Class IV laser therapy, hands free, is offering doctors of chiropractic new therapies to fight pain
There has not been a new modality or treatment that has grown as quickly and been as widely accepted as laser therapy. Not only is Class IV laser therapy a game changer in the results obtained with your patients, it has proven to be a fantastic clinic income producer as well.
Within six months, my practice had converted to a 50/50 chiropractic and laser-only clinic, with my laser therapists able to perform all of the treatments. I simply reviewed progress and re-exams. Patient results have been excellent, and this is a cash-based treatment only.
Class IV Laser and FDA clearance
One point of concern is whenever you buy a laser from any source or any company, and it doesn’t matter if it’s Class IIIb or Class IV, the laser must have clearance and registration from the FDA.
There are so many lasers and even LED devices one can buy on eBay or Amazon, or even from equipment dealers, that are being illegally imported, illegally sold, and thus being illegally used by the doctor or practitioner. All you have to do is ask the supplier if they have an FDA clearance. This must be furnished if you ask for it. If you are treating patients, then FDA clearance and registration is a must. There are several great laser companies that are more than willing to provide that information.
Cut through the babble
A second item I have reservations about is so-called “techno babble.” This is simply scientific or technical information being presented by a salesperson that really has no specific purpose, impact on patients’ health, or could even actually be a fact as it relates to laser therapy.
I have found that some salespeople have no real clinical experience treating real patients paying real cash out of their pockets. If a salesperson tells you things like it is fine to treat through clothes or a leather belt or a coat, then be concerned as these statements don’t correspond with the laws of laser physics or proper patient protocols and standards.
One of the thoughts many doctors expressed was if Class IV lasers could be done hands-free or with no patient contact. Class IIIb lasers had been done hands-free for some time. However, the differences in the classes of laser have posed new challenges.
Class IIIb lasers usually only operate with a maximum power output of 500mW, while most newer Class IV lasers from proven manufacturers usually have at least a 10mW minimum output for much faster treatment, and here was the situation. A Class IIIb laser running at maximum power at 500mW delivers ½ joule of energy per second, or 30 joules per minute. A Class IV laser at only 10W delivers 600 joules per minute. In a five-minute treatment, for example, that would be 3,000 joules. A Class IIIb laser at 500mW would take 100 minutes to deliver the same treatment.
There is a threshold, or a point where one must deliver enough photons to turn on the therapeutic value of the laser. With super-pulsing, although the peak power is very high, the average output of super-pulsed lasers is comparatively low. Even though the peak power of the laser may be very high, it lasts for an extremely short time, often said to be in millionths of a second, compared to the pulse cycle, resulting in an average output power that is usually 100 to 1,000 times lower than the peak power.
For clinical use, it is the average power that counts. These are the reasons that allow Class IIIb lasers to be unattended — they are associated with low power and very long treatment times.
Designing hands-free systems
The issues to address with doing hands-free Class IV laser were how to administer the maximum number of joules needed for maximum patient outcome without tissue thermal overload, as a Class IV laser is meant to be moved over the tissue.
A few of the excellent laser manufacturers designed hands-free systems for their lasers as add-ons to their existing attended therapy laser, and many work well. These systems consisted of a special cart with a flexible arm and emitter holder and a device that would allow the beam to be spread over a larger treatment area, which is also a bonus. However, one of the issues was that the hands-free system was an option to an already-expensive piece of equipment. As mentioned, these are quality lasers from manufacturers that can help you accomplish your goals.
Once set up, the laser emitter was placed over the area of concern and treatment started. This is an excellent way of using Class IV laser as it frees up staff and the doctor, allowing both to work with other patients. Hands-free is also great for the smaller practitioner in that the clinic doesn’t need extra staff to run the therapy. Hands-free Class IV laser therapy also allows the doctor to add a complete, new, safe addition that can produce a sizable income stream. Listed below are the major benefits of hands-free Class IV laser therapy in the reduction of pain:
Summary of Light-Induced Analgesic Responses
- Increase in beta endorphins
- Increased nitric oxide production
- Decreased bradykinin levels
- Ion channel normalization
- Blocked depolarization of C-fiber afferent nerves
- Increased nerve cell action potentials
- Increased release of acetylcholine
- Axonal sprouting and nerve cell regeneration
Class IV laser: addressing the challenges
In addressing the situation of Class IV hands-free treatment and no-contact therapy, there were several challenges. The first issue was building a system that could fully address the needs of the doctor, clinic and patient load safely. The second was to make the complete system as affordable as possible. It is always easy to build expensive treatment devices; manufacturing top-quality equipment that produces the results you need and want is difficult.
We took a top-selling 27.2w four-wavelength laser and designed special software. The software was written to only perform hands-free Class IV laser therapy using the accessories that came with the hands-free kit. A special cart was created that fits all the needs of a busy clinician as well as being two-finger height adjustable. The custom flex arm and emitter holder were constructed to fit the emitter and allow for precision placement on the area to be treated.
The final piece was the optical headpiece. This is a special, custom-cut aluminum billet diffuser that screws on the end of the laser emitter. The exceptional ground lens inside is specific only for hands-free laser therapy. Once the system was easily assembled, the doctor or clinician could be doing hands-free Class IV laser therapy in three inputs on the touch screen.
If you want to add the remarkable benefits of Class IV laser therapy and do it unattended, or with non-contact therapy, then check out the various systems on the market. Not only will you be pleased with the results, but you will save time and staffing in the process as well as add to your bottom line.
GARY HUDDLESTON, DC, owns Accuflex Tables & Lasers and is a 40-year practicing chiropractor and manufacturer. He has treated thousands of patients using laser therapy and manufactures both the Medray and Accuray family of lasers as well as Accuflex Tables. The Medray Prime System with S.T.A.R. software is the only Class IV laser system designed specifically for hands-free non-contact Class IV laser therapy. His current practice consists only of professional sports and the film and music industry. He can be contacted at 573-745-1086 or email@example.com.
ROB HANOPOLE is CEO of The Laser Masters, a company that helps doctors and therapists design, open and run laser pain and rehab clinics through one-on-one development and nationwide seminars. He can be reached at 954-296-8473, at firstname.lastname@example.org or at thelasermasters.com.