Photobiomodulation Training Course Testimonial: Penny Dyer Physiotherapist Berks, United Kingdom
“Always a great course. Love to hear the latest research. I’m hugely frustrated that physios don’t use laser more. I use it every day and it’s like having a magic wand. It’s only ever a part of what I do, unless it’s something like chronic sinusitis, which it sorts out brilliantly all on its own. So glad to be able to come on your courses. Don’t give up – one day they’ll all listen!”
130 new LLLT papers for you including a systematic review on shoulder tendinopathies, a lovely article review in an orthopaedics journal by Howard Cotler, four systematic reviews on orthodontic tooth movement, a trial showing LEDs improve sperm motility, another systematic review on oral mucositis and much more.
As reported here in 2013 there are no licensed drugs for non-specific neck pain because “there isn’t much specific research that shows drugs help neck pain”. For LLLT/PBM however, there are at least 16 (mostly positive) RCTs and a positive systematic review published in The Lancet. Despite this unequivocal evidence, the 2014 revised patient advice leaflet from the BMJ fails to mention LLLT/PBM but states “your doctor may recommend one or more of the following” and goes on to list pain killers, NSAIDs, antidepressants and muscle relaxants”.
This 15 minute video starts with an overview of Photobiomodulation and low level light therapy. Later in the presentation James introduces the Lumithera treatment for Dry Age related Macular Degeneration (AMD).
The VA, Boston University and Harvard Medical School published the results of a Transcranial LLLT (LED) pilot study on mild Traumatic Brain Injury (TBI). Incredibly; TBI is a leading cause of death and disability among children and young adults in the United States. Each year an estimated 1.5 million Americans sustain a TBI, 50,000 people die as a consequence, 230,000 are hospitalized and an estimated 5.3 million currently live with a permanent TBI-related disability (because there is no cure). This study showed significant improvement in Executive Function, Verbal Learning, Long Delay Free Recall and fewer post-traumatic stress disorder (PTSD) symptoms. Participants and family reported better ability to perform social, interpersonal, and occupational functions. This was a small pilot study on just eleven patients with chronic mTBI, there was no placebo control group so further studies are necessary to truly establish the effect size.
The paper “High-intensity versus low-level laser therapy in the treatment of patients with knee osteoarthritis: a randomized controlled trial” Kheshie et al 2014 pitches the 3B BTL laser against the HIRO class IV “High intensity” laser. The results appear to show that the HIRO class IV “High intensity laser” was more effective than the “Low Level Laser”. HOWEVER, the HIRO class IV “High intensity” laser was delivered over a large area (not adequately defined but approx 100cm2 by my estimation) so the intensity was actually very low (about 13mW/cm2 which is less than most LED systems), and the 3B BTL “Low Level Laser” was actually very high (4 x 200mW small, high intensity beams) and were held stationary on the patella for over half an hour, YES, HALF AN HOUR IN ONE SPOT! This is insane.
This paper leads people to think that the class IV Hiro laser was more effective because it was higher intensity when in fact the beam distribution meant the average intensity distribution was low (13mW/cm2). The 3B laser was not so effective because it was held stationary such that it would cause an overdose. If the 3B laser treatment had been delivered in using same scanning technique as the class IV then they would likely have achieved the same result. (I am not a fan of scanning because you can never be sure how much energy you have delivered to an area, better to use a low intensity device and hold it still in my view).
This paper misdirects the reader towards favouring class IV lasers rather than 3b or LED by misinforming the reader.
TV, radio and newspapers all over the world got very excited last week reporting that “laser regenerates teeth” following a Harvard study. The study showed that LLLT stimulates the stem cells resident in the tooth pulp to form dentin (for details click below). This is the highest profile announcement for any LLLT paper ever and will add significant awareness and credibility for everyone in the field. Congratulations and huge thanks to the author Dr Praveen Arany B.D.S., M.D.S., M.M.Sc., Ph.D. who is now a Clinical Investigator at NIH.
Last October a systematic review on LLLT for neck pain was written by Kadhim-Saleh et al and published in the British Journal of Sports Medicine. They report that the evidence for LLLT in neck pain is inconclusive. The paper criticises the 2009 Lancet review by Roberta Chow & Bjordal et al on LLLT for non-specific neck pain claiming their review was more stringent. Well you have to read the rebuttal Bjordal shot back to the journal editor revealing the weakness, errors and fundamental flaws in the work of Kadhim-Saleh et al
The title of last months PMLS editorial was Low Level Laser Therapy (LLLT) and World Association for Laser Therapy (WALT) Dosage Recommendations. Written by the Scientific Secretary Prof. Jan Bjordal. He describes how far we have come and the importance of the WALT dosage recommendations. No abstract is available for editorials so I have prepared one for you below. Continue reading →
A paper titled ”The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis” [ref] showed that 10 Watt Class IV laser (mixed 8W 970nm, 2W 810) was successful in reducing pain and improving function in an RCT with 15 patients, and that there was good statistical significance at 6 months following a course of 6 treatments.
The claim by class IV laser manufacturers is that class IV lasers are better (faster, deeper and more effective) than Class 3b and LED systems. Conversely the 3B laser and LED manufacturers argue that less power density is more effective because delivering energy too quickly can overdose tissues and class IV lasers might burn the skin.
Throughout this paper there are marketing messages claiming the advantages of shorter treatment times than low power LLLT systems and of course the title shouts “10 Watt Class IV laser” just in case the reader is in any doubt that more power is what you need.
Regular readers of this column know my obsession with irradiation parameters, particularly dose rate effects (W/cm2) and will not be surprised to learn that I deconstruced the irradiation parameters used in this trial . Surprise, surprise they were the same low irradiance levels typically used by 3B lasers and LED systems, if not less and the treatment time was longer too.
Yes, it was a 10 Watt laser and yes, 3,000 joules was delivered, however it had a large beam area and treatment was delivered over (45cm2) in a “painting fashion”. The fluence (dose) was 6.6 Joules/cm2 and the power density was a tiny 22mW/cm2, consequently treatment time was a hefty 5 mins.
The average irradiance was not disclosed in the paper and the reader is directed to think that more power is quicker.
P.S. research trials with 3B lasers are typically 30 seconds to 3 mins and our recommended treatment is 1 min with a large LED cluster to the lateral epicondyle and 30 seconds for any related trigger points.
David Sengeh has been developing powered limbs at MIT for amputees (like the bionic man). Where the powered limb attaches to the body (the stump of the original leg) it gets very sore. David has been using our standard THOR products to heal the stump and reduce pain. It works very well, though it takes a lot of time to treat the whole area. I am in Boston now to help David start clinical trials with a new device we designed that will treat the whole stump. The amputee puts the the leg stump into the LED treatment cylinder and gets a complete treatment in just one minute :-)
The BMJ reported that the US Centers for Disease Control and Prevention had declared there was a national epidemic of prescription drug overdoses which led to 14,800 deaths in 2008. This is more than cocaine and heroin combined for the same period. If you think this an exaggeration click here to see the full government report.
They highlight the following key points :
Death from opioid pain relievers (OPR) is an epidemic in the United States.
Sales of OPR quadrupled between 1999 and 2010.
Enough OPRs were prescribed last year to medicate every American adult for a month
Abuse of OPRs costs health insurers approximately $72.5 billion annually in health-care costs.
And just in case you were not astonished already, I will remind those of you that have not heard me say it before that NSAIDs were the 15th biggest cause of death in the USA according to the New England Journal of Medicine 1999. Unfortunately there is no abstract so I am going to show you a little snip from the full paper
Available only to people who have attended a THOR training course in the last 3 years. All treatments are based on our four step method which includes treatment of the injury, trigger points, lymphatics and nerve roots.
Take a look to see how it works and let us know what you think.
Photobiomodulation Training Course Testimonial: Bonnie S. Block B.A. (University of Texas at Arlington) M.S. (University of Pennsylvania)
“The training course exceeded my expectations. I am very pleased that I attended because James Carroll and Mark Granic answered all of my questions and taught me as much as I could possibly absorb in one day. I was so impressed with the knowledge and integrity of both of them that I ordered a Thor Laser. Thank you.”
Photobiomodulation Training Course Testimonial: Dr Reem Hanna BDS, LDS, RCS (Eng) Associate Specialist in Oral Surgery/ Specialist oral surgeon King’s College Hospital, London, UK
“I attended the Thor training day. I found it extremely useful and informative. Mr. James Carroll is very eminent in the field of photobiomodulation. I enjoyed the interaction and the discussion with the group. I thoroughly recommend this course for clinicians who have a great interest in photobiomodulation.”
LLLT Training Course Testimonial: Elsa Izaguirre Veterinary Surgeon, Holistic Pet, Northern Ireland, UK
“I attended the thor lllt course at Leeds and it was a very interesting course, very focused on it’s mechanism of action, and never forgetting about animal’s treatments (not very common in other areas). Really pleased, in general with the course.”
“I have had my Thor laser for four months and so far have treated countless TMJ patients, three oral mucositis patients and a few xerostomia patients. All of them feel instant effects and rave about the results. This has been one of the most amazing pieces of technology I have introduced into my practice. I definitely recommend it for every dental office.”
Dr. Jennifer Waters, DDS Clear Creek Dental Clinic, Colorado, USA