Laser therapy could be the adjunct your practice needs.
Laser therapy is a wonderful tool for people seeking a drug-free, noninvasive treatment option for musculoskeletal pain. But it is only as effective as the clinician using it. Pointing it at the wrong spot won’t get you far and having the correct diagnosis is crucial.
The diagnosis is not the cause of the condition. Treating the site of pain with the proper therapeutic laser dosage is a fundamental first step to baseline success. If you don’t identify the correct dosage to target tissue, your clinical outcomes will be poor. You also need to treat contributing factors outside the site of pain such as soft-tissue or fascial restrictions, decreased joint mobility, and trigger points. A linchpin location for laser therapy that has carryover to many musculoskeletal conditions is the thoracolumbar fascia (TLF).
Why the TLF? This area is important for the biomechanics of movement because of its unique ability to shift loads and transfer forces from the lower extremities to the upper extremities.
This is critical to understand if you want to successfully treat tissue damage anywhere in the body.
The TLF has three layers attaching to many other core-stabilizing structures of the central stabilizing zone:
- Anterior layer: Attaches to the anterior aspect of the lumbar transverse processes and the anterior surface of the quadratus lumborum.
- Middle layer: Attaches to the medial tip of the transverse processes, giving rise to the transverse abdominis.
- Posterior layer: Covers all of the muscles from the lumbosacral region through the thoracic region, and as far up as the cervical splenii attachments. The posterior layer attaches to both the erector spinae and gluteus maximus aponeurosis. The gluteus maximus and contralateral latissimus dorsi attach with each other and coordinate, allowing crosslink movements between the upper and lower extremities, which makes walking and running possible. This crosslink is known as the posterior oblique sling.
The high number of mechanoreceptors found in the TLF indicates that the fascial connective-tissue system provides important sensory feedback to the body. Releasing over-contracted fascial fibers and reducing upregulated (facilitated) neural input is a key strategy for re-establishing movement patterning efficiency.
Laser therapy can reduce fascial adhesions and restrictions in the TLF, helping to optimize force production across the body and reducing pain.
Studies of the spine show that mechanical loads are transferred from the hips, pelvis, and low back across the TLF to the upper back, shoulders, and arms.
They accomplish this in a cross- body, X-shaped pattern. The TLF is the “punctum fixum” (fixed end) axis of rotation.
Let’s look at some examples of laser therapy for common musculoskeletal conditions integrating the TLF. Laser light penetrates deeply into tissue and accelerates cellular reproduction and growth. The same light increases the energy available to cells so that they can uptake nutrients faster and expel waste products. As a result of exposure to laser light, the cells of tendons, ligaments, and muscles are repaired faster. Recommended dosage parameters are 6–8 joules/cm2 for superficial conditions and 8–10 joules/cm2 for deeper tissue injuries.
Apply laser to the symptomatic elbow with 1,000 joules of energy over an area of 100 cm2. Then apply laser above and below the site of pain with an additional 1,000 joules of energy at each location. This is approximately 10 joules/cm2.
Apply 3,000 joules to the TLF and follow up with soft-tissue release by hand or with instrument-assisted tools
Apply laser to the knee anterior, medial, lateral, and posterior with a total of 3,000 joules of laser energy, paying particular attention to the posterior knee and the popliteus muscle.
Apply 3,000 joules to the TLF and then follow up with soft-tissue release by hand or with instrument-assisted tools.
Apply laser to the anterior and posterior lateral shoulder with 3,000 joules of energy. Then use laser deep inside the axilla for the subscapularis, with 1,000 joules. Assess the pectorals as a location for laser application.
Apply 3,000 joules to the TLF and then follow up with soft-tissue release by hand or with instrument-assisted tools. You will often see an immediate improvement in shoulder range of motion.
By now you should be seeing a common theme for the treatment process. No matter what area of the body you are treating, apply laser therapy to the TLF with approximately 3,000 joules. Pay attention to the lower thoracic and lumbar region and drift laterally to the posterior fibers of the internal oblique.
You can also apply laser to the fascial attachments into the gluteus maximus region with an additional dose of 2,000 joules. Laser therapy to the TLF is often the linchpin of resolving chronic musculoskeletal pain conditions in the body. Add it to your protocol today and see the results for yourself. Better yet, let your patients feel the results.
Perry Nickelston, DC, NKT, FMS, SFMA, is the owner of Stop Chasing pain and pain Laser Center. He is a speaker, author, and lecturer on corrective movement, and the creator of the primal movement Chains: moving Beyond mobility courses. He is also a board member and instructor for the American Institute of medical Laser Applications. He can be contacted through painlasercenter.com.
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