2021 Industry Review for Cold Laser Therapy

Laser Therapy has become more widely available over the last few years thanks to the number of trained practitioners in the field that employ the use of Class 3b Laser for healing across a wide range medical and healthcare practices. Cold Laser Therapy, also known as Low Level Laser Therapy (LLLT) has gained wide appeal for the treatment of pain, inflammation, tissue repair, sports injuries, carpal tunnel syndrome, tendon and ligament damage, arthritic pain relief and fibromyalgia etc. Many osteopaths, physiotherapists, podiatrists and chiropractors integrate the use of Cold Laser into their practice. Cold Laser Therapy has also enjoyed recent growth in the aesthetics industry, and many skin specialists embrace its natural healing effect to increase the production of collagen, without creating a thermal or ablative reaction in the skin. Laser Medicine in London is a General Practice Cold Laser Clinic, offering a full range of Low Level Laser Therapy (LLLT) services for both health conditions and skin aesthetics.

On a broader scale, Cold Laser Therapy produces positive results for the treatment of many health conditions, with clinical research indicating the effectiveness of Laser Therapy for post-chemotherapy recovery, fertility, hypothyroidism, Hashimoto’s Disease, enlarged prostate (BHP), Parkinson’s, Alzheimer’s, and stroke recovery, to name but a few. There is, however, a way to go in terms of educating the medical community and health professionals, many of whom are unaware of the benefits of Cold Laser Therapy. Similarly, the public at large may have heard of ‘laser therapy’ in the broadest sense of the word, but do not know that Low Level Laser Therapy (LLLT) is a distinct Class of Laser Therapy, different to Class 4 Laser used for invasive medical procedures and aesthetics procedures alike.

As more Laser Therapy products and therapies enter the market, there is a lot more information available. During the course of my regular research I have found some of this information to be at worst, inaccurate, and at best, confusing, when differentiating between Cold Laser Therapy / Low Level Laser Therapy (LLLT) and the application of a higher powered Class 4 Laser Therapy.

This paper aims to provide a current view of the Cold Laser Therapy / Low Level Laser Therapy (LLLT) field in terms of latest research and treatments available. I address some of the anomalies, inconsistencies and legitimate areas of confusion that I have identified in both the general health and aesthetics fields respectively. In conclusion I look to the future of Cold Laser Therapy, identifying what I believe are the strongest and most exciting areas of growth.

Does Cold Laser work and what does it do?

Two of the most frequently asked questions on Google about Cold Laser are “Does Cold Laser Therapy actually work?” and “What does Cold Laser Therapy do?”. One could be forgiven to believe that these questions reside in the patient community, however it has become increasingly obvious over the last 5 years, that medics in general are more familiar with the use of Medical Class 4 Lasers than they are of Medical Class 3b Laser. I shall therefore give a brief summary of what Cold Laser does.

Low Level Laser Therapy (LLLT) is the therapeutic application of laser light at a low intensity. It is a non-invasive treatment that uses a light source that generates coherent (Laser) and non-coherent (LED) light wavelengths that are effective through photochemical reactions in cells, rather than through a thermal effect. These wavelengths are specifically in the red (visible) and near infrared (invisible) range. The visible light ranges, while beneficial, are limited by their shallow penetration of 1-3 mm. Invisible or near infrared light range penetrates much deeper (clinical results indicate up to 10 cm). The process enables Lasers to carry electrons throughout the body to restore damaged cells and the problems that arise from those damage cells, and to provide pain relief. Both coherent and non-coherent light with the same wavelength, intensity and dose provide the same biological response.

The most effective LLLT equipment combines both Laser and LED in the IR and NIR wavelength range. What the light does, in a nutshell, is to reduce pain and inflammation. It does this via a process of bio-stimulation and photo-stimulation, endogenous opiate production, slowing sensory nerve production, restoring cellular resonant energy, stimulating the Na/K pump mechanism in the cell membrane and inhibiting bradykinin and leukotriene production. During this process Cold Laser Therapy triggers the re-polarization of sick and injured cellular membranes to allow for essential nutrients to transfer from the blood into the cell. Laser photons are taken up and transformed into cellular energy within the mitochondria when there is a deficiency. This added energy causes therapeutic change. Research has shown that LLLT can increase cellular ATP (body fuel) by as much as 150%.

In answer to the question “does it work?” it depends largely on the dose of light given to the patient, which for Cold Laser Therapy is measured by irradiance and time. Energy (J) = Power (W) x Time (s). The best paper I have read on this subject is Biphasic Dose Response in Low Level Light Therapy (Huang, Chen, Carroll and Hamblin, 2009. University of Massachusetts).

Shades of grey

Now that Cold Laser Therapy has been defined, it is clear that any Laser other than a Class 3b Laser (or LED on the same wavelengths) is not relevant to Cold Laser or Low Level Laser Therapy (LLLT). During my research I have found a few contradictions that are worthy of note.

The first is a term that has entered the market recently: ‘Cool Laser’. As we have offered Cold Laser Facials for skin rejuvenation at Laser Medicine since 2015, I stay informed of other London skin specialist services. When ‘Cool Laser’ Facials began to appear, at first I thought they were similar to Cold Laser Facials or Low Level Laser Therapy (LLLT) facials. On further investigation I discovered this is not the case.

What is being referred to as a ‘Cool Laser’ Facial uses Laser at a higher power than a Class 3b Laser and is therefore, ablative Laser. Light is delivered in a way that prevents ablation on the skin’s surface, but it is an ablative Laser nonetheless. ‘Cool Laser’ uses a method of ablation (skin removal) with a shorter pulse of light that targets water within the skin. It reportedly “does not burn the skin or heat the skin as much as other types of laser such as CO2 lasers” (Beauty Lady), and as result is considered less painful, with a shorter recovery time. As discussed earlier, Cold Laser Therapy produces a collagen increase in the skin through a biological process which is non-ablative and non-thermal, resulting in no inflammation, no pain and no recovery time. The Cold Laser Therapy process also builds so the results improve over time.

Within the Cold Laser Therapy field there is another anomaly : a product from Italy that identifies itself as Class 4 laser, which utilises the healing principles of Class 3b Low Level Laser (LLLT). Branded and patented as a MLS (Multiwave Locked System) Laser Therapy, the product potentially confuses the Laser Therapy market, although technical specifications are not publicly available online. In the application of Cold Laser Therapy it is normal to use a range of wavelengths at the same time. Equipment we use at Laser Medicine (Class 3b Laser from Omega Laser Systems) radiates 6 wavelengths in a single cluster probe (for example). Cells respond to certain wavelengths and energies and if these parameters are correct the cells will respond, regardless of the power. Class 4 Lasers (Class 4 is anything over 500mW) must be held away from the skin to ensure it does not burn and so when light eventually meets with the cell tissue, power will have been lost naturally through the air. In any event it’s encouraging to see new clinical innovation in the Cold Laser Therapy market.

LLLT contraindications and the Thyroid

There are very few contraindications presented by Cold Laser Therapy. Guidance to avoid cancerous lesions, carcinoma and pregnancy fall within standard medical guidelines for the above conditions. Potential harm to the eye if the light is shone directly into the retina is avoided by the use of protective glasses during treatment so that there is no direct eye exposure. There are positive results for the use of Cold Laser Therapy for the treatment of AMD (Age related Macular Degeneration) where light is applied to the side the eye area, targeting the optic nerve, and never into an open eye. Some of our patients have experienced improved eyesight for this problem.

Interestingly one source I read recently, states that Cold Laser cannot be used for epileptic patients, which is not true. People with epilepsy are safe to receive Cold Laser Therapy, as their eyes are completely protected from the lightwaves during a treatment.

One other major guideline for the use of Cold Laser is to not place the Laser probe directly over the Thyroid gland. This is common guidance for all electrical devices and guidance that we follow accordingly.

Interestingly, at Laser Medicine we have witnessed the kind of success in treating Hypothyroidism with Cold Laser Therapy as described in the clinical research carried out at Sao Paolo University in 2018. We carry out the procedure with a number of protocols which avoid placing the Laser probe directly over the Thyroid gland. Instead we work through the lymphatic system and key nerves in the body. Interestingly many of our patients experience healing and a significant improvement in their symptoms for Hashimoto’s Disease and / or Hypothyroidism through Cold Laser Therapy.

Laser Therapy Clinical Trials and Research during 2020

There were many successful Cold Laser Therapy clinical trials published during 2020, some we feel worthy of comment:

  1. A randomised controlled trial for the Therapeutic Effect of Low Level Laser in Controlling Low Back Pain (a common musculoskeletal disorder) took place at the Shahid Beheshti University of Medical Sciences in Tehran. A significant number of patients reported a decrease in lower back pain over 3 months, and the results were conclusive for the use of Cold Laser Therapy for non-surgery patients. Read the full report here.
  2. A further trial focused on the relief of lower back pain was carried out in the Middle East, in Saudi Arabia and Egypt. This was a randomised comparative study between High Intensity and Low Level Laser Therapy in the treatment of low back pain. The study concluded that both LLLT and HILT reduce pain and disability and improve lumbar ROM and quality of life in patients with chronic non specific low back pain. Read the full report here.
  3. Prompted by Covid-19 during 2020 a number of articles discussed the effectiveness of Cold Laser Therapy for treating respiratory illness. A report focussed on the use of Cold Laser to reduce the use of ventilators for Covid-19 patients was published here. This was supported by the first clinical trial of a patient with Covid-19 with positive results. Read the full report here.
  4. A further long term clinical trial on the efficacy of using Low Level Laser Therapy (LLLT) to treat Covid-19 is underway, the results expected in March 2022.
  5. A report on a number of randomised placebo controlled trials into the efficacy of Low Level laser Therapy (LLLT) for the treatment of Knee Osteoarthritis (KOA) was published in November 2020 with positive conclusive results that Cold Laser reduces pain and disability. Read the full report here.

Looking forward

Cold Laser Therapy continues to prove a safe, non-invasive treatment for pain, inflammation and increased healing across a wide range of musculoskeletal and health conditions, with a growing body of evidence to support its efficacy each year. The ever increasing clinical and home use equipment coming to market is a testimony to its proven effectiveness. There are many opportunities to use Cold Laser as an alternative to anti-inflammatory pain killers and medication, and I often think that if more households had a home use device they would be able to naturally heal headaches and arthritic pain as a matter of course. Optimistically I also look forward to seeing the results for treating post and long-Covid symptoms such as tiredness and respiratory compromises.

It is fantastic to see that many leading osteopaths and physical health specialists have incorporated LLLT into their practices. As a full member of the British Medical Laser Association (BMLA) I anticipate the contribution of a highly informative and diverse section of the beauty and medical industry at the BMLA 2021 Virtual Conference this year. Low Level Laser Therapy is only becoming more widely known used, and the future for Cold Laser Therapy, I believe, is bright!

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