As chiropractic care continues to embrace integrative approaches, laser therapy stands out as a scientifically supported modality that enhances healing and recovery across a wide spectrum of musculoskeletal and neurological conditions.
In recent years, laser therapy has emerged as a powerful tool in chiropractic care, offering a wide range of therapeutic benefits that extend far beyond pain relief. Laser therapy has the beneficial effects of relieving pain, resolving inflammation and increasing the speed, quality and tensile strength of tissue repair. It has also been shown to stimulate the immune system, reduce infection and improve the function of neurological tissue. Laser therapy is effective in increasing collagen production, repairing bone, reducing edema, increasing lymphatic drainage and increasing production of capillary beds.1,2
Managing expectations
Patients may be very apprehensive about trying laser therapy or may be ready to start immediately. In either case, you need to properly manage their expectations.
Clinical tip: Many DCs offer a complimentary laser therapy treatment session to take away the “fear factor” or the unknown. Patients can also see and feel the physical effects and positive clinical outcomes of the laser therapy and make a more informed decision.
Selecting the appropriate settings
Like your treatment plan for each patient, your recommended laser therapy plan should be developed based on the uniqueness of your patient. Key considerations to look for are acute or chronic condition, skin tone/color, body structure/size, area(s) of concern and age.
Most lasers come with a number of pre-set protocols for common conditions. You may find these pre-sets are a good starting point. However, they also may need to be tweaked to consider the considerations mentioned above. Many lasers have a custom-setting area for temporary or permanent protocols.
Clinical tip: You may have a perfect protocol, but make sure you check for contraindications first. The main ones are active cancer (laser accelerates cell growth), blood thinners (laser speeds up blood flow) and drugs that make the patient photosensitive (laser is light).
Some lasers also allow you to enter specific considerations, such as those listed above, for suggested treatment settings. Those settings will include the amount of peak power measured in milliwatts or watts, average power measured in milliwatts or watts, continuous wave (100% duty cycle) or pulse duty cycle (1-99%), wavelength(s), number of joules produced during the session and duration of each treatment. These parameters may be stored under a patient’s name in some models. Either way, the parameters need to be entered into your documentation. Whether the patient is cash pay or insurance pay should not impact how you document your treatments.
Clinical tip: Good documentation allows you or your staff to replicate the same treatment each time the patient arrives in your office for a visit.
Acute or chronic conditions: Experience and many studies show acute conditions resolve more quickly than chronic ones. Setting patient expectations for the number of treatments is key to patients completing their entire treatment protocol.
Clinical tip: In my experience, the number of treatments for chronic conditions may be twice as many or more than for acute conditions.
Skin tone/color (very light): Very light or freckled skin may be extra photosensitive since the melanin absorbs light differently. The Fitzpatrick Scale is a six-point scale that denotes different skin colors.3 For light skin tone think Fitzpatrick Scale Classes I and II.
Clinical tip: Please test an area before proceeding with the entire first treatment.
You may need to reduce power or utilize pulse mode for these patients.
Skin tone/color (dark): A by-product of higher-power lasers is heat. The higher the number of watts, the greater the amount of heat that is generated. For dark skin types think Fitzpatrick Scale Classes V and VI. The melanin will hold the heat more than lighter skin. The same advice applies for tattoos.
Clinical tip: Please test an area before proceeding with the entire first treatment. You may need to reduce power or utilize pulse mode for these patients.
Body structure/size: The body structure for size of muscles, bones, fat, etc., is not the same for a 100-pound person as a 250-pound person. How deep is the tissue in the body? The photons of energy need to reach the targeted tissue. Larger muscles or fat mass will impact the depth of penetration of the laser light.
Clinical tip: Pushing the laser treatment head against the skin will move away some of the blood from the area and allow deeper penetration.
Area(s) of concern: Research has established recommended average dose per tissue type at the target tissue.4,5 The World Association for Laser Therapy (WALT) has provided guidelines as well. These recommendations range from 2 J/cm2 to 10 J/cm2 with the most common ranges from 4 J/cm2 to 8 J/cm2.
Clinical tip: In the author’s experience, the average dose at the target tissue shown in Table 1 are reasonable guidelines.
Age: Is most relevant for open growth plates in children and pregnancy in women.
Clinical tips: Children can be treated, but avoid the open growth plates. For pregnant women, avoid treating the belly.
NOTE: The protocol factors noted above are general recommendations designed to help guide you with choosing appropriate treatment parameters.
Treatment heads: Now, you have calculated the best personal protocol for your patient. How do you deliver the healing photons of energy? Some lasers have permanently attached fiber and handle, often referred to as a stem. You simply swap the various size tips for different situations. The treatment tips often range from about 7mm to 30mm with some going much larger. Other lasers allow you to remove the fiber and substitute in other fibers with permanently attached tips or add a fiber that has a variety of tips. Again, choose from your toolkit the appropriate handpiece to execute your plan.
Treatment techniques: Three techniques are most frequently used for contact with skin. These are shown in Figures 1-3. Figure 1 shows the point-to-point method of selecting key points or acupuncture points to treat. Figure 2 depicts a zig-zag or “treat the entire area” approach. Figure 3 is most similar to “circling the dragon” when you work from the outside in toward the area that needs laser treatment.
Unattended lasers may not adhere to these approaches since there is no direct contact with the body. Some models have the laser head move over the selected area, while others are stationary and treat only where the laser head is aimed.
Multi-modal approach
Your report of findings to your patients should include chiropractic care and your laser therapy protocol. Many DCs will take a multi-modal approach to assist the laser’s photochemical and biological effects.
Supplements and nutrition: Supplements, homeopathy and nutrition are at-home treatments designed to work on the underlying condition with the laser.
Energy, sound or vibration modalities: Other modalities may be teamed with laser. They might include energy (electrical stim and TENS), sound (therapeutic ultrasound and shockwave) or vibration (vibration platforms and percussion devices/guns). These modalities would be recorded in the electronic health records but not in the laser (if it has that capability).
Clinical tip: Consider the mechanism of action for each modality and whether it is better utilized before or after laser treatment.
Final thoughts: The bottom line
Building and implementing a personalized laser treatment plan for your patients will lead to optimal results. Consider how adjustments and any other modalities can be critical components of the entire plan. Remember, patient buy-in is the key to success in laser treatment and any other tools and techniques in your practice.
Rob Berman, MBA, is a partner at Berman Partners LLC, a medical device sales and marketing company. Berman Partners specializes in new and pre-owned therapeutic lasers. He also is partner at Energia Medical LLC, which specializes in light therapy and vibration products. He helps doctors improve patient outcomes while increasing their income. He can be contacted at 860-707-4220, rob@bermanpartners.com or bermanpartners.com.
References
- de Oliveira MF, et al. Low-intensity laser and LED (photobiomodulation therapy) for pain control of the most common musculoskeletal conditions. Eur J Phys Rehabil Med. 2022;58(2):282–289. https://pubmed.ncbi.nlm.nih.gov/34913330/. Accessed October 20, 2025.
- de Freitas LF, Hamblin MR. Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE J Sel Top Quantum Electron. 2016;22(3):7000417. https://pubmed.ncbi.nlm.nih.gov/28070154/. Accessed October 20, 2025.
- Sharma AN, Patel BC. Laser Fitzpatrick Skin Type Recommendations. 2025. StatTips Publishing: Treasure Island, FL. https://www.ncbi.nlm.nih.gov/books/NBK557626/. Accessed October 20, 2025.
- Hode L, Tuner J. Laser Phototherapy Clinical Practice and Scientific Background. 2014. Sweden: Prima Books.
- Karu T. Ten Lectures on Basic Science of Laser Phototherapy. 2007. Sweden: Prima Books.
