laser therapy is delivered using dedicated systems, designed to produce optimum levels of laser energy at specific wavelengths to achieve the desired therapeutic effect in complete safety. These systems should be compact enough to be easily portable; rugged enough to withstand extended use in and out of the treatment room; and reliable enough to preclude constant technical problems while being easily maintained.
Why use it?
Laser surgery systems are very efficient and have well-documented applications, but are extremely expensive and physically take up a great deal of space. This expense adds to the financial burden of both the medical institution carrying out the laser surgery and the patient undergoing it. In almost all cases, the patient must come to where the laser is, due to the aseptic needs associated with surgery and the electrical connection requirements of laser surgical equipment. Well-designed laser therapy systems on the other hand require a normal mains supply. Many LLLT systems offer a fully portable, battery-powered option allowing the laser to be taken where it is needed, easily and simply. This is a boon for trained laser therapists working in rural areas or developing countries. LLLT systems are comparatively inexpensive, but have a wide range of applications, thus helping to bring about a reduction in the never-ending upward spiral of health care costs to both institutions and patients. Although the end result is very often equally good, LLLT has been proved to work more quickly and at an earlier stage than conventional surgery or therapy, thus, amongst other advantages, dramatically reducing bed time in acute injuries, the period of incapacitation in ambulatory patients, and analgesic requirements post-surgery. All of these point to potential savings for institutions and better health care for patients at lower costs. The reports in the literature on the clinical applications of LLLT all agree that laser therapy, in appropriate situations and delivered by fully-trained professionals, is efficient and safe. Although the systems are still lasers and must therefore be used safely and by trained therapists, laser therapy is totally noninvasive. It can additionally be applied interstitially in certain cases, or through flexible endoscopes to reach the articular aspects of affected joints. LLLT is usually painless, and in more than 30 years of application has been serious side-effect free. LLLT is well-tolerated by all ages and conditions of patients and in a large variety of specialities from neurosurgery and dentistry to podiatry. As each year passes, more and more applications are being presented in which LLLT is not only appropriate, but is better than conventional methods. Hand in hand with the clinical reports, advances in scientific research are elucidating the pathways and mechanisms by which laser therapy works, thereby firmly establishing LLLT as the medical tool of tomorrow, but available today.
A therapeutic laser system is athermic (no heat), with no appreciable heat transfer to the tissue. (< 0.65 degree Celsius) An athermic laser system, therefore, is not able to cause tissue damage as tissue damage arises only through thermal actions.
Thermic lasers, on the other hand, are used for invasive surgery as they cut, burn or vaporize tissue to achieve tissue removal.
 
Therapeutic lasers utilise a wavelength of monochromatic light in the 630 to 905 nanometer (nm) range, known as the "therapeutic window". A wavelength of 905 nm has the least absorption in this "therapeutic window", due to the primary influence of melanin. In the 630 to 905 nm range, the 905 nm wavelength is absorbed least by the skin and hence provides the greatest penetration of photons into the underlying tissues. It is this principle which creates the ability to "inject" photons of energy harmlessly into tissue, "energising" or "biostimulating" this tissue into an accelerated rate of healing.
The tissue effect of lasers can best be characterized by understanding the absorption of light in tissue. The three main components of tissue that affect the absorption of light are water, haemoglobin (pigment that renders blood red) and melanin (pigment that gives skin its natural color). The absorption curves for these three substances versus the laser wavelength will determine the precise impact that a particular laser will have on tissue.
The purpose of a low level laser is to stimulate. The lower energy levels and the unfocused light beam do not impart large amounts of energy. They do provide enough energy to excite the mitochondria and cause it to undertake big-chemical reactions.
The mitochondria once stimulated by the application and infusion of light energy produces enzymes and ATP. Cells communicate and operate using chemical signals - enzymes. Low level laser therapy is safe because cells have a natural ability to resist over-stimulation. It is not possible to harm tissue by overdosing.
Serotonin is a neurotransmitter that is used as a marker chemical for low level laser therapy. A patient who receives this type of therapy will, within 24 hours, test positive for increased serotonin by-products in their urine (Walker, Neuroscience Letters). The amount of 5- hydroxyindoleactic acid, the serotonin byproduct, is disproportionately large in comparison to the amount of energy put into the system by the treatment.
The photoactivation of enzymes used provides a huge amplification factor for initiating a biological response using light energy. (Smith, The Photobiological Basis of LLLT). The measurable effects of LLLT appear in calcium ion channels, RNA and DNA at the cellular level, and the production of proteins, fibroblasts, Iymphocytes and leukocytes (Basford, The Orthopedics Journal).
There is a well-documented inter-cellular communication phenomena of "enzyme cascading." Once cells are stimulated to produce an enzyme with the LLLT laser, the adjacent cells are stimulated by the presence of the newly produced enzymes to also produce the same chemical, effectively duplicating and enlarging the effects of light stimulation.
All of the enzymes produced are those naturally used and produced by the cell. They are produced in the ratios and quantities normally used by the body and the result is a natural healing process. The major difference between a laser and a powerful normal light is the laser beam's ability to travel long distances without being dispersed. This is known as coherence, and it enables the laser to focus its power very specifically. This source of light has been shown to have a strong therapeutic effect. The Theralase therapeutic lasers do not produce heat or cut like industrial lasers or powerful surgical lasers. At specific wavelengths, a Theralase laser can have profound beneficial effects on the functioning of human cells - the "building blocks" of all the body systems and body tissue (bone, skin, muscle, etc.)
The energy produced by a Theralase laser can be directed at damaged tissue cells, and by giving the cell a massive energy boost, helps to speed up the healing process. Lasers have been shown to improve the repair of tissues, from injuries such as muscle strains/sprains, ligament and tendon injuries, open wounds and bone injuries including fractures and joint dysfunction.
Technology Overview
In 1917, Albert Einstein established the physical principle of Light Amplification by Stimulated Emission of Radiation, thus paving the way for the development of the laser. In June 1960, Theodoro H. Maiman constructed the world's first laser using a ruby crystal, now known as the ruby laser. In 1965, doctors Sinclair, Knoll and Mester pioneered the way for therapeutic lasers, through their research with human tissue. These lasers do not cut or destroy tissue, but biostimulate the tissue creating a therapeutic curative effect.
Therapeutic lasers work by supplying energy to the body in the form of non-thermal photons of light. The body is able to absorb this external energy on a cellular level and transform light energy into chemical energy, which the body uses to accelerate the normal healing rate of tissue for a wide range of ailments.
Laser Design Parameters and Tissue Interaction
Wavelength
There are 3 main components of tissue that affect the absorption of light, specifically: water, haemoglobin (pigment that renders blood red) and melanin (pigment that gives skin its natural colour). The absorption curves for these three substances versus the laser wavelength will determine the precise impact that a particular laser will have on tissue.
This laser light has the unique properties of monochromaticity, (a single wavelength), coherence (travels in a straight line) and defined location (concentrated beam). These properties are what allow lasers to penetrate the skin surface, non-invasively, delivering energy directly to the cells which the cells then convert into chemical energy.
T. Oshiro, a leading expert on therapeutic medical lasers, testifies to the effectiveness of the 905nm laser in his book Low Level Laser Therapy: A Practical Introduction:
"The peak of tissue penetration is around 900 nm. This would appear to make the GaAlAs diode system the most effective LLLT (Low-Level Laser Therapy) system for penetrating to the desired depth. In addition the comparative cost of a GaAlAs makes it both financially and biomedically competitive. The near infrared GaAlAs diode laser systems are even more inexpensive than the HeNe systems, and are also proving more effective in therapy."
Power
The power of a laser determines how much energy is initially delivered to the tissue surface and along with the wavelength, the power at any given depth of penetration. Energy density (Joules / centimeter2) is equal to the power of the laser in watts multiplied by the treatment time in seconds, divided by the surface area irradiated in square centimetres.
Energy Density = (Power x Time) / Surface Area
Continuous versus Pulsed Wave Technology
A super pulsed laser such as the Theralase therapeutic medical laser uses a peak power up to 50 Watts (50,000 mW) delivering this energy in a fraction of a second (200 billionths of a second) for an average power output of 100 mW.
A super pulsed laser system has a peak power which is 500 times greater than the peak power of a continuous wave system of the exact same average power rating.
The Theralase laser system achieves tissue penetration by delivering powerful bursts of energy versus a continuous output, which has difficulty penetrating different densities of tissue.
Delivery System of Laser Probes
In order for your laser system to provide optimal penetration through the skin it must be in direct contact with the skin and be at an incident angle of 90 degrees (perpendicular to the skin). This will minimise any reflection from the skin's surface and allow the best penetration into the tissue. The Theralase therapeutic laser system's unique design ensures each and every probe is always in direct contact with the skin surface, thus minimising surface reflection.
True Lasers versus Super-luminous Diodes
True lasers such as the Theralase system focus all of their energy in one direction in a very concentrated line. A super-luminous diode, on the other hand, diffuses its energy in all directions with only a small percentage of the energy travelling in the direction of the treatment. A true laser system will deliver over 90% more power to the treatment area than a super-luminous diode system of exactly the same average power rating.
Oshiro's studies confirm this fact:
"A laser beam travels only in one direction from source, unlike a light bulb. The resulting (true laser) beam has a considerably higher photon density than a monochromatic beam produced by filtering and collimating a conventional multi-wavelength light source. In in-vivo tissue targets, several layers of non-homogenous particulate matter have to be penetrated before the beam can reach the LLLT targets, and it is the superior photon density of coherent light which ensures this penetration, even though actual coherence may be lost in the first few cell layers."
Time Per Treatment Session
There is a large time benefit in choosing a laser system that will minimise the treatment time needed for a given treatment. The Theralase laser system, with its multiple probes allows treatment of up to 9 times the surface area of a single probe system. This translates into shorter treatment times by 90% and consequently the ability to treat more patients in a given day, thereby maximising the revenue stream possible versus a single probe system.
Simple to Operate
The Theralase therapeutic laser system has been designed to be very user friendly with laser settings that can be activated with the push of a button. The system also comes with a complete protocol manual detailing many of the treatments for common ailments in an easy to read format.
Reliability
The Theralase laser system comes complete with a full 1 year warranty on parts and labour and is built to the highest quality medical standards available.
Safety
The Theralase therapeutic laser system has four levels of safety controls to ensure that the laser is energised only when desired and by certified healthcare practitioners, ensuring total control of the incident laser beam.
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