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Learn tips about Class IV laser therapy and other health related topics on the Companion Therapy Lasers blog!  Check back weekly for updated posts.

Contributed by Ren Houyoux, LVT

When administering laser therapy, it is important to select the appropriate treatment head given the desired treatment technique (on or off-contact) as well as the power (wattage) selected. Here, we will discuss aspects pertinent to maximizing the effectiveness of an “off-contact” treatment delivery.

Companion Therapy Lasers all come with two flat “cone” attachments designed to be used in an off-contact treatment setting. The appropriate hover distance from the surface of the tissues is 1” to 3”. This is important to remember when we take into account the divergence (widening) of the beam. Each treatment head’s optical window has a specific divergence, and in this case both the large and small non-contact treatment heads will diverge the beam at a 47⁰ angle. Coming closer than 1” is not an appropriate technique, just as backing away more than a few inches will reduce fluence (J/cm²), and potentially expose near-field objects to the laser beam. Thus, the operator should always stay within manufacturer recommendations so as to safely and most effectively treat sites that cannot handle direct contact.

Empower Delivery System Attchement Details_Off Contact_Companion

There are several advantages in being able to treat sites with which we cannot make direct contact. With this treatment technique, we are able to effectively treat open wounds, exudative lesions, sterile sites (intraoperative treatments, such as a cystotomy incision while the bladder is still exteriorized), or sites which are just too painful for the patient to allow any contact (rattlesnake envenomation, severe degloving injuries, etc.). Granted, any time we operate the laser unit without making direct contact with our target tissue, we know that there will be a certain amount of natural reflection from the surface of these tissues, but the benefit gained in these instances is greater than the disadvantage of increased energy loss.

Superficial conditions, such as hot spots, can be quite sensitive, so operating with a conservative amount of power reduces the possibility of a patient developing any sensitivity during the treatment. When using a built in protocol, the laser will automatically adjust the settings to ideal parameters for treatment. However, when operating the laser in a manual mode, utilizing a pulsed beam emission provides for thermal relaxation time to these superficial tissues, preventing any potential for thermal buildup at the surface of these tissues.

Even when treating off contact, you must still apply laser to directly exposed skin (or fur). In other words, you cannot apply laser through bandages, casts, splints, tape, etc. In order to get consistent results, we must deliver consistent treatments, and adhering to this restriction when operating in an off-contact technique is imperative.

Another important factor to take into account when treating off-contact is the possibility of a topical ointment or cream being part of the treatment plan. For example, the attending clinician may very order a topical product such as Quadritop or Silver Sulfadiazine paste for wound care. In this instance, the laser treatment should be applied without the topical agent being present. Due to the local vasodilation that occurs with photobiomodulation therapy (PBMT), as well as angiogenesis, there could be a change in the natural absorption rate of a topical product. Another concern is whether or not using a NIR beam may inactivate/potentiate, or otherwise alter the normal chemical functioning of a topical product. With these factors in mind, the operator must always ensure that PBMT treatments be done either prior to applying a topical, or that any topical be removed prior to the PBM session.

Just as with any PBMT treatment, regardless of whether we are utilizing an on-contact or off-contact technique, the operator must keep the hand piece perpendicular to the tissues being illuminated. This will ensure an even beam spot will be delivered to the tissues, and thus provide for complete and even illumination of the target tissues, delivering a therapeutic dose of energy to these sites, producing a clinically-effective treatment.

Lastly, it is also important to remember that each treatment head attachment has an ideal power range for delivery. The large non-contact hand piece attachment should be used whenever we are operating at a power higher than 3W. In this instance, we can ensure patient comfort during treatment and maximize treatment head attachment lifespan.

The on-contact treatment heads (also called deep tissue) can also be used with an off-contact technique. The advantage of this application is that the laser beam remains much more collimated with these (either 3⁰ or 13⁰, depending on whether the large {3⁰} or small {13⁰} deep tissue applicator is being utilized). This in turn enables the operator to treat a very defined site (such as an intraoperative enterotomy incision) effectively without contaminating tissues or widening the beam spot to the point where a decreased dose is delivered to the target tissues.

The Companion Therapy Lasers delivery system provides the operator with a significant amount of flexibility in being able to address various conditions effectively. One size does not fit all, and thus not one single treatment head attachment should be used for all treatments. The ability for the laser operator to choose from four different treatment heads provides a clinical efficiency in addressing a myriad of conditions and treatment design applications.

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Have you heard of the term “prolotherapy” and wondered: “Is that the same as platelet rich plasma or stem cell therapy?”. If you answered “yes”, you’re not alone! Prolotherapy, also known as “proliferation therapy” or “regenerative injection therapy”, is a term that is used to describe an area of therapeutics that result in proliferation and healing of damaged tissues.

Sounds very familiar to regenerative medicine, doesn’t it? That’s because prolotherapy works under the same principal of utilizing the body’s own healing capabilities to heal and repair tissues. But what makes it different than platelet rich plasma and stem cell therapies? In this blog, we will explore the uses of prolotherapy, what it consists of and how it differs in its method of action from the regenerative therapies we have come to understand.


What is prolotherapy?

Prolotherapy is a therapy in which an irritant solution is injected at a site of injury/pain with the goal of eliciting a temporary, low grade inflammatory response resulting in healing and repair of connective tissues. The irritant typically used for these procedures consists of 12-25% of Dextrose, the naturally occurring form of glucose.


How does prolotherapy work?

It is generally accepted that when a solution consisting of more than 10% dextrose is injected into a tissue, it creates an osmotic gradient outside of the cells. When a prolotherapy solution is injected into the tissue, it draws out water from within the cells, resulting in their lysis, also described as osmotic shock. When cells undergo apoptosis, they release signals to the body to undergo a wound-healing cascades at the specific sites of injuries. In essence, prolotherapy creates a minor injury to the tissue with the goal of an increased healing response to the tissue.1


What is prolotherapy typically used for?

Prolotherapy has been reported to be useful in facilitating the repair of weakened or unstable tendons and ligaments as well as various forms of spinal pathologies resulting in pain. While numerous studies have attempted to investigate prolotherapy for use in osteoarthritis, there has been very little evidence showing its efficacy over placebo for outcomes surrounding pain, peak vertical force, and range of motion in enrolled canine patients.1


How does prolotherapy differ from platelet rich plasma and stem cell therapies?

While prolotherapy does elicit an inflammatory response resulting in growth factors and healing cascades, it requires injecting an irritating solution to produce such a response. This irritating solution can be painful during and after the injection, necessitating an anesthetic agent to be utilized in conjunction with the injection.

In platelet rich plasma and stem cell therapies, the body’s own cells are injected into the site of injury where they initiate the healing cascade at the affected tissue. The environment of the tissue is modulated through naturally occurring pathways facilitated by the cells being injected. Since platelet rich plasma and stem cell therapies utilize the body’s own cells and the injection of them creates minimal irritation, further damage of the tissue is avoided.

 PRP Injection

1. J. Matthew Sherwood, James K. Roush, Laura J. Armbrust, and Walter C. Renberg (2017) Prospective Evaluation of Intra-Articular Dextrose Prolotherapy for Treatment of Osteoarthritis in Dogs. Journal of the American Animal Hospital Association: May/June 2017, Vol. 53, No. 3, pp. 135-142.
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Contributed by Ren Houyoux, LVT

When performing a laser therapy treatment, selecting the appropriate treatment head for the intended technique as well as the selected power is imperative. When treating using an on-contact method, only the deep tissue applicators (also referred to as “massage ball” applicators) are appropriate to use. The two flat “cone” attachments can NEVER be used with this technique, as it is not their intended method of delivery and could cause harm to the patient or damage to the treatment head itself – their use is restricted to an OFF-contact technique.

Benefits of Treating On-Contact

There are several advantages to treating with an on-contact technique. First, making direct contact will reduce the amount of light reflection off the skin’s surface and maximize penetration into the deeper target tissues. Any time we operate off-contact, a certain amount of natural reflection from the surface of the skin and the hair coat occurs.

Second, by making contact and applying a moderate amount of pressure (similar to a massage), we are able to blanch the tissue and reduce the amount of incidental light absorption by hemoglobin in superficial capillaries, etc, thus further optimizing photonic saturation of deeper target tissues. Additionally, this massage-like technique not only feels good to the patient, it also encourages local blood blow.

Lastly, applying a combination of on-contact treatment while applying a moderate amount of pressure will compress superficial tissues (such as fat), bringing the target tissues closer to the laser’s point of emission. A myriad of deep musculoskeletal conditions can and should be treated with an on-contact technique, including osteoarthritis, sprains, fractures, tendinopathies, cystitis, asthma, and pneumonia.

Benefits and Best Practices for On Contact Laser Therapy Blog Image 2

Ensuring Adequate Dose Delivery

In order to ensure complete saturation of the target tissues, the hand piece must be held perpendicular to the tissue surface. Any time we operate at any other angle than perpendicular (90⁰), the beam spot will be distorted, reflection from the tissue surface will increase, and there is an overall uneven distribution of light to the tissues.

In addition to treating perpendicularly, it is also important to remember to treat all limbs/extremities with a circumferential approach (from 360⁰) so as to fully and evenly illuminate the target tissues and structures.

Knowing Your Equipment

We should also be mindful of the parameters specific to each attachment head. The two attachment heads meant for an on-contact technique (also called “massage ball” or “deep tissue applicator”) each have their own power applications and beam divergence (widening). While the large deep tissue applicator can be used at any power and has a divergence of 3⁰, the small deep tissue applicator should NOT be used when operating over 3 watts, and it has a divergence of 13⁰.

Thus, we should select the appropriate treatment head as per the specifics of the case and should be able to “visualize” tissue exposure. So, while the large massage ball has a larger beam spot (at the surface of the lens) than the small massage ball, the latter has a more pronounced beam divergence (widening) as the laser gets further away from the hand piece.

That being said, the deep tissue applicators may be used with an off-contact approach when the situation allows. The beam of the large deep tissue applicator only diverges at a 3⁰ angle, meaning the beam itself remains highly collimated. This high-degree of collimation is ideal when performing intraoperative treatments when we cannot make contact with sterile tissues. Thus, a very specific area (such as a cystotomy incision, anastomosis, enterotomy, gastrotomy, etc.) can be treated from a short distance without compromising sterility.

Benefits and Best Practices for On Contact Laser Therapy Blog Image 1

Maximizing Patient Comfort

Part of deciding on a treatment approach (i.e. on/off-contact) also depends on the amount of sensitivity a patient displays. If a patient is extremely painful, it may be needed to start therapy with an off-contact approach and work our way up to an on-contact technique once we’ve attained a significant clinical (palliative) response.

Sometimes, a patient may seem sensitive when it may actually be a “startle” response when the operator makes initial contact with the skin. This startle response could also be from a temperature gradient (i.e. the treatment head surface may be cold). It is useful for the operator to make initial contact nearby, but away from the painful tissues so as to minimize or prevent this type of response. Making initial contact with a non-painful part also decreases the stress the patient will experience. For example, a geriatric cat suffering from lumbar spondylosis can be relaxed by using the deep tissue applicator as a massage ball on the neck just prior to moving to the lumbar spine and starting treatment.

It is also important to determine if the patient is hypersensitive to touch, temperature, or both, especially in cases in which the laser operator is treating for chronic pain. This is particularly true over boney prominences, and in areas of thinned skin, especially of the elbow and the stifle. In these patients, as well as in any patient with a wound in the treatment area, treating in an off contact manner may be necessary. A simple technique that can differentiate between patients objecting to physical contact and those sensitive to warmth is to attempt to “treat” with the laser off, that is simply applying gentle pressure with the massage ball treatment head. If the patient does not object to this technique, but displays agitation or signs of discomfort during treatment when the laser is on, adjustments may need to be made in turning the power down (usually in increments of 2W) and attempting to treat again, following proper guidelines on monitoring patient comfort as discussed in previous blogs.


Proper treatment head selection and delivery technique are of crucial importance with any photobiomodulation (PBM) treatment. Following manufacturer guidelines and recommendations for treatment head use ensures safe treatments and optimal results, and should thus be strictly adhered to.


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