Editor's note: The first article by Drs. Fitz-Ritson and Kahn, "Lasers Heal: Chiropractors Could Benefit from This Technology," ran in the 11/18/96 issue of DC.
An Overview
Currently the key word in therapeutic solutions is "managed" care. This term lauded by politicians and the corporate sector with equal enthusiasm, purports to maximize efficacy in health care delivery for the consumer with limited cost to the provider. Administered by legions of managers, sales personnel, and financial institutions, in essence it siphons off an ever-growing segment of the health care dollar, which due to financial constraints is already diminished. Where will it all lead? Of two things we can be certain: restricted access and erosion of quality.
Still, there is hope on the horizon with emerging technologies such as low intensity laser therapy, particularly in the treatment of arthritis and musculoskeletal pathologies. This therapy is highly effective, totally safe, non-toxic, and easy to administer. If it is not the ideal therapeutic resolution, it certainly is a leading candidate for that title.
Multiple advances with regard to the technology have been achieved in recent years. This has been stimulated by improved basic scientific research as conducted by Professor Tiina Karu at the Laser Institute of the University of Moscow; research in application such as conducted by Dr. David Baxter, professor of Rehabilitative Science at the University of Ulster, Northern Ireland; and the development of advanced therapeutic systems.
The availability of superior, inexpensive laser and superluminous diodes and synergies moulded by companies, combining clinical concepts with the appropriate engineering, have been an additional and significant component of the advance.
Mechanism of Action - How Does It Work?
A range of laser therapy-mediated biological and physical effects have been reported which explain the observed clinical effects of these devices. These effects include: modulation of various cellular events in vitro1 (e.g., increased cellular proliferation, altered respiratory burst, and apparent modulation of growth factor release); a variety of physiological effects in vitro and in vivo ranging from altered synaptic activity and nerve conduction to modulation in limb blood flow. Controlled laboratory pain studies in both humans and in animals have indicated significant hypoalgesic effects of laser therapy and combined phototherapy/laser therapy when applied at appropriate irradiation parameters.2 Evidence from animal studies would further indicate that such pain relieving effects are, at least in part, opiate-mediated. Finally, while nerve conduction studies (in vivo and in vitro) would indicate that direct stimulation of large diameter fibres at therapeutic intensities is unlikely, suppression of activity in smaller diameter might represent an important antinociceptive mechanism underlying the pain relieving effects of these devices.3
The photon bombardment of cellular molecules results in energy absorption by cytochromes and chromatophores in tissue. In essence, light energy is converted into biochemical energy.
Current Applications
Laser therapy has found applications in physiotherapy/physical medicine for the management of musculoskeletal conditions (including acute and chronic pathologies, i.e., lateral epicondylitis, tendiopathies, and muscle tears), in patient and community nursing for the management of wounds (particularly chronic ulceration, e.g., venous ulcers and pressure sores), and in veterinary medicine and dentistry. While in many cases good evidence to support such applications from well-designed and executed clinical trials is somewhat lacking, controlled clinical research is underway at several international centres. It is hoped that these studies will help to definitively establish the indications for and efficacy of this promising modality. Current evidence in support of the modality finds it superior to most other currently employed electrophysical agents, e.g., ultrasound and electrical stimulation.
Current Situation
The term "laser therapy" is commonly used to describe the therapeutic application of laser and monochromatic light sources at relatively low output powers (usually in the 10-1000 milliwatt range), principally for therapy of multiple tissue pathologies, including those in the musculoskeletal field and for healing wounds and other tissue dysfunctions. Such therapy is based upon the observations of Endre Mester. In the early 1970s he first reported photobiostimulation of wounds as a result of helium neon laser irradiation, first in experimental animals and then in humans. Since these early reports, the therapy has become a popular treatment choice for a variety of clinicians: physiotherapists, dentists and physicians, most notably in the countries of the former Soviet Union and in a number of centres in Europe.4 In these intervening years, the technology has progressed somewhat from "first generation" treatment devices (based upon gaseous media such as helium neon), through the use of diode-based "second generation" units, to the currently popular "third generation" multi-diode arrays. To date, however, no laser therapy device has received FDA approval for a single application.
A new system is scheduled to be available to the market by April 1997, and represents the fourth generation of treatment devices. Apart from its exceptionally high standard of design, the three principal advantages it offers are:
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
