My Cold Laser Protocols

Revised to August 13,2009

The more people we treat in the clinic the more conditions we find responding to the cold laser. The cold laser is so simple to use - don’t over complicate it! Our treatments have been modified over the past couple of years as we have used the cold lasers on more people and treated more conditions. When reading this paper keep in mind we all practice in different states or countries with different scope of practice laws and regulations. Please check your own states laws.

The use of a cold laser, also know as a low level laser can be approached several ways. A great approach to treatment is from the point of the nerves and the blood supply to the area involved as well as the area itself. Another approach is from a “site of injury” or more purely an anatomical perspective, like aiming the laser “through the opening between the femur and tibia, from 5 directions, to treat the meniscus, cartilage, ligaments, and even points of arthritis within the knee joint. One could also treat with the cold lasers from an Acupuncture perspective, replacing the needle with a laser. I personally prefer using a combination of acupuncture needles the cold laser and even microcurrent. I have found cold laser to be very effective for treating the nerves, blood system, “site of injury” treatment and from an Acupuncture perspective.

Use a simple method to communicate cold laser treatment plans to a capable assistant, just like with ultrasound, etc. A full-page blank human line drawing is great for that purpose. Most of the time we use the laser wand with five true pulsed cold lasers (three 635nm 5mw Class 3A and two 808nm 150mw Class 3B) set at 10hz. with a 65 second time. That delivers 20 Joules of energy every time you treat. Remember that the cold laser controller beeps at the end of the programmed time and it also pauses when the button is pushed during treatment.

The treatment time could then be written on the line drawing in the locations treated. The CA can program the per point treatment time into the cold laser controller or just watch the timer, pause and restart. Drawing a line under the number ( 10s, 15s, 30s, 1m, etc) might indicate to leave a little air gap between the laser and the skin, lowering the “dose” for the more sensitive patient.

Laser Dosage is measured in Joules. There are two dosages to consider. One is “Total Body Dose”. Two is dosage to a specific joint or body area. The World Association of Laser Therapy states that between 100 and 200 Joules per six hour period is the total body dose we don’t want to exceed in order to avoid exacerbating our patient’s condition. Skin color and type is an important factor to consider in treatment. Older or very frail or thin skinned patients and also really light skinned sensitive patients could max out at as little as 30% of the stated numbers, while a very dark skinned person could need double the stated treatment, err on the side of caution. The frail and light skinned can experience a form of burn from a powerful laser but so can the darker skinned patient due to the melanin in the skin offering resistance to the lasers penetration causing heat. Another consideration is medicines that are “photo reactive”, they may cause the patient to “burn” very easily. If the patient has been advised to stay out of the sun because of some medicine I only treat with a 635nm 5mw laser.

I find it easy to determine the amount of laser light required to deliver a total body dose treatment. About 10 minutes (per six to eight hour period) of treatment will be a maximum (200J total body dose) when using the programmable laser with the laser wand which contains five true pulsed lasers (three 635nm 5mw Class 3A and two 808nm 150mw Class 3B).

The five true pulsed lasers (three 635nm 5mw Class 3A and two 808nm 150mw Class 3B) totals 315 mw and puts out about 18.9 joules per minute.

The 635nm 5 mw puts out about 0.3 joules per minute. The Five 635nm 5mw totals 25mw and puts out about 1.5 joules per minute. The 650nm 50 mw puts out about 3 joules per minute. The 808nm 150 mw puts out about 9 joules per minute.

Now that that is all out of the way lets discuss the use of the “laser wand” on general tissues, and some acupuncture points used for different conditions. Remember, the single 808nm 150mw laser, single 650nm 50mw or the single 635nm 5mw laser can also be used in the same ways as we discuss about the multi laser wand. The human line drawing sheet is a good place to document the dose a patient is treated with then it can be included in the patients file. A copy of the WALT Dosage Chart is good to have visible wherever patients are treated. It is available at:
http://www.walt.nu/images/stories/files/dosage-table-780-860nm.pdf

I make it a practice to keep a box of fold top sandwich bags (bought at a dollar store) in each treatment room. I use them to cover any laser tip or wand for sanitary purposes. I usually put the wand or tip against the patients skin to maximize the effect on the tissue plus it makes reflection less of an issue.

Many patients present with spinal subluxation/degeneration, I believe that when combined with the adjustment the cold laser helps the subluxation heal faster. I often find myofascial restrictions and/or trigger points as well. You can use the cold laser before or after you adjust but if you’re doing soft tissue work like Graston or A.R.T., laser AFTER you’re done.

Click Photos for Cold Laser Details or Catalog

GENERAL TX and SPINE TX:
When the complaint is of pain and the other factors have been considered and possibly even referrals made, remember we are possibly talking about some very different conditions here and you may want a condition checked out by a medical doctor, it will relieve you of a significant amount of liability if you aren’t comfortable with what you are presented with.

It is good to begin by treating the lower cervical ganglia that is anterior to the C7 TVP bilaterally for 30 seconds each. Remember to stay away from the thyroid gland here - please! If the problem is joint pain like a knee, shoulder or hip the next spot to treat is that joint, treat it with the amount of energy (in Joules) as shown on the WALT Chart http://www.walt.nu/images/stories/files/dosage-table-780-860nm.pdf Depending on the amount of energy already used, you could then do the laser treatment bilaterally just lateral to the spine at the involved spinal level as well as just above and just below (posterior aspect of the body, 3 to 5 vertebral levels in all) do 30 sec on each side of the spine keeping the wand moving slowly. For the acupuncture folks this treatment covers the Hua-To points and the Associated points. This basic treatment is for a primary subluxated area that’s being adjusting as well. Then move out to the involved extremity for problem areas like muscle spasm or trigger points and treat them.


BLOOD SUPPLY:
When I first learned about lasers I was taught to treat non-healing fractures when the injury was covered by a cast by treating the nail beds and the arterial blood supply to the limb. Many a non-healing fracture has been healed this way, if the patient is compliant to the treatment plan. The blood supply treatment method is somewhat indirect so the energy is spread over a large area allowing more treatment in that involved area. I find this type treatment actually treats the whole body so it can be great for a wellness care approach. In those cases we might treat the abdominal aorta above and below the naval assuming the patient wasn’t so obese that the treatment couldn’t make it to the abdominal aorta. In that case, remember those lower and middle cervical ganglia, the carotid arteries are superficial to them and they can both be treated at the same time if you direct your laser wand properly. Remember to stay away from the area where there is or might be fetus!
MUSCLE / TENDON / LIGAMENT / NERVE:
Over time I have changed the way I treat tendonitis/osis/opathy. I only use the 635nm 5mw laser on a tendon problems. I found the 650nm 50mw to be too powerful for some people and I can’t reliably predict when a patient will experience an exacerbation of symptoms. Why should I? The 635nm 5mw laser is almost always successful and never hurts a patient. Alternatively, (if all you currently have is the laser with three 635nm 5mw Class 3A and two 808nm 150mw Class 3B laser wand) you can cover the two 808nm lasers and still treat with 2 or 3 of the 635nm 5mw lasers. I believe you will find the 5mw 635 nm single laser tip to be much more convenient.

When dealing with sprains/strains and/or nerve irritation it is advisable to keep the laser moving over the area being treated. Covering the entire involved area slowly in a “spray painting” sort of fashion, while the laser head is against the skin is great. I also rotate the wand within the baggie. Keeping the laser stopped on one spot could possibly begin to over treat a single spot which could decrease its effectiveness. This “spray painting” method is also used for neuropathy and phantom limb pain, just “spray paint” the nerve pathways for 30 sec to 2 minutes depending on the size of the area. For both neuropathy and phantom limb pain I treat the corresponding auricular points with laser, needles and/or microcurrent. As for trigger points, treatment should be 1-4 joules per trigger point. Use of a single 808nm 150mw to get to the small area would be ideal.

JOINTS:
The WALT Chart http://www.walt.nu/images/stories/files/dosage-table-780-860nm.pdf gives specific dosages and the number of points to treat according to the World Association of Laser Therapy. Generally I find I am thinking along the same lines. I treat the involved joint, treat the pathway of the involved nerve(s), treat the involved spinal level and treat the auricular point(s) related to the condition.

ACU-POINTS:
I really don’t focus on treating acu-points with the laser like I used to. I primarily use needles or a micro current machine. I am including this for completeness sake knowing that some will prefer treating acu-points with the cold laser.

As we discuss treatment of a “point” I am talking about using either a 635nm 5mw, 650nm 50mw or 808nm 150mw. When treating acu-points I would usually begin at the spine by treating the general area of the spine where the nerve roots exit that possibly have a relationship to the complaint. In the neck or low back I commonly treat between each spinous process (Du Meridian) for 2-3 levels above and below the level I believe to be the culprit, then I treat the Hua To Points (1/2 tsun out from center and between each spinous) again treat 2-3 levels above and below the offending, subluxated area. Finally I treat any Associated Points on the Bladder meridian that are within a few levels up or down. I treat each level regardless of whether I’ve seen it in an acupuncture point manual. I learned this concept from a paper Dr. Amaro wrote a long time ago and it works! You want to apply between 0.5 - 2 Joules per acupuncture point. Please note that the 5 laser wand treats all the points near the spine quite nicely.

OTHER ACU-POINTS:
I find LI 4, ST 44, & ST 43 seem to help reduce pain in general. To relax the stressed out, decrease headaches and sometimes even blood pressure I use GV 20, the Four Points located 1 tsun anterior, posterior and lateral to GV 20 on top of the head, HT 7, BL 62, & Auricular - Shen Men, Tranquilizer Point and Muscle Relaxing Point. To increase the energy levels of “lethargic” patients I’ve had success with CV 6, CV 8, ST 36, & SP 6.

OTHER CONDITIONS:
We see patients with every condition known and as a general rule neuro-musculo-skeletal complaints will respond to the low level laser, some great some may take a while and it can be difficult to keep the patient motivated. Most conditions are treated with a “common sense” approach. For example it makes sense that you would treat a fibromyalgia patient by using the laser on the tender “fibro” points. But if you think about it you will also recognize fibromyalgia as a condition that also requires you to cut the dose down to 30% of normal in the beginning of treatment so with only 30-60 Joules to “spend” where will you treat and for how long? If the 315mw laser wand is your only laser, you might think about an air gap to decrease the dose, or covering the two 808nm 150mw infrared lasers. You could just count 1 Mississippi, 2 Mississippi in your head and move off the points quickly.

The digital hand held laser controller can be programmed to a fifteen second treatment time so you can treat without counting. Now we can treat all 18 “fibro points” if we wish and still have a little time left for the anterior C7 ganglia before reaching 50 Joules. One could simply use the 635nm 5mw laser and “spray paint” each point for a minute or so. That keeps the dosage down so you see how the patient responds to care and you’re sure not to exacerbate the fibro. Then you can use the wand for the Ant C7 spot.

The above is the basic way I approach any condition. I don’t need a manual a foot thick with pictures and exact cook book like recipes. As a doctor I know things like, the referred pain patterns trigger points and where the trigger points are that refer, treat the trigger point and the referred pain will likely respond. If you can possibly do it (ie: it is legal in your state and you are trained) needle the trigger point – this one needling technique has made me believe that the trigger point injections really aren’t what help the patient, it is the hole the needle makes, it is just my opinion but WOW do I see amazing results with it!!

Neuropathy has another aspect. Obviously you would think of “spray painting” the entire affected limb, right? Now follow the nerves pathway and “spray” it all the way up the limb to the cord level. Then go to the ear and treat the auricular point for the area. If you don’t have one of the optional small laser tip for auricular points you can use an inexpensive micro current type point locator/stimulator for the auricular points.

To summarize: we treated the area of the complaint, the pathway of the involved nerve, the involved cord level and I might include the entire spine protocol here - Du points, Hua To points & Associated points for about 5 levels, involved + 2 above and 2 below. Keep the dose low - don’t over treat.

For something like TMJ dysfunction do whatever you do other than laser then treat the Tempomandibular joint itself, the general jaw muscle area and the temporalis muscle above the ear. Here is an example of a time it is good to have more than just the large multi laser wand because the TMJ is a tiny joint and a small treatment area sometimes calls for a small treatment tool. Apply according to the TMJ on the WALT Chart but treat the muscles in addition to the TMJ.

Do NOT over treat the base of the skull with the wand. The occipital nerves are very sensitive. I only use the 635nm 5mw on the upper cervical spine and on the scalp. I made a little cover for the multi laser wand so the two 808nm 150mw lasers are not treating, just the three of the 635nm 5mw lasers in the multi laser wand.

One final thought for patients with multiple complaints. Just like in Chiropractic care, treating the primary problem is most likely to offer relief and give the patient relief for a longer period of time. With that said don’t overlook what appears to be a secondary condition because sometimes that’s really the problem. Be careful not to get caught up in treating so many things you end up over treating one of the more sensitive conditions and making it worse. Remember any laser treatment affects the WHOLE BODY.

As you can tell the WALT Chart chart offers you a guideline for muscles/tendons as well as specific recommendations for most joints and you have a standardized guide to determine your own treatment plans. As far as maximum doses are concerned the two 808nm 150mw's in the wand are 300 mw total whereas the three 635nm 5mw's lasers total 15 mw. So with the wand you are really treating two of the points with a lot of energy every time you push the button; for this reason, I recommend you mark your wand so you know where the two 808nm near infrared lasers are located without looking at it during operation. You want to aim into the “openings” of the joint, then you can move the laser wand around during treatment so as to continue to aim into joint, while you simultaneously have the patient moving the joint through its ranges of motion the best they can, this allows you to get to all different angles to treat the joints. You can also rotate the wand head while it is still against the skin in the plastic bag if necessary.

With the single 808nm 150mw laser wand you can direct your treatment a little more specifically to the “openings” and that can really make a difference on small joints where you have to get the treatment done with a really low number of Joules. Finally, if you need to decrease the density (mW/cm2) of the treatment you can just use “air”. Just like x-rays need more MAS at 72 FFD the laser loses density if it isn’t against the skin. Where it says max 100mW/cm2 you could lower the density of your laser wand or single 808nm 150mw laser tip by simply holding it where it is just a millimeter or two from touching the skin.

Thank you for reading this far down, your patients will benefit and pay you well!

Sincerely,
Charles Dixon, DC, FASA http://DrCharlesDixon.com
DrCharlesDixon@DrCharlesDixon.com

Disclaimer:
You are completely responsible for any treatment you decide to offer, as well as your compliance with your state laws and your treatment decisions for patients. I have no knowledge about the exact building or marketing processes of any cold laser product and I make no representations that I do. I use the cold lasers I bought from http://ColdLaserTherapy.us in practice every day and with great results, how you use it is your own responsibility. Obviously everyone in any treatment room must wear laser goggles approved for the wavelength of the laser being used.

Important information you must read!
In order to avoid possible eye damage the use of laser goggles is NECESSARY by everyone in the room where any laser equipment is in use.

Using cold lasers or low level lasers on others may be considered practicing medicine. It is solely the purchasers responsibility to conform to all applicable laws and regulations!

We supply and custom made cold laser components for scientific and medical research use (pain reduction and other conditions) to medical professionals and clinicians only.

Photos on our web site depict user assembled equipment (assembly consists of one simple twist connection).

The contents of our web site, cold laser equipment, low level laser equipment, other equipment, components and or cold laser parts, low level laser parts, other parts, purchased from our web site and other material contained on our web site are for informational and scientific research purposes only. We do not render medical advice or represent products we sell are FDA approved or will achieve specific results. The information provided our web site should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your licensed health care provider.

Equipment and components purchased from our web site are manufactured by and for Healing Lasers Design Company, Cape Girardeau, MO and are sold by Accurate Inspections, Inc., a New Jersey Corporation doing business as Laser-Therapy.US.

Reverse engineering of our designs is strictly prohibited and aggressively prosecuted.