New tissue growth supercharged as class 4 laser stimulates stem cells and injectionables
Therapeutic lasers have become ubiquitous in chiropractic practice, with the higher-powered class 4 devices the most popular. Their ability to deliver beneficial dosages of infrared laser light to large volumes of tissue ensures they will deliver the well-established benefits of photobiomodulation: pain relief, modulated inflammation and enhanced tissue healing. Laser has become a standard of care in many chiropractic clinics, and now research is showing that laser stimulates stem cells growth.
So what is next on the horizon? Regenerative medicine, or orthobiologics — the process of replacing or regenerating human cells, tissues or organs to restore or establish normal function.
Orthobiologics and healing
Orthobiologics involves the injection of naturally occurring biologic substances to help heal injuries to ligaments, tendons, cartilage or bone. These substances may be derived from several sources. Product that comes directly from the patient is an autograft, while product from donated human tissue is an allograft. In some cases, biologic materials may also be a combination of synthetic and biologic materials.
The most-used orthobiologics are stem cells and platelet-rich plasma (PRP). Could therapeutic lasers be used in combination with these injections to enhance their effects as laser stimulates stem cells?
Stem cell therapy consists of inserting autologous non-differentiated cells into an area of tissue damage, with the intention of differentiation of these cells into the type necessary for tissue rebuilding. In bone repair, this may mean osteoblasts; in connective tissue, fibroblasts; in the gut, endothelial cells; and so on.
While it remains debatable whether adipose-derived stem cells are truly undifferentiated, they have certainly been shown to develop into a broad range of cell types, even organ-specific tissue under the right experimental or physiological conditions.
Stem cells and photobiomodulation
For the injection of stem cells to have a biological effect, these cells need to start metabolizing and dividing — enter photobiomodulation. Recall that the fundamental function of laser therapy is to enhance cellular metabolism via increased throughput of oxygen to energy. Regardless of the condition, stem cells will do better if their metabolism can be augmented.
With platelet-rich plasma (PRP) injections, the mechanism is slightly different. The use of PRP to repair muscle, joint, ligament and tendon injuries is popularized by social media from professional athletes. Platelet injection treatments have a stimulating effect on the stem cells within the targeted area, making those stem cells work harder to help the body heal damaged tissues.
The alpha granules inside platelets release their growth factors more readily when exposed to laser therapy. And while this seems very theoretical and abstract right now, with the number of practices utilizing these combinations (of laser with stem cell or PRP injections) ever increasing, laser stimulates stem cells, and the clinical data will start to fill in the gaps.
Laser stimulates stem cells: Prolotherapy
Another injection technique is prolotherapy, which works by stimulating the body’s natural healing mechanisms to develop new tissue in the weakened area. This is done by a very precise injection to the injury site, using non-pharmaceutical tissue irritant such as a dextrose solution. The mild inflammatory response created by the injection spurs growth of new, normal ligament or tendon fibers, resulting in a tightening of the weakened structure.
All three types of injection mentioned can be very painful for the patient. Prolotherapy sessions can involve 20 or more injections in the site. And even though the agent is a simple sugar solution, rebooting the inflammatory process can be agonizing. The most common answer for this post-injection pain has been opiate pain relievers. But with their addictive propensity, both patients and doctors are seeking alternatives.
Laser stimulates stem cells and injectionables, so therapy treatments can safely be given immediately after these injections to help with pain and inflammation. And studies have noted the ability of PBM treatments to synergize with the therapeutic benefits of stem cells in alleviating pain and inflammation as well as promoting tissue healing.
Regenerative medicine is truly the next horizon, growing new tissues to replace those lost to degenerative processes or injury. And therapeutic lasers will be riding shotgun on this journey to the future of health care.
PHIL HARRINGTON, DC, CMLSO, FASLMS, is clinical manager, human medical director and laser safety officer at Summus Medical Laser. To learn more, go to summuslaser.com.