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What is lllt device?

What i s lllt device?

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LLLT Device (Low Level Laser Therapy) is the application of red and near infra-red light over injuries or lesions to improve wound and soft tissue healing, reduce inflammation and give relief for both acute and chronic pain. First developed in 1967, it is now commonly referred to as LLLT Device.

LLLT Device is used to: increase the speed, quality and tensile strength of tissue repair; resolve inflammation and relieve pain (analgesia).

The red and near infrared light (600nm-1000nm) commonly used in LLLT Device can be produced by laser or high intensity LEDs. The intensity of LLLT Device lasers and LED’s is not high like a surgical laser. There is no heating effect.

The effects of LLLT Device are photochemical (like photosynthesis in plants). When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases ATP. This improves cell metabolism and reduce inflammation. These effects can be enhanced with pulses however when analgesia is required there is a second mechanism which works best when a strong continuous beam is applied.

LLLT Device devices are typically delivering 10mW – 500mW (0.01 -> 0.01 Watts). The power density typically ranges from 0.005W/Cm² -> 5 W/Cm².

LLLT Device is popularly used for soft tissue injuries, joint conditions, neuropathic pain, non-healing leg and pressure ulcers.

NEWS The Lancet publishes landmark review of LLLT Device for neck pain read more and listen to interview here
Introduction to LLLT Device Video

Introduction to LLLT Device and dose response by Prof. Michael Hamblin, Wellman Centre for Photomedicine, Harvard Medical School
Source: International Dose Response Society

Download ‘LLLT Device dose review (PDF)’
This paper from Harvard Medical School reviews the LLLT Device mechanisms and the biphasic dose response. It summarises the molecular and cellular mechanisms of LLLT Device, gives a scientific explanation for the biphasic dose response (why a low dose has a stimulatory effect and why a high dose inhibits). Low power densities tend to get better healing and anti-inflammatory effects where higher power densities are more likely to inhibit (which may be useful if you just want an analgesic effect). I have to disclose an interest in this paper because I am a co-author. James Carroll CEO THOR Photomedicine.

 

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What is History of LLLT Device?

In 1903, Dr. Nils Finsen was awarded a Nobel Prize for his contribution to the treatment of diseases, especially lupus vulgaris, with concentrated light radiation . In 1960, Professor Maiman TH  built the first working red ruby laser , but it was not until 1967 when Mester E et al.  was able to demonstrate the phenomenon of “laser bio stimulation” . In 1999, Whelan H et al.  presented his work on the medical applications of light emitting diodes (LED) for use on the NASA space station . Subsequently over 400 Phase III randomized, double-blind, placebo-controlled trials have been published, with over 4000 laboratory studies of LLLT Device. (Pubmed.gov)

A laser is a device that generates light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. There are four main classes of lasers as defined by the International Engineering Consortium (IEC standard 60825.) These classes indicate potential danger the radiation is to the eye.

Class 1/1M – CD player
Class 2/2M – laser pointer
Class 3R/3B – LLLT Device and CD and DVD writers
Class 4 – Surgical laser

LLLT Device is the application of light (usually a low powered laser or LED typically power range of (10mW–500mW). Light with a wavelength in the red to near infrared region of the spectrum (660nm–905nm), is generally employed because these wavelengths have the ability to penetrate skin, and soft/hard tissues (Figure 2) and are proven in clinical trials to have a good effect on pain, inflammation and tissue repair. The power density (irradiance) is usually between 5W/cm2 and is applied to an injury or to a painful site for 30–60 seconds a few times a week for several weeks. The result is a reduction of inflammation, pain relief and accelerated tissue regeneration. In most cases the lasers/LEDs used for LLLT Device emit a divergent beam (not focused or collimated) because collimation is lost in tissue, but as a consequence ocular risks are also diminished over distance.

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How LLLT Device to the treatment of pain?

Acute orthopedic conditions such as sprains , strains, post-surgical pain, a whiplash injury , muscular back pain, cervical or lumbar radiculopathy, tendinitis and chronic conditions such as osteoarthritis , rheumatoid arthritis, frozen shoulder, neck and back pain, epicondylitis, carpal tunnel syndrome, tendinopathy, fibromyalgia, plantar fasciitis, post tibial fracture surgery and chronic regional pain syndrome are amenable to LLLT Device. Dental conditions producing pain such as orthodontic procedures, dentine hypersensitivity, and third molar surgery respond well to treatment with LLLT Device. Neuropathic pain conditions can also be treated such as post herpetic neuralgia, trigeminal neuralgia , and diabetic neuropathy. Due to the wide spectrum of conditions one would surmise that multiple mechanisms can operate to achieve pain relief.

The peripheral nerve endings of nociceptors, consisting of the thinly myelinated A∂ and unmyelinated, slow-conducting C fibers, lie within the epidermis. This complex network transduces noxious stimuli into action potentials. Moreover these nerve endings are very superficial in nature and thus are easily within the penetration depths of the wavelengths used in LLLT Device. The cell bodies of neurons lie within the dorsal nerve root ganglion, but the elongated cytoplasm (axons) of the neurons extends from the cell body to the bare nerve endings in the surface of the skin. The direct effect of LLLT Device are initially at the level of the epidermal neural network, but the effects move to nerves in subcutaneous tissues, sympathetic ganglia, and the neuromuscular junctions within muscles and nerve trunks.

LLLT Device applied with a sufficient level of intensity causes an inhibition of action potentials where there is an approximately 30% neural blockade within 10 to 20 minutes of application, and which is reversed within about 24 hours . The laser application to a peripheral nerve does have a cascade effect whereby there is suppressed synaptic activity in second order neurons so that cortical areas of the pain matrix would not be activated.

Adenosine triphosphate (ATP) is the source of energy for all cells, and in neurons this ATP is synthesized by mitochondria while they are located in the dorsal root ganglion. These mitochondria are then transported along the cytoskeleton of the nerve by a monorail system of molecular motors. LLLT Device acts like an anesthetic agent, in that both LLLT Device and anesthetics have been shown to temporally disrupt the cytoskeleton for a matter of hours as evidenced by formation of reversible varicosities or beading along the axons, which in turn cause mitochondria to “pile up” where the cytoskeleton is disrupted. The exact mechanism for this effect is unknown but it is not a thermal action. It has been shown that LLLT Device at the correct dose decreases mitochondrial membrane potential (MMP) in DRG neurons and that ATP production is then reduced  so perhaps the lack of ATP could be cause of this neural blockade. The most immediate effect of nociceptor blockade is pain relief which occurs in a few minutes and has been shown by the timed onset of a conduction blockade in somatosensory-evoked potentials (SSEPs). This inhibition of peripheral sensitization not only lowers the activation threshold of nerves but also decreases the release of pro inflammatory neuropeptides (i.e. substance P and CGRP). In persistent pain disorders this reduction of tonic input to activated nociceptors and their synaptic connections, leads to a long-term down-regulation of second-order neurons. The modulation of neurotransmitters is a further possible mechanism of pain relief, as serotonin and endorphin levels have been shown to increase in animal models and following laser treatment of myofascial pain in patients [81]. Thus LLLT Device can have short, medium and long term effects. Fast acting pain relief occurs within minutes of application, which is a result of a neural blockade of the peripheral and sympathetic nerves and the release of neuromuscular contractions leading to in a reduction of muscle spasms.

In the medium term there is a decrease of local edema and a reduction of inflammation within hours to days. The action of LLLT Device in reducing swelling and inflammation has been well established in animal models as well as in clinical trials. The numbers of inflammatory cells has been shown to be reduced in joints injected with protease, in collagen-induced rheumatoid arthritis, and in acute pulmonary inflammation . The expression levels of pro-inflammatory cytokines have been shown to be reduced by LLLT Device in burn wounds, in muscle cryo lesions and in delayed type hypersensitivity. The long term effects of LLLT Device occur within a week or two and can last for months and sometimes years as a result of improved tissue healing.

 

How do I use LLLT Device ?

Simple LLLT Device Treatment Technique

Example shown here is for a THOR LLLT Device system with 200mW laser probe and cluster probe.

Having thoroughly palpated and assessed the area, set the timer to 20 seconds
Set the Pulse frequency to one of the following settings:
2.5 Hz – for acute injuries;
5 KHz – for chronic injuries and non-healing or infected wounds.
Treat the top of the neck/occiput atlas for 20 seconds
Then treat the nerve exits at C7 / T1 for 20 seconds
Then treat the nerve root exit related to injury for 20 seconds, and continue to treat several points along the course of the nerve towards the injury at 20 second intervals.
Treat each tender point for 20 seconds with the THOR 200mW laser probe. Palpate for any changes (eg: reduction in pain, change in tissue texture, relaxation of muscle, etc). If there is no response, then treat the tender points again. Palpate for any changes and repeat once more if necessary.
Finally treat the surrounding soft tissue with the cluster probe for 2 mins per area

Times are approximate and can be varied according to the dept of the injury / build of the patient.

Be accurate during treatment, gapping and positioning joints appropriately to gain maximum exposure of the joint, treating ‘around’ tendons where possible and be as thorough as time permits. Use LLLT Device as soon as possible after injury, treating daily for acute conditions and less frequently as resolution occurs. Treat chronic inflammatory conditions twice weekly and osteo-arthritis weekly or fortnightly. Treat as many points as necessary during one session; do not move the probe during each application. Treat with single, then cluster probe during one session.

There are normally no adverse effects from LLLT Device, however, patients occasionally experience mild discomfort / ache after treatment. This is due to a restimulation of the inflammatory phase and should settle down after 24 – 48 hours.

 

 

 


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