The present and future for this electrical modality
Let’s face it: While most Americans are familiar with the concept of physical therapy, very few actually know about the wide range of treatments it can entail. New patients tend to come in with a set of ideas about physical therapy and, generally, these ideas aren’t wrong.
They might anticipate utilizing brightly colored resistance bands, pedaling on an exercise bike or perhaps even using electrical muscle stimulation devices. However, it’s unlikely that laser therapy will cross their minds.
Though lasers still may sound like technology of the future, physical therapists know otherwise. In fact, physical therapists have been using lasers to accelerate the healing process for nearly five decades, starting in 1967 with the work of Professor Endre Mester, a Hungarian physician who experimented with using lasers to treat skin cancer.1,2
Now, laser therapy is a modality used to improve and accelerate results in treatments for physical therapy patients with the utilization of a red-beam or near-infrared laser, with varying ranges of wavelengths and power depending on the class of laser.3
As a modality, laser therapy is incredibly flexible and is used for conditions ranging from sports injuries to arthritis.
Simply put, it’s impossible to encompass all that laser therapy can do in a single article. To get an idea of the current standards, ADVANCE spoke with Kim Nartker, PTA, owner and founder of Stretch Physical Therapy & Total Wellness in West Chester, Ohio, to learn about how her team utilizes this treatment.
Therapeutic Uses
While “laser therapy” may sound daunting to patients, explaining the process is likely to eliminate any fear they might have. At Stretch Physical Therapy & Total Wellness, a laser unit uses laser to penetrate deep into the patient’s tissue to promote photobiostimulation. The cellular metabolism increases, which accelerates cell repair, increases blood flow and stimulates the immune and lymphatic systems.
Although this modality is often associated with treating sports injuries, Nartker’s team is very familiar with the wide range of uses for this therapy. “In our outpatient clinic, we use the cold laser for chronic and acute injuries that don’t respond to grade IV or grade V mobilizations quickly,” Nartker said. As she’s seen, those ailments include plantar fasciitis, fibromyalgia, tennis elbow, lumbar stenosis, knee osteoarthritis, acute muscle spasms, carpal tunnel and tendonitis.
As can be expected with such a large range of uses, the length of treatments varies. “It depends on the injury and how chronic in nature the injury is,” Nartker said. “Each diagnosis has its own specific protocol that is followed by the treating PT.” These treatments range from 5-8 visits with 6-10 minutes of laser treatment for ailments such as Bell’s palsy and TMJ pain, to 8-10 visits with 22-30 minutes of laser treatment for lower back pain and sciatica/radiculopathy.
Choosing Laser Therapy
Like any modality, low-level laser therapy (LLLT) isn’t a one-size-fits-all treatment. “We have teams of PTs and PTAs that look primarily at outcomes and results of each treatment,” Nartker said. “If we do not see results within three treatments, we typically discuss the case and determine treatments that would make the biggest impact on patient pain and function.”
Even when LLLT is determined to be a good treatment for a patient, it is very rarely used as the sole treatment in a therapy plan. At Nartker’s practice, laser therapy is used in conjunction with manual therapy for all but one ailment: neuropathy. “We have great outcomes in the regrowth of damaged nerves and typically use the cold laser to improve outcomes in gait with this diagnosis,” she said.
Unfortunately, most patients will be hard-pressed to find an insurer willing to cover the cost of laser, as it’s commonly considered experimental due to inadequate evidence of its effectiveness.4 Yet with declining reimbursements for most therapies, Nartker has found that patients are becoming increasingly drawn to it due to the promise of a relatively short and affordable treatment.
“I learned the hard way that our clients seek fast, result-driven treatments, and they will pay for laser in conjunction with joint mobilizations if we feel it will help them,” she said. “Early on as an owner, I didn’t push the laser and almost lost patients due to a local podiatrist recommending the cold laser. I’ve learned to recommend the treatment to severely chronic patients as an alternative if they choose it. It still blows me away how many say, ‘Yes, please!’ when it’s offered.”
The Future of Laser Therapy
Despite being utilized by many physical therapy practices, such as Nartker’s, there is still much to be learned about the effectiveness of laser therapy. Most devices are classified as Class II devices by the U.S. Food and Drug Administration, and between 2002 and 2009, 43 such devices received 510(k) clearance for marketing – but only for temporary pain relief. Additionally, most of these clearances were only for symptoms related to wrist pain due to carpal tunnel syndrome.3
Of course, PTs strive to supply long-lasting pain relief and deal with much more than carpal tunnel, so further clearances are crucial for laser to be universally seen as a valid, safe treatment and advertised as such. Yet these clearances are not possible without extensive research on the impact of thetreatment. It’s realistic to anticipate that ever-increasing co-pays will result in an increased demand for quicker therapies such as LLLT; however, until further research is done, it’s unlikely this modality will become as commonplace as ultrasound or electrical stimulation.
Justifying Resistance
While many physical therapy practices are utilizing this therapy, there are countless practices that are not. At first glance, the reasoning behind not offering this treatment is solid: Scientific evidence supporting the treatment is in its infancy, and the absence of financial reimbursement from insurers forces PTs to present the therapy to patients while knowing they’ll have to pay out of pocket.
“Physical therapists don’t like to sell things,” Nartker said. However, as she’s seen more and more of her patients opt for LLLT, she’s started to envision suggesting the treatment less as trying to make a sale and more as fulfilling her duty to her patients.
“We are in a profession that can help people live pain-free,” Nartker said. “I feel that we are obligated to offer solutions that help our clients achieve their personal goals.”
References
- Schnee A. History of cold laser therapy. Spine Health. 2009.
- Avci P, et al. Low-level laser (light) therapy (LLLT) for treatment of hair loss. Lasers in Surgery and Medicine 46(2):144-151. 2014. DOI: 10.1002/lsm.22170
- Barrett S. A skeptical look at low level laser therapy. Device Watch. 2016.
- Aetna. Cold laser and high-power laser therapies. 2016.
