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Passive Modalities

Class IV Laser

At Legacy Medical Centers, we use Class IV lasers that have the capacity to reach a power of 60 Watts and penetrate many centimeters below the skin’s surface. Our lasers work by photobiomodulation, a process by which the laser supplies photons of energy in the form of near infrared light, which is absorbed by chromophores in the mitochondria of the cells. The primary chromophore is cytochrome c oxidase, the terminal enzyme in the respiratory chain. Activating this enzyme increases its rate of reaction, and more adenosine triphosphate (ATP) is produced, allowing for an improved rate of healing and repair within damaged tissues. The laser light increases the energy available to the cells so that they may assimilate nutrients faster and remove waste products. The most important and most basic effect of laser therapy is the improved production of ATP, which is the universal biological fuel within our body. When one receives laser therapy, they get a significant boost in ATP. According to Tiina Karu, Head of the Laboratory of Laser Biology and Medicine, many of the widespread benefits from laser therapy may, in fact, be related to the effects on ATP.

Ultrasound Guided

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Class IV laser therapy has various benefits depending on how it is used, including:

  • Anti-Inflammation – Laser therapy reduces edema, swelling, and bruising because it helps with vasodilation and activates the lymphatic drainage system. Laser is also capable of reducing the inflammatory mediators TNF, interleukin-6, interleukin-1 beta, and prostaglandin E2 often found in arthritis and tendinitis.
  • Anti-Pain (Analgesic) – Laser therapy has a beneficial effect on neurons that reduces pain transmitted to the brain. Laser can also stimulate the body to produce endorphins, which combat pain. Laser directed at the sympathetic ganglia leads to parasympathetic dominance in the targeted area, which can trigger blood vessel dilation and a pleasant warming sensation.
  • Nerve Function – In damaged nerves, laser therapy can boost production of proteins such as Gap-43 which speeds up the process of neuron regeneration. Laser has been demonstrated to stimulate Schwann cells and increase the thickness of the myelin sheath (the insulation that wraps around a nerve) of damaged nerves. These effects can improve overall neuron function, optimize muscle action, and restore sensation.
  • Tissue Repair and Healing – Photons of light from lasers penetrate deeply into the body and accelerate cellular reproduction, growth, and metabolic processes. Laser light stimulates the proliferation and health of fibroblasts (cells which produce collagen, a protein essential for wound healing). Collagen synthesis and fibril size is significantly increased. This is relevant for the healing of many types of injuries, because collagen is found throughout the body, including the intervertebral disc of the spine, tendons, and ligaments.
  • Vascular Activity – Laser will significantly increase the formation of new capillaries, a process called angiogenesis, in damaged tissue in order to speed up the healing process. Laser is capable of significantly boosting the blood flow into the soft tissues and limb(s) treated via vasodilation. Laser therapy at sites in the neck may boost circulation and oxygenation of the brain and has been found to be helpful in certain cases of headache, vertigo, tinnitus, and balance disorders.

At Legacy Medical Centers, we use Class IV laser therapy most often for:*

  • Neuropathy
  • Plantar fasciitis
  • Radiculopathy
  • Sciatica
  • Sprains and strains
  • Temporomandibular joint disorders (TMD)
  • Tendinitis (e.g., Achilles tendinitis)
  • Thoracic outlet syndrome
  • Trigeminal neuralgia
  • Arthritis (e.g., osteoarthritis, rheumatoid arthritis)
  • Bone injuries
  • Carpal tunnel syndrome
  • Fibromyalgia
  • Headache
  • Herniated discs
  • Low back pain
  • Muscle tears or trauma
  • Neck pain

*Keep in mind that your health insurance may have a disclaimer stating that laser therapy is considered experimental or investigational for all conditions except carpal tunnel syndrome. At Legacy Medical Centers, we treat each case as unique and explain the intended purpose of treatment and obtain consent before starting care.

Electrotherapy

A normal electrical potential is essential for our cells and thus our body to carry out normal functions. According to Dr. Jerry Tennant (Healing is Voltage), in order to heal and make new cells, a voltage of -50 millivolts is needed. At Legacy Medical Centers, we use interferential current, transcutaneous electrical stimulation (TENS), and high voltage in various settings to apply electrical stimulation to the body in order to reduce pain and speed tissue healing.

Electrical stimulation may block the transmission of pain signals along nerves. Additionally, electrical stimulation has been shown to promote the release of endorphins, which are natural painkillers produced by the body. Electrical current is painless and patients commonly report a “tingling” or “pins and needles” type of sensation when it is applied. With a larger than normal flow of current along a neuron, a refractory period is induced within the nerve and thus the sensitivity of the nerve is reduced (Wedensky inhibition). The ability of interferential therapy to control pain (the analgesic effect) is caused by inhibition of type C nociceptive neurons.

Electrotherapy is used at Legacy Medical Centers for:

  • Pain Management
    • Improves range of joint movement
  • Treatment of Neuromuscular Dysfunction
    • Improvement of strength
    • Improvement of motor control
    • Retards muscle atrophy
    • Improvement of local blood flow
  • Improving Range of Joint Mobility
    • Induces repeated stretching of contracted, shortened soft tissues
  • Tissue Repair
    • Enhances microcirculation and protein synthesis to heal wounds
    • Restores integrity of connective and dermal tissues
  • Acute and Chronic Edema
    • Accelerates absorption rate
    • Affects blood vessel permeability
    • Increases mobility of proteins, blood cells and lymphatic flow
  • Improvement of Peripheral Blood Flow
    • Induces arterial, venous and lymphatic flow
  • Iontophoresis
    • Delivery of pharmacological agents

Therapeutic Ultrasound

This technique should not be confused with diagnostic ultrasound (as described separately), used in prenatal screening and musculoskeletal pathologies. Ultrasound can be used in treatment of inflammatory conditions, and has a massage-like effect that enhances fluid exchange and promotes tissue healing. Ultrasound has been shown to Increase in tensile strength, increase mobility, improve collagen fibril alignment, and reduce inflammatory infiltrate and scar tissue in tendons. The heating effect of ultrasound is absorbed especially by collagen, which is found in tissues such as bone and tendon. Ultrasound is a painless procedure and most often the patient cannot perceive any sensation except slight warmth when it is applied.

At Legacy Medical Centers, we use therapeutic ultrasound for:

  • Inflammatory conditions (e.g., plantar fasciitis, epicondylitis)
  • Tissue warming
  • Speeding healing

Additional Resources:

Jang, Ho, and Hyunju Lee. “Meta-analysis of pain relief effects by laser irradiation on joint areas.” Photomedicine and laser surgery 30.8 (2012): 405-417.Karu, Tiina I. “Multiple roles of cytochrome c oxidase in mammalian cells under action of red and IR?A radiation.” IUBMB life 62.8 (2010): 607-610.Alves, A. C., et al. “Effect of low level laser therapy on the expression of inflammatory mediators and on neutrophils and macrophages in acute joint inflammation.” Arthritis Res Treat 15 (2013): R116.Lukowicz, Malgorzata, et al. “The impact of laser irradiation on global stability in patients with vertebrobasilar insufficiency: A clinical report.” Medical science monitor: international medical journal of experimental and clinical research 17.9 (2011): CR517.Chow, Roberta T., et al. “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.” The Lancet 374.9705 (2009): 1897-1908.Bjordal, J. M., R. A. B. Lopes-Martins, and V. V. Iversen. “A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations.”British journal of sports medicine 40.1 (2006): 76-80.Ebrahimi, T., et al. “The influence of low-intensity laser therapy on bone healing.”Journal of dentistry (Tehran, Iran) 9.4 (2012): 238.Sattayut, S., and P. Bradley. “A Study of the Influence of Low Intensity Laser Therapy on Painful Temporomandibular Disorder Patients.” Laser therapy 21.3 (2012): 183.Takahashi, Hiroshi, et al. “Low level laser therapy for patients with cervical disk hernia.” Laser therapy 21.3 (2012): 193.Kuran, Ebneshahidi, Narges Sadat, et al. “The effects of laser acupuncture on chronic tension headache a randomised controlled trial.” Acupuncture in Medicine 23.1 (2005): 13-18.Wang, Chau-Zen, et al. “Low-Level Laser Irradiation Improves Functional Recovery and Nerve Regeneration in Sciatic Nerve Crush Rat Injury Model.” PloS one 9.8 (2014): e103348.Chen, Yi-Jen, et al. “Effect of Low Level Laser Therapy on Chronic Compression of the Dorsal Root Ganglion.” PloS one 9.3 (2014): e89894.

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