This article comes from the Endolaser HP Therapy Book (art.nr. 1636960)

Click here  to download the Endolaser HP Therapy Book

Lasers in physical medicine

The development of increasingly specialised medical laser systems in the past four decades has given rise to an increasing narrowing of the individual methods to ranges of indications within a rational system. Appropriate therapeutic objectives were allocated to the laser systems as well as the operating conditions. Physical medicine also uses certain laser methods whose effects undoubtedly demonstrate success in the established range of indications.
The design of the “Endolaser HP”, a special high-power laser for physical medicine, is based on this scientific development.

Laser radiation develops through the stimulation and amplification of light (LIGHT AMPLIFICATION by STIMULATED EMISSION of RADIATION) in special resonators.
In contrast to regular light, the features of laser radiation are defined with the following terms:

• Beam intensity
• Monochromasia
• Collimation
• Coherence

The effects of laser

General effects

Like regular light, laser light is subject to the laws of optics. Therefore, laser light is to some extent reflected on the surface of the tissue; on the other hand, it penetrates into the tissue, is scattered and absorbed there, and thus enters into interaction with the tissue. A small part of the laser light also passes through the tissue and exits at the opposite side.

In physical medicine, the portion of the laser light which is scattered and absorbed in the tissue is therapeutically relevant. The site and amount of the laser energy which remains in the tissue and is converted into other forms of energy are crucial for the effect.

The biological effects of the laser light are described as biostimulation and thermal effects.

Interactions

In the tissue, the laser light encounters molecules with certain colours and colour properties. In the near infrared range (780-1400 nm) it is primarily absorbed by melanin, myoglobin and haemoglobin. In doing so, there is a thermal reaction due to the conversion of light energy into heat, that is, there is a heating of the tissue.
The heat which develops also spreads to adjacent areas of tissue via conduction (thermal conduction).

Note: Other effects, such as ionisation or the breaking of molecular bonds, do not occur with lasers in the near infrared range in the energy spectrum of the Endolaser HP laser.

The heating of the skin limits the total energy since thermal damage occurs at an excessively high dosage. The total energy administered can be increased through cooling at least in white skin since there is less blood due to the vasoconstriction because of the cold and thus also less haemoglobin in the skin.
Thus less laser energy is absorbed; the laser light penetrates deeper into the tissue.

Biostimulation

At the same time, a part of the laser energy is converted into chemical reaction energy, as a result of which molecules are directly excited through the transmission of electrons and indirectly through the formation of oxygen radicals.

These primarily include coloured molecules of the respiratory chain, such as flavoproteins and cytochromes.
This results in an increase in energy metabolism activity which is known as “biostimulation”.

Wavelengths

The wavelengths of the Endolaser HP of 810 nm, 980 nm and 1064 nm, are within the absorption minimum of melanin and haemoglobin. In this way, the maximum penetration ability of the laser light is achieved. Melanin is contained in the epidermis which forms a very thin layer. For this reason, the laser energy can penetrate this layer very easily.

The wavelength 1064 nm favours penetration of the radiation into the tissue. The scatter of the laser radiation decreases as the wavelength increases. Since the penetration depth is limited not only by absorption but rather also by scatter, a higher depth of penetration is expected for radiation of the wavelength 1064 nm.

More to know (consult the therapy book)

The use of laser in general, and high power laser specifically, is further related to:

• Frequency, superposition, and interaction with the tissue
• Depth of penetration
• Thermal effect
• Mechanisms of laser therapy (Analgesic mechanism, Reflexive effects, Regeneration of tissue)
• Emission mode (continuous, intermittent)
• Application techniques (static, dynamic, combined)
• Determining the thermal threshold

Treatment recommendations

Myopathy, tendinopathy

Humeroscapular periarthritis (”frozen shoulder”)
Infraspinatus muscle and insertional tendinopathy
Supraspinatus muscle and insertional tendinopathy
Biceps longus tendon
Insertional tendinopathy of the adductors
Radial epicondylopathy
Ulnar epicondylopathy
Patellar tendonitis
Tendinopathy of the greater trochanter
Achillodynia
Plantar fasciitis
Insertional tendinopathy of the pes anserinus

Low back pain

Painful muscle tension
Sciatica
Facet syndrome

Osteoarthritis

Osteoarthritis of the knee
Osteoarthritis of the base of the thumb
Spondylarthrosis, cervical
Spondylarthrosis, cervical

Traumatological diseases

Ankle sprain
Pulled muscle, torn muscle

Impingement syndromes

Carpal tunnel syndrome
Morton’s neuralgia

Skin diseases

Acne vulgaris
Herpes simplex
Plantar warts
Anogenital warts
Impaired wound healing
Venous ulcer
Decubitus ulcers

Please download and consult the Endolaser HP Therapy booklet for in depth knowledge and explanation of the above.

For more information please go to

Indications High Power Laser Therapy

• The Endolaser HP is indicated as an adjuvant application for the treatment of the musculoskeletal disorders listed below:
  • Knee osteoarthritis,
  • Lateral epicondylitis,
  • Low back pain,
  • Chronic neck pain.

  Treatment effects are usually enhanced by a combination with exercise or other state-of-the art therapies.

Contra-indications High Power Laser Therapy

• Fresh hematomas and active haemorrhage
• Tumorous diseases (malignant, semi-malignant and benign), even over areas that are suspicious or contain potentially cancerous tissue, irradiation of malignancies and precancerous growths
• Eye area and its vicinity
• Pregnancy
• Low back and stomach during menstruation
• Epilepsy
• Fever
• On patients suspected of carrying serious infectious disease and or disease where it is advisable, for general medical purposes, to suppress heat or fevers
• Sensitivity on the treatment area
• Placing an active applicator over metal implants, e.g. cochlear implants
• Application on freckles
• Application directly over areas with open wounds or infected areas
• Application on the sympathetic, vagus or cardiac area in patients with heart diseases or pacemakers
• Photosensitive medication or application on photosensitive areas
• Irradiation of endocrine glands
• Sensational deficit in the treatment area
• where analgesia may mask progressive pathology, and where the practitioner would normally avoid the use of any other analgesia to retain the beneficial aspects of pain
• over areas injected with steroids in the past 2-3 weeks
• over the neck (thyroid or carotid sinus region) or chest (vagus nerve or cardiac region of the thorax)
• treatment over sympathetic ganglia
• for sympathetic local pain relief unless ethology is established or unless a pain syndrome has been diagnosed
• on ischemic tissues in individuals with vascular disease where the blood supply would be unable to follow the increase in metabolic demand and tissue necrosis might result
• Particular caution is required when administering treatment near the ear, nose, mucous membrane and blood vessels. Direct radiation must be avoided.
• If there are skin diseases, metabolic diseases or inflammatory diseases, a physician should be consulted prior to treatment.
• suspected or confirmed neoplasms

Please consult the Instructions for Use for more information on indications and contra-indications and for warnings and recommendations.

The above indications and contra-indications originated from the Endolaser HP Operating Instructions EN 1636750-40.

1. Bjordal, J.M. et.al. A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Australian Journal of Physiology 49: 2003, p. 107 – 116
2. Dougal, G.; P. Kelly A pilot study of treatment of herpes labialis with 1072 nm narrow waveband light. Clinical & experimental dermatology: 26/2, March 2001
3. Hackert, J.; Ch. Offergeld Laser in der Dermatologie [Lasers in dermatology]. Laryngorhinootologie 2003, p. 144 – 156
4. Hering, P.; H.-J. Schwarzmaier Einführung in die Lasermedizin [Introduction to laser medicine]. Script: Institute for Laser Medicine, Heinrich Heine University, Düsseldorf
5. Janetti, G.D. et al. A nociceptor response to laser stimuli: selective effects of stimulus duration on skin temperature, brain potentials and brain perception. Clinical Neurophysiology 115, 2000, p. 2629 – 2637
6. Landthaler, M. et al. Treatment of zoster, post-zoster pain and herpes simplex recidivans in loco with laser light. Fortschr. Med. 1983, Jun. 9; 101 (22): p. 1039 – 1041
7. Mayrhofer, V. (Ed) Moderne Anwendungen der Lasertechnik [Modern applications in laser technology]. Chap.3, Medicine
8. Min-Wei, Chr. L. Combination 532 nm and 1064 nm lasers for noninvasive skin rejuvenation and toning. Arch. Dermatol. 2003, 139: p. 1265 – 1276
9. Morovino, T. Cold lasers in pain management. Practical pain management, 2004: p. 1 – 5
10. Morton, H. A comparison of the use of low laser light therapy and cell-mediated immunity for the treatment of verrucae pedis. University College Northampton, April 2000
11. Russ; Meier Berechnung der Lichtintensität in biologischem Gewebe [Calculation of light intensity in biological tissue]. Laser Institute Ulm, 2005
12. Shiomi, Y. et al. Efficacy of transdermal low power laser irradiation on tinnitus: a preliminary report. Ansis Nasus Larynx 24, 1997, p. 39 – 42
13. Welch, A.J; et al. Laser physics and laser-tissue interaction. Texas Heart Institute Journal 1989, 16; p. 141 – 149
14. Yassene, M; J.F. Verhey A finite element method to simulate laser interstitial thermo therapy in anatomical inhomogeneous regions. Biomedical Engineering Online 2005; http://www.biomedical-engineering-online.com/content/4/1/2