Laser Therapy Definitions
Below are ‘Key” Definitions when learning about Class 4 Laser Therapy. Remember to choose a laser based on physics and science, NOT fancy advertisements. Decide which laser is best for YOU and your desired clinical outcomes. Never purchase a laser based on price alone. Price is temporary, profits and patient results last forever! (If you have the right laser and proper training) Successful laser therapy is always contingent on an accurate diagnosis and proper application.
LIGHT: Light is a small spectrum of electromagnetic energy with wavelengths between 380 nanometers (nm) and 760nm in length. This spectrum of energy is visible to the naked eye.
LASER: Light Amplification by Stimulated Emission of Radiation; refers to the specific qualities and methods by which lasers produce light. Originally theorized and defined by Albert Einstein in 1917, it was not produced until the 1950s. Laser light is Coherent, has a Monochromatic wavelength, is Collimated, and Polarized. These four characteristics differentiate lasers from LED & SLD light sources.
COLLIMATION: A property of light commonly associated with lasers and accomplished with focusing lenses where all the photons are traveling in the same direction.
COHERENCE: The photons within a laser beam are extremely well organized and directional. This means that all of the photons (energy) have waves that travel in unison – they are highly parallel with a specific wavelength. True laser systems focus all of their energy in one direction in a very concentrated line. A super-luminous diode, on the other hand, diffuses its energy in all directions with only a small percentage of the energy travelling in the direction of the treatment. A true laser system will deliver 90% more power to the treatment area than a super-luminous diode system of exactly the same power rating.
MONOCHROMATIC: Contains one specific wavelength of light (one specific color). It is an exclusive property of laser light, setting them apart from all other light sources. Because the wavelength of laser light determines its effect on tissue, the monochromatic property of laser light allows energy to be delivered to specific tissues in specific ways. Non-laser therapies such as LED’s (Light Emitting Diodes) are sufficient for superficial treatment (wounds), but are questionable on penetration for musculoskeletal conditions. Lasers penetrate deeper.
FREQUENCY: The frequency of light is inversely proportional to its wavelength, and is dependent upon the energy value of the individual photons being emitted. The higher the frequency, the higher the energy, and the shorter the wavelength.
WAVELENGTH: The property that differentiates different spectrums of energy within the electromagnetic spectrum of energy is wavelength. The wavelength of light is measured in billionths of a meter, or nanometers (nm). The energy of a wave is inversely proportional to its wavelength. In other words, the greater the energy, the shorter (smaller) the wavelength. Light of shorter wavelength carries greater the energy of the light. As wavelength becomes longer, the energy carried is less. Some wavelengths work better than others. Wavelength is the prime determinant of tissue penetration. The wavelength is very specific for cell absorption. In the infrared (IR) spectrum, the longer wavelengths penetrate deeper and a greater percentage of the laser light will be transmitted in a forward direction. This means less scatter and better results! Each photon contains energy and just as energy of the ocean comes to shore in waves of high and low energy the same is true of photons. Only with photons the energy is not measured by the height of the wave but the number of waves the photon carries. These waves are measured in two ways, the number of waves that will pass a given point in one second, or wavelength, the distance between one wave and the next.
POWER: Power = Energy / Time 1 Watt = 1 Joule / Second.It is important not to confuse power and energy, although they are closely related. Power is the rate at which energy is delivered, not an amount of energy itself. With simple algebra, you can turn the formula above around to solve for energy instead of power, and write:
Therapeutic Energy = Power (Watts) or Joules/sec x Time(sec).
POWER DENSITY: Power density is amount of power delivered per unit area. Power density indicates the degree of concentration of the laser output. It is expressed in Watts per square centimeter, or milliwatts per square centimeter, W/cm2 or mW/cm2. Some studies have concluded that the power density may be of even greater significance than the dose. Example: A laser’s output is 4 Watts, and it is illuminating a circle of 3 centimeter diameter. First find the area of the circle, 3.14 x 1.5 x 1.5 = 7 cm2. Then divide the power by the area, 4W / 7cm2 = 0.6 W/cm2.
ENERGY DENSITY: The energy density expresses the total amount of energy delivered per unit area, in Joules per square centimeter, J/cm2. The energy is measured in Joules, and is calculated by multiplying the power output of the laser times the amount of time elapsed during the laser treatment. (Energy = Power x Time, and the units are Joules = Watts x Seconds.) A 4 Watt continuous wave laser would deliver 240 Joules in one minute. (4 Watts x 60 seconds = 240 Joules) Then simply divide the total energy by the area to arrive at the energy density in Joules per centimeter squared.
PENETRATION: Penetration refers to the distance an energy wave travels into the tissue before it is absorbed and dissipated as heat or molecular vibration. Penetration is a physical and thermal phenomenon, not a therapeutic phenomenon. Penetration of laser light is dependent on the wavelength of the light. Lower wavelengths are absorbed by hemoglobin and melanin, and higher wavelengths are absorbed by water in the tissues.
THERAPEUTIC WINDOW: Therapeutic laser light is primarily absorbed by the hemoglobin, melanin and water in human tissue. These three components each have a unique absorption curve that is dependent on the wavelength of the laser light. Hemoglobin and Melanin absorb more at the shorter wavelengths, around 630 nanometers. Water absorbs more of the laser light above approximately 960 nanometers. The three absorption curves have a relative minimum around 800 nanometers. Laser light in the range of 780nm to 810 nm penetrates the deepest into human tissue.
DUTY CYCLE: Duty cycle relates to the amount of time the light source is active, usually from 10% to 100%. A laser operating in continuous wave is running at 100% duty cycle. The modulation setting of K-Laser is a 50% duty cycle. Out of every second the light source would ‘On’ half of a second and ‘Off’ half of a second.
BIOMODULATION: Biomodulation is the process of changing the natural biochemical response of a cell or tissue within the normal range of its function, stimulating the cell’s innate metabolic capacity to respond to a stimulus. A cell can heal itself by this stimulation mechanism.
PHOTOBIOMODULATION: When biomodulation occurs from a photon transferring its energy to a chromophore it is referred to as photobiomodulation.
CHROMOPHORES: Chromophore literally means, “Color lover” (L. chromo = color; L. Phore = to seek out, to have an affinity for, to love). Chromophores are generally pigmented molecules that accept photons within living tissue. When the chromophore accepts a photon, it causes a biochemical change within an atom, molecule, cell or tissue. If this change increases cellular function, it is said to have activated the tissue. If this change decreased cellular function it is said to have inhibited the tissue. Biomodulation occurs in both cases.
PHYSIOLOGICAL DOSE OF THERAPY: A Physiological Dose of any therapy is designed to stimulate production of, or provide to the body what it needs to normalize and heal itself through biomodulation. The symptomatic response to a physiological dose of therapy is dependent of the capacity of the patient’s body to respond to the therapy. The physiological dose of any treatment has specific advantages. • A physiological dose represents the body’s own response to a stimulus• A physiological dose generally improves the patient’s health. • A physiological dose will always be consistent for symptomatic response because it depends upon an interaction with the individual patient’s entire body system.
BIOLOGICAL AMPLIFICATION: When photobiomodulation occurs, the photon activates a chromophore, amino acid, nucleic acid, or molecule. Activation of a single enzyme molecule rapidly catalyzes thousands of other chemical reactions amplifying the signal to the cell. This is similar to the calcium regulated 2nd messenger cAMP cascade. Biological amplification explains how systemic, cellular, and clinical effects can occur almost instantaneously after exposure to light therapies.
DOSE: The term dose is an estimate of a therapy which produces a desired therapeutic action without harmful side effects. The therapeutic dose (safe and effective) range is defined by clinical evaluation of the response of a sufficient number of patients, generally 50 percent who improve without toxicity. The most important parameter in laser therapy is always the dose, often referred to as “fluence”. By dose (D) is meant the energy (E) of the light directed at a given unit of area (A) during a given session of therapy. The energy is measured in Joules (J), the area in cm2 and consequently, the dose in J/cm2.
PULSED (TRUE) OR SUPER-PULSED: Lasers emit short, powerful burst of light at intervals. While depth of penetration is greater, pulsed Ga-As lasers have two disadvantages. First, because the width of the pulse is fixed and extremely short (no more than 200 billionths of a second) the average output power will be relatively low and treatment time will be much longer. Secondly, true pulsed laser diodes have a narrower therapeutic dosage range. The risk of an increase in pain post treatment is considerably greater.
PULSED (SIMULATED): In most modern therapeutic lasers, the pulsing is simulated by mechanically or electronically interrupting the output of a continuous beam laser. The pulse rate may be adjusted up or down without significantly affecting treatment time. This is accomplished by modulating pulse duration and/or the space between pulses. From research we know that pulsing has significant positive effects on pain relief. The body’s sensitivity to any steady stimulus diminishes over time. Varying the pulse rate helps to ensure a better response. Changing the rate to keep the body interested is far more important than strict adherence to continuous laser stimulation.
LASER DIODE: A semiconducting device which emits monochromatic non-ionizing radiation by a process of stimulated emission. A laser beam has a number of unique properties, such as coherence, polarization and directionality. Beams emitted by laser diodes are not, as is often stated, ‘straight’ and/or ‘parallel’. Unless manipulated with additional optical devices such as lenses, a laser diode’s beam is broadly divergent along one plane and narrowly divergent along the perpendicular plane, producing an elliptical cross-section.
VISIBLE RADIATION: Non-ionizing electromagnetic radiation within the wavelength band from 400 to 700 nanometers which is able to be ‘seen’ by the human eye.
RETRACING: From time to time, a patient will experience an increase in pain following treatment. It is NOT an adverse reaction, but indicates that the laser treatment is working. Patients will frequently observe improvement once this pain subsides which is usually within 24-hours. This is a normal process. Always advise the patient in advance of the possibility of the pain response. Otherwise, they may assume that the laser has caused them harm. If a patient experiences significant pain increase, suspend treatment for a few days.
Dr. Perry Nickelston, DCClinic Director of the Pain Laser Center in Ramsey, NJ and VP of Practice Development for K-laser,USA.www.painlasercenter.com
1-866-595-7749 Ext #102