Dr.Koh’s article on Lighting the Way

Laser Therapy
Over the years, there have been more articles written on the effectiveness, application and science behind laser modalities as a treatment tool in the health care field. Many of those articles, including those inADVANCE, talk about the science, research, applications, indications, contraindications and emerging growth of laser modalities within our field.

But in addition to these aspects, I wish I heard more about real-life experiences with lasers from patients or practitioners, and why they would spend money on a machine that costs eight to 10 times more than a comparable e-stim/ultrasound unit.

The story of how I even entertained the idea of incorporating cold laser into my practice began with the personal experience of a close PT friend, Colin. His wife, also a PT, had multiple neck surgeries and was involved in a severe car accident that re-aggravated much of the cervical neck pain that she had suffered for many years. It was so sensitive that she would not even let her own husband perform the most basic or lightest manual techniques to help alleviate pain.

Using a demo unit offered to him by a sales representative, Colin first applied the laser modality to her neck for five to six minutes. Afterward, she was instantly able to rotate her head throughout full range of motion while stating her pain level was down by 80 percent.

Later he told me that even if the cold laser machine only helped his wife and no one else, it was still worth the $10,000 investment. Knowing both of them for many years and her situation very well, I found that to be a profound statement-and it convinced me to do my own research into cold laser therapy.

Pinpoint Convenience
After purchasing my first cold laser machine, I realized how convenient it is. The laser probe allowed me to pinpoint specific areas for treatment. It also allowed me to specifically treat common nerve entrapment sites, trigger points, small or very large treatment areas at the same time. No more gels, wires or electrode pads were needed as with other traditional modalities.

Treatment and setup times were significantly reduced compared to ultrasound or e-stim units. I also noticed that laser therapy made my manual therapy treatments considerably easier, with less recovery time.

My patients also noticed a difference. For example, I had been treating a patient with TMJ pain that was due to strained digastrics muscles. Treating those muscles was extremely painful and it often took several minutes for my fingers to work into the muscles.

The same clinical affect was also noted when working on deep muscles such as cervical rotators or multifidi muscles. Laser treatments prior to joint mobilizations made Grade V mobilizations much easier to cavitate and allowed joints in general to release easier.When I applied the laser probe to the digastrics muscles prior to manual treatment, the patient noticed a big difference. The soft tissues were significantly softened immediately after laser treatment and I could work much deeper with noticeably less pain for the patient. From that time on, that patient always made sure I applied the cold laser before we did any of our manual treatments.

Recovery Time
Lasers have also had a positive effect on my patient recovery time between treatments. One example came from a skeptical patient with an ACL tear who once told me that he did not want to have the “red flashlight” anymore. He had been receiving laser treatments after all of his manual therapy treatments. He felt the laser treatment was a waste of time and requested to discontinue its use.

After the fourth treatment without the laser modality, he asked, “Can you start re-applying the laser, because my knee has been noticeably sorer after treatment for longer periods than before.” His soreness after treatment returned to baseline levels once cold laser treatments were again performed on his knee.

Despite the successes I saw in my patients, I also wanted to be able to share my own experiences of being treated by laser. My first personal treatment with cold laser came soon after I purchased my first cold laser machine. The incident occurred when I began jogging again.

For about three weeks a plantar fasciitis-type pain began to arise in my left heel. I started to feel the same type of pain every time I went jogging. Generally the pain would dissipate after my running routine. But following my fourth jog, the pain in my left heel did not go away.

One day after work, I decided to go ahead and give the laser a shot, thinking it would at least help the rate of healing. After treatment to my left heel, I noticed a difference. To my surprise the next morning, I had no pain in my heel when I stood up. After just one treatment, I also did not have any pain running and returned to my training without a recurrence of left heel pain. A few months afterward, a second experience further convinced me that cold laser was more than just a “theoretical red flash light.” I was performing a manual treatment technique on one of my patients when I hyper-extended two of my fingers. This injury was minor but by the end of the day quite painful.

I decided to perform an impromptu experiment where I would only apply the cold laser to one finger. Both fingers were experiencing equal amounts of pain so I applied the cold laser to the first PIP joint of my third digit and left the fourth digit alone.

The next day the treated finger on my left hand was no longer sore. The untreated finger stayed sore for three days. Again, that immediate change was surprising to me and further convinced me that cold laser can clinically speed up the recovery process.

Best to Buy?
People always ask me which laser machine is best to buy. I tell them it depends on a variety of factors and is not a question of one machine being better than another, but rather which machine fits the specific needs of your treatment style and patient population. I currently own three different types of cold laser therapy machines.

One of my favorites is a portable cold laser. It latches onto my belt and is perfect for using laser with a manual technique at the same time. My home health PTs love it because it is much easier and cleaner to use than lugging an ultrasound machine or an e-stim unit with all of its cords, gels and pads.

If your specialty is hand or foot, the laser pad would be a good option. The pad allows you to perform laser therapy over the entire hand or foot at the same time. The pad is unique in that it also enables the laser modality to affect hard-to-reach areas of the foot or hand at the same time.

For therapists with heavy emphasis on manual techniques, I would suggest making sure one of your laser heads is a probe to directly treat trigger points or work specifically on tiny muscles, joint capsules etc. prior to any exercise or manual treatment, as I’ve mentioned before.

Be wise in your selection, since laser machines are still six to seven times more expensive than more traditional modalities. Some physical therapy clinics have offset the costs of the laser machine by charging patients a premium. I have heard that anywhere from $15 to $35 per treatment can be charged to the patient for laser therapy at these clinics. Other PT clinics have simply offered laser modality as a separate treatment entirely on a cash basis.

These stories are just the tip of the iceberg for my use of laser modalities over the past eight years. Based on experience and patient feedback, I believe laser modality is, at worst, just as effective as any more traditional modality to promote healing and pain relief, but with much greater efficiency. At best, it is a modality that creates an environment of healing faster than other modalities.

Davis Koh is president and CEO of Koh Physical Therapy Lab in Irvine, CA. He has been invited as a consultant/speaker by organizations such as TaylorMade, Skechers USA, CPTA, NSCA, the U.S. government and U.S. Olympic Committee on various topics including laser therapy.

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