(Roberta Chow and Jan Bjordal, Lancet, November 2009) This paper is an important milestone for the progress of Low Level Laser Therapy towards mainstream use. The authors did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of Laser Therapy in neck pain. They identified 16 randomised controlled trials including a total of 820 patients. They showed that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. The paper declares that neck pain is approaching epidemic proportions with 10 – 24% of the population affected. Health economic reports from USA and European Union state that musculoskeletal injury and disease costs €240 Billion / €194 Billion annually. The paper also reports that pharmacological therapies for neck pain are widely used but have “not shown any conclusive evidence of benefit”. There is now more evidence for the use of laser for neck pain than any other medical procedure.

In recent years we’ve seen huge advances in laser and LED nerve regeneration as more significant research is published. Building on the pioneering work of Prof. Shimon Rochkind (Israel), US military funded research conducted by Prof. Juanita Anders and Kimberly Byrnes PhD (USA). Prof. Harry Whelan studied Retinal Toxicity treated with NASA LED’s, and Prof. Michael Hamblin from Harvard Medical School, Wellman Center For Photobiomedicine, showed that Laser therapy improves the outcomes for Traumatic Brain Injury cases. Low level laser has neuro-regenerative and neuro-protective effects There are no approved therapies for traumatic brain injury (TBI) despite an incidence of over 1 million cases per year in both the civilian and military arenas. Transcranial application of near-infrared laser or LED light is non-invasive, inexpensive and without side-effects. The light penetrates the scalp and skull reaching the brain where it has pronounced neuroprotective, anti-inflammatory effects and can stimulate neurogenesis allowing the brain to repair itself. LLLT increases neurogenesis (formation of new brain cells) and synaptogenesis (new connections between existing brain cells). Taken together these findings suggest that transcranial LLLT can have wide benefits in stroke, neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. In collaboration with clinicians we have shown evidence of benefit of LLLT in clinical trials for chronic TBI, major depression and anxiety. (Huang YY, Gupta A, Vecchio D, Arce VJ, Huang SF, Xuan W, Hamblin MR. Transcranial low level laser (light) therapy for traumatic brain injury. J Biophotonics. 2012 Jul 17 doi: 10.1002/jbio.201200077). There is massive increased survival times after LLLT and neuroprotective effects reducing cell death of neurons. There is evidence that laser light may enhance recovery of neurons from injury by altering mitochondrial oxidative metabolism.Low power laser effects on the non-neuronal component of the nerve. Laser irradiation directly stimulates the proliferation of Schwann cells which are a key factor for successful nerve recovery. Laser irradiation also stimulates proliferation of macrophages and fibroblasts. These are responsible for the generation of collagen fibrils that form the scaffold of the nerve.Reference: Phototherapy promotes regeneration and functional recovery of injured peripheral nerve. (Anders JJ, Geuna S, Rochkind S).(Neurol Res. 2004 Mar;26(2):233-9. Review.) Parkinson’s disease is a common progressive neurodegenerative disorder characterized by the degeneration of …neurons…Results indicated that (laser therapy) LED treatments …. decreased the number of neurons undergoing cell death…. These results strongly suggest that LED treatment may be therapeutic to neurons damaged by neurotoxins linked to Parkinson’s disease by energizing the cells and increasing their viability. (Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA) (Neuroscience 2008 Jun 2 153(4) 963-74)

(Tatsuhide Abe – Laser Therapy 1989) A 40 year old woman presented at the clinic with a 2 year history of lower back pain and pain in the left hip an leg, diagnosed as a ruptured disc between the 5th lumber/1st sacral vertebrae. The condition had failed to respond to conventional treatment methods including pelvic traction, non-steroid anti-inflammatory drugs and dural block anesthetic injections. MRI scans were made of the affected disc, showing it protruding on the left side through the dural membrane. Treatment was used in outpatient therapy, and after 7 months, the patients condition had dramatically improved, demonstrated by motility exercises. This improvement was confirmed by further MRI scans, which clearly showed the normal condition of the previously herniated L5/S1 disc.

(Laser therapy) “LED photomodulation reverses signs of aging…. The anti-inflammatory component of LED in combination with the cell regulatory component helps improve the outcome of …rejuvenation treatments. (Maryland Laser, Skin and Vein Institute, Hunt Valley, MD, USA) (Dermatol Surg 2005 Sep 31(9 Pt 2) 1199-205).

(Bjordal JM et al – pub. Aust J Physiother 2003;49(2):107-16) A literature search of 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. [Of these] 11 trials including 565 patients were acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). Conclusion: [Treatment] with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders.

(Jean Stelian et al – pub. J Am Geratric Soc. 1992; 40: 23-26) Partially double blinded, fully randomized trial. Pain reduction in the treated group was more than 50% in all scoring methods. There was no significant pain improvement in the placebo group. This study also observed significant functional improvement in the treated group but not in the Placebo Group.

(Shigeyuki Nakaji et al – pub. Photomedicine and laser surgery vol. 23 num. 1, 2005) Subjects were 1087 patients treated between April 1992 to august 1995. The efficacy rating immediately after treatment was 46.8% in men and 47% in women, rising to 73.3% in men and 76.8% in women at time of survey (1996). Conclusion: Infrared Diode Low Level Laser Therapy (Photomedicine) is considered safe, effective and side effect free making an ideal adjunctive therapeutic modality for intractable chronic pain.

In our study, immediate and cumulative effects of … laser applied on myofascial trigger spots were demonstrated….. laser irradiation may inhibit the irritability of myofascial trigger spots in .. skeletal muscle. This effect may be a possible mechanism for myofascial pain relief with laser therapy. (Chang Gung Memorial Hospital; College of Medicine, Chang Gung University; HungKuang University; Graduate Institute of Rehabilitation Science, China Medical University, Taiwan )(Am J Phys Med Rehabil 2008 Jul 9).Tennis Elbow/Golfer’s Elbow: (Low Level Laser Therapy)

“Low-power laser treatment in patients with frozen shoulder. The use of low-level laser energy has been recommended for the management of a variety of musculoskeletal disorders…. The results suggested that laser treatment was more effective in reducing pain and disability scores than placebo at the end of the treatment period, as well as at follow-up.” (Laboratory of Health, Fitness, and Rehabilitation Management, Faculty of Humam Movement and Quality of Life, Peloponnese University, Sparta, Greece, and Peania Physical Therapy Center, Attica, Greece) (Photomed Laser Surg 2008 Apr 26(2) 99-105).

This study measures… low-power laser therapies (LPL) by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). There were significant reductions in pain and disability scores between baseline and follow-up periods… There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment. This study showed that ….(low-power laser therapies) LPL therapies were all effective in the treatment of this group of patients with acute LDH. (Department of Physical Medicine and Rehabilitation, Medical Faculty, Celal Bayar University, Manisa, Turkey).

(Bjordal JM et al – pub. Physical Therapy Reviews 2001;6:91-99) To investigate whether [treatment] can reduce pain from tendinopathy, they performed a review of randomized placebo-controlled trials with [treatment] for tendinopathy. [Treatment] can reduce pain in subacute and chronic tendinopathy if a valid treatment procedure and location-specific dose is used. “LLLT administered with optimal doses …directly to the lateral elbow tendon insertions …offer short-term pain relief and less disability in LET (lateral elbow tendon), both alone and in conjunction with an exercise regimen. (Institute of Physiotherapy, Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway) (BMC Musculoskelet Disord 2008 9 75).

(Kevin C. Moore et al – pub. J. Wiley and sons 1992) There was a significant difference in the number doses of narcotic analgesic required between the groups. No patient in the treatment group required narcotic analgesia after 24 hours. Similarly the requirement for oral analgesia was reduced in the treated group. Control patients assessed their overall pain as moderate to severe compared with mild to moderate in the treated group.

“LED (Laser therapy ) produced improvement of greater than 40% in musculoskeletal training injuries in Navy SEAL team members, decreased wound healing time in crew members aboard a U.S. Naval submarine,…. produced a 47% reduction in pain of children suffering from oral mucositis. We believe that the use of (laser) LED light therapy …will greatly enhance the ….healing process, and more quickly return the patient to a pre-injury/illness level of activity. This work is supported and managed through the NASA Marshall Space Flight Center-SBIR Program.” (Department of Neurology, Medical College of Wisconsin, Milwaukee, USA) (J Clin Laser Med Surg 2001 Dec 19(6) 305-14).

(Chow RT et al – pub. Pain. 2006 Jun 23) A randomized, double-blind, placebo-controlled study of low-level laser therapy (LLLT) in 90 subjects with chronic neck pain. [Treatment] was efficacious in providing pain relief for patients with chronic neck pain over a period of 3 months.