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Caroline: Hi, everyone, and welcome to the Tuesday webinar series, Chiropractic Economic Webinar for Doctors of Chiropractic. I’m Caroline Feeney, the associate editor of Chiropractic Economics magazine. Today’s webinar, Musculoskeletal Laser Therapy: Integrated Clinical Protocols is sponsored by Erchonia and as always, our program is being recorded and will be archived at Chiropractic Economics website, chiroeco.com/webinar, for one year.
Our expert is on board here today to speak with you. And when his presentation is complete, we will follow with a Q&A period. You can submit questions throughout the presentation by clicking on the appropriate icon on the right side of your screen. We will do our very best to get to all of your questions. But if we run out of time, we will forward the remaining questions to our experts and then notify you via email when the answers we are posted, we have posted on our website.
Our expert today is Dr. Robert Silverman. The CEO of New York Chiro Care and a specialist in successful private practice in White Plains, New York, where he specializes in the diagnosis of joint pain and soft tissue management. He is here to help you understand the ways in which you can incorporate laser therapy in clinical practice.
Dr. Silverman, thank you so much for taking the time today to participate in our webinar and for sharing your expertise in musculoskeletal laser therapy. We appreciate you helping the audience understand how they might benefit from adding this modality of care to their practices. Now before we get started, please give us a brief background on yourself and your work with laser therapy.
Dr. Silverman: Were going to talk about Musculoskeletal Laser Therapy: Integrated Protocols. As I said earlier, thank God everybody now can hear me, I’m very happy. I’ve been using lasers in my office for over the last eight years. I found it to be a great tool to increase with clinical outcome with patients.
My background, obviously, is in chiropractics and I am a chiropractor but as I went through chiropractic school, as I said earlier, there was a burning question in my head. And that burning question in my head was very simple. How could we fix the body from the inside out? And I do believe that low level laser therapy has one of the two, if not the only tool, to truly help that. The other one would clearly be nutrition and we can expand the field on that also, but low-level laser therapy helps heal the body from the inside out.
Now over the last eight and a half years I’ve used all the different models that Erchonia has to offer, and I’ve found them to be extraordinarily effective in clinical outcome. The thing that I like most is the FDA clearance. If you’re going to take laser therapy into your office please consider the concept of FDA clearance. FDA clearance for what? FDA clearance for specific conditions like plantar fasciitis and/or for decreased pain and increased range of motion.
So without further ado since we’re a little shorter on time now, I would like to move ahead and talk about Musculoskeletal Laser Therapies: Integrated Clinical Protocols.
Great picture that we see right over here. I have one of my patients and they’re standing on a particular proprioceptive unstable board. So they’re getting proprioception from their lower gait in a small foot beyond the position with scapula stabilization and I’m lasering him, I’m core lasering him, I’m trying to facilitate his core muscles with the laser something called the base station. So you see how diverse and integrated laser therapy can be done. There’s many different manners in which we can apply laser therapy. The quote is very simple in there, “Let there be light.” I mean, we always used to use light and light energy in healing 30, 40, 50, and 60 years ago, and we’ve gone away from it. I’m very comfortable now seeing the reintroduction of laser light therapy.
This slide explains really where we are in the concept of pathogenesis of cumulative trauma disorder. The top graph really depicts somebody who has an injury, has ample recovery but unfortunately, or fortunately for them, the symptomatic injury threshold does not indicate pain and they have any complaints. That doesn’t mean that they’re healed, because I’m a big proponent that even though they were injured without pain, I’m really concerned about their movement.
The second graph, the bottom graph, the pathogenesis of cumulative trauma disorder, truly depicts what we see every day in our office today. A great example of this would be carpal tunnel.
Here we have injury cycle. We have unfortunately insufficient tissue recovery between the cycles. Tissue damage accumulates and we go over symptomatic injury threshold. We now have a dysfunctional joint, muscle injury, nerve injury and/or typically, the patient complains about pain. This is what we deal typically with in the chiropractic office. Both have their place.
Well, integrating laser into a practice. Everybody knows Dr. Oz. He cleverly called the Erchonia low-level laser, the “No Pill Pain Buster”. Unfortunately for me, I wasn’t on the Dr. Oz Show at that point, but I said it was the most versatile healthcare tool of the 21st century. So you’re seeing two different concepts. Oz really coined it decreasing pain. I’m talking about its versatility. It’s versatility and ability, actually carry it anywhere you want. Many times I travel, I do about 40 weekends a year. I travel with it. You can put it in your pocket and/or for the diversity or versatility it brings to different conditions.
I’m a big proponent in a blueprint. What do you do when the patient comes in? So here’s a basic blueprint. Number one, we must find the cause. Number two, explain the source. You know most M.D.s unfortunately spend 18 seconds before they interrupt their patients. We as D.C.s have a little bit more, if you will, verbal give and take. I have a lot of students that follow me around and they ask me the first class they should take. And I tell them, communication. You have to be able to communicate with our patients. They want to know a short- and a long-term goal. Laser provides that. In addition, you always have to determine an effective treatment time and, I’m in the northeast. Everybody wants a shortened treatment time. Everybody wants it fixed yesterday. One visit, all sorts of ailments. So it’s a nice little blueprint to look at when you start dealing with patients.
One of the questions that a lot of doctors ask me is, “What comes first? Injury or pain?” You know what, I’m not really sure it’s the old chicken or the egg, but I know what is key in that it’s called altered motor control. That is our fundamental question in which we should diagnose. Altered motor control. So a sprained ankle? Clearly we’re able to treat a sprained ankle. Even though it has the highest reoccurrence rate of any injury. But when you think about the swelling and the change in the patient’s gait, if you address the swelling in the injury, but you don’t address how they move, the brain will change their motor control to address the injury. However, if you did not re-change, or reprogram or inground that altered motor control, the person’s always going to move in an aberrant manner. So we can apply a laser to help that.
Also, this is the neuromusculoskeletal detonation sequence. I think this was put together beautifully by Dr. Yanda. This depicts upper and lower crossed syndrome and if you combine them, layer syndrome. In a nutshell, on the left there is a pain dynamic. You have a tight muscle, a hypertonic muscle. That muscle neurogenically inhibits the balancing muscle, together between the tight and the weak, or the tight and the neurogenically inhibited muscle, you get a strain point. At that strain point there’s pain. The patient has a complaint. And that is based on Sherrington’s law in the 1950s of reciprocal inhibition.
It would be as if I turned in front of the audience right now and you can visualize me doing a bicep curl like Arnold Schwarzenegger, you would hopefully see my bicep contract. However, what is my tricep doing at that point? It is neurogenically shutting off so it can lengthen to allow for the muscle contraction. When you look at the center part of this particular slide, the head is like a bowling ball. It’s 9 to 12 pounds. For every inch that it’s pointed forward, in interior head carriage, that’s one to two times the weight.
The Washington Post just did a particular article on what they call text neck. Which is the average person texting is a six inches forward, that’s as if an 80-pound child is on their back. The pressure, the damage done to the joints. There’s literature to show if someone who has an interior head carriage that they have an increased SI radiculopathy.
Enough of that, now let’s look at the upper cross syndrome, in that the pecs are typically tight causing round shoulderness and there neurogenically inhibiting the mid and lower trap regions. The sub occipitals usually are tight shutting off the deep neck flexors, the longus capitis and the longus coli. The sub occipitals are an interesting set of muscles. Because they really don’t have long endurance value. So typically somewhere between three days and three weeks they fatigue. And that’s why we see most people with acceleration/deceleration injuries moving forward. The strain points are intriguing in that the strain point is at the TMJ, the cervical thoracic region, and the GH joint region. So yes, a postural imbalance will cause a jaw jut, interior head carriage and can lead to TMJ issues. The glenohumeral joint, if you’re round shouldered, you have repositioned your scapula not to allow your arm to go and the GH joint now could have what we would call an impingement leading to a rotator cuff injury and the like.
When we go below the waist the erectors are typically tight shutting off the abdominals. Also we have the psoas, probably the most indicative of lower back pain. A hypertonic psoas shuts off the strangest muscle in the body, not per square inch, the gluteus maximus. This leads to lower cross syndrome. This leads to specific strain points at the TL junction, lumbosacral junction, and the hip.
Stuart McGill, who I have a tremendous amount of respect for, really has done a wonderful job on the literature front. He has said, “Immediate pain reduction can be achieved by altering muscular activation and movement patterns.” Kind if piggy backs on what we said earlier about the altered motor control.
Well, I’m a big proponent of movement, I think that movement is a key component with that. It’s all about movement. It’s not about individual muscles. We have to look at the body as a whole, interconnected, integrative unit that has muscles, nerves, vessels, all interconnected to the brain, not isolating a muscle. The sole purpose as a body is to hold our brain, and encase our brain and allow it to move. So I believe that the search is on, in that I think that the search is on for a great answer for musculoskeletal injuries and things to help musculoskeletal injuries.
So I think it all starts with laser focus. We need a laser focus. Now laser’s interesting in that it is an acronym. It is light amplification by simulated emission of radiation. It is a true focused beam of light that emits photon energy. It is a coherent light, meaning all photons travel in the same direction at the same wavelength at the same time. The best way to describe coherent light is the conversation that my wife and I have had multiple times about hairspray. I love to take the hairspray and put it right by my hair and it all goes in the same spot at the same speed with the same wavelength. My wife hates it because she says my hair clumps. She loves to spray all around. But I like the hairspray close to the hair because it’s coherent. She’s doing it incoherent diverse because it spraying it all over the place. We want our laser light to be coherent, non-scattered.
The cell is a machine driven by energy. In every medical transition before ours, healing was accomplished by moving energy.
Well, how does laser work? What are we talking about? The best answer, the most simplistic answer, the best way to explain it is using the basic principles of photochemistry. Light chemistry. Light causing chemical reactions.
What I like to talk about most about the concept of a light energy, you know people talk about laser light. Do you have to touch the skin? No. Can you be a few inches away? Yes. How does it work? It’s truly the branched-chain effect because a single photon can trigger a reaction in a cell that causes emission of several photons. They then trigger photon emissions in other cells like a chain reaction. So this actually accounts for the fact that a signal can be multiplied to cause a rapid and regenerating flow of energy through the system.
So the branched-chain, the power of one. The metaphor would be as if you were to take a mousetrap with a ping pong ball. I take 8,270, somebody actually counted this, mousetraps with ping pong balls to put on a football field. If I had that one ping pong ball on the sideline, the laser, and I threw it in the middle and it hit one of the mousetraps, there would be a cascade of reactions effecting everything. That’s the branched-chain effect of low level light therapy.
Well how does it work? Well, it stimulates cell activation in turn, turning into a physiological activity. Healing is essentially a cellular process. Light energy initiates a cascade of reactions. From our cell membrane, understanding that the light is absorbed by the cell membrane, to the cytoplasm, to the nucleus positively effecting the DNA. Simply put, its cellular amplification.
So the question and the way it’s been phrased to me is, “How does this Star Trek medicine benefit our patients?” The word photobiostimulation. If you were to Google that right now, you would look up and see that photobiostimulation allows it to result in two basic responses. The low level light therapy, LLT, increases cellular regeneration due to increases ATP production. Let me say that again. LLT, increased cellular regeneration is increasing ATP production. And not only the production, but the efficiency of ATP production, whereas also increasing cellular communication due to a positive effect on the nervous system, by living matrix, and the cell membrane.
So in the end, when you’re not sure and you have a laser, you want to talk about cellular regeneration and cellular communication. Cellular regeneration functions by laser therapy causing an increase of ATP production, which is a true precursor to cell division. Photons are absorbed by the chromophores on the cell membrane. These chromophores are light emitting portion of the cell membrane. The absorption of these lights starts a chemical cascade through the cell membrane leading to efficiency of ATP production.
Cellular communication is intriguing in that the integrants, these are specific receptor sites on the cell surface, they link the cell to the surrounding environment. Now we know that cells are all interconnected as I talked earlier, they’re actually like and binding sites which bind all of our extra cellular matrix. Our extra cellular matrix being our cartilage, our ligaments, our tendons, and the big player, the fascia. Once they’re able to affect the fascia, fascia is the key to interconnecting the whole body because fascia is an intercellular signaler.
So laser therapy, there’s three major components that are integral to the beneficial outcome of light laser. The most important, and this is the take-home, the literature is vast, or if you will there is a plethora of information of information and literature that indicates a wavelength, a specific wavelength is responsible for influencing biochemical cascades. The wavelength that’s most important is 635 nanometers, the wavelength of visible light.
Two, the dosage. The power of light determines the response. Too little, not enough. Too much, adverse effect producing heat. I don’t want to produce heat because in my mind if I have a heat generating laser, yes, its hot. How hot? They’re not sure. Why don’t I want a heat producing laser? Too much blood flow. Too much blood flow.
Heat. Do you want heat in acute condition? I think the consensus would be no. Do you heat an entrapped nerve? Probably not. The only time you may consider heat viable would be in a chronic condition, which is one out of the three types of conditions we see. Light therapy will produce the right amount of intensity to allow the cells to heal from the inside out. And of course, the delivery mechanism, the key is coherent focused light ensuring appropriate tissue stimulation.
Six thirty-five is the key wavelength because it’s the frequency of a healthy cell. Absorbable dose. It is visible life. It is where DNA replication occurs, which the word photobiostimulation comes from, and it’s 20 times more effective than longer wavelengths. This study really showed that low level laser therapy accelerated tension healing, increasing fibroblastic proliferation, leading to collagen synthesis. The 635 nanometer light produced a high deposition of collagen, increasing tensile strength of completely severed and surgically repaired rat tendons.
Key component. The outer cell membrane we call the cytochromes, but the inner cell membrane, which gets stimulated from the 635 wavelength, is cytochrome c-oxidase. That’s the key component, that is essentially hitting home, if you will. So as long as we can stimulate CCO absorption we’re going to pierce and penetrate the cell. Because by far, it may be considered a mitochondrial photoreceptor. We’ve shown in literature that 635 nanometers has the ability to influence mitochondria enzymatic reaction, particularly CCO, leading to mitochondrial activity and efficient ATP synthesis.
The frequency. People talk about the beeping of light. It essentially is the beeping of the red light. It’s the number of flashes per second. It is the modulation of light that will enable people to overcome clinical plateaus. FYI, the frequency of 30 or less, is visible to the naked eye. Over 30, the pulse is too fast to see and it appears as continuous. So when you look and you put it on your hand, you’ll see one beeping and one looking straight, that straight one has a frequency of over 30.
For me, my big fab five when a patient walks in, very simple. Number one, joint dysfunction. Always will get joint dysfunction first. Number two, as I go from the inside out. I look at the extracellular matrix. Once again, the cartilage, the tendons, the ligaments, and the fascia. Always seeing and determining if the patient is exercising. Well how are they performing their exercise? Their ergonomics. Are they having any proprioception and what proprioceptive moves to increase? Number four, without question, laser therapy. And finally, not last but quite important, nutrition. Number one, their diet and number two, supplements to diet.
By applying, and this is my take, by applying laser energy to affected areas, the frequency sensory nerve firing is increased, which subsequently increases the stimuli to the spinal cord, brain stem and brain, and in turn decreases pain at the spinal cord and brain stem levels.
Do you need a lot of power to penetrate? No, too much power indicates that it’s not a low level laser. Low level laser therapy are affecting biochemical but did not affecting dermal because they’re causing no heat, thereby causing no damage to living tissue. It’s sort of like burning the toast when you heat the skin.
The Arndt-Schulz law is quite interesting in that he really depicts some interesting things in that he really talks about biomodulation. He explains that a very weak stimuli doesn’t do much, a moderate stimuli favors biomodulation, a strong one retards it and a very strong one can arrest it. So biomodulation is restoring the cell back to its natural frequent. Because as we all know, the body is all interconnected.
Andrew Weil really talked about spontaneous healing. The circuitry and machinery is there, the problem is to discover how to turn the right switches to activate the processes at the right time. I can tell you that laser light is used to turn on the right switches, and what I mean by that is we have something called upregulation. We’re turning muscles on and off, we’re enabling muscles to be stronger. That is not our end goal when I teach a seminar. Our end goal is to get them to move functionally because we’re now in that 21st century. However, here is some muscle test that you can do. C1, C2, C3, 4,5,6,7, 8 and T1. You can run through those and I can split the heads of one of our lasers which is now the PL Touch or the P5 Touch. When we split the heads, we can put one of the heads’ laser light by the spinal cord and the other one by the nerve root, enabling us in 5 or 10 seconds to get a different result in any kind of the associated muscle tests that you see before you now.
We also can apply the muscle testing and the splitting the heads to the lower kinetic chain going through all the myotomal muscles in the lower body. I’m a big proponent and I like to break these down a little bit, lasering individual muscles to lead to a functional movement. So some people have a tight FCM. I happen to have it, I have congenital torticollis unfortunately, so I have extremely hypertonic fibric calcific FCMs with associated scalenes. It elevated my levator trap, I have an adverse effect to my trapezius. We can break these muscle down and laser each individual muscle like the supraspinatus, the lat dorsi, the psoas, the glute max, the piriformis and erector spinae before we upregulate the whole body to a functional movement.
Laser motor lock-in. Just pointing the laser is very effective. Just pointing the laser gets you outcome. It’s not enough for us. I recommend everybody do a laser local motor lock-in. It’s resetting the neuromusculoskeletal system in a 3D motion. The frequency I put up there, people always ask, it’s 4, 9, 33, 60. I like to call the facilitated body’s global integration. You’re in a standing position and you’re doing what we call a cross crawl, a natural movement, a neurogenically appropriate movement. Right arm forward, left arm back, left arm forward, right arm back. We do that for five seconds with our eyes open, and we do it five seconds with our eyes closed as we apply the laser light to the posterior mid-line of the spine. And then after doing five and five, we then repeat by pointing at the brain to get all the integrative altered motive control working together. Besides, as we all know, the brain is the highest level of ATP mitochondria so we’re going to upregulate the brain at the end of the day.
Here is a picture of core motor lock-in. Once again the frequency is 4, 9, 33, 60. Everybody that has a lower back injury has a core that is not firing right, and the intrinsic endurance local core muscles aren’t stabilizing the spine. So in this picture, I’m depicting a rocker board with Vanessa, my front desk help actually, and I’m lasering her lower back core. And I’m also lasering her interior core for 30 seconds after a lower back injury.
If anybody’s interested, I have made a video, it’s on my website, drrobertsilverman.com. I put together a functional movement assessment. There’s so many movement forms out there. So many people that have done a beautiful job and I’ve trained under many of them, that I decided to put this together. And I think I use this as a backbone in my office to assess their functional movement. So my magnificent seven is very specific in that posture is quite important. I do assess posture. Posture is the shadow of movement.
Pain. I don’t chase the area of pain. He who treats the site of pain is lost, but I do know that pain is indicative of something being wrong in the system.
The overhead squat. The overhead squat is the staple in any movement strain. I can tell you that most people come in and say they can’t do it. Everybody should be able to squat because everybody does use the lavatory and everybody does sit in a chair. So they can squat, so it a question of how they get there is what we need to assess.
A one legged squat. The young lady on top on the left is demonstrating a one-legged squat below parallel. It can be done, it should be done, we spend more time on one leg than on two legs.
Trunk stability push-up basically is testing their core ability to stabilize their core.
Valgus jump test is a wonderful test. It’s determining if someone’s going to turn in valguz lateral and if they’re susceptible to ACL injury.
Upper and lower firing muscle patterns are quite critical in that they will determine, for instance, of my trap fires before I raise my shoulder, if my hip doesn’t extend 10 degrees. And finally, a push-up. If it’s good enough for the Marines and the Navy Seals, it’s good enough for me.
Finally, functional movement. It’ll make the visible invisible very quickly. Movement will never lie. It tells a unique story of every individual’s history in compensations and adaptations. So movement or aberrant movement created adhesions that will limit more movement. Limited movement then will create compensations. Compensations create stress, ultimately chronic stress creates more adhesions, and here we have adhesions and lack of movement and we’re in this vicious chronic cycle.
So let’s talk about some key laser therapy protocols for musculoskeletal injuries. My computer has a mind of it’s own. Carpal tunnel. My suggestion is to laser at the point/points of involvement, three to five minutes. Laser during movement for approximately 30 to 60 seconds. Add laser motor lock-in. Nerve floss is conceivable. Corrective exercise. I believe in a nutritional protocol, the B vitamins, omega-3 fatty acids are a great nutrition protocol for carpal tunnel. Mobilize/manipulate joint restrictions and of course myofascial release.
So essentially your lasering either at the carpal tunnel or any one of the points up from the carpal tunnel to the scalenes that may be indicated. Typically, the pronates teris is one that is very popular with carpal tunnel protocols. There’s a picture of all I’m doing is lasering in the carpal tunnel region.
Rotator cuff treatment protocols. Laser at the point/points of involvement. The muscle, the joint, and of course, the scapula. Laser during movement so have the person go through an appropriate shoulder movement as I laser that particular area. I do my laser on motor lock-in, which we discussed previously, and any other chiropractic treatment that you deem necessary to aid in outcome for the rotator cuff injury. So we’ve covered already carpal tunnel and rotator cuff with the Erchonia laser.
Here’s a study that’s shown that actually exercise and laser was more effective than just exercise alone for sub acromial impingement. As we know, if we can’t cure or positively effect that sub acromial impingement, we’re going to lead to rotator cuff tear. So there I am lasering a particular supraspinatus, which is the number one muscle that’s typically injured in rotator cuff injuries.
The disc. Well, like now, I could recommend the FX 635 because the FX 635 is pending a FDA clearance for lower back, which you should get any second. As far as some of the other ones, here is the protocol. When I do the disc, I do a core motor lock-in after lasering the area. Something that you saw before when the patient was on the rocker board and I lasered behind and in front, I always upregulate people’s core. There’s a specific nutritional protocol incorporating glucosamine MSM, omega-3s, turmeric, ginger, boswelia, and the like. Of course, mobilize/manipulate and you may want to use flexion distraction, decompression, and take care of joint restrictions. There I am with the PL5 Touch just lasering into the particular lumbar area before I do core motor lock-in.
Lateral and medial epicondylitis. Laser at the point/points of involvement. Both of these are very interesting in that they’re typically considered tendinosis. They’re long-term events, people don’t have a great resolve with them, soft tissue seems to be a major player. You laser at the point and points of involvement, the flexor being the medial component, typically has two muscles. That being the flexor carpi ulneris and/or the pronator teris, where there’s typically six muscles on the lateral side that are indicated. Laser during movement. Laser motor lock-in. Do some corrective exercises.
Here you’ll see the particular protocol as I’m trying to just laser into the lateral epicondyle passage. Here’s a picture doing it on the inside. Which you won’t see in pictures is that I’m doing it on the inside. Vanessa is also moving her wrist so I can get motion with it.
Hers a great little slide. This is back in the PT Journal of 2007, where I talked about LLT, reduced pain and reduced function. It had a higher quality of evidence than ultrasound, TENS, heat, exercise, STIM, and acupuncture. The low level laser therapy application improved the healing process of Achilles tendons with rats.
Achilles tendon is a very hard tendon to get to heal in a short period of time because the lack of blood flow. To see an improvement with any modality is something everybody should run with. Here’s an interesting study in that the effect of low level laser therapy in the development of exercise induced skeletal muscle fatigue and changes in biochemical markers. Essentially the laser was applied to two locations, both heads of the bicep. There was an increased endurance for repeated elbow flexion and decreased post exercise levels of blood lactate, creatine kinase and C-reactive protein. So we’re seeing an increase in muscle strength at the same time depicted decrease in blood markers. So it’s working, healing the body from the inside out.
Low level therapy, laser therapy for sports injuries. The conclusion was it is effective for specific sports injuries. This is back in 2013, particularly jumper’s knee, tennis elbow, and Achilles tendinitis. This was in a journal, and I have journal articles that are talking about laser in chiropractic economics, and basically I said, “Most athletes with chronic ankle sprains have a proprioceptive deficit in that injured ankle. Proper proprioceptive exercise, coupled with laser therapy, have enabled many of my athletes that I treat avoid the recurrence so commonly seen with the injury.” This is in the Lancet in 2009 and it showed that up to 22 weeks after laser therapy, people still had a resolve by using laser for their neck pain.
The International Association for the Study of Pain found strong evidence for low level laser therapy on the myofascial pain syndrome. So you’re seeing the true versatility/diversity that I talked about in slide number six with this particular type of treatment.
Here we have a study done 2010 that warrants a conclusion that laser therapy effectively relieves pain of various etiologies making it a valuable addition to contemporary pain management.
Frozen shoulder,and I can tell you it is a very difficult ailment having seen and treated so very many of them, so vast in the female population. The conclusion to the study was strong evidence for the effectiveness of laser therapy.
Here we have another study showing a positive outcome with low level laser therapy on TMJ. Interesting here that low level laser therapy helps stem cells to regenerate tissues. Essentially when you look at the bottom, the doctor from Harvard had a team that used a low-level powered laser to trigger human dental stem cells to form dentin. Now hard tissue like that is extremely similar to bone and makes up the bulk of out teeth. So therefore, they outlined the precise molecular mechanism involved and demonstrated its ability using multiple laboratory and animal models. This was a true breakthrough study for low level laser therapy.
Neurodynamic tests. It’s something that I do, I’m making a video on that right now for all that are interested. Essentially it’s a way to determine if there is tension through a nerve in a particular area, or through a nerve through its whole course that it runs through the body. So I threw that in to let people know that chiros, manual therapists, can use low level laser therapy.
If you wanted to laser nerves, or at the nerve area, here’s a chart that’s wonderful. At the brachial plexus clearly, the scalenes, that medial nerve, the two most common areas would be the pronator teres and the flexor retinaculum. The ulnar nerve, you would most commonly get between the olecranon and the medical epicondyle. The radial nerve would be most common at the triangular space between the teres minor, the longheaded triceps, and the humerus. Sciatic nerve, great spot. Piriformis. Femoral nerve through the psoas, the tibial nerve typically posterior to the knee. The peroneal nerve, medial biceps, femoris, head of the fibula. The sural nerve at the calve region. And the tarsal tunnel, specifically at the tarsal tunnel in the foot/ankle region.
To piggyback on this, here is a particular part taken out of a book where we see the effect to action a wavelength for potentiation of a nerve occurs between 540 and almost 635 nanometers, 904, 660 830 880 and 950 have no effect. So to piggyback once again on what I said earlier, a hot laser isn’t going to really lead you down the road. It’s going to adversely affect the action potential of a nerve, whereas a light laser will positively affect the actual potential of a nerve.
In the interest of time, I would have loved to gone through this particular slide. In a nutshell, cell membrane health is a key component to patient’s recovery and a key component to enable the laser to work even better. The big problem is were always fighting between omega-3s and omega-6, so the takeaway is we always want people to eat more and more omega-3s to have a better positively functioning cell membrane.
Laser should be directed to the affected site. In a nutshell, photons enter the tissues, it’s workers are cell membrane permeability. We then get cellular photochemical reactions. This is going to get absorbed into mitochondria, the mitochondria will produce ATP. When they produce ATP efficiently they produce less free radicals. The resulting effects are very simple, increased metabolic activity, faster activity and decreased inflammation.
I’m a big proponent of always having simple strategies first. That does look like my old college roommate.
Choosing your next laser, to try and conclude. Regulation considerations. If it’s not FDA cleared, don’t consider it. If it is FDA cleared, and ask what it’s FDA cleared for.
Therapeutic factors. The dosing frequency, the wavelengths, the power, the modulation. So we don’t want it too high, we want it lower level power. Wavelengths, we’ve really established, 635. The non-therapeutic factors. Is it portable? The size and the weight. Is it corded? Can you carry it around?
What does low level laser do? It stimulates both the nervous system and the site of the tissue injury. It is clinically proven to suppress inflammation, increase oxygen and blood flow, promote calcium uptake and increase neurotransmitter release. So in the end, I call it my Dr. Rob’s sexy six. Laser delivers light energy. Lasers can stimulate cell activity, laser is classified based on its power supply. FYI, anybody over a level three laser must wear goggles or glasses, level four the FDA require them to have a special robe. Lever two or less, the blink reflex protects the eye, we don’t have to wear glasses.
Wavelength is the length of the wave of light energy. The kinds of tissues treated depends on wavelength and power supply, and it[inaudible 00:42:11] everything in our life and our world. Laser companies don’t always agree.
So hopefully everybody can adhere to Oliver Wendell Holmes in that, “A mind once stretched by a new idea never regains its original dimensions.” Hopefully we have some stretchmarks on these webinar attendees and I am open to questions now. Hopefully you all enjoyed.
Caroline: Thank you so much, Dr. Silverman. This was extremely informative. We’ve been collecting some questions from the audience so I will go ahead and get to those now.
Dr. Silverman: Great.
Caroline: All right. So one doctor asks, “Is there any downside on a cellular level to the stimulation of ATP production if done at frequent intervals via low level laser therapy?”
Dr. Silverman: That’s a fabulous question and when you say frequent intervals and if you want to re-email or contact me at email@example.com, that would be fine. When you say frequent intervals, I’m usually lasering people once a day or once every other day. So on those intervals, no. And the fact that we’re stimulating the ATP really theorizes what we’re doing. The whole goal of ATP is the energy that’s needed, so think of the muscles that we’re able to get to contract more. Think of the organs that are ATP-oriented. The brain, the cardiac muscle and the liver. And now that we talk about the efficiency of the ability to produce ATP, and not producing free radicals, we can almost theorize it as sort of like anti-aging.
Caroline: Fantastic. Are you ready for the next one?
Dr. Silverman: I’m ready.
Caroline: All right. I think we’ve got time for one more. Another doctor asks, “Is low level laser therapy helpful for hypotonic syndrome and the case at hand is a child now one year old who was deprived of oxygen in the birth canal,” and he’s wondering can LLLT accelerate recovery of nerve function?
Dr. Silverman: I’ll be honest with you, I have never had anybody with that in my office, so all I’m going to say to that or speak to that question is that you could try, but I haven’t tried it on that condition. I’m really sorry.
Caroline: All right, would you like to do one more?
Dr. Silverman: Yeah, let’s do another one.
Caroline: All right. Do you have to touch the skin with the laser?
Dr. Silverman: Great question. It is better to touch but you don’t have to. As long as with low level laser therapy you’re within three to five inches, you are in the realm of possibilities. So it’s excellent, you don’t have to touch it. Theoretically you could be on the other side of the room. I would never do that, I would stay within three inches and/or touch the skin.
Caroline: Okay, thank you, Dr. Silverman. At this time we would like to thank our sponsor, Erchonia and Dr. Robert Silverman for today’s webinar and thank you all so much for attending. Remember this webinar, including our speaker’s Power Point presentation is being recorded, so if we didn’t get to your question during the webinar, the questions will be posted to our expert and the answer will be posted shortly on chiroeco.com/webinar. We’ll alert you all when the webinar is available online. Thank you again for attending and we look forward to seeing you next time. Have a wonderful day.