Laser therapy is not a new topic in the physical therapy world. You have only to search ADVANCE's archives to know that. However, its status as a hot topic in rehab medicine does not mean that laser therapy is the most commonly used modality by therapists or, for that matter, commonly understood by clients.
Laser therapy was not approved by the FDA until 2003, explained Daniel Oest, PT, MPT, owner and director of Hicksville Physical Therapy in Hicksville, NY. As a result, it isn't as widespread in practice in the United States as it may be in, for example, Europe. In fact, Oest was one of the first PTs to use the cold laser, when he invested in it seven-and-a-half years ago and the very first PT on Long Island to begin using the higher-powered, so-called "hot laser" two-and-a-half years ago.
Outside of therapists, Oest estimated that the majority of patients he treats with laser therapy have never heard of the modality prior to his initial presentation of treatment. "They only know what laser therapy is if they find me on the Internet," he said. "Most of them don't; maybe about a quarter know [what laser therapy is]."
With that in mind, ADVANCE explored with Oest as well as Dave Everett, MPT, physical therapist and owner of Laser Integrated Physical Therapy Inc. in Santa Barbara, CA, why laser therapy has been slower to skyrocket into practice-and why patients may be hesitant to move forward with this form of treatment.
To best understand the perspectives of other PTs and patients, therapists must first understand laser therapy. Laser therapy is a modality of physical therapy in which a laser is used to treat, most commonly inflammatory and muscular conditions such as tendinitis, tennis elbow, sciatica, volleyball shoulder, neck injuries, bursitis and muscular strains.
When administering laser therapy, there are two types of possible lasers: hot and cold. "The basic difference is intensity," Oest explained. "You gauge the intensity by how quickly it can emit the laser energy. With a cold laser, you have to hold it for about two minutes to emit 12 joules of energy. The hot laser can emit the same in about one second."
Everett expanded on the difference between the two, describing what the energy does: "Higher-powered or hot lasers work by utilizing thermal properties. Lower-level lasers, or cold lasers, work by activating enzymes, which in turn promote cellular regeneration. Pain reduction is achieved via endorphins being released." Essentially, the laser encourages the body to heal and, subsequently, the presenting symptom-typically pain-is lessened.
Patients may receive laser therapy any number of times, depending on the severity and type of ailment. It is uncommon that an individual receives only one session but "90 percent will feel a difference after the first session," Oest said of the hot laser.
Further, laser therapy is almost always used in conjunction with other modalities, such as mobilizations, soft-tissue manipulation and therapeutic exercises, Everett described.
And the results? "Remarkable," Oest said. "I consider it the most effective physical therapy modality out there."
If laser therapy is so remarkable, however, why is it still relatively new to the field in terms of active use in America?
When it comes to physical therapists, part of the answer comes down to payment. "The way it's covered by insurance-well, it's not," Oest said. "When I use the cold laser, I do it in conjunction with other physical therapy modalities and don't bill for it. If patients are not getting the [desired] results, I switch to the hot laser."
Oest does bill the patient for this, as the equipment is considerably more expensive. And of course, there is the fact that other modalities are known to be effective by both therapists and patients, such as ultrasound therapy.
"Ultrasound was the standard modality that people used when I was going through my training," Everett said. "People are comfortable with it because it is so readily available."
There is a lot to be said for that comfort, particularly because when patients worry, they're less likely to be open to lesser-known therapies. So what exactly are PT patients thinking about laser therapies? What are their concerns and beliefs about the modality?
"Usually, the biggest concern patients have is, 'What are the side effects?'" Oest said.
Fortunately, Oest is able to tell his patients that laser therapy has minimal, if any, side effects. "The only thing I've seen," he reflected, "is with the high powered laser ... sometimes the inflammation temporarily increases before it decreases."
And, while laser therapy does emit a form of radiation, the concerns from that are negligible, Oest explained. "I actually called the company [that manufactured the lasers used at Hicksville] and asked them myself. The owner of the company told me, 'Put it this way: If you measured how much radiation comes from the alarm clock next to you while you sleep at night, administering the hot laser is nothing.'" And as Oest noted above, the hot laser emits more energy than the cold laser, so "nothing" is an even more accurate descriptor of radiation when it comes to the latter.
"One concern some patients come in with is thinking that a laser has to be a cutting tool or something for surgical procedures," Everett added. "In this case, my cold laser has no thermal or cutting properties and could never damage tissue even when used for extended periods."
On the flip side of these concerns are the people who are too confident in laser therapy's abilities. "I've had a few patients who come in and want the pain or condition cured instantly with the first treatment," Everett recalled. "In rare occurrences this has happened, but this expectation becomes a burden."
Similarly, Oest has had a few patients-typically those who have come to him specifically for laser therapy-who want laser therapy to alleviate their pain without necessarily considering the source of the pain. "I don't use laser therapy as the sole treatment," Oest said, agreeing with Everett. "I look at the causes, determine how to treat those and then use any modalities, such as laser therapy." Thus, it can be difficult when a patient arrives expecting a quick laser treatment and nothing more.
With these concerns, hesitations, misbeliefs and challenges in mind, what can be done by physical therapists to help move laser therapy into the realms of ultrasound therapy? How can laser therapy become something readily available that clients confidently accept as effective treatment?
For physical therapists who don't yet use laser therapy, the answer can be easy. "See if you can get a demo unit," Oest suggested. "Do your research to see which cold laser you would want to use, and ask to borrow the unit for a week. Pick a certain number of patients already coming to therapy [and administer the treatment]. See if the progress is getting better over that one week. I'm pretty confident if they do that, then they'll see positive results."
For patients, physical therapists have two things to do: explain and demonstrate. "I try to explain up front what laser integrated physical therapy is all about," Everett said. "It is what you might define as physical therapy, which includes an evaluation, education, therapeutic exercise and other techniques, with laser therapy used to augment or assist in the healing process."
Everett also demonstrates the laser on himself, aiding the explanation by illustrating the ease with which laser therapy is administered.
"Explaining the difference between a hot and cold laser usually alleviates most patient concerns," Everett said. "A quick demonstration on my hand [as well] with the light, showing how gentle it is, usually alleviates any further concerns."
Once treatment has begun, both Oest and Everett feel that the modality can speak for itself.
"Overall, there are more therapists adopting the cold laser now, because they are seeing the effects," Oest explained, which is doubly beneficial because it allows more therapists and patients to witness these effects as well.
"Seeing the results from my work using the laser has been very rewarding," Everett said. "It is especially rewarding to have a patient come into my practice doubting he will have any results and leaving with a completely different outlook, being a 'believer.'"
Sue Coyle is a freelance writer in Bucks County, PA. Contact her at firstname.lastname@example.org