An Introduction to Photobiomodulation Therapy (PBMT).
Photobiomodulation Therapy (PBMT) employs the use of Class 3b Laser for healing across a wide range medical and healthcare practices. Also known as Low Level Laser Therapy (LLLT), PBMT 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. Osteopaths, physiotherapists, podiatrists and chiropractors integrate the use of PBMT into their practice. PMBT is also becoming more widely used by the aesthetics industry, with many skin specialists embracing the natural healing effects of PBMT to increase the production of collagen, without creating a thermal or ablative reaction in the skin. Laser Medicine in London is a General Practice Photobiomodulation Therapy Clinic, offering a full range of Low Level Laser Therapy (LLLT) for health conditions and skin aesthetics.
On a broader scale, Photobiomodulation Therapy (PBMT) 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.
This paper explores recent Low Level Laser Therapy case studies from Laser Medicine, a Photobiomodulation Therapy Clinic in Central London.
Does PBMT work and what does it do?
Two of the most frequently asked questions on Google about Photobiomodulation Therapy (PBMT) 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 Photobiomodulation Therapy (PBMT) .
Photobiomodulation Therapy (PBMT) 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 Photobiomodulation Therapy (PBMT) 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).
PBMT contraindications and the Thyroid
There are very few contraindications presented by Photobiomodulation Therapy (PBMT) . 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 PBMT cannot be used for epileptic patients, which is not true. People with epilepsy are safe to receive Photobiomodulation Therapy (PBMT) , as their eyes are completely protected from the lightwaves during a treatment.
One other major guideline for the use of PBMT 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.
At Photobiomodulation Therapy clinic, Laser Medicine we have been successful addressing Hypothyroidism with Photobiomodulation Therapy (PBMT), 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 or cluster, 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 Photobiomodulation Therapy (PBMT).
Photobiomodulation Therapy (PBMT) Clinic Case Studies
PBMT Clinic Case Study: Fertility and ART
PBMT Clinic Case Study: Costochondritis
PBMT Clinic Case Study: Hashimoto’s Disease
PBMT Clinic Case Study: Tennis Elbow
PBMT Clinic Case Study: Scar Tissue
Photobiomodulation Therapy (PBMT) Clinical Trials and Research during 2020
There were various successful Photobiomodulation Therapy (PBMT) clinical trials published during 2020, some we feel worthy of comment:
- 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 Photobiomodulation Therapy (PBMT) for non-surgery patients. Read the full report here.
- 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.
- Prompted by Covid-19 during 2020 a number of articles discussed the effectiveness of Photobiomodulation Therapy (PBMT) 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.
- A further long term clinical trial on the efficacy of using Photobiomodulation Therapy (PBMT) to treat Covid-19 is underway, the results expected in March 2022.
- A report on a number of randomised placebo controlled trials into the efficacy of Photobiomodulation Therapy (PBMT) 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.