What is LLLT?

One of the many treatments I use in clinic is Low level Laser Therapy (LLLT). I am often asked by my patients, “how does it work and what benefits it will provide me?”. So I thought what better topic to write about.

LLLT is the application of red and near infra-red light over injuries or lesions to improve wound and soft tissue healing, reduce inflammation and give relief for both acute and chronic pain. First developed in1967, it is now commonly referred to as LLLT.

LLLT is used to:

Increase the speed, quality and strength of tissue repair
Resolve inflammation, and
Relieve pain (analgesia).

The red and near infrared light (600nm-1000nm) commonly used in LLLT can be produced by laser or high intensity LEDs (light emitting diodes). The intensity of LLLT lasers and LED's is not high like a surgical laser. There is no heating effect.

The effects of LLLT are photochemical (like photosynthesis in plants). When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases ATP (energy). This improves cell metabolism and reduces inflammation. These effects can be enhanced with pulses however when analgesia (pain relief) is required there is a second mechanism which works best when a strong continuous beam is applied.

In the clinic I use LLLT for the following conditions (but not limited to):

Neck pain
Back pain
Soft tissue injuries (including post-surgery wound healing)
Joint conditions (including pain relief for oseto-arthritis)
Neuropathic pain

The Lancet report declares that neck pain is approaching epidemic proportions with 10 - 24% of the population affected. Health economic reports from the USA and the 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". The British Medical Journal agrees saying, "…there isn't any specific research that shows drugs help neck pain".

There is now more evidence for the use of LLLT for neck pain than any other medical procedure. The Lancet report says, "…(relief using) laser for neck pain lasted for up to 22 weeks. Trials of LLLT for knee osteoarthritis, tendinopathies and low back pain reported similar results. This contrasts with drug therapies where the effect ends rapidly when treatment is discontinued."

LLLT under the microscope – the science

BRIEF SUMMARY OF LASER STUDIES REVIEWED FOR THE LANCET

16 RCT's of acceptable methodological quality
Mean duration of symptoms 7.5 years +/-36.9months
Mean baseline of pain intensity 56.9mm +/-7.5mm

RESULTS

Reduced pain intensity
Reduced disability
Reduced recurrence of acute neck pain
Mean pain intensity reduction over placebo 20mm (95%CI: 17.1 to 29.8 @ 10-22 weeks)

COMMENT

This establishes LLLT as an evidence based treatment for neck pain. It is at least equivalent to and probably better than other accepted medical treatments for neck pain.

WHAT IS LLLT AND HOW DOES IT WORK ON NECK PAIN?

A gentle beam of laser light can stimulate cells to repair tissues, reduce inflammation and inhibit pain fibres to reduce pain. The application of specific wavelengths of red or near infrared laser or LED light on acute injuries and degenerative conditions relieves pain and improves healing. There are two main mechanisms:

At low doses it acts on mitochondrial proteins to reduce oxidative stress and increase production of ATP (energy)
At high doses it inhibits fast axonal flow in C and A delta fibres causing a temporary neural blockade, reducing central sensitisation.

HOW LONG IS A TREATMENT SESSION?

Following the initial consultation, actual therapy time typically takes around 15 to 20 minutes.

HOW SOON DOES IT START TO WORK?

Patients will typically experience improvement (reduction in pain/greater range of movement) immediately after the first treatment.

HOW MANY TREATMENTS DOES IT TAKE?

It can take as many as a dozen sessions, but sometimes as few as three.

HOW OFTEN SHOULD PATIENTS COME IN FOR TREATMENT?

Twice a week for the first two weeks then once a week for a further two weeks.

HOW LONG DO THE BENEFITS LAST?

In most cases, once an acute episode is over, patients are unlikely to need further treatment. For a few people, the benefit may only be temporary - they may need long term maintenance every six to eight weeks.

ADVANTAGES OVER DRUG THERAPIES

The evidence for use of LLLT is much stronger than for drug therapies. There are no analgesics or anti-inflammatories licensed for the treatment of neck pain. LLLT also has the advantage of having no side effects, unlike many drug therapies.

Watch a short A Current Affair segment showing LLLT in action