WHAT IS LOW LEVEL LASER THERAPY (LLLT)?
Dr. Peter Gruenewald, MD
The term
LASER stands for:
Light Amplification by Stimulated Emission of Radiation
A laser is a device that emits a special form of light. The light is special
because it consists of light waves of a single wavelength, in which all the
waves reinforce one another. It is also called coherent light. Normal
daylight is incoherent light and consists of varying wavelengths of all the
colors of the rainbow, from blue (400 nanometers) to red (750
nanometers).
Clinically studies show that the most beneficially wavelengths for
biostimulation effects are in the red and near infrared region (from 630 to
850nm). Green lasers (532nm) have shown to be effective in the
treatment of some skin conditions (wound healing, ulcers, acne etc.).
In our clinic we use red (630nm) and infrared (740 and 830nm) laser
light.
High Powered Laser
There are 2 types of medical lasers: High Power Lasers and Low Power
Lasers. In summary for high power laser or hot laser the output of laser
energy is between 3000 to 10000 mW (milliwatt). It is usually used to
solidify the bleeding and to cut the tissues, called "laser knife" or also
known as "surgical lasers". In order for a laser to be suitable to be used
as a surgical lasers, it must be powerful enough to heat up the tissues to
temperatures of over 50 degrees C. High Powered Lasers are not used at
our clinic.
Low Power Laser
On the other hand, in low power laser or low level laser, the output is
lower between 1 and 500 mW. The power is low and will not damage the
hydrogen bonds in the tissues, does not cause any change but the
photochemistry effect. Sometimes, low power laser is also called "cold
laser" or "soft laser". For our purposes we also call it "Therapeutic lasers
or low level laser". At our clinic we only use low power lasers.
Clinical Research on Low Level Laser Therapy (Low Power Laser)
For the last 30 years, scientists in Europe, China and the United States
have been researching the clinical uses of lasers.
The research has partly focused on the use of low-level lasers in a process
called photobiostimulation - their ability to stimulate a variety of cellular
functions in a non-thermal (heat) and non-destructive manner. Cold
lasers, as they are called, are now available for use.
Monochromatic light waves produced by laser light are the crucial factor in
photo-biostimulation. Light created by a laser have the ability to
'concentrate' these photons. In physics, the photon is the elementary
particle responsible for electromagnetic phenomena. The photon is the
carrier of electromagnetic radiation of all wavelengths, including visible
light and infrared light, has no resting mass and travels (in vacuum) with
the speed of light.
Photo - Bio Therapy (Light therapy)
When photons are introduced onto the skin, they are absorbed by the skin
and the underlying tissue, triggering biological changes within the body.
The DNA absorbs photon energy, and will be activated by this energy. The
cell's DNA then transmits this new energy to the cell walls by means of a
protein and calcium transfer. Then the cell walls transform themselves
into healthy shapes, allowing the cell to function again at full capacity.
The tissues exposed to light increase blood flow, thus helping to carry
vitamins and nutrients into the area where they are needed most, with no
damage to surrounding tissues.
As a result of increased blood flow, toxins and waste by-products are
taken away from the tissues. Light therapy is also called "photo therapy".
For instance, visible red light has been shown to effect positive changes at
a cellular level on living tissues. It is very beneficial in treating problems
close to the surface, whereas infrared light penetrates the skin better and
reaches deep tissues and blood vessels.
Characteristics of Lasers Light

Laser light is monochromatic. Which means all the energy is
essentially within one wavelength or colour, whereas normal light
produced by a light bulb or lamp or from the sun produces a broad
spectrum of light and energy waves. In effect the most beneficial
wavelength with bio-stimulating impact are around the Red to near
Infrared Red Spectrum (630 nm to 850 nm).

Laser light is coherent, sync and in order. For example when
soldiers march, they move coherently, on the other hand a crowd in
riot moves incoherently or is very chaotic and not in sync with each
other (disorderly). The main reason laser light is coherent is
because laser light is usually monochromatic.

Laser light is collimated which means it is a tight beam of light
energy that spreads or diverges only a little at great distances
(concentrated and high intensity), while a light bulb loses its
brightness very quickly with distance (spread and diffuse).
These characteristics make laser energy a truly unique form of light
energy.
Therapeutic Lasers
Therapeutic Lasers are used for bio-stimulation. In low power lasers, the
output is between 1 and 500 mW. This power is low, will not damage the
hydrogen bonds in the tissues and does not cause any change but the
photochemistry effect.
Bio-stimulation Effects of Low Level Laser Therapy
Low Level Lasers supply energy to the body in the form of photons. This is
in contrast to electricity, which supplies electrons, and in contrast to
acidity and alkalinity, which is based on protons. It is becoming apparent
that the body signals within itself in protons, electrons and photons. The
wavelength of photons determine their effect:

Visible light is transmitted through the skin's layers (the dermis,
epidermis and the subcutaneous tissue or tissue fat under the skin)

Light waves in the near infrared ranges penetrate the deepest of all
light waves in the light spectrum.
Low Level Lasers "energize" the tissue since light is a form of energy. The
term for this is photobiostimulation. The most common example of light
converting into chemical energy is photosynthesis, where plants transform
light into chemical energy.
In a similar way, laser penetrates into soft tissue and increases the action
of Adenosine Triphosphate (ATP), a molecule that is a major carrier of
energy from one reaction site to another in all living cells. By doing so,
laser light increases the energy available to cells so they take in nutrients
faster and get rid of waste products.
Effects of Laser on Cells
Low Level Laser Therapy can have very positive impact on cells and organ
tissues, namely:

Increased Arterial Micro- Circulation: Both vasodilatation and
regeneration of blood vessels.

Increased Venous and Lymphatic Flow: Results in reduced oedema
clinically.

Decreased Inflammation in Tissue:
Marked increase in the number of leucocytes that participate in
phagocytosis.

Faster Rate of Cell Division

Faster Re-growth of Epithelium

Faster Rate of Collagen Formation

Faster Rate of Wound Healing

Decreased Scar (Keloid) Formation

Increased Energy of the Tissue - Increased ATP in the cellular
mitochondria. - There is activation of RNA- and DNA production

Stimulation of Hair Growth
Trans-dermal, non-invasive systemic laser therapy (TDSLT)
is applied through the skin over a large blood vessel (artery and vein). The
infrared laser light irradiates the blood. It exposes the blood to low level
energetic, but highly mono-chromatic and coherent light (coloured light
therapy of the blood). This strongly bio-simulative treatment triggers a
number of health-promoting changes within the blood and the cellular
metabolism of the whole organism.
Effects of Laser Blood Irradiation Therapy / Trans-dermal Systemic Laser
Therapy (TDSLT) on the organism:
…heals and increases functioning efficacy of the vascular, immune and
respiratory system:
Currently the methods of laser and non-laser (incoherent monochromic, narrowband or broadband) light blood irradiation therapy - the methods of photohaemato-therapy - are widely applied in the treatment of different pathologies.
Direct intravenous and extracorporeal (with red, UV and blue light) as well as
non-invasive transcutaneous (with red and infrared light) irradiation of blood are
used. Unlike the treatment mechanisms of local laser therapy, the medical effects
of photo-haemato-therapy methods are determined by predominance of systemic
healing mechanisms above the local ones, increasing the functioning efficacy of
vascular, respiratory, immune, other systems and organism as a whole.
… normalisation of parameters of hormonal, immune and reproductive
systems
The method of laser blood irradiation was developed in 1981 by the scientists
E.N. Meshalkin and V.S. Sergievskiy. Originally the method was applied in the
treatment of cardiovascular pathologies. Some authors reported that the
treatment possibilities of the method are very large and include the improvement
of rheological characteristics of the blood and microcirculation, normalisation of
parameters of hormonal, immune, reproductive and many other systems.
…
antitoxic,
bio-stimulative,
immuno-corrective,
anti-allergic,
antibacterial, antiviral, analgetic, anti-inflammatory
The
laser
stimulates
the
immune
response
of
the
organism,
activates
erythrogenesis and improves deformability of erythrocyte membranes, has anti-
hypoxic activity on tissues and general antitoxic influence on the organism at
different pathological processes. Our laser is used for its bio-stimulative,
analgetic, antiallergic, immunocorrective, antitoxic, vasodilative, antiarrhythmic,
antibacterial, antihypoxic, spasmolytic and anti-inflammatory.
…boosts the cellular part of your immunity, decreases concentrations of
microbes in the abdomen, activate microcirculation
The
laser
activates
non-specific
mechanisms
of
anti-infectious
immunity.
Intensifying of bactericidal activity in the serum of the blood and system of the
complement, reduction of the degree of C - reactive protein, level of average
molecules and toxicity of plasma, increasing the content of IgA, IgM and IgG in
the serum of the blood, as well as decreasing of the level of circulating immune
complexes have been proved. There are studies on boosting effects of the laser
on the cellular part of immunity (N. F. Gamaleya et al., 1991). Under influence of
the
laser,
the
phagocytic
activity
of
macrophages
markedly
increases,
concentration of microbes in the abdomen of patients decreases, reduction of
inflammatory exhibiting of disease, activation of microcirculation are detected.
The medical effect of the laser is stipulated by its immuno-corrective activity by
normalisation of intercellular relationships within the subpopulation of Tlymphocytes and increasing the amount of immune cells in the blood. It elevates
the function activity of B-lymphocytes, strengthens the immune response,
reduces the degree of intoxication and as a result improves the general condition
of patients (V. S. Sergievskiy et al., 1991).
…increases energy and normalises tissue metabolism, activates ATP–
synthesis and energy formation in cells, increases oxidation of energycarrying molecules
The laser promotes improving the rheological properties of blood, rising fluidity
and activating transport functions. That is accompanied by increasing the oxygen
level, as well as decreasing the carbon dioxide partial pressure. The arteriovenous difference of oxygen is enlarged, that testifies the liquidation of a tissue
hypoxia and enrichment of the oxygenation. It is a sign of normalisation of tissue
metabolism. Probably, the basis of the activation of oxygen transport function is
the
influence
on
haemoglobin
with
transforming
it
in
more
favourable
conformation state. The augmentation of the oxygen level improves metabolism
of the organism tissues. In addition, the laser irradiation activates the ATP
synthesis and energy formation in cells (A. S. Krjuk et al., 1986).
Application of the laser in cardiology has shown that procedures have an
analgetic effect, show reliable rising tolerance of patients towards physical
tolerance test, elongation of the period of remission. It was proved that the laser
reduces aggregation ability of thrombocytes and activates fibrinolysis, which
results in peripheral blood flow velocity increasing and tissues oxygenation
enriching. The improvement of microcirculation and utilisation of oxygen in
tissues as a result of the laser is intimately linked with positive influence on
metabolism: higher level of oxidation of energy-carrying molecules of glucose,
pyruvate, and other substances.
… unblocking of capillaries, positive pre- and post-surgical effects
The improvement in microcirculation system is also stipulated by vasodilatation
and change in rheological properties of blood as a result of a drop of its viscosity,
decrease of aggregation activity of erythrocytes due to changes of their
physicochemical properties, in particular rising of negative electric charge. Finally
the activation of microcirculation, unblocking of capillaries and collaterals,
improvement of tissue trophical activity and normalisation of a nervous
excitability take place (N. N. Kapshidze et al., 1993).
TDSLT is recommended to apply before surgical operations as preparation for
intervention, as well as in the postoperative stage, because the laser irradiation
of blood has not only analgetic effect, but also spasmolytic and sedative activity.
…increases functional activity of the hypothalamus and positive effects
on the activation of energetic, metabolism, immune and vegetative
responses.
In order to explain the generalised and multifactor effects of the laser, its positive
influence practically on all tissues and functional systems of the body, clinical
effectiveness for the treatment of different diseases, some authors mentioned
that the improvement of microcirculation after TDSLT is detected in all structures
of central nervous system, but this improvement is most active in the
hypothalamus, which has a highly developed vascular system. The capillaries of
the hypothalamus are remarkable for high permeability for macro-molecular
proteins, which should even more amplify the influence of the irradiated blood to
subthalamic nuclei. So it is supposed, that TDSLT increases the functional activity
of the hypothalamus and the whole limbic system, and as a result the activation
of energetic, metabolism, immune and vegetative responses.
Summarising, systemic effects and indications of LLLT are:

Increased energy levels (consuming and exhausting disease)

Modulation of the immune system (auto-immune disease, immune
deficiency, allergies)

Analgesic effect (increased endorphin release)

Anti-inflammatory effect

Lowering of blood pressure (peripheral vasodilatation)

Lowering of serum cholesterol levels
Mitochondria
Our body is made up of cells. In each cells there is a Power House
(Mitochondria) in the cytoplasm, whereby the cells’ energy is produced for
the daily functioning of our body. ATP functions are the carrier of such cell
energy.
Mitochondria contain enzymes that help to convert food material into
adenosine triphosphate (ATP), which can be used directly by the cell as an
energy source. Mitochondria tend to be concentrated near cellular
structures that require large inputs of energy, such as the flagellum,
which is responsible for movement in vertebrate sperm cells and singlecelled plants and bacteria.
Adenosine triphosphate (ATP)
ATP is the universal carrier of chemical energy in the cell and coined the
expression "energy-rich phosphate bonds".
Adenosine Triphosphate or ATP is the main usable energy source found in
all
living
things.
ATP
fuels
most
cell
activities,
including
muscle
movement, protein synthesis, centriole movement during cell division (see
Meiosis; Mitosis), and nerve signal transmission. Most living things need
to store energy—plants cannot photosynthesize at night and animals do
not spend all of their time feeding, yet the demands of the cells for energy
are never-ending. ATP is believed to be the main energy-providing and
energy-storing molecule for all processes in all cells.
ATP Energy Release
When energy is needed in the cell, the third phosphate bond can be
broken in a hydrolysis reaction catalyzed by the enzyme ATPase. The
result of this hydrolysis is adenosine diphosphate (ADP) and a free
inorganic phosphate group (Pi). About 34 kJ (7 kcal) of energy are
released per mole of ATP hydrolyzed. Some of this energy is lost as heat,
but some is also used for energy-requiring biological activities. The
release of two phosphate groups from ATP by the enzyme adenyl cyclase
forms AMP (adenosine monophosphate), a nucleotide component of
nucleic acids, the material of DNA; this enzyme is important in many of
the body's reactions.
Production of ATP
The breakdown of ATP into ADP and inorganic phosphate is a reversible
reaction. Usually, ADP quickly regains the third phosphate unit through
the action of cytochrome, a protein that builds it up by using food energy.
Catabolic reactions—for example, the breakdown of glucose during cellular
respiration in both plants and animals—can be coupled to the synthesis of
molecules of ATP from ADP and phosphate groups. This reaction is also
catalysed by ATPase. Energy is thus stored in the ATP molecule, ready for
use when required in anabolic reactions (see Metabolism).
In vertebrate muscle and brain cells, excess ATP can join with creatine to
provide a reserve energy store.
The main site of ATP production in the cell is in the mitochondria, where
the ATPase enzyme is sited on the folded inner membranes. The process
by which ATP is made is universal, appropriately for the molecule believed
to be the universal energy supplier for all living cells. Plants produce ATP
by
direct
utilization
of
the
energy
in
sunlight,
that
is,
through
photosynthesis.
Low Level Laser Therapy and ATP
As explained in Biostimulation Effects of LLLT, Low Level Lasers Therapy
"energize" the tissue since light is a form of energy. The term for this is
photo-biostimulation. The most common example of light converting into
chemical energy is photosynthesis, where plants are fed via light
converted into chemical energy. In a similar way, laser penetrates into
soft tissue and increases the action of Adenosine Triphosphate (ATP), a
molecule that is a major carrier of energy from one reaction site to
another in all living cells. By doing so, laser light increases the energy
available to cells so they take in nutrients faster and get rid of waste
products.
No Radiation Risks
Different wavelengths have different energy levels. High Energy Photons
(gamma rays, X-rays and Ultra-violet light) can "break" (ionize) atoms
and break up chemical bonds in molecules, while Low Energy Photons
(radio waves, microwaves, infrared light and visible light) do not cause
ionization, but only excitation and heating.
Low Level Laser or Soft Lasers often use visible light - wavelengths in the
region of 600 nm to 830 nm, around in the Red and Near Infrared
Spectrum, which is totally safe and harmless to our organ tissues, cells or
skin. Such wavelength is even suitable for people who are oversensitive to
light (photo-sensitive or photo-allergy), and usually these people can even
tolerate red light from a laser yet cannot be exposed to even the light of a
candle.
No Cancer Risk
Can laser therapy cause cancer? The answer is NO. More than 2000
clinical studies have been conducted on the use of LLLT and in all of these
studies NO mutational effects have ever been observed resulting from
therapy with wavelengths in the Red or Infrared red range, in doses used
within laser therapy.
The effects of laser therapy on cancer cells in the test tube have been
studied, and it was observed that they could be stimulated by laser light.
However with respect to a cancer in the living organism, the situation is
rather different. Experiments on rats shown that small tumours treated
with laser therapy may recede and completely disappear, although the
laser treatment had no effect on the tumours over a certain size [1]. The
local immune system is probably stimulated more than the tumor [2] [3]
[4].
[1] Saldo I et al. Effcets of GaAs-lasers combined with radiotherapy on murine
sarcoma depends on tumor size. Lasers in Surgery and Medicine. 1989; Suppl
1:40.
[2] Dima F V et al. Dose related immunological and morphological changes
observed in rats with Walker - 256 carcino-sarcoma after photodynamic therapy:
a controlled study. Laser Therapy. 1991;3(3):159-168
[3] Skobelkin OK et al. Preoperative activation of the immune systems by low
level laser therapy (laser therapy) in oncologic patient: A preliminary report.
Laser Theraoy. 1991;3(4):169-176
[4] Mikhailov V A et al. Investigations on the influence of low level laser diode
laser irradiation of the growth of experimental tumors. Laser Therapy. 1993;5(1):
33-38
The situation is similar for bacteria and viruses in cultures. Laser light in
certain doses stimulates the growth of bacteria and viruses in cultures;
while a bacterial or viral infection within the human organism is cured
much
faster
after
the
right
treatment
with
laser
therapy
(anti-
inflammatory and immune modulating effect).
In summary LLLT is non-ionizing, and will not cause cancer, damage to
skin or damage to tissues or DNA.
For safety and legal reasons, we do not apply laser in cancer or sarcoma
areas, but treat symptoms associated with malignant diseases, such as
weakness, fatigue and poor immunity through trans-dermal systemic laser
therapy TDSLT (palliation – symptom relief).
Risks of Eye Injury
Risk of injury to the eyes has always to be considered when handling laser
devices. For this reason lasers were divided into five categories (Class 1,
2, 3A, 3B and Class 4) according to their potential to damage the eyes
and other tissues.
Classes 1 to 3A are considered safe, whereas Class 3B involves a certain
risk and Class 4 is a definite risk. Class 4 lasers are usually strong
industrial lasers and surgical lasers capable of generating such heat for
cutting and burning.
At our clinic we only use medical lasers in the category of 1M and 3B.
These lasers can damage the retina, if the eye is directly or indirectly (by
reflection from a smooth surface) exposed.
Protective goggles have to be used when applying laser therapy at our
clinic and at home.
Research literature: please see web link on LLLT page