Light Up the Laser – Treatment Techniques to Optimize Outcomes

Light Up the Laser – Treatment Techniques to Optimize Outcomes

It is crucial to apply proper treatment techniques so that the therapy is not only delivered optimally, but safely as well. When combined, all the small details that the operator adheres to form a treatment which delivers therapeutic benefits to the patient.

The first set of proper treatment techniques apply to the laser therapy delivery platform itself. In order to allow the light energy to travel as efficiently as possible, the fiber needs to be fully unwound and should not be kinked or forcefully bent, this will also provide for minimal resistance when the hand piece is maneuvered by the operator. Selecting the appropriate treatment head is an important factor as well. For maximum patient comfort, the small treatment heads should only be used at a maximum power of 3 watts, never higher. The off-contact (often called “cone”) treatment heads should be held at about 1 to 2 inches from the tissue surface, never in direct contact with the patient’s skin or hair coat. The optical window of each treatment head piece must also be clean, intact, and free of any debris, defect, or scratches. The operator will select the appropriate protocol applicable to the condition / body part / surface area being treated. Once these parameters have been selected, we are then ready to begin treating the patient.

The patient should be allowed to position itself so that it is as comfortable as possible, as long as the target site remains accessible. A soft, fleece-like substrate (such as a pad, blanket, or bedding) also makes for an excellent material to rest on. It will also wick away urine if the patient is incontinent. Whenever possible, in treating musculoskeletal conditions, it is best to make direct contact with the deep tissue applicator (aka “the large massage ball” treatment head) so as to maximize penetration of the light energy into the tissues. If, however, we are dealing with exposed tissues such as with a hot spot, open wound, or a fresh surgical incision, a non-contact technique is required, holding the treatment head at 1 to 2 inches from the surface of the area being treated.

When performing the treatment, the treatment head is held perpendicular to the surface of the target tissues to ensure an even beam spot. The laser beam should make a full excursion, crossing over from the affected tissues into the nearby healthy tissue margins, never hovering over the same treatment area. As the treatment is being carried out, the operator will continuously move the hand piece at 1 to 3 inches per second so as to fully and evenly illuminate the treatment site, the hand piece should never be kept motionless when the laser is being delivered to the patient. The operator will also monitor the patient and treatment area for any possible increase in warmth, this is especially important when treating tissues which are heavily pigmented or with a dense hair coat. The latter also especially applies to the anesthetized patient, such as when treating dental extraction sites, for the patient will not be able to physically respond to any sensation of discomfort or excessive warmth.

Specific parts of the patient also carry inherent treatment nuances. When treating joints or an extremity, it is optimal to treat as circumferentially as possible, while putting that joint through a gentle passive range of motion (if possible) so that all aspects of the intra articular surfaces are well-illuminated. Any biomechanically associated structures to the target site should also be assessed and possibly considered for treatment, secondary sites are often affected due to the deterioration of the primary target structures and compensation changes in biomechanics. When treating with a contact technique, it is usually to the added comfort and medical benefit to the patient to apply a massage-like technique, but care should be taken to decrease applied pressure when passing over a boney prominence, such as a dorsal spinous process, as this may create discomfort in those areas. The laser operator should use both hands to constantly monitor the patient as the treatment is being carried out – feeling for increased coat temperature, withdrawal and/or muscle spasm during treatment.

Applying these treatment techniques is easily achieved, they are all small facets that together create an optimal treatment delivery of this cutting-edge medical modality. An experienced operator following these guidelines will be able to give the patient the full benefit of a treatment well designed and well carried out in a non-invasive manner.

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August 2016
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