Category Archives: Rants

Class IV laser dose concern. An update from Prof. Jan Bjordal. World Association for Laser Therapy (WALT)

Posted on 30 November 2013 by James Carroll

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. (more…)

Posted in Rants, Special Feature | on Class IV laser dose concern. An update from Prof. Jan Bjordal. World Association for Laser Therapy (WALT)

Class IV laser treatments take longer than 3B lasers

Posted on 20 November 2013 by James Carroll

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.

Posted in Rants, Research | on Class IV laser treatments take longer than 3B lasers

Protected: Class IV laser misinformation

Posted on 9 November 2013 by James Carroll

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Protected: Class IV laser vs Class 3B laser vs LEDs

Posted on 7 November 2013 by James Carroll

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None so blind as the BMJ who will not see

Posted on 31 October 2013 by James Carroll

A few weeks ago (September 2013) the BMJ updated their patient information for neck pain and I quote “There isn’t much specific research that shows drugs help neck pain, but your doctor may recommend one or more of the following” and then they list painkillers (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants and muscle relaxants. Well, guess what, there was NO mention of LLLT.

Of course I wrote to the BMJ, pointing out there are at least 17 RCTs for LLLT on neck pain and a systematic review in the Lancet and added “What kind of a review did your team do that missed LLLT and yet suggests drug therapies that lack evidence?” and the reply was “The patient leaflets are written from reviews of the evidence on treatments compiled by our scientific and clinical teams for the Best Practice and Clinical Evidence products. The treatments to be included are decided upon with advice from clinical experts in the field. I will forward your message to the teams involved in deciding the scope of the Clinical Evidence and Best Practice topics linked to the neck pain patient leaflet, so that they can consider your comments when they next review the scope of the topic”

Should I respond and what should I say?

I am a fan of the BMJ. They are not usually a slave to the pharma industry and they are not afraid to confront them or any blinkered “business as usual” physicians so I fully expect LLLT to be in next years guidlines (I shall make sure of it). That is my upbeat comment for this month.

Posted in Rants | 7 Comments

The Bottom Line – lazy or ignorant professors?

Posted on 28 September 2013 by James Carroll

Irradiation parameters and dose are critical aspects of LLLT and if you are a doctor or therapist you probably trust the research you read. Prepare to be disappointed.

(more…)

Posted in Rants | 6 Comments

LLLT companies may be no better than Big Pharma

Posted on 24 July 2013 by James Carroll

It is a popular sport in the LLLT industry to sneer at Big Pharma for their side effects and marketing practices, but the LLLT industry is far from criticism itself. Whilst LLLT side effects are hard to find, marketing overstatement and misdirection are common place.

In this months literature watch is a paper titled “The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis”. This small study 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 very large beam area and treatment was delivered over a very large area (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. Perhaps LLLT companies are no better than the pharma industry when it comes to disseminating specious information.

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.

Attend a THORLaser One Day Training Course to see the research and get all the information in making an informed decision: https://www.thorlaser.com/courses/

Posted in Rants | 3 Comments