Learn tips about Class IV laser therapy and other health related topics on the LightForce Therapy Lasers blog! Check back weekly for updated posts.
Contributed by Mark Callanen, PT, DPT, OCS
Most health care providers do not like addressing the topic of money with patients, especially when it is related to the services they are providing. That being said, the topic of value with regard to a patient’s healthcare dollar is becoming more and more relevant as deductibles and co-pays rise each year.
Laser therapy is normally presented to patients as an overall cost saver when looking at total healthcare dollars spent, despite the fact that it is often not covered by insurance. For those practitioners utilizing Tendon Dry Needling (TDN), the discussion on how laser therapy can benefit a patient should be very similar. Like TDN, laser therapy is a procedure that helps patients heal quicker and can make dramatic impacts on a patient’s pain in a very small amount of time.
Laser therapy works through a process called photobiomodulation, which works to restore normal cellular function in damaged cells.1 Repeated sessions in a smaller timeframe will help stimulate cells regularly and allow for the repeated influence of afferent nerves to control pain generated from peripheral nocioceptors.2 Infrequent application of the laser will not allow for an ideal “push” of the system.
Accordingly, appropriate plans of care normally require multiple treatments within a set time period to maximize benefit. Common deep tissue laser therapy protocols call for 6-8 treatments over the course of 3 weeks for most problems. This can vary depending on multiple factors such as the size and scope of the injury, chronicity of the problem, and the tissue type(s) involved, to name a few. Subjective and objective patient feedback will help determine the best prescription.
If the patient is not interested in the additional cost of laser therapy, it’s not a problem. For those patients that resist being treated by the laser initially, don’t be surprised if they come back to their next visit wanting to try it out. Sometimes patients need time to think it over and do their own research before they try something that is perceived as “new”. Having some brief literature on photobiomodulation to hand out, as well as dedicated website page with testimonial and educational videos, can go a long way.
After your initial consult with the patient, hopefully you can agree upon the specific plan of care that best meets their needs and proceed accordingly. As the healthcare provider, you are only making your recommendation as to what you feel will get the patient better as quickly as possible. It is ultimately the patient’s decision on how they would like to proceed.
1. Chris E. Stout, Matt Kruger and Jeffrey Rogers, (Eds)- © 2011 Bentham Science Publishers Ltd. Current Perspectives in Clinical Treatment & Management in Workers’ Compensation Cases, 2011, 15: 191-2. 2. Kawatani, M, Matsumoto, I, Sato, T, Takeshige, C, Tsuchiya K 1993, ‘Diode laser irradiation selectively diminishes slow component of axonal volleys to dorsal roots from the saphenous nerve’, Neuroscience Letters, vol. 161, no. 1, pp. 65-68.
The State of Workers Compensation
Workers compensation is a major expense for manufacturing companies and in environments where physical labor is prevalent. The skilled workers performing these tasks are often referred to as “Industrial Athletes”. They experience many injuries similar to those in professional athletics due to the demanding physical environment and repetitive nature of physical movements.
In 2013, benefit payments through worker’s compensation programs soared to an impressive $63.3 billion dollars.1 OSHA estimates that employment-related musculoskeletal disorders in the United States made up over 600,000 of the on-the-job incurred injuries and illnesses, accounting for 34% of all lost workdays based on a report from the Bureau of Labor Statistics.2
As a result of the prevalence of work-related injuries, and high direct and indirect costs associated with these cases, many companies are looking for new ways to prevent injuries, and expedite recovery when injuries do occur.
Bringing it In-House, Realizing Cost Savings
According to the Insurance Journal, the top five workers compensation injuries as a percentage of total claims are:
- Strains and sprains (30%)
- Cuts or punctures (19%)
- Contusions (12%)
- Inflammation (5%)
- Fractures (5%)3
Strains, sprains, and inflammation (accounting for 35% of the top 5 claims) can often be successfully treated with early intervention through both conventional rehabilitation methods and newer techniques such as deep tissue laser therapy. If these common musculoskeletal issues are treated early, they can majorly reduce the number of workers compensation claims and missed days of work, ultimately impacting the bottom line.
Many companies are investing in in-house physical therapy clinics to intervene at the first sign of pain. One such clinic is Zellstoff Celgar Ltd. (ZCL), located in British Columbia, Canada. ZCL is one of the largest kraft pulp mills in North America and has leveraged an in-house physical therapy program since 2005 to keep their industrial athletes healthy and on the job.
ZCL’s in-house physiotherapy program focuses on injury prevention and has found the addition of their deep tissue therapy laser a valuable tool in quickly resolving pain, inflammation, and acute sprains & strains. ZCL’s data shows that prior to implementing their laser therapy program they experienced an average of 35.17 musculoskeletal injuries (MSI) per year. After the addition of the therapy laser, their average MSI per year decreased to 12 MSI – a 65% decrease that resulted in nearly $500,000 of claim savings.4
Laser Therapy for Post-Injury Recovery
Injury prevention is the goal, however, when injuries do occur, laser therapy can help shorten recovery times and return workers to their normal job functions faster.
Tendinopathy is one condition commonly found in industrial settings. Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis reviewed the effectiveness of laser therapy for tendinopathy. These studies identified evidence to support that laser therapy can be effective in treating tendinopathy when an optimal dosage is applied.5
Back, neck and shoulder pain are another common complaint among industrial workers in a wide range of job functions, from those operating machinery, to those lifting heavy loads and performing repetitive overhead movements. In a randomized controlled study performed by the University of Colorado Denver, 55 patients with low back pain were randomized to receive either manual adjustment or adjustment followed by laser therapy. After 4 weeks, the laser therapy group had a 71% reduction in pain score (VAS) and showed significantly better improvement than the group who received manipulation alone.6
In order to achieve these kind of positive clinical results, it is essential that a proper diagnosis be made and adequate energy be delivered to target tissue. In the textbook Current Perspectives in Clinical Treatment & Management in Workers’ Compensation Cases, the chapter “Advances in Laser Therapy for the Treatment of Work Related Injuries“ discusses the history of therapeutic lasers and the technological advancements of newer technology that enable consistent positive outcomes for common work related injuries.7 It is well documented that adequate dosing is the most important factor in achieving clinical outcomes on all injuries, but especially when conditions involving deep tissue structures (such as back pain) are involved.
Get Your Industrial Athletes Back in Action
Adding laser therapy as an adjunct to your current physio and rehabilitation programs can prevent injuries, shorten recovery times when injuries do occur, and positively impact your bottom line. Deep tissue laser therapy can be an effective modality for any conditions where pain and inflammation are present, with no side effects, and no drugs.
For more information about the impact deep tissue laser therapy can have on the common conditions present in your clinic please contact firstname.lastname@example.org. Sengupta, I. (2013). Annual Statistical Supplement, 2015. Retrieved from https://www.ssa.gov/policy/docs/statcomps/supplement/2015/workerscomp.html 2. Finkle. A (2014). 2014. Prevention of Work-Related Musculoskeletal Disorders. Retrieved from https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=UNIFIED_AGENDA&p_id=4481 3. (2016. May, 18). Top 5 Workers Compensation Claims and Their Causes. Retrieved from http://www.insurancejournal.com/news/national/2016/05/18/409006.htm 4. Advance for Directors in Rehabilitation. October 2016. www.advanceweb.com/rehab 5. Photomedicine and Laser Surgery. 2010; 28(1): 3-16. doi: 10.1089=pho.2008.2470 6. ACBSP Poster abstract. Los Angeles, CA; June 2010. 7. Current Perpectives in Clinical Treatment and Management in Workers’ Compensation Cases. 2011: 191-201.
Contributed by Mark Callanen, PT, DPT, OCS and Perry Nickelston DC, NKT, FMS, SFMA
Osteoarthritis (OA) is a debilitating joint condition that effects more than 27 million individuals in the United States.1 According to the Centers for Disease Control and Prevention (CDC), 80% of patients with OA have some limitation of mobility, while 25% are unable to perform the activities of daily living (ADLs)2. Osteoarthritis is thought of as “wear and tear” arthritis and is caused by prolonged, abnormal stress on joints that leads to the breakdown of cartilage on joint surfaces. This is often associated with increased pain while performing daily activities.
When OA pain flares, people often become desperate for relief when they find themselves unable to tolerate the physical demands of a normal day. Many arthritis sufferers often see medication as the only option to alleviate their symptoms. This is part of the reason excessive opioid use has become a national health epidemic. While medication plays a part in most treatment plans, there are other activities and treatments that arthritis sufferers should consider when trying to manage the pain associated with OA.
Closed Chain Exercises
Loosely defined, closed chain exercises are activities that are performed with the feet on the ground. Examples would be squatting or sit to stand activities. Some people suffering from OA in their lower extremities are afraid of weight bearing because of the pain they are experiencing. However, when done properly, this is exactly what is needed.
Small amounts of weight bearing exercise performed over 3 months might not change the volume of cartilage in the knee, but it can significantly reduce pain and improve functional levels.3 This is because even when a joint is considered “arthritic”, exercises like squatting and wall slides can help strengthen the muscles around the joints of the hip, knee, and ankle. This can help improve the biomechanics of how a person is moving and reduce their pain.
Other studies have shown that people committed to exercising for 4 months or longer, focusing on exercises that cyclically load the legs three times a week, can increase the production of cartilage in the knee.4 Setting yourself up with a program that stresses the legs, but isn’t too aggressive, stimulates the cartilage to produce chemical changes that retain more water and thicken.4 This can make the difference between function and failure. Working with a trained professional to get a safe, pain free exercise regimen is imperative to incorporating the correct exercises into your program.
Another important fitness component to helping with arthritic pain is making sure that normal muscle length is maintained throughout the body. Lack of stretching can lead muscles and tendons to become morphologically shortened, which increase the probability they will contribute to pain around the joint. The last thing an arthritic joint needs is to be surrounded by soft tissue that is inflamed and irritable. Staying proactive with a regular stretching regimen should help minimize the chances of this happening.
Stretching can directly promote joint health when it restores normal range of motion. People with OA often have reduced knee ROM which can be due to numerous factors. 5 When joints move, the various surfaces of the joint contact each other which is needed for cartilage to remain healthy. When joints get stiff or if muscles are tight, often the resultant loss of motion does not allow all of a joint’s surfaces to be stimulated. This can lead to cartilage break down. The best defense against this is to keep joints moving through their full ranges.
For those individuals that have more severe OA, they might not be able to bend or squat effectively against gravity due to pain. A pool allows exercise to be conducted in a partial weight bearing environment, which can be a great bridge to help increase strength and endurance. The buoyancy of the water decreases the forces that are transferred to the legs when contacting the bottom of the pool and the hydrostatic pressure of the water helps reduce pain in arthritic joints.
Generally, when standing in waist deep water, body weight is reduced by 50%. When standing in water at chest height, relative body weight drops to 25%. Participants want to gradually migrate to shallower water as their program progresses to increase the percentage of weight bearing with activity. The eventual goal is to try to transfer the program to land-based as tolerated. Seeking out an experienced aquatic therapist to help build and progress a water based program is a great place to start.
Deep Tissue Laser Therapy
In addition to actively addressing fitness levels, deep tissue laser therapy offers an effective passive treatment option that can help reduce arthritic pain. The pain and inflammation that occur in the majority of the body’s joints is created by inflammation of the tissue lining the joint capsule. Therapeutic laser can impact this tissue by improving the microcirculation in the tissue and impacting several anti-inflammatory mediators in the joint. Pain is normally reduced when these changes take place.
In addition to the metabolic effects laser has on inflamed tissue, it also provides a soothing warmth during treatment which also helps the body relax. Individuals will often feel a significant improvement from the first session. While each case is unique, typical treatment protocols call for 6-10 sessions for optimal results, and treatments are often short (about 5-10 minutes in length).
Here’s an example of how these approaches can be combined to minimize pain in an arthritic knee:
- Laser therapy: apply deep tissue laser therapy to the knee joint, calf, lower thigh and lumbar spinal nerves 3-5 at 10 watts of power for 7 minutes (4500 joules total). Better outcomes have been recorded when recipients actively move the joint being treated during 40-50% of the treatment duration in that area. Motion ensures that light reaches all aspects of the treatment area and encourages better range of motion in the affected joint.
- Stretching: spend 5 minutes stretching the knee by fully bending and straightening it while standing next to a stable object. Hold stretches for 15 seconds, rest, and repeat for approximately 2 minutes per muscle to be stretched. Additional stretches at the ankle to promote dorsiflexion and hips to promote motion in multiple planes is recommended. Specific stretching techniques should be provided by a trained professional.
- Closed chain exercises: spend 10-15 minutes working on sit to stands, squats, wall slides, and some type of step up exercise to help build strength in the lower extremities. They should not be painful. Again, specific exercise techniques should be provided by a trained professional to match the program to an individual’s specific functional ability.
- For those individuals that cannot perform a land based program, substitute an aquatic program to work on strength and endurance for 20-30 minutes.
You can take back control of your life from the pain and discomfort of arthritis. Empower yourself to feel good again with movement, stretching, and laser therapy. While the idea of stretching and strengthening isn’t ground breaking, combined with the unique capabilities of deep tissue laser therapy, it might just be your ticket to lasting relief.1. Leahy M. Changing the paradigm for diagnosing and treating arthritis. American Academy of Orthopaedic Surgeons. http://www.aaos.org/news/ aaosnow/nov12/clinical6.asp. November 2012. 2. Centers for Disease Control and Prevention. Arthritis basics. Physical activity for arthritis. http://www.cdc.gov/arthritis/basics/physical-activityoverview.html. September 1, 2011. Updated January 7, 2016. 3. The effects of closed kinetic chain exercise on articular cartilage morphology: myth or reality? a randomized controlled clinical trial. Dinçer U et al. Turk J Phys Med Rehab 2016;l(62):28-36 DOI: 10.5606/tftrd.2016.93899 4. Roos EM, Dahlberg L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: a fourmonth, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis Rheum 2005;52:3507-14. 5. Dieppe, P. Osteoarthritis: time to shift the paradigm. British Medical Journal, 1999; 318, 1299-1300