Class IV Deep Tissue Laser (Photobiomodulation)

Laser therapy, or photobiomodulation, is the process of photons entering the tissue and interacting with the cytochrome c complex within the cell mitochondria. The result of this interaction, and the point of conducting laser therapy treatments, is the biological cascade of events that leads to an increase in cellular metabolism (promoting tissue healing) and a decrease in pain. Laser therapy is used to treat acute and chronic conditions as well as post-activity recovery. It is also used as another option to prescription drugs, a tool to prolong the need for some surgeries, as well as pre and post-surgery treatment to help control pain.

Laser therapy treatments must be administered directly to skin, as laser light cannot penetrate through layers of clothing. You will feel a soothing warmth as the therapy is administered. Many patients receiving LightForce® Therapy Laser treatments report enjoying the experience, especially when a massage-ball treatment head is used to deliver what is often referred to as a “laser massage.”

Patients receiving treatments with higher-power lasers also frequently report a rapid decrease in pain. For someone suffering from chronic pain, this effect can be particularly pronounced. Laser therapy for pain can be a viable treatment.

Class IV laser therapy (now called photobiomodulation) devices were cleared in 2004 by the FDA for the safe and efficacious reduction of pain and increasing micro-circulation. Therapy lasers are safe and effective treatment options to reduce musculoskeletal pain due to injury. The biggest risk to injury during laser therapy treatments is to the eye, which is why certified, protective eyewear is always required during LightForce® treatments.

With LightForce® lasers, treatments are quick usually 3-10 minutes depending on the size, depth, and acuteness of the condition being treated. High-power lasers are able to deliver a lot of energy in a small amount of time, allowing therapeutic dosages to be achieved quickly. For patients and clinicians with packed schedules, fast and effective treatments are a must.

Most clinicians will encourage their patients to receive 2-3 treatments per week as the therapy is initiated. There is a well-documented support that the benefits of laser therapy are cumulative, suggesting that plans for incorporating laser as part of a patient’s plan of care should involve early, frequent treatments that may be administered less frequently as the symptoms resolve.

The nature of the condition and the patient’s response to the treatments will play a key role in determining how many treatments will be needed. Most laser therapy plans of care will involve 6-12 treatments, with more treatment needed for longer standing, chronic conditions. Your doctor will develop a treatment plan that is optimal for your condition.

Patients often report improved sensation, including a therapeutic warmth and some analgesia immediately after the treatment. For noticeable changes in symptoms and condition, patients should undergo a series of treatments as the benefits of laser therapy from one treatment to the next are cumulative.

Generally insurances do not reimburse for laser treatments despite there being codes that can be used to submit for the service. Laser treatments are usually handled as a cash transaction between the clinic and the patient. Average cost of a treatment varies across the country. Many clinics offer discounts when purchasing visits in packages. We recommend checking with your provider to get specific pricing.

Laser therapy will not limit a patient’s activities. The nature of a specific pathology and the current stage within the healing process will dictate appropriate activity levels. Laser will often reduce pain which will make it easier to perform different activities and will often help restore more normal joint mechanics. That being said, reduced pain should not overshadow the advice of a medical professional that understands how the laser will fit into a rehabilitation protocol when deciding how aggressively to push functional limits.

The following are contraindications with laser therapy.

• Do not treat over growth plates in children.
• Do not treat pregnant patients over the abdominal area or the low back/ pelvic area.
• Avoid treating around glandular tissue (such as thyroid, testes, ovaries).
• Do not treat over pacemakers or internal pain pumps.
• Do not treat patients taking photosensitive medications (such as steroids or antibiotics)

Based on peer-reviewed literature, there are no known significant side effects from laser therapy for most conditions. Increased blood flow is a positive benefit associated with laser therapy that can cause the skin to get flush and the feeling of warmth. These changes are short-lived, typically lasting for up to a few hours. Improper dosing can lead to increased swelling for acute injuries where there is a lot of inflammation present as well as increased nerve-related pain for certain conditions when irritable nerve tissue is over stimulated. This is usually correctable by adjusting the treatment settings. On these rare occasions, the setbacks usually reverse themselves within 24-36 hours. Understanding proper dosing parameters minimizes this phenomena.

The term “Cold Laser” is a dated term. It was created to help describe lower power Class II and III lasers that don’t have power densities (irradiance) sufficiently high enough to create surface heat when applied. Therefore, Class IV lasers are not technically “Cold Lasers” since they do create a warming sensation on the skin when applied in most cases.

Since 2015 , the correct term that encompasses all therapy lasers and LEDs is photobiomodulation (PBM). This term describes all light sources that are designed to promote circulation, improve tissue repair, and reduce pain.

Yes, it generally works well with other modalities that are designed to promote tissue repair. Examples might include blood flow restriction and shockwave devices. The mechanisms that are associated with these modalities work well with laser therapy. Generally using modalities that are designed to provide cryotherapy which generally reduce blood flow and promote vasoconstriction are not recommended as adjunctive therapies with laser.

Absolutely! Some of the most consistently reported benefits of laser therapy are related to reduced pain after treatment. Research has shown that PBM can speed up the healing process of certain tissues through increased cellular metabolism. For post-surgical patients, appropriate doses of light energy can be delivered to effectively reduce pain, without negatively impacting the body’s natural healing process5.

Yes, laser can be used over metal implants/ hardware. At the irradiance levels used with LightForce equipment, light will simply bounce off of metal. There will be no heating that takes place at depth when using LightForce® lasers within recommended parameters.

The suffix, -itis comes from the Greek that denotes inflammation. Several studies have shown that laser is an excellent therapy to help address the symptoms related to both osteo and rheumatoid arthritis. While it will not restore damaged cartilage, it can help improve ROM of the affected joints and help reduce pain so that functional levels can be maintained, NSAIDS can be reduced, and in some cases, more invasive procedures can be delayed or prevented.

Yes, there is a growing body of peer-reviewed clinical research supporting the use of Class IV, deep tissue lasers as a safe and effective treatment option for a myriad of conditions in rehabilitation. This body of literature includes numerous randomized control trials.

As of 2020, a search on Pubmed.com yielded over 7500 publications on “Low Level Laser Therapy” and over 1200 articles on the more recently coined term “Photobiomodulation”.