Phototherapy, (combining laser therapy and therapy with other light sources, such as light-emitting diodes, LEDs) is now applied in Sports Medicine with the objectives of not only the diagnosis of and treatment for sports related diseases and disorders, but also improvement of physical strength and the autoimmunological system, leading to an enhancement of each individual athlete’s ability, skill, and capacity in their own particular field. As the rise of interest in sports increases dramatically, so have the injuries, and so has the number of occasions that we reconstructive surgeons find ourselves treating such injuries. The area of sports injuries which we cover extends from facial soft tissue trauma, facial bone fractures, and hand surgery to post-contusion skin necrosis, ulcers, skin soft tissue deficiency and bone deficiency. Low level laser therapy (LLLT) has areas in which its efficacy is already well-documented, like pain attenuation, promotion of wound healing, activation of blood flow and so on. From my own research and clinical applications, some of which are précised here, I have shown that LLLT stimulates local blood flow in flaps, can rescue failing grafts and flaps, heal a large variety of recalcitrant ulcers and remove pain in temporomandibular joint injury. Furthermore, the actions and reactions associated with laser therapy have been proved to promote the living body to use its inherent powers of healing and recuperation to bring itself back to a normal condition, the theory of laser homeostasis. Recent spin-offs from the NASA space medicine program have included a new generation of LEDs, vastly more powerful, stable and with quasimonochromatic outputs that have enables their clinical application in almost every field where laser therapy has proved effective, but at a fraction of the cost of laser diodes. My hope is that active therapeutic application of light, either from laser systems, LED systems or a combination of both of them, will enable everybody including sports professionals and amateurs to lead healthy lives, with a higher quality of life, and to enjoy sports throughout their lifespan.
The final stage of severe infection round the apex of a tooth is granuloma formation, the treatment of which can be a major problem in clinical dentistry. Although granulomas in the early stages can respond to conservative conventional therapy, such as the application of calcium hydroxide, many in the later stage require surgical intervention with the risk of postoperative sequelae and patient downtime. Low reactive-level laser therapy (LLLT) has been shown to reduce inflammation and accelerate wound healing. The present study was designed to assess the role of 830 nm diode laser therapy in conjunction with conservative conventional therapy in the treatment of severe apical granulomas. Thirty-three young male patients with severe apical granulomas participated in the study, 19 of whom were treated with conventional treatments, and 14 with calcium hydroxide combined with 0.5 J/cm2 - 2 J/cm2 intra- and extraoral diode laser therapy. Significant improvements were seen in the LLLT combination group compared with the control group in the time taken for the resolution of acute postoperative pain (100 vs 500 min) and inflammation (1.6 vs 5.6 days), and long-term tooth remineralization and alveolar bone regeneration (15 vs 33 months). LLLT with the 830 nm diode laser was shown to be safe and effective in combination with conservative conventional therapy in the treatment of severe apical granulomas and was superior to the conventional approach on its own for granulomas of similar severity.
Reports on the efficacy of low reactive level laser therapy (LLLT) cover a range from 60% to 90%, depending on the criteria set by the authors, and also cover a large range of methodologies based on anatomical considerations, Oriental Medicine acupuncture-based tenets, or a blend of the two. From his experience in having treated 48,145 patients (correct as of July 1st 2005) in over 25 years of practicing LLLT, the author presents an anatomically-based treatment method which gives consistently good results, and maximizes the efficacy of laser therapy in a large variety of conditions including pain attenuation, wound healing, scar revision or treatment of areas of abnormal skin colour. No matter what entity is being treated in what location, laser therapy is always started in the contact pressure method bilaterally on the side of the neck approximately 2 cm down from the ears, and then on the C1/C2 intervertebral points, the C1/C2 zone, working round the base of the skull at points about 1 cm apart while angling the laser probe upwards by about 45°. The system used is an 830 nm GaAlAs diode laser (60 mW, continuous wave, incident power density 3 W/cm2, 10 sec/point, energy density 30 J/cm2). Subsequent treatment points run from proximal to distal towards the final treatment site, thence the name ‘proximal priority’. Irradiation of the sides of the neck targets increased blood supply to the brain; the C1/C2 zone targets in particular the 2nd and 3rd neurons, and the cerebellum, pons and medulla oblongata, in which lie a number of important control centres including those which control blood pressure and the descending inhibitory pathway of the reticulospinal tract. By activating these centres before moving to the site of interest, it is believed that a more efficient endorphin and enkephalin synthesis is triggered in the case of pain attenuation, via activation of the reticulospinal tract through the pyramidal and extrapyramidal fibres, and the parasympathetic system is given a ‘wake-up’ call in the case of all conditions. Laser therapy applied directly to a site of interest will still have some effect, possibly a good one, but the author suggests that adherence to the proximal priority method will make a good effect even better.
Vitiligo, presenting as depigmented patches of skin surrounded by normal skin, is present in up to 2% of the population under the age of 40 and can present major problems as far as treatment is concerned, although diode laser therapy (LLLT) has had good results in the treatment of systemic vitiligo where melanocytes are present but are malfunctioning. The root cause of vitiligo remains uncertain, but possible etiologies are autoimmunological destruction or down-regulation of melanocytes, neural influences, hormonal influences, post-traumatic destruction of melanocytes, or a combination of these. Other than LLLT, oral psoralen plus ultraviolet A (PUVA) treatment has been used for resistant cases of vitiligo, but side effects from long-term UVA irradiation of the skin are now emerging. Corticosteroids have also been used but long-term corticosteroid application is also associated with undesirable side-effects. Copper has been recognized as an essential element in maintaining or restoring homeostasis of the organism. A new approach is presented, whereby a topical preparation containing copper is used in combination with helium-neon (HeNe) LLLT to induce photolytic-based photophoresis of the copper into the epidermal basal layer cells, including melanocytes. This technique is called copper laser photophoresis (CLPP). A 30-day controlled study was performed in 43 vitiligo patients, (ages 17-56 yr, 29 males and 14 females), comparing CLPP (n=20), PUVA (n=23). A further 14 unirradiated placebo controls with vitiligo (ages 12-60 yr) received only starch tablets and no form of phototherapy. After the 30 days 15 of the 15 CLPP subjects had complete repigmentation, compared with 5 of the PUVA group and none of the placebo group. No side effects were seen in the CLPP group, and no contraindications were noted. Burns occurred in 3 of the PUVA group. This was a preliminary trial with a small patient population, but the favourable results suggest that CLPP may well be a safe, easily administered, well-tolerated and effective treatment for vitiligo.
Effective and consistent pain attenuation in acute and chronic pain patients remains a major goal for clinicians in the small hospital environment. In our own experience, we have found that phototherapy, at first with a helium-neon (HeNe) laser and subsequently (and currently) with a broad band polarized polychromatic visible red ∼ near infrared light source has had good efficacy, both in acute pain types in addition to chronic pain patients: the latter, however, require more treatments. We report on two studies, one using general phototherapy for acute and chronic pain, and a smaller trial using irradiation of the area around the stellate ganglion as an alternative to conventional stellate ganglion anesthetic blockade. In the first and second trials, the immediate efficacy rates for acute pain patients were 87.5% and 100%, respectively. For chronic pain the immediate efficacy after the first treatment was 69% and 57.1%, and after the last treatment 82% and 89.5%, respectively. Phototherapy would therefore appear to have an interesting role to play in the treatment even of chronic pain. In addition to pain, phototherapy can be applied in a number of other areas, and some of these are listed. Phototherapy over the stellate ganglion is compared with conventional stellate ganglion anaesthetic block. Our studies were, however, only preliminary studies, and are limited by small patient populations and the lack of stratification of efficacy by pain aetiology. Larger studies are planned for the future, as we feel that phototherapy is an effective, safe and patient-friendly therapeutic modality, easily applied and well-tolerated by patients of all ages.