High-intensity laser therapy in acute injury care

You can offer your patients nonpharmacologic, performance-centered injury care by integrating photobiomodulation therapy into your practice.

As DCs continue to expand their role in conservative musculoskeletal care, high-intensity laser therapy (HILT) has emerged as a meaningful tool for managing acute injuries. When applied correctly, HILT reduces pain and supports and maximizes cellular processes involved in tissue repair. This article outlines the rationale for using HILT across the injury cycle and discusses the DC’s role in delivering nonpharmacologic, performance-centered injury care.

Reframe acute injury management

Acute musculoskeletal injuries are often handled with generic protocols: rest, ice, medication and a wait-and-see attitude. This model can ignore the opportunity to maximize tissue healing, while also dealing with the common metric, pain. From the moment of tissue trauma, a cascade of inflammation and metabolic activity occurs, along with the opportunity to go down a further injury or healing pathway. What the patient does—or doesn’t do—in the first 72 hours can shape the course of recovery. DCs are well-positioned to intervene at this stage. With a functional understanding of biomechanics, neurology and soft tissue behavior, you can offer hands-on care that both reduces symptoms and actively supports recovery. Over the past two decades, I have found that integrating photobiomodulation into this early phase adds precision and efficiency to that process.

Photobiomodulation as a clinical strategy

Photobiomodulation (PBM) refers to the cellular effects produced by exposure to specific wavelengths of light—typically in the red and near-infrared spectrum. These effects include increased ATP production, modulation of reactive oxygen species and improved tissue oxygenation.¹

In acute injury care, PBM facilitates:

• Nociceptive suppression, reducing the sensitivity of peripheral nerves²
• Vasodilation and microcirculatory activation, essential for inflammation control and debris clearance³
• Enhanced fibroblast activity, accelerating the repair phase⁴
• Mitochondrial normalization, promoting recovery of damaged cells⁵
• Critically, the effectiveness of these outcomes depends on adequate energy delivery. Higher-powered laser systems, capable of delivering output in the 15–45W range, ensure you can dose efficiently and reach deeper structures in a reasonable treatment window.⁶

Progressive use of HILT through the phases of injury

In my clinical practice, laser is not a stand-alone modality; it’s a system component. We use it in tandem with movement analysis, joint mobilization and progressive rehabilitation. But laser therapy does have a distinct role in each phase of the injury process:

Phase 1: Inflammatory (0–5 Days)

• Goal: Modulate excessive inflammation and limit secondary tissue damage
• Laser approach: Low to moderate power needed (<3W), pulsed mode, targeting both injury and reflexogenic zones
• Outcome: Improved tolerance to manual techniques and reduced pain without pharmacologic suppression

Phase 2: Repair (5–21 Days)

• Goal: Support fibroblast activity, angiogenesis and collagen deposition
• Laser approach: Increased energy density (e.g., 12–16 J/cm² at surface), deeper penetration with continuous or pulsed delivery
• Outcome: Faster granulation and improved tissue organization

Phase 3: Remodeling (>3 Weeks)

• Goal: Normalize tissue extensibility and neuromuscular control
• Laser approach: High-energy applications combined with therapeutic exercise
• Outcome: Reduced re-injury risk and improved performance metrics

Clinical insights: High-power laser in acute and subacute performance phases

PBM therapy has demonstrated utility in rehabilitation, especially when treating the early phases of injury. One study determined the application of laser can spare the destruction of blood cells by reducing effects of osmotic pressure and hemolysis.⁷ Similarly, the same group later showed the dose and wavelength dependence on this protective mechanism, outlining the importance of varying total energy across wavelengths.⁸ In particular, high-power laser may produce at least improved, if not more rapid, recovery and efficiency in treatment.^9,10

Integrating high-intensity laser therapy into your practice: Final thoughts

Managing acute injuries requires the ability to triage, diagnose and initiate care without unnecessary delays or passive protocols. DCs trained in movement evaluation, soft tissue diagnostics and functional rehabilitation are uniquely suited for this task.

Moreover, the integration of tools like HILT and PBM allows you to meet patients’ goals—pain control, mobility, performance—with precision and without pharmacologic dependence.

As patients continue to seek drug-free solutions for injury care, and as performance medicine pushes more deeply into clinical practice, DCs have a unique opportunity to lead—provided we stay current, critical and clinically flexible.

Christopher M. Proulx, DC, PHD, CSCS, is a DC and sport scientist with advanced training in clinical neuroscience, exercise physiology and conservative sports medicine. He has authored peer-reviewed articles and lectures nationally on therapeutic technology integration, injury recovery models and evidence-based rehabilitation. In his current clinical practice and his experience as a former certified athletic trainer, he has been involved with the management of sports injuries for more than two decades. Proulx is currently the VP of Clinical Affairs and Strategy for Medray Laser and Technology. For more information, visit medraylaser.com.

References

1. Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics. 2017;4(3):337–361. https://pubmed.ncbi.nlm.nih.gov/28748217/. Accessed June 5, 2025.

2. Chow RT, et al. Efficacy of low-level laser therapy in the management of neck pain. Lancet. 2009;374(9705):1897–1908. https://pubmed.ncbi.nlm.nih.gov/19913903/. Accessed June 5, 2025.

3. Taha N, et al. The effects of low-level laser therapy on wound healing and pain management in skin wounds: A systematic review and meta-analysis. Cureus. 2024;16(10):e72542. https://pmc.ncbi.nlm.nih.gov/articles/PMC11602420/. Accessed June 10, 2025.

4. Dompe C, et al. Photobiomodulation-underlying mechanism and clinical applications. J Clin Med. 2020;9(6):1724. https://pmc.ncbi.nlm.nih.gov/articles/PMC7356229/. Accessed June 10, 2025.

5. Bettleyon J, Kaminski TW. Does low-level laser therapy decrease muscle-damaging mediators after performance in soccer athletes versus sham laser treatment? A critically appraised topic. J Sport Rehabil. 2020;29(8):1210-1213. https://journals.humankinetics.com/view/journals/jsr/29/8/article-p1210.xml. Accessed June 10, 2025.

6. Tache-Codreanu D-L, Trăistaru MR. The effectiveness of high intensity laser in improving motor deficits in patients with lumbar disc herniation. Life. 2024;14(10):1302. https://www.mdpi.com/2075-1729/14/10/1302. Accessed June 10, 2025.

7. Walski T, et al. Near-infrared photobiomodulation of blood reversibly inhibits platelet reactivity and reduces hemolysis. Sci Rep. 2022;12(1):4042. https://pubmed.ncbi.nlm.nih.gov/35260751/. Accessed June 5, 2025.

8. Walski T, et al. Biphasic dose-response and effects of near-infrared photobiomodulation on erythrocytes susceptibility to oxidative stress in vitro. J Photochem Photobiol B. 2024;257:112958. https://pubmed.ncbi.nlm.nih.gov/38875890/. Accessed June 5, 2025.

9. Yoon SH, et al. The efficacy of high-intensity laser therapy in wound healing: A narrative review. Lasers Med Sci. 2024;39(1):208. https://pubmed.ncbi.nlm.nih.gov/39096352/. Accessed June 5, 2025. Accessed June 11, 2025.

10. Pereira FLC, et al. Use of a high-power laser for wound healing: A case report. J Lasers Med Sci. 2020;11(1):112-114. https://pmc.ncbi.nlm.nih.gov/articles/PMC7008737/. Accessed June 5, 2025.