Laser Therapy - Class IV "high power"

High Power-Laser Therapy?

Laser Therapy has been approved by the FDA. It is a Laser Therapy treatment that utilizes specific wavelengths of light that affect muscles and tissues. Cold Laser Therapy expedites the healing process and is used primarily for patients suffering from an assortment of acute and chronic conditions. The main objective of "Cold" Laser Therapy is to help eliminate pain, swelling, reduce spasms, increase functionality and much more.

How Cold Lasers Work:

L-A-S-E-R is an acronym that stands for Light Amplification by Stimulated Emission or Radiation. In simple terms this refers to light waves of a specific wavelength – both artificial and sunlight usually consist of many different wavelengths of light scattering in all different directions.

Cold laser therapy produces a beam of light that is applied over the injured area to stimulate healing. There is no pain with the treatment. When laser light is absorbed by a living tissue, it triggers biological reactions in the cells. Chemical substances are produced, released and carried by the blood and lymphatic flow to other parts of the system. In this way the effects of cold laser light may not be only local, but can also achieve wide systematic physiological responses, including reduction in pain by causing production of natural pain killers called endorphins. Inflammation is reduced by suppressing inflammatory enzymes that create swelling, redness, pain and heat. It can also enhance lymphatic drainage, which increases circulation and speeds healing.

Cold laser therapy helps release tight muscles that create chronic pain, joint problems and decreased mobility and promotes faster bone repair by stimulating fibroblastic and osteoblastic proliferation.

How does the Cold Laser Therapy compare to other laser therapies?

Our Laser therapy system utilizes a high power, Class IV, “soft,” “cool,” or “cold” laser, which has longer wavelengths than Class I, II, III systems to promote rapid reduction of pain, accelerate healing time, and accelerate tissue regeneration and repair.

Cold lasers are called “cold” because they do not induce any temperature change in the body’s tissues. “Hot” lasers have shorter wavelengths, which have catabolic effects that can deliberately destroy tissue in cauterizing and surgical applications. The cold laser has been called “The Therapy” of the 21st century. In more than 2,500 scientific research studies on laser therapy, there is verification of the clinical value of laser therapy with no recorded negative side effects. This versatile tool is totally safe, painless and medication-free, non-toxic, and with virtually no negative side effects.

Cold laser therapy has stimulative effects rather than destructive ones. It compliments the orthotic deprogrammer protocol of treatment for TMD (Jaw). Clinical applications of the cold laser have included acute and chronic pain reduction from many etiologies, inflammation reduction, enhanced tissue healing, and cell regeneration. Extraordinary results when applied to head, neck and shoulder regions of the body. The results have shown very rapid pain reduction and accelerated recovery times, far exceeding conventional methods.

Benefits of High Power Cold Laser Therapy:

Numerous clinical studies and research trials have been conducted on the beneficial effects of laser therapy for a whole host of clinical conditions. The following is a simplified list of the more widely studied biological effects of Laser Therapy.

Laser Therapy Effect #1: Pain Relief

Laser Therapy relieves pain through several different biological mechanisms. 1) Laser Therapy blocks the pain signals transmitted from injured parts of the body to the brain. This decreases nerve sensitivity and significantly reduces the perception of pain. 2) Laser Therapy also reduces pain by decreasing inflammation and swelling. 3) Laser Therapy also reduces pain by increasing the production and release of endorphins and enkephalins which are natural pain-relieving chemicals within our bodies.

Laser Therapy Effect #2: Improved Nerve Function

Laser light speeds up the process of nerve cell reconnection which decreases the time necessary for nerve cells to heal after an injury. Laser Therapy also increases the amplitude (strength) of action potentials (signals sent along nerve fibers) which improves overall nerve and muscle function. Both of these reasons explain why Laser Therapy is so beneficial at reducing the symptoms related to nerve injury – namely sharp pain, numbness, tingling and burning.

Laser Therapy Effect #3: Inflammation Reduction

Laser Therapy causes the smaller arteries and lymph vessels of the body to increase in size – a mechanism called vasodilation. This increased vasodilation allows inflammation, swelling and edema to be cleared away from injury sites more effectively. Vasodilation of lymph vessels also promotes lymphatic drainage which also aids in this vital healing process. Bruising is often resolved more quickly as a result of this particular biological effect.

Laser Therapy Effect #4: Faster Wound Healing

Laser therapy stimulates the production of fibroblasts which are the building blocks needed to create collagen. Collagen is the essential protein required to replace old tissue or to repair damaged tissue. Because of this effect Laser Therapy is effective at treating open wounds and burns.

Laser Therapy Effect #5: Accelerated Tissue Repair and Cell Growth

Photons of light emitted by therapeutic lasers penetrate deeply into the tissues of the body to stimulate the production centers of individual cells. This stimulation increases the energy available to these cells causing them to absorb nutrients and expel waste products more rapidly. This dramatically accelerates the repair of injured tissue leading to faster tendon, ligament and muscle healing.

Laser Therapy Effect #6: Improved Blood Flow

Laser Therapy significantly increases the formation of new capillaries (tiny blood vessels) within damaged tissues. With more capillaries bringing more blood to the injury site healing is sped up, wounds are closed more rapidly and scar tissue formation is reduced.

Laser Therapy Effect #7: Increased Metabolic Activity

Laser Therapy also has a profound impact on individual blood cells that pass through the laser beam during treatment. The laser light significantly increases the oxygen and nutrient load capacity of the red blood cells (RBCs). This allows for increased metabolic activity and production of certain specific enzymes. Both of these effects can be felt across the entire body and are not just limited to the area exposed to the laser light.

Laser Therapy Effect #8: Reduced Formation of Scar Tissue

Laser Therapy reduces the formation of scar tissue (fibrous tissue) following tissue damage related to cuts, burns and surgery. Laser Therapy is able to reduce this formation by speeding up the healing process, improving the blood flow to the injured area and more effectively carrying away waste products – all are mechanisms mentioned above. Faster healing always leads to less scar tissue formation.

Laser Therapy Effect #9: Enhanced Immune Function

Photons of laser light are directly absorbed by chromophores (molecular enzymes within cells) that are embedded within most cells of the body. This laser light absorption activates a specific enzymatic process that triggers the production of ATP. ATP (adenosine tri-phosphate) is the single most important form of energy that powers ALL chemical reactions within ALL cells of the body. Higher energy production leads to faster and more efficient function – especially true of immune-specific cells that are exposed to Laser Therapy. This improved efficiency aids the immune system in fighting off undesirable microbes and pathogens.

Laser Therapy Effect #10: Acupuncture Point Stimulation

Laser Therapy is also an effective alternative to traditional Acupuncture treatment. Traditional Acupuncture delivers therapeutic effects through the mechanical stimulation of “Acupuncture Points” throughout the body. This is achieved by piercing the Acupuncture Points with needles and then twisting the needles by hand, tamping them or connecting them to electrical stimulation devices. Laser Therapy may be used to stimulate the same Acupuncture Points without the need for invasive needling or similar mechanical stimulation.

Conditions treated by Class IV Laser Therapy:

Class IV laser therapy stimulates all cell types so it can be used to help promote healing in muscle, ligament, cartilage and nerves. It can be used with any of the following:

  • Arthritis pain
  • Back pain and spinal conditions
  • Carpal tunnel syndrome
  • Knee pain
  • Neck pain
  • Tendonitis
  • Musculoskeletal Pain
  • Stenosis
  • Fractures
  • Frozen shoulder
  • IT Band syndrome
  • Shin splints
  • Restless Leg syndrome
  • Leg cramps Soft Tissue Injuries
  • Migraine Headaches
  • Myofascial Trigger Points
  • Tennis Elbow / Golfer's Elbow
  • Bells’s Palsy
  • Plantar Fasciitis
  • Sports Injuries (ligaments and tendons)
  • Sprains & Strains
  • Bursitis
  • Hamstring Tears
  • TMJ
  • Disc disorders
  • Skin conditions and surgical incisions


In the last 3 years six systematic reviews have found in favour of LT (Cold Laser)

The BMJ sports medicine journal, systematic review of surgical and conservative interventions for frozen shoulder found "strong evidence" for LLLT. (2010) The International Association for the Study of Pain (Global Task force on musculoskeletal pain) found "strong evidence" for Low Level Laser Therapy on myofascial pain syndrome. (2010)

The BMJ clinical evidence recommendations for tennis elbow 2011 now include LLLT.

American Physical Therapy Association guidelines recommend LLLT for Achilles tendonitis. (2010)

Lancet systematic review: "LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain". (2009)

World Health Organization (Bone and Joint Task Force) for neck pain Low Level Laser Therapy "more effective than no treatment, sham, or alternative interventions". (2008)

In August 2010 The Lancet reported that the systematic review of LLLT for neck pain was in their top 20 most downloaded papers for 2010.

Cold Laser Research

The effect of 300 mW, 830 nm laser on chronic neck pain: a double-blind, randomized, placebo-controlled study

Chow RT, Heller GZ, Barnsley L.
Castle Hill Medical Centre, 269-271 Old Northern Road, Castle Hill, NSW 2154, Australia.
Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27. [PMID: 16806710]

CONCLUSION: A study was performed (randomized, double-blind, and placebo-controlled) on 90 people with chronic neck pain to determine the efficacy of an 830 nm laser, 300 mW, low-level laser therapy. They noticed that cold laser (LLLT) was effective in providing pain relief for chronic neck pain sufferers over a period of three months. For more information and the full study go to – Pain. 2006 Sep;124(1-2):201-10. Epub 2006 Jun 27. [PMID: 16806710]

Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.

Lasers Surg Med. 2003;32(3):233-8
Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M.
Physical Medicine and Rehabilitation, School of Medicine, Dicle University, Diyarbakir, Turkey.

The study was aimed to find out if low power laser therapy (GaAs laser) was useful for a therapy on chronic low back pain.

They studied 75 patients; (25 patients laser alone, 25 patients laser and exercise, and 25 patients exercise alone).

Their tests included; “Visual analogue scale (VAS), Schober test, flexion and lateral flexion measures, Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the clinical and functional evaluations pre and post therapeutically. A physician, who was not aware of the therapy undertaken, evaluated the patients.”

CONCLUSION: In the treatment of chronic low back pain, low power laser therapy was an effective method in reducing pain and functional disability.

Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials

Dr Roberta T Chow MBBS, Prof Mark I Johnson PhD, Prof Rodrigo AB Lopes-Martins PhD, Prof Jan M Bjordal PT
Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.

Lancet. 2009 Dec 5;374(9705):1897-908. Epub 2009 Nov 13. [PMID: 19913903]
CONCLUSION: The authors identified 16 randomized controlled trials that included a total of 820 patients. They did a systematic review and meta-analysis of the trials to determine the efficacy of LLLT in neck pain. They showed that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.

For a full study go to – The Lancet, Volume 374, Issue 9705, Pages 1897 – 1908, 5 December 2009

(Joint pain; low back, neck, shoulder, arm, and more)

LLLTwith trigger points technique: clinical study on 243 patients

Simunovic Z, Journal of Clinical Laser Medicine and Surgery (Aug. 1996) 14(4):163-167.

CONCLUSION: This study was performed on >200 patients that were suffering with low back and radicular pain, skeletomuscular ailments, headaches, facial pain, myogenic neck pain, shoulder and arm pain, epicondylitis, tenosynovitis, and achilles tendonitis. They used various LLLT methods which included; infrared 820-830 nm continuous wave, 632.8 nm visible red, and 904 nm pulsed emission on “trigger points” and focal pain points due to ischemic conditions. They observed spontaneous or induced pain decreased or even disappeared by movement, mobility was restored, rigidity decreased, and microcirculation improved along with improvement of oxygen supply to hypoxic cells in the treated areas and removal of collected waste products.Results measured according to VAS/VRS/PTM: in acute pain, diminished >70%; in chronic pain >60%. They also concluded that LLLT (Cold Laser) may be used by its self or as an added supplement to other therapeutic procedures for pain treatment. No negative effects were noted with LLLT and the use of analgesic drugs could be reduced or completely excluded.


Practical Pain Management, Nov/Dec 2003, by Richard Martin, BS, CLT, (photobiologist)

Low Level Laser Therapy (LLLT) precipitates a complex set of physiological interactions at the cellular level that reduces acute inflammation, reduces pain, and accelerates tissue healing.

Injured cells and tissues have greater affinity for LLLT than healthy cells and tissues. LLLT in the treatment of inflammation, pain and healing is a highly integrated process, but the author separates those processes categorically for identification.

Acute Inflammation Reduction (flowchart provided in the original article) – After injury, tissues initiate a series of biological responses and cellular membrane reactions which manifest in a combination of edema, inflammation, pain and functional debility.LLLT mediates by: (1) Stabilizing cellular membranes; (2) Enhancing molecule ATP production and synthesis; (3) Stimulating vasodilation via increased Histamine, Nitric Oxide and Serotonin; (4) Accelerating leukocytic activity; (5) Increasing Prostaglandin synthesis; (6) Reducing Interleukin-1; (7) Enhancing lymphocyte response; (8) Increasing angiogenesis; (9) Modulation temperature; (10) Enhancing superoxide dismutase levels; and (11) Decreasing C-reactive protein and neopterin levels.

Pain Reduction(flowchart provided in the original article) – Evidence justifies a conclusion that LLLT reduces pain by combination of processes: (1) Increase in b-Endorphins; (2) Blocked depolarization of C-fiber afferent nerves; (3) Increased nitric oxide production; (4) Increased nerve cell action potential; (5) Axonal sprouting and nerve cell regeneration; (6) Decreased Bradykinin levels; (7) Increased release of acetylcholine; and (8) Ion channel normalization.

Tissue Healing – LLLT enhances wound healing by: (1) Enhanced leukocyte infiltration; (2) Increased macrophage activity; (3) Increased neovascularization; (4) Increased fibroblast proliferation; (5) Keratinocyte proliferation; (6) Early epithelialization; (7) Growth factor increases; (8) Enhanced cell proliferation and differentiation, and (9) Greater healed wound tensile strength

The information above was taken from Practical Pain Management, Nov/Dec 2003 by Richard Martin (see bio below). For the full study go to Practical Pain Management at

Richard Martin, BS, CLT is a photobiologist specializing in laser therapy and holds the position of Director of Science at MicroLightLaser, a subsidiary of Innovative Medical Group Corporation in Santa Monica,CA. He has taught laser physics and photodynamics for eight years. He has served as manager for several biomedical design and service facilities and participated as lead researcher for biomedical devices involved in emergency cardiac care, warmed intravenous fluid therapy and laser therapy. Richard has participated in medical clinical trials for 15 years as a clinical trial analyst and contributing clinician.

A Systematic Review Of Low Level Laser Therapy With Location-Specific Doses For Pain From Chronic Joint Disorders.

Bjordal JM, Couppe Roberta C, Chow RT, Tuner J, Ljunggren EA. Section of Physiotherapy Science, University of Bergen, Bergen, 5020, Norway. [email protected]
Aust J Physiother 2003;49(2):107-16

They indentified 11 out of 88 randomized controlled trials that included 565 patients with chronic joint disorders that were using an appropriate and acceptable method of treatment procedures. They also added that there should be caution with treatment procedures and trial design for interpretation of the results. CONCLUSION: Cold Laser (LLLT) gave significant reduction of pain and improvement in health status in chronic joint disorders.

HERNIATED LUMBAR DISC; LLLT Using A Diode Laser In Successful Treatment Of A Herniated Lumbar/Sacral Disc, With Magnetic Resonance Imaging (MRI) Assessment: A Case Report

Tatsuhide Abe, Abe Orthopaedic Clinic Futuoka City Fukuoka Prefecture Japan X12′ Laser Therapy 1989

A forty (40) year old woman presented at the Abe Orthopaedic Clinic suffering with pain in the low back and left hip and leg for 2 years. MRI showed a ruptured disc in the last lumbar disc (L5-S1). Her condition failed to respond with convention treatment methods including; NSAIDS (Non-steroidal anti-inflammatory drugs), lumbar/pelvic traction, dural block anaesthitic injections. Cold Laser (LLLT), GaA1A diode laser with 830 nm wavelength, 60 mW, was used on the patient as an outpatient therapy. CONCLUSION: The patient’s condition dramatically improved which was demonstrated by motility exercises. A follow-up MRI confirmed the improvement with significant results showing a normal condition of the previous lumbar disc herniation at L5-S1.

(Long Term Relief For Chronic Pain Using Cold Laser Therapy)

Retrospective Study of Adjunctive Diode Laser Therapy for Pain Attenuation in 662 Patients: Detailed Analysis by Questionnaire

Shigeyuki Nakaji, M.D., Ph.D., Chiyuki Shiroto, Misako Yodono, Takashi Umeda, Qiang Liu.
Photomedicine and Laser Surgery. February 2005, 23(1): 60-65. doi:10.1089/pho.2005.23.60. (Published in Volume: 23 Issue 1: March 1, 2005)

The authors noted, under “Background Data”, that the use of LLLT (cold laser) for chronic pain attenuation has been reported in international literature for over 20 years.

The study was assessing the long term effects of Cold Laser (LLLT) through retrospective surveys using questionnaires. 1,087 patients were treated with LLLT from April 1992 to August 1995 at the Shiroto Clinic.

662 patients (397 females, 265 males) replied to the questionnaires that were sent to September and October 1996. The treatment method consisted of Cold Laser (LLLT) diode laser system using 830 nm wavelength, continuous wave 60 mW, (which they noted was the most effective wavelength).

The total efficiency rating immediately after treatment was 47% in women, and 46.8% in men, at the time of the survey the rating soared to 76.8% in women, and 73.3% in men, which was considered good – excellent. Additional factors were also positive including; physical energy, well-being, general fatigue, emotional stability, and mental vigor. CONCLUSION: Cold Laser (LLLT infarred diode), is considered effective, safe, and side-effect free, therefore making the treatment an ideal adjunctive therapeutic modality for intractable chronic pain and other pain.

Low-power laser treatment in patients with frozen shoulder: preliminary results

Stergioulas A.
Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Human Movement and Quality of Life, Peloponnese University, Sparta, Greece. [email protected]

Photomed Laser Surg. 2008 Apr;26(2):99-105.
The author noted in background data that the use of Low Level Laser energy has been recommended for the management of a variety of musculoskeletal disorders.

This study tested the efficacy of Cold Laser (LLLT), 810 nm wavelength, continuous 60 nW applied to eight points on the shoulder in patients with frozen shoulder. A total of 63 patients were treated; 31 active laser group, 32 placebo laser group. With the active laser group, there was significant decrease in shoulder pain, a significant decrease in overall, night and activity pain, significant decrease of shoulder, arm, and hand, and significant decrease in health-assessment questionnaire (HAQ sores. Most activity pain scores were tested at the end of 4 weeks, 8 weeks, and 16 week post-radomization.

CONCLUSION: Cold Laser (LLLT) treatment was more effective in reducing pain and disability scores than a placebo at the end of the treatment period and at the follow-up period.

The effect of low-level laser in knee osteoarthritis: a double-blind, randomized, placebo-controlled trial

Hegedus B, Viharos L, Gervain M, Gálfi M.
Physio- and Balneotherapy Center, Orosháza-Gyopáros, Hungary. [email protected]
Photomed Laser Surg. 2009 Aug;27(4):577-84. [PMID: 19530911]

CONCLUSION: This was a study to examine how LLLT (Cold Laser) 830 nm wavelength, continuous, power 50 mW, with 6 J/per point skin contact, had an pain relieving effect and microcirculatory changes to osteoarthritis in knee pain sufferers. There was a placebo controlled group that was treated with the same appearance laser. Both groups were examined at two weeks and two months after cold laser (LLLT) therapy. Thermography was performed using a AGA infrared camera and checked, circumference, joint flexion, pressure sensitivity, and the visual analogue scale was recorded.

RESULTS: Significant improvement in the treated group, with Cold Laser; was found in pain (before treatment [BT]: 5.75; 2 mo after treatment : 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in pain and joint flexion were not significant. Thermographic measurements showed at least a 0.5 degrees C increase in temperature—and therefore an improvement in circulation compared to the initial values. Changes did not occur in the placebo group. The results showed that Cold Laser (LLLT) reduces pain in Osteoarthritis in the Knee and improved microcirculation in the treatment area.

Low Level Laser Therapy For Tendinopathy. Evidence Of A Dose-Response Pattern.

Bjordal J M, Couppé C, Ljunggren E.
Physical Therapy Reviews. 2001; 6: 91-99.

This study was performed to see if Cold Laser (LLLT) can reduce the pain from tendinopathy in randomized placebo controlled trials. The authors ended up using 13 trials out of 78 studied that met their criteria on treatment procedure and trial design. They concluded that Low Level Laser Therapy does reduce pain in chronic and subacute tendinopathy when a specific does, location, and valid treatment was performed. For more information go to Physical Therapy Reviews, 2001; 6:91-99.

(Post-surgical pain)

Effects of Low-Level Laser Therapy on Pain and Scar Formation after Inguinal Herniation Surgery: A Randomized Controlled Single-Blind Study

de Paiva Carvalho RL, Alcântara PS, Kamamoto F, Cressoni MD, Casarotto RA.
Postgraduate Program in Rehabilitation Sciences , University of São Paulo, São Paulo, Brazil.

Photomed Laser Surg. 2009 Oct 12. [PMID: 19821701]

CONCLUSION: This was a study to investigate the efficacy of an infrared GaAlAs laser, 830 nm wavelength, on post-surgical scarring process after inguinal hernia surgery. They concluded that 830nm LLLT applied after inguinal hernia surgery was efficient is preventing keloids (excessive growth of scar tissue) from forming. In addition, cold laser (LLLT) resulted in better scar appearance and quality six months post surgery. For the full study go to -Photomed Laser Surg. 2009 Oct 12. [PMID: 19821701]

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