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low level laser therapy contraindications

What is low level laser therapy?

low level laser therapy contraindications

What Is Low Level Laser Therapy?-A light source (low intensity diode array) is placed in contact with the skin allowing the photon energy to penetrate tissue cells. Light energy absorbed by the cell becomes biochemical energy, thus fuelling tissue repair. Normally-functioning cells are not adversely affected by LLLT.

Low Level Laser Therapy does not heat or cut tissue, unlike high intensity lasers.

Many pharmacological treatments (medications) mask pain or only address the symptoms of the disease. Low Level Laser Therapy treats the underlying condition or pathology to promote healing, reduce inflammation and give relief for both acute and chronic pain. This means that the treatments are effective and the benefits of Low Level Therapy are long lasting.

low level laser therapy contraindications
contraindications for low level laser therapy
contraindications of low level laser therapy
contraindications to low level laser therapy

L-A-S-E-R is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. In simple terms this refers to light waves of a specific wavelength.

Sun light is a mixture of seven different colours, is disorderly and is not parallel.

Low level laser light is compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation. It’s different from natural light in that it’s one precise colour, coherent (it travels in a straight line), runs parallel (collimated), monochromatic (a single wavelength) and polarised (it concentrates its beam in a defined location or spot). The healing properties of Laser Light come from these differences.

These properties allow laser light to penetrate the surface of the skin with no heating effect, no damage to the skin and no known side effects. The wavelengths of light actually create physiological changes within the cells of the body, a process called photobiomodulation. Laser light directs biostimulative light energy to the body’s cells, which the cells then convert into chemical energy to promote natural healing and pain relief.

LLLT utilises low powered wavelengths of light in the infra-red and far infrared spectrum which has no effect on normal tissue but is active where there is injury or inflammation.

Red and near-infrared light wavelengths of 600-1070nm penetrate tissue maximally. The technology utilizes superluminous (light emitting) and laser diodes to irradiate diseased or traumatised tissue with photons.

One important way in which laser therapy adds energy is through photon absorption by mitochondria. These tiny organelles which have been called the “powerhouses” of the cell, are found in most plants and animals. Mitochondria are able to absorb laser light which then activates a series of reactions to increase and store more cellular energy in the form of adenosine triphosphate (ATP).

By increasing energy available in this readily accessible form, laser light is able to greatly stimulate the biological function of cells, tissue, and systems and even raise overall vital energy throughout the individual.

“Bio” stimulation = Life stimulation!

When energy is available, the body can heal itself.

low level laser therapy contraindications

Laser therapy has been shown to stimulate the regeneration of bone, blood, the lining of blood vessels, cartilage, nerve, muscle and much more. Moreover, it has been documented to enhance the quality of healed tissue. Laser therapy may be an ideal treatment. It may not only effectively address many medical conditions but also has been widely reported to improve health and wellbeing as evidenced by a host of biological markers.

The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing.

LLLT actually improves healing, as well as reducing inflammation and pain.

LLLT is curative because it works at the cellular level rather than modulating symptomatology.

Intracellular biomolecules respond, resulting in the restoration of normal cell function. This stimulates, promotes, enhances and accelerates the healing process.

How low level laser therapy work?

How does low level laser therapy work?-LASER light, in the right wavelengths, penetrates into the tissue eliciting photochemical and photo-biological responses. The effect takes place within the mitochondria; the organelle (part of the cell) responsible for producing ATP. When light is absorbed it causes a build-up of single oxygen molecules that accelerate the formation of ATP (adenosine triphosphate), the cells’ energy and fuel source, to 10 times the average rate. Increased ATP production leads to a secondary cascade or reactions: increasing immune response, accelerating the healing process and reducing pain.

low level laser therapy causes vasodilation, an increase in the size of small arteries and lymph vessels, this allows inflammation, swelling, and edema to be cleared from an injury site more effectively. The laser also stimulates light sensitive structures in your cells triggering a series of events within the cells leading to enhanced cell function and accelerate the healing process.
TARGET (Treatment Area Recognition and Guidance Enhanced Technology) Technology

The treatment found on the M4 Super Pulsed LaserStim is the first and only FDA-cleared device to use electric stimulation and laser in a single device. It is able to target areas of spasm both superficial and deep by constantly measuring the electroconductivity of the tissue. This helps to assist in identifying the optimal treatment location.

There are many different types of cold laser devices.Many used by clinicians are often the size of a flashlight. and may be connected to a larger unit (computer), or may be a handheld device. The laser may be placed directly over the injured area for 30 seconds to several minutes depending on the size of the area being treated and the dose provided by the cold laser unit. Some may move the laser around, move the joint or muscle during treatment, and some may remain in contact without movement of either unit or patient.

During treatment the non-thermal photons of light that are emitted from the laser and pass through the skin layers (the dermis, epidermis, and the subcutaneous tissue or tissue fat under the skin). This light has the ability to penetrate 2 to 5 centimeters below the skin. Once the light energy passes through the layers of skin and reaches the target area, it is absorbed and interacts with the light sensitive elements in the cell, such as the mitochondria. This process can be compared to photosynthesis in plants – sunlight is absorbed by plants, which is then converted to usable energy so that the plant can grow. The mitochondria absorbs the light, which is used to make energy in the form of ATP.

When cells absorb this light energy, it also initiates a series of events that is theorized to eventually result in healing damaged or injured tissue. Some of these events include increasing the movement of immune cells from the blood vessels, into the area of tissue injury. Increase lymphatic flow and drainage, as well as increased blood flow and drainage can occur. In short, low level laser therapy can assist in reduction of pain, inflammation, edema and an overall reduction in healing time by increasing intracellular metabolism.

low level laser therapy contraindications

low level laser therapy contraindications

Contraindications for Use of Therapeutic Laser-Of the relatively few contraindications for the use of therapeutic laser, many are relative rather than absolute and a skilled clinician, together with careful patient selection, should minimize any risks.

While I have written a number of articles over the past years discussing the benefits of utilizing therapeutic laser for a variety of conditions, I would like to take the opportunity to discuss contraindications in greater depth. While laser therapy has relatively few contraindications associated with it when compared with some other therapeutic modalities, some cautions are worth noting. Likewise, it is also worth noting that some contraindications are assumed when they are not—or are relative rather than absolute.

According to Tuner and Hode, the use of therapeutic laser over internal pacemakers (illustrated in Figure 1) is mistakenly considered to be contraindicated. They are encased in metal and cannot be influenced by photons.1 The only exception is any light therapy device that also uses electrical stimulation—such as the LaserStimTM from Multi Radiance Medical.


Pregnancy is an alleged contraindication largely because extreme caution has historically been exercised with any modality during pregnancy—especially during the first trimester. It would be prudent to avoid large doses over the pregnant uterus. However, there is no evidence to support the idea of there being any risk in treating distant regions of the body relative to the uterus.

While Avila observed cell damage in chicken embryos after irradiation with a HeNe laser through an opening in the egg, it is important to keep in mind that the dosage represented a very high dose of laser irradiation for the size and weight of the chicken egg compared with a human fetus inside a pregnant abdomen of an adult female. Nevertheless, it would be wise to note that if any complication occurred subsequent to the use of a therapeutic laser, it would automatically be suspect and leave the clinician with the burden of proof.
Epileptic Seizures

It is known that pulsing visible red light in the 5–10 Hz range can trigger epileptic seizures. Many light therapy devices utilize flashing visible light so it should be used with extreme caution in epileptics. There is nothing in the scientific literature on the subject of pulsing invisible light therapy such as infrared—except for one study by Simunovic. He observed a patient that could only tolerate frequencies below 800 Hz with a GaAs laser.
Thyroid Gland

The thyroid gland is considered to be a delicate structure. It may be prudent to avoid treating over the thyroid with therapeutic laser. Rat studies have demonstrated the development of thyroid disorders in rats treated with large doses of light radiation.

Hernandez found that GaAs laser therapy reduced mRNA levels of thyro-globulin, changes in the cytoskeleton of thyroid cells and a reduction in thyroid hormone plasma levels. This was associated with an increase in thyroid-stimulating hormone (TSH).

Mikhailov performed an interesting study in which he utilized an 890 nm infrared laser in treating 42 patients with autoimmune thyroiditis. Each patient received 10 treatments at 2.4J/cm2. The thymus projection, vascular junction, and thyroid itself were irradiated. A control group of similar size was given 100mg of L-thyroxin. The clinical effect in all laser-treated patients was a decreased feeling of squeezing in the field of the thyroid, as well as a decrease in facial edema. The thyroid gland became palpably soft and decreased in size as observed on ultrasound. The number of winter colds decreased. The immunoregulatory index (Th/Ts) normalized decreasing from 7.5 to 4.2%. These effects were still observable in 78% of the patients after four months.


There is concern over the treatment of children with therapeutic laser, especially over bone growth plates. Cheetham irradiated healthy growth plates in young rats. One knee of each animal in the experimental group was irradiated three times/week at 5J/cm2. The animals were examined histologically after 6 to 12 treatments. There were no observable differences between the treated group and the control group.

Renstrom successfully treated 30 children with Osgood Schlatter disease (aged 11 to 15). Their knees and lower legs were treated with a 60 mW GaAs laser at 30 Hz and 0.1J/cm2 dosage.

Paolini also successfully treated 15 children with Osgood-Schlatter disease with 30 sessions of GaAs laser. These patients were compared with 15 patients who underwent conventional care including surgery. The laser group obtained the best results.

Tuner and Hode caution that cancer should not be treated by anyone but an oncologist or other appropriate specialist because of legal regulations, especially in the United States.

Laser therapy is commonly considered to be contraindicated in patients undergoing radiation therapy yet recent scientific research paints a more positive view. Tamachi studied the effect of therapeutic laser on cytoxin, 5-florouracil (5-FU) uptake in various experiments on rats. The rats received 6J/cm2 of HeNe laser. They demonstrated a greater uptake of cytoxin, 5-FU than a group that only received cytoxin, 5-FU. The laser irradiation caused blood vessel to dilate allowing more chemotherapy to accumulate in the lesion. This may allow lower doses of anti-cancer drugs.

Podalskaya has used an HeNe laser on post-radiation reactions and injuries on lips and oral mucosa. This treatment has had better results than any previous treatment approaches.

Soldo studied the effect of GaAs laser irradiation on murine sarcoma. There was an anti-tumor effect on small tumors probably due to increased immune defense.

low level laser therapy contraindications

Funk investigated cytokine production after HeNe laser irradiation to cultures of human PMN cells The cells were irradiated for various periods at selected intensities then stimulated with various mit-ogens. When these cells were stimulated after irradiation at 18.9J/cm2, significantly higher levels of all cytokines were observed. Cells that received 37.8J/cm2 of laser irradiation showed significantly decreased cytokine levels.

There has been debate about whether or not diabetes is a contraindication for therapeutic laser. Several studies have shown positive results in diabetic patients.

Radelli performed an experiment on rats utilizing a 904nm GaAs laser. There was no observable affect on insulin-glycemic balance.

Schindl carried out thermographic studies on patients with microanginopathic disorders. Blood flow began to improve within 15 minutes after the initiation of laser therapy and persisted for 45 minutes after ending the treatment session. A maximum temperature in-crease of 2.5 degrees was observed.

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