Laser Therapy for Elite Athletes

A Major League Baseball PT shares his experiences using deep tissue therapy lasers

Three years ago, when I first started working in professional baseball and began using deep tissue therapy lasers, I would not have imagined writing an article about laser therapy and the impact it's having on treating and rehabilitating elite athletes in the big leagues. Furthermore, back in 2007, I hadn't even considered it as a treatment option when I made the transition to exclusively working with athletes at Athletes' Performance in Phoenix, Ariz.

Yes, the technology has always been intriguing, and the science makes sense, but I didn't think using it would translate into results in the athletes and conditions we see. I have to confess - I was a laser skeptic, but after giving it a chance in both training room and rehab environments, the laser is measuring up, and has become a critical component of our treatment programs.

Skeptical on Modalities

I pride myself in a hands-on, movement-based treatment approach. Because of this, my record would show that I've been a modality skeptic. Consistent results are paramount in order for me to consider a modality.

Since graduating physical therapy school in 2002, I've done my best to debunk the old "PT stereotype" - one that characterizes PTs as being known for non-skilled and passive therapies. I believe this misconception has changed over the last decade, but still somewhat lingers today.

My adverse impression of modalities, in general, is what mostly kept me from considering laser as a treatment option. We are constantly inundated with treatment fads, so laser therapy had the odds stacked against it. Rarely does something "stand up" and become part of our everyday regimen.

Also, the vast misinformation about laser made it difficult. Sifting through the different messages out there was frustrating at times. Depending on which self-proclaimed expert you speak with, there are multiple approaches to "dosing" with laser.

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Based on my experiences, I now subscribe to the simple premise that if you can deliver an appropriate number of joules to target tissue, you will get results. Delivering an appropriate dose of energy to deep structures can be especially challenging, so it's necessary to deliver a lot of energy at the skin surface in order to get an appropriate dose at depth, especially since a lot of the energy is being absorbed by the skin and subcutaneous tissues. I've found that higher-power lasers provide the ability to accomplish this in a reasonable period of time.

Outcomes have been the key to laser therapy becoming an increasingly bigger part of what we do day-to-day, both in the big league training room as well as in our rehabilitation facility in Phoenix. Results are consistent and predictable, which gives us the confidence we need across the board.

Value in Versatility

Not unlike a utility player who's an asset to the team by playing multiple positions, the laser provides great versatility, allowing us to incorporate it into treatment protocols in many different ways. It's effective on both acute injuries and chronic conditions, and we can vary the power settings accordingly.

The flexibility to combine deep-tissue laser therapy with manual tissue manipulation gives us the multipurpose tool we need in the training room, and it's great for myofascial work. In some acute injury cases we even treat a player twice daily with 6 to 8 hours between treatments. The adaptability of contact and non-contact treatment delivery gives us customizable solutions we need for each player's treatment program.

Professor Karel Lewit once said, "He who treats the site of pain is lost." I agree. However, you still need a method to treat the site of pain. We need to be concerned with both structural pathology and functional pathology.

Deep tissue laser therapy is our "go-to" tool to treat the site of pain and injured tissue. When treating large areas, including dysfunctional pain referral regions, the laser is effective and efficient in that our treatment times are reasonable.

Players who use laser for maintenance or as part of their daily or 5-day routine typically say that they immediately feel some relief. They like the soothing warmth they experience during treatment, and they trust it as effective. Athletes are experiencing accelerated healing, especially soft-tissue shoulder strains in pitchers, and low-back soft tissue strains and postoperative cases.

Put Me In Coach

Baseball has a unique schedule - we play almost every day from March until late September, and hopefully into October. Between the constant play and a packed travel schedule, players inevitably get injured and have aches and pains from the demanding nature of the sport. Everyone wants these high-impact players on the field.

Performing at top level is the nature of the profession and it's in the training room that players look for therapies that will speed recovery. Ultimately, the goal is for players to play pain free and without hindrance.

However, in reality, the schedule is grueling and almost all players have something that we're either challenged with reversing or, at least, maintaining the status quo. In either case, laser therapy plays a role and the players support it.

In the training room, players will use the laser daily to help them warm up "tight" or "sore" areas before the game. We're also using it as part of a maintenance program for old injuries or chronic problems. For acute conditions, we use the laser to help reduce swelling, improve microcirculation, and facilitate lymph drainage.

We work in a fast-paced environment - there's no time for lengthy treatments when we have five other players in line. Players have a lot to do before the game even starts, and medical care is just one component of their preparation, so reducing treatment time is critical. The ability to deliver an effective treatment quickly is a principal advantage that keeps the flow of our training room moving.

At our rehab facility, we treat more long-term injuries. With the respite from the player's demanding schedule, we can focus on a rigid treatment program. We treat the injured tissue to facilitate quicker healing and again, treat twice daily if possible. I use the laser before or after soft-tissue or joint work, and have found that it works well to reduce tension and improve blood flow in ischemic areas that have trigger points.

In both the training room and rehab facility environments, deep tissue laser therapy is used to complement our manual therapy and provide faster results.

Looking Ahead

Despite initial skepticism, I've truly gravitated to deep-tissue laser therapy as an approach I can count on. I still don't use a lot of modalities but, in laser, I have something I'm confident in. Fast, consistent results can be a game changer.

Evidence is building, and laser therapy is becoming a standard of care within our organizations and those around us. I expect it to only grow, and to play an even bigger part within rehab in the future.

Steve Smith is head physical therapist for the Los Angeles Dodgers.

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I as well am very skeptical about most modalities. I'd love anyone's thoughts on how the increase in heat and presumably blood flow compares to dry needling, ultrasound, or exercise. If anyone has any thoughts I'd love to hear them.

Nick Rainey,  Physical TherapistAugust 22, 2014
Baltimore, MD


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