1. Meditech International Inc.
Tel: (416)
Toll Free: (888)
415 Horner Avenue, Toronto, Ontario M8W 4W3
Low Intensity Laser Therapy
Science and Clinical Applications
Slava Kim, MD
Clinic Director
Copyright © 2008 Meditech International Incorporated. ALL RIGHTS RESERVED.

2. Lasers – What comes to mind?

3. Sun Gods Ra Egyptian Sun God Temple of Apollo Greek Sun God Belenus
From the dawn of time all of the great ancient civilizations have had some form of sun god.
The temple of apollo build for the greek sun god apollo.
This statue build to honor the egyptian sun god ra.
And finally this mask dedicated to Belenus the celtic sun god.
These sun gods were not only worshiped for crop growth but also for the benefits that the sun was known to have on the human body
Belenus
Celtic Sun God

4. Healing with light is a common concept in many cultures

5. Light as a healing force

6. Heliotherapy – Sunlight Therapy
Helotherapy or sunlight therapy was practiced in the rooftops of hospitals or sun terraces well up until the mid 30’s.
Doctors, Nurses and Patients alike all saw the benefits of sunlight therapy on their patients.
Fortunately at this point we found out about the negative effects of the mid UV light on the human body and this practice was ceased.
University of Virginia Medical Center
Charlotteville, Virginia
Circa 1929
Samuel and Nettie Bowne Hospital
Poughkeepsie, New York.
Circa 1935

7. Absence of Light on Human Body - SAD
Seasonal Affective Disorder (SAD)
Bright Light Phototherapy has been shown to effectively treat seasonal affective disorder (SAD).
Non thermal and does not require specialized cells
The second disorder which results from the absence of sunlight is the psychological disorder called Seasonal Affective Disorder or SAD
It is also called Winter Depression and it is triggered by a lack of sunshine during the winter months when the days are shortened or under prolonged cloudy conditions.
It is more prevalent in regions which experience shortened days such as the arctic and Scandinavian regions.
Finland has the highest rate of diagnosed SAD in the world with 9% of the population exhibiting some symptoms.
The only known treatment is to use bright light phototherapy arrays like in this picture
When experimenters began researching this treatment and its effects they were surprised to find out that a non-occular treatment provided the same outcomes as if they had treated patients in the face.
They have since found that you can irradiated various regions of the body with the same outcomes.
Meaning that it does not require specialized cells and is athermal

8. Endre Mester - The Father of Laser Therapy
May 29, 1966
Endre Mester working at Semmelweiss hospital in Budapest, Hungary publishes the first paper on the stimulatory effects of ruby laser light on the skin of rats
Endre Mester gets credited with discovering laser therapy.
He was working at Semmelweiss hospital in Budapest, Hungary and attempting to cause tumors using a high powered laser.
Well his laser was actually mis-calibrated and was at a lower power than he thought.
But low and behold instead of burning or causing cancer he found that the laser light was stimulating the skin of rats.

9. Biological Photoacceptor Molecules
Plants
Chlorophyll
Carotenoids
Humans
Rhodopsin (vision)
Hemoglobin (blood)
Myoglobin (muscle)
Cytochrome (all cells)
Various molecules within nature absorb light differently
In plants the major photoacceptor molecule is chlorophyll. This is the pigment that makes plants leaves green.
This molecule drives the majority of energy production on our planet.
It harvests light energy from the sun in the blue, yellow and red wavelengths and converts it into usable energy for the plant.
Carotenoids are other pigments in the plant leaves that we usually don’t see until the fall. They are responsible for the beautiful colours in the trees in the fall.
Within humans we have rhodopsin which is the pigment in our eyes responsible for vision
We have hemoglobin and myoglobin which are the light absorbing pigments in our blood and muscle. They change the way they absorb light when oxygen is bound to them.
We also have cytochrome molecules. These molecules are instrumental in our energy production pathways and are one of the main targets of light absorption for laser therapy.

10. The Electromagnetic Spectrum
What I would like to show you is that visible light makes up a very small portion of the entire electromagnetic spectrum
Starting from the left hand side you have very large wavelength radiation like Radio waves which have wavelengths the size of buildings. At these wavelengths the radiation acts more like a wave than a particle.
Then as the wavelengths become smaller we move into microwaves then infrared radiation then we can see visible light starting with red moving to violet and into ultraviolet
Finally we have x-rays and gamma rays which have very small wavelengths. At these wavelengths the radiation acts more like a particle
The general rule is as you decrease in wavelength you increase the amount of energy and because the wavelength is smaller it occupies a smaller area
Now radiation has a negative connotation with it but it really shouldn’t because without radiation we wouldn’t be able to live.
Decrease in wavelength = Increase in energy in a smaller area

11. Damage with Electromagnetic Radiation
Two ways to cause damage
Ionizing radiation
Able to break bonds (i.e. DNA causing mutations)
Intensity
Thermal heating of tissue (i.e. microwave heating food)
There are two ways which we can cause damage with electromagnetic radiation
The first is the most commonly associated with the word radiation and that is ionizing radiation
These are from UVA and beyond.
They consist of very small wavelength radiation which has the ability to break bonds within our DNA as well as other molecules and thus can result in increased risk of cancer
The second way to cause damage is with high intensity.
By increasing the intensity you can increase the thermal temperature and you can do this using all the wavelengths of electromagnetic radiation.
This is how microwaves heat food.
We do not attempt to heat tissue because laser therapy works mainly through a photochemical reaction than a photothermal reaction.
At Meditech we use both wavelengths that are very far from ionizing and intensities that are well below the ability to heat tissue so it is a very safe therapy.
In fact there has not been one published study to demonstrate any negative or adverse effects resulting from laser therapy.

12. Wavelengths in the BioFlex Systems
What wavelengths do we use to in this device.
Well we use red light at 660nm and infrared light at 840 and 830 nm.
These seem rather arbitrary when you look at this figure but there is a reason behind this and I will get to why these wavelengths are selected.
Red light at 660nm
Infrared light at 840nm and 830nm

13. Cytochrome C Oxidase Absorption
So if that is what we are targeting we better look at how it absorbs light.
I took some of the data from Mark Cope’s thesis who did an amazing amount of work on looking at what the major photoacceptors where within the red to near infrared region of light.
When we look at the absorption of cytochrome c oxidase in both the reduced and oxidized forms we can see a large absorption peak at around 605nm and another smaller peak at 660nm and then another further absorption peak at nm.
M. Cope thesis data modified by M. Patterson
Red light at 660nm and Infrared light at 830/840nm

14. Published Absorption Spectra
If we look at the published absorption spectra we can see that this absorption has been confirmed by NASA and a group at the University of Milwaukee.
As you can see here it has peaks of absorption at 660nm and again at nm.
Desmet et. al., Photomed. Laser Surg. 24(2): , 2006
Red light at 660nm and Infrared light at 830/840nm

15. Published Action Spectra
CuA
CuB
CuB
red
oxid
red
620 nm
680 nm
760 nm
CuA
oxid
820 nm
Karu and Afanasyeva, DAN 392(5):693, 1995
And if we look at the published action spectra we can see that there are more peaks resolved at 620nm, 680nm, 760 nm and again at 820nm from work done by Tiina Karu.
So in order for a laser therapy device to work we have to go back and remember the first law of photochemistry.
Does everyone remember it?
It states that the light must be absorbed to have an effect. What that means is that we want to be on or near a peak of absorption to have a maximal effect on the tissue.
The wavelengths which we use (660nm, 840nm and 830nm) were carefully selected to maximize the absorption of light by the cytochrome c oxidase and I will get back to why that is so important in a little bit.
But as you all know the human body is not all cytochrome c oxidase and in actual fact it makes up a very very small percentage of the human body.
So what else is absorbing light?
Wavelength, nm
Red light at 660nm and Infrared light at 830/840nm

16. Biological Treatment Window
We know that the body is mainly made up of water (50-75% by weight).
So we avoid the water absorption curve seen in blue. All thermal or surgical lasers operate mainly where water absorbs the light and causes a photothermal reaction to ablate or cut the tissue
We also want to avoid the hemoglobin absorption curve seen in red and dark red here. This is why we don’t select a wavelength that is in the middle of the red region because it increases its absorption dramatically at 600nm so any wavelength below that has a very low depth of penetration. Hemoglobin is an interesting molecule that absorbs light differently when oxygen is bound to it, which is why are arteries (oxygenated) are a different colour than our veins (deoxyhemoglobin).
I have also put on both the oxidized and reduced forms of cytochrome c oxidase to give you and idea of the level of absorption when compared with both Hemoglobin and Water.
There is another major absorber of light in this region as well in the skin but I am going to speak about that a little later.
M. Cope thesis data modified by M. Patterson
Treatment Window

17. Laser Therapy Dosage - Arndt-Shultz LawC
Physiological Activity A B
Control D
Laser therapy follows the arndt-shultz law.
This law states that the following curve governs the response to laser therapy
At point (A) no light obviously gives no response
At point (B) a very small amount of light also produces no effect. This is why you can’t use a laser pointer to heal your carpal tunnel syndrome patients
From point (B) to point (C) these dosages will produce a stimulatory effect.
From point (C) to where it crosses the control line we will also produce a stimulatory effect.
From where the line crosses the control line to point (D) these dosages and intensities result in an inhibition of the tissue being irradiated.
Strength of Stimuli
No light gives no effect
Small amount of light also has no effect
Maximal effect at the apex of the curve
Inhibitory amount of light inhibits healing

18. Energy Production - Components
ATP Synthase
NADH Dehydrogenase
Cytochrome c Oxidase
Cytochrome bc1 Complex
In order to understand how it works I need to speak about how we produce energy within our cells.
Here is a regular animal cell.
The power house of our cells is the mitochondria. It is where our cells produce the majority of its energy.
Within the inner mitochondrial membrane is where the majority of that energy is produced.
This is a simplified version of the membrane showing the major players in our electron transport chain.
The first transmembrane proton pump is the NADH Dehydrogenase. Its absorption is overlapped by hemoglobin and as such does not play a big role in the effects of laser thearpy at the wavelengths which are currently used in the field.
The second transmembrane proton pump is the cytochrome bc1 complex.
It also is not thought to be highly affected by the wavelengths and intensities used in laser therapy.
This brings me to the Transmembrane proton pump which I have been highlighting. The cytochrome c oxidase. It is one of the most important proteins in the body as it performs the last reaction in the electron transport chain by taking electrons, protons and oxygen and making water while pumping protons into the inner membrane space.
The last transmembrane protein defined here is the ATP synthase. This is like the cells own hydroelectric generator and I will show you how it works in the next slide.

19. Electron Transport Chain
The electron transport chain is the final step in are aerobic energy production pathway.
It takes highly charged electrons from the krebs cycle and makes the cells main fuel ATP out of them.
It does this by making a proton gradient across the inner mitochondrial membrane.
Those three proton pumps take energy off the electrons and pump protons or hydrogen ions across the membrane.
This is similar to putting water in a hydroelectric dam.
Once this gradient builds up you have a source of potential energy
The ATP synthase protein then uses this gradient similar to a hydro electric generator to produce energy.
The end energy that is produced is ATP.
ATP is the cells main source of useable energy.
ADP
ATP

20. Effect of Red and Infrared Light
So I haven’t spoken about the effects of red and near infrared light on the energy production as a result of being absorbed by the cytochrome c oxidase
Well both isolated mitochondrial and cellular studies have shown that there is an increased proton gradient following irradiation and that this results in an increased production of ATP.
This is one of the primary mechanisms of action which will be discussed further tomorrow in the mechanisms of action presentation.
Basically red and near infrared light help improve the efficiency of our energy production pathways
ADP
ATP

21. Laser Therapy Effects Primary Put title of slide here Secondary
The light is absorbed by cytochrome c oxidase
Secondary
Release of NO into endothelium of blood vessels
Small increases in free radicals
Increased proton gradient in mitochondria
Clinical
Wound Healing, Acceleration of the Inflammatory Process and Pain Influence
Put title of slide here

22. Published Effects of Light on Cells
Increased ATP production
Circulation
Relaxation of smooth muscles surrounding blood vessels
Angiogenesis
Increased production of:
Fibroblasts
Macrophage
Collagen
Altered nerve conduction
Increased metabolism of:
Endorphins
Acetylcholine
Serotonin
Increased synthesis of:
DNA
Proteins
Stimulation of immune response

23. Advantages of Laser Therapy
Non-toxic
Non allergic
Non invasive
Ease of application
No side effects
No complications
Completely safe
Cost effective
Superior alternative to:
analgesics
NSAID’s
other medications
Surgery may not be
required

24. Conditions Treated I Acute injuries/trauma muscle tears/hematoma
tendon tears
ligament strain/sprains
fractures
subluxations
sport injuries
Musculoskeletal
repetitive stress injuries
rotator cuff tears
carpal tunnel syndrome
reflex sympathetic dystrophy
fibromyalgia
tempero-mandibular joint pathologies

25. Conditions Treated II Inflammatory conditions tendonitis bursitis
myositis
fasciitis
synovitis
rheumatoid arthritis
Autoimmune disease
Degenerative disorders
osteoarthritis
discogenic and vertebrogenic radiculopathies
calcifications
e.g. bone spurs
chondromalacia patella

26. Conditions Treated III
Other areas
dermatological
plastic surgery
dental (e.g. gingivitis)
gynecological
cervical pathologies
Podiatry
plantar fasciitis
biomechanical problems
Wound management
ulcers
venous stasis
diabetic
contact
atherosclerotic
Veterinary
equine
companion animals

27. Pain Mechanisms Pathways for pain relief by
Red or Infrared laser therapy
Local photoradiation effects occurring in less than 24 hrs
Effects on biochemical inflammatory pathway
Reduced PGE
Levels (5)
Reduced TNF
Levels (2)
Reduced IL1
Levels (3)
Reduced COX-2
expression
(2)
Reduced
Plasminogen
activator
Levels (3)
Effects on cells and soft tissue
Reduced
Edema
formation (7)
Hemorrhagic
formation (2)
Neutrophil
cell influx (4)
Cell apoptosis (3)
Improved
Microcirculation
(4)

28. Inflammation Acute Phase Chronic Phase Plasma derived mediators
- Bradykinin - complement (C3, C5a, MAC)
- coagulation (Factor XII, Plasmin, Thrombin)
Cell derived mediators
Preformed: Lysosome granules - vasoactive amines (Histamine, Serotonin)
Synthesized on demand:
- cytokines (IFN-γ, IL-8, TNF-α, IL-1)
- eicosanoids (Leukotriene B4, Prostaglandins)
- Nitric oxide - Kinins
Chronic Phase
Macrophage - Epithelioid cell
- Giant cell
- Granuloma

29. Key Effects that Apply to Diabetes
Primary Effects
ATP production and Membrane permeability
> Accelerated Metabolism
Secondary Effects Clinical Effects
Nitric Oxide Stimulation > Angiogenesis
Endothelial Growth Factor > Angiogenesis
Endorphin Release > Pain Reduction
Elevated Immune Response > Wound Healing
Increased Cell Metabolism > Acc. Inflammation Resp.
e.g. Fibroblast activity > Increased collagen production

30. Evaluation of the degree of effectiveness of low level light therapy on the treatment of skin ulcers and delayed postoperative wound healing.
Iusim M, Kimchy J, Pillar T, Mendes DG.
Center for Implant Surgery, Flieman Geriatric Rehabilitation Hospital, Technion, Haifa, Israel.
Orthopedics Sep;15(9):
Twenty-one patients with 31 postoperative delayed open wounds resistant to conventional therapy were randomly allocated to three groups.
Group 1 was treated with red low level narrow band (LLNB) light (660 nm);
Group 2 was treated with infrared LLNB light (940 nm);
Group 3 was treated with a placebo such as the Biobeam machine (no light irradiation).
Group 1 showed a significant improvement compared to groups 2 and 3 (t-test).
T Pillar, an LILT researcher well known for his work on LILT and lymphedema, is familiar with ulcers on the lower extremities.
He understands the secondary effects of angiogenesis, elevated immune response and the healing aspects of wounds treated with Laser therapy
This random controlled trial places Infrared vs Red Light on ulcers, shows improved outcomes of Red light for ulcer healing. This confirms the relative differences in tissue stimulation (differences in Action Spectra) when using different wavelengths.
BioFlex technology specifically uses the best ‘Action Spectra Performers” combined, in a sequence, for optimum light energy therapy.

31. Systemic effects of low-intensity laser irradiation on skin microcirculation in patients with diabetic microangiopathy.
Low-intensity laser irradiation has been shown to induce wound healing in conditions of reduced microcirculation. We demonstrate low-intensity laser irradiation on skin blood circulation in patients with diabetic microangiopathy.
Patients are randomized; A) single helium-neon (HeNe, nm) low-intensity laser irradiation with a dose of 30 J/cm(2) or B) sham irradiation over the forefoot region in a double-blind, placebo-controlled clinical study.
Skin blood circulation by means of temperature recordings over forefoot regions was detected by infrared thermography.
A single dose of low-intensity laser irradiation = a rise in skin temperature.
The placebo group = a drop in skin temperature occurred.
Our data show a significant increase in skin circulation due to athermic laser irradiation in patients with diabetic microangiopathy and point to the possibility of inducing systemic effects.
With more sophisticated measuring devices that Sendai had in 1989 to validate the circulation increase in tissue with an infrared thermography device, again, research conclusively shows; with a double blind placebo controlled approach, red light stimulating positive response. Red light stimulates more response to improved circulation.
Of course circulation is important but only a transportation improvement. The key is WHAT IS BEING TRANSPORTED. That is a story elsewhere in this talk.

32. Healing of Bone Affections and Gangrene with Low Intensity Laser Irradiation in Diabetic Patients Suffering from Foot Infections.
Schindl M, Schindl A, Polzleitner D, Schindl L.
Forsch Komplementarmed. 1998;5(5):  
OBJECTIVE: Evaluation of low-intensity laser irradiation on the healing of bone affections and gangrene in patients suffering from diabetic microangiopathy.
PATIENTS: Two consecutive diabetic male patients with gangrene, Osteomielitis, and bone fractures.
INTERVENTION: Helium-neon laser irradiation (36 J/cm2 ) 50 min/day.
MAIN OUTCOME PARAMETER: Healing of gangrene and corticalis lesion as well as remineralisation of bone affections.
RESULTS: Within a mean period of 14 weeks not only a complete healing of the diabetic gangrenes but also a radiographically determined reestablishment of corticalis and remineralisation of preexisting bone affections could be achieved.
CONCLUSION: low-intensity laser irradiation should be further tested as an additional beneficial therapeutic modality for the healing of gangrene and bone affections in diabetic patients.
Forsch Komplementarmed. 1998;5(5):   Links
Healing of Bone Affections and Gangrene with Low-Intensity Laser Irradiation in Diabetic Patients Suffering from Foot Infections.
Schindl M, Schindl A, Polzleitner D, Schindl L.
OBJECTIVE: Evalution of low-intensity laser irradiation on the healing of bone affections and gangrene in patients suffering from diabetic microangiopathy. DESIGN: Case-report study. PATIENTS: Two consecutive diabetic male patients with gangrene, osteomyelitis, and bone fractures. INTERVENTION: Helium-neon laser irradiation (36 J/cm2 ) 50 min/day. MAIN OUTCOME PARAMETER: Healing of gangrene and corticalis lesion as well as remineralisation of bone affections. RESULTS: Within a mean period of 14 weeks not only a complete healing of the diabetic gangrenes but also a radiographically determined reestablishment of corticalis and remineralisation of preexisting bone affections could be achieved. CONCLUSION: We therefore conclude that low-intensity laser irradiation should be further tested as an additional beneficial therapeutic modality for the healing of gangrene and bone affections in diabetic patients.
PMID: [PubMed - as supplied by publisher]

33. Diabetes Mellitus: infected dermal ulcers
Interim progress
Healing progressing
Initial:
Diabetic with 3 week old ulcer, previously
surgically debrided. The ulcer was deep,
painful and prior to treatment, resistant to
surgical and antibiotic therapy.
Final photo:
Total healing achieved
Patient, asymptomatic
and discharged
10 treatments over 3 weeks

34. Diabetes Mellitus: Gangrenous Leg Dermal Ulcers
After 6
1 hour treatments
Initial

35. Diabetes Mellitus: Initial

36. Final, after 35 treatments

37. Diabetes Mellitus: Amputated III toe

38. Diabetes Mellitus Pre-Gangrenous Right Foot
Initial

39. Intermediate

40. Intermediate

41. Final

42. Hemochromatosis Dermal Ulcers – 2 Years
Initial

43. After 1 Treatment

44. After 5 Treatments

45. After 23 Treatments

46. After 36 Treatments

47. Final

48. 1-Year Follow-up

49. Study: Achilles Tendons
Laser photostimulation of collagen production in healing rabbit Achilles tendons. Reddy GK, Stehno-Bittel L, Enwemeka CS.
Following tenotomy and repair, the surgical hind limbs of the rabbits were immobilized in customized polyurethane casts. The experimental animals were treated with a nm HeNe laser daily at 1.0 J cm(-2) for 14 days.
Results: Biochemical analyses of the tendons revealed a 26% increase in collagen concentration with laser photostimulation indicating a more rapid healing process in treated tendons compared to controls.
Laser photostimulation of collagen production in healing rabbit Achilles tendons. Reddy GK, Stehno-Bittel L, Enwemeka CS. BACKGROUND AND OBJECTIVE: Low energy laser photostimulation at certain wavelengths can enhance tissue repair by releasing growth factors from fibroblasts and stimulate the healing process. … STUDY DESIGN/MATERIALS AND METHODS: A total of 24 male New Zealand rabbits, ages weeks, were used. Following tenotomy and repair, the surgical hind limbs of the rabbits were immobilized in customized polyurethane casts. The experimental animals were treated with a nm He:Ne laser daily at 1.0 J cm(-2) for 14 days.. RESULTS: Biochemical analyses of the tendons revealed a 26% increase in collagen concentration with laser photostimulation indicating a more rapid healing process in treated tendons compared to controls. Sequential extractions of collagen from regenerating tissues revealed that the laser photostimulated tendons had 32% and 33% greater concentrations of neutral salt soluble collagen and insoluble collagen, respectively, than control tendons suggesting an accelerated production of collagen with laser photostimulation. A significant decrease (9%) in pepsin soluble collagen was observed in laser-treated tendons compared to controls. …CONCLUSION: This study of laser photostimulation on tendon healing in rabbits suggests that such therapy facilitates collagen production in a manner that enhances tendon healing. (“Musculo-skeletal Conditions”)
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50. Left Achilles Tendonitis
10 treatments over 2 months
Tenderness, Edema and partial loss of flexion
100% function,
asymptomatic
Initial
1 Month after final treatment

51. Inflammation – Achilles Tendonitis
LLLT at a dose of 5.4 J per point can reduce inflammation (PGE2) and pain in activated Achilles tendinitis.
Bjordal et al. Br J Sports Med. 40(1):76-80, 2006.
Low-level laser therapy accelerates clinical recovery from chronic Achilles tendinopathy when added to an Eccentric Exercise regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.
Stergioulas et al. American J. Sports Med. 36(5):881, 2008.

52. Muscle Tear/Hematoma
3 treatments over 5 days

53. Hamstring Tear/Hematoma
4 treatments over 7 days

54. Post-Traumatic Hematoma
Initial
After 4 Treatments
After 5 Treatments

55. Lateral Epicondylitis (tennis elbow)
A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy was recently performed because other reviews had found laser therapy to be ineffective.
LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen.
Bjordal et. al. BMC Musculoskelet Disord. 29(9):

56. Subacromial Impingement Syndrome
A meta-analysis of the literature in Subacromial Impingement Syndrome (SAIS) found that laser therapy is an effective single intervention when compared with placebo treatments, but adding laser treatment to therapeutic exercise did not improve treatment efficacy.
The overall results of this meta analysis found that exercise, joint mobilization, and laser therapy are effective physical interventions for decreasing pain and functional loss or disability for patients with SAIS. The current evidence does not support the use of ultrasound.
Sauers. J Athletic Training. 40(3): , 2005.

57. Muscle Fatigue
Recently published study was aimed to investigate the effect of low-level laser therapy (LLLT) (830 nm wavelength, 100 mW output, spot size cm(2), 200 s total irradiation time) on skeletal muscle fatigue.
Concluded that 830 nm LLLT can delay the onset of skeletal muscle fatigue in high-intensity exercises, in spite of increased blood lactate levels.
Leal Junior et. al. Lasers Med Sci. Jul 23, 2008.

58. Joint Disorders
A systematic review on the effects of laser therapy in chronic joint disorders found “Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders.”
Bjordal et al. Aust J Physio. 49: , 2003.

59. Osteoarthritis
Efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomized placebo-controlled trials.
LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for osteoarthritis of the knee.
Bjordal et. al. BMC Musculoskelet Disord. 22(8):51, 2007.

60. Thermal Burn (Heat)
5 Treatments Over 8 Days

61. 19 treatments over 2 months
Thermal Burn (Heat)
19 treatments over 2 months

62. Burns LLLT of deep second-degree cutaneous burns significantly
increased the number of intact mast cells during the
inflammatory and proliferative phases of healing, and
decreased the total number of mast cells during the remodeling
phase.
Kaviani et. al. Lasers in Med. Sci. 21: 90, 2006.
A small pilot study used 400mW laser at 670 nm laser twice a week over 8 weeks on 19 patients with burn scars who were requesting laser therapy
Seventeen out of 19 lesions showed macroscopic improvement after the treatment (expressed in points on the Vancouver Scar Scale) with no scars becoming worse
Gaida et. al. Burns. 30: 362, 2004.

63. Fracture. R-Humerus. Age: 66/M
Initial
Intermediate
Final
10/29/2006
11/04/2006
11/29/2006
10/25/2006
11/01/2006
12/06/2006

64. Bone Healing
A study performed in human osteoblast cells found “low-level laser therapy has a biostimulatory effect on human osteoblast-like cells during the first 72 h after irradiation.”
Stein et. al. Wien Klin Wochenschr. 120(3-4): , 2008.
The results of a study carried out in laboratory mice indicates “that the use of low-intensity laser promotes better repair of bone injury”.
De Souza Merli et. al. Photomed Laser Surg. 23(2): , 2005.
A more recent study in rabbits found that LILT “may accelerate the process of fracture repair or cause increases in callus volume and BMD, especially in the early stages of absorbing the hematoma and bone remodeling”
Liu et. al. Photomed Laser Surg. 25(6): , 2007.

65. Pain Laser therapy in acute pain: a systematic review of possible
mechanisms of action and clinical effects in randomized
placebo-controlled trials.
The goal of the study was to review the biological and clinical short-term effects of laser therapy in acute pain from soft-tissue injury.
Laser therapy can modulate inflammatory processes in a dose-dependent manner and can be titrated to significantly reduce acute inflammatory pain in clinical settings.
Bjordal et al. Photomed Laser Surg. 24(2):

66. Case Study: Pain Reduction
Low level laser therapy with trigger points technique:
A clinical study on 243 patients.
(HeNe nm visible red or infrared nm continuous wave and 904 nm pulsed emission.
There are very promising "trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions.
Headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis humery, tenosynovitis, low back and radicular pain, Achilles tendinitis) to whom the "trigger points"
Results: rigidity decreases, the mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even disappears, by movement, too. LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the TP areas and at the same time it can remove the collected waste products.
Results measured according to VAS/VRS/PTM: in acute pain, diminished more than 70%; in chronic pain more than 60%.
Clinical effectiveness (success or failure) depends on the correctly applied energy dose--over/underdosage produces opposite, negative effects on cellular metabolism. The use of analgesic drugs could be reduced or completely excluded.
LLLT suggests that the laser beam can be used as monotherapy for pain treatment.
Low level laser therapy with trigger points technique:
A clinical study on 243 patients. J Clin Laser Med Surg 1996 Aug;14(4):163-7 Simunovic Z. Laser Center, Locarno, Switzerland. Among the various methods of application techniques in low level laser therapy (LLLT) (HeNe nm visible red or infrared nm continuous wave and 904 nm pulsed emission) there are very promising "trigger points" (TPs), i.e., myofascial zones of particular sensibility and of highest projection of focal pain points, due to ischemic conditions. (headaches and facial pain, skeletomuscular ailments, myogenic neck pain, shoulder and arm pain, epicondylitis humery, tenosynovitis, low back and radicular pain, Achilles tendinitis) to whom the "trigger points" were applied were better than we had ever expected. / it has been observed that the rigidity decreases, the mobility is restored (functional recovery), and the spontaneous or induced pain decreases or even disappears, by movement, too. LLLT improves local microcirculation and it can also improve oxygen supply to hypoxic cells in the TP areas and at the same time it can remove the collected waste products. The normalization of the microcirculation, obtained due to laser applications, interrupts the "circulus vitiosus" of the origin of the pain / Results measured according to VAS/VRS/PTM: in acute pain, diminished more than 70%; in chronic pain more than 60%. Clinical effectiveness (success or failure) depends on the correctly applied energy dose--over/underdosage produces opposite, negative effects on cellular metabolism. We did not observe any negative effects on the human body and the use of analgesic drugs could be reduced or completely excluded. LLLT suggests that the laser beam can be used as monotherapy or as a supplementary treatment to other therapeutic procedures for pain treatment.
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67. Pain Reduction - Mechanism
830 nm laser irradiation induces varicosity formation, reduces mitochondrial membrane potential and blocks fast axonal flow in small and medium diameter rat dorsal root ganglion neurons: implications for the analgesic effects of laser.
Laser-induced neural blockade is suggested as a primary candidate for the mechanism of laser-induced pain relief.
Chow et al. J Peripher Nerv Syst. 12(1): 28-39, 2007.

68. Peripheral-Arterial Occlusive Disease (Frostbite 1992) – 86 yr
Peripheral-Arterial Occlusive Disease (Frostbite 1992) – 86 yr. old podiatrist
After 5 Consecutive
Days of Treatment
Initial
11/29/2006
Acute for 6 months

69. Buergers Disease. Thromboangitis Obliterans
Initial:
Final photo:
June 11, color normal, one ulcer
totally healed, 2nd ulcer almost healed,
foot warm to the touch,
ready for weight bearing.
12 treatments over 3 weeks
Interim (4-5)
2 days after initiating treatments,
foot no longer in jeopardy.
Improved arterial circulation and venous
filling.

70. Venous Stasis Dermal Ulceration
5 Treatments Over 9 Days

71. Chronic Lymphedema After 10 Treatments Cyanosis and induration gone
Good venous filling
Mid-calf diameter same as left

72. Neck Pain
A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain was conducted with the aim of determining the efficacy of 300 mW, 830 nm laser in the management of chronic neck pain.
Low-level laser therapy (LLLT), at the parameters used in this study, was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.
Chow et al. Pain. 124: , 2006

73. The Patients
Our proven methods, our clinically tested protocols and out trained professional staff, ensure we have the best outcomes possible with every pathology we treat.
Clinical outcomes are in the high 90th percentile across all patients and vary within a condition group, depending on Degenerative/ repetitive/ sports/ Traumatic states.

74. Laser Therapy Publications

75. Intellectual Property
Meditech is recognized for strength in technology and the value in its name.
The technology is proprietary.
The Brand is recognized for excellence in clinical outcomes globally.
Technology

76. Regulatory Technology
Meditech adheres to a quality system that means the for you; when a problem arises with your product/service from Meditech, we are driven to address the issue in a timely manner.
If this is not done, on the annual audit, these occurrences will come forth and the company can be served a warning or a suspension of the license. These are not theoretical idle issues.
3 years ago, a Canadian laser manufacturer was served such a suspension.
Meditech devotes considerable energy to comply and exceed the quality standards set for the in the protocol.
We have been audited over the past 8 years and have successfully passed each audit.
We are approved in Canada. USA. European Community and other theatres with applications in others.
Technology

77. Thank You!
Questions?