Indication Inflammation Neuralgia/Neuropathy Pain, acute Dosage 2-5 J/cm2 10-12 J/cm2 6 J/cm2 Frequency 5000 Hz Continuous Continuous Pain, chronic 12 J/cm2 Continuous Soft tissue injury, acute 4-8 or 2-8 J/cm2 100 Hz, suggested to increase to KHz once acuity decreases Soft tissue healing Fracture healing Soft tissue Injury, chronic Tendonitis/Bursitis Trigger Points 5-16 J/cm2 5-16 J/cm2 12 (10-20) J/cm2 continuous when improves Continuous Continuous Continuous Wounds, Acute 2-10 J/cm2 5000 Hz 5-12 J/cm2 (Baxter Continuous 2003 study 10-12 J for recalcitrant trigger points) 8 J/cm2 700 Hz Wounds, Chronic 1-6 J/cm2 Continuous Arthritis, acute Arthritis, Chronic Lymphedema Joint Disorders, chronic 2-4 J/cm2 4-8 J/cm2 1.5 J/cm2 Finger: .5 J/cm2 Knee: 6 j/cm2 Spine: 12 J/cm2 Continuous Continuous Continuous Continuous Application Over inflamed Tissue Along course of nerve Over pain or trigger point Over pain or trigger point Over lesion Frequency 3x/wk Daily or QOD for 2-3 wks 3x/wk Over lesion Over lesion Over lesion 5x/wk 5x/wk 3x/wk Over inflamed tissue Over trigger point 3x/wk 3x/wk In and around wound bed In and around wound bed Over Joint surface Over Joint surface Over Lymphedema Over Joint surface 5x/wk 3x/wk Up to 3x/day or 5 days/wk (varies in literature) 2x/wk minimum 3-5x/wk 3-5x/wk 3-5x/wk 3x/wk Use 600-700 nm applicator for superficial lesions, 700-1000 nm applicator for deeper lesions in general General Treatment Protocols for Laser The above and below information is from: Gallo, Joseph A Low Level Laser Therapy: Clinical Mentoring Series. 2006 and Cameron, 2014 Contraindications to laser: over eyes, cancer, photophobia, over the uterus in pregnancy, when using photosensitizing medication, hemorrhage, over endocrine glands; possibly over growth plates ***Make sure to wear protective eyewear***** Apply firm contact to the surface applied to as tolerated (right angle to the tissue), increase dosage as inflammation subsides Note that high dosages in chronic conditions may temporarily exacerbate symptoms When treating trigger points studies have suggested that the treating the center of the trigger points with the single diode and then the cluster applicator may result in decreased pain. You are treating a patient with post herpetic neuralgia due to shingles in the L3 dematome. Apply a laser treatment to this patient. Record the settings you would use. What are the contraindications to laser? What other treatment would work for this patient? You are treating a patient with an infected ulcer on their sacrum, which is a Stage III. Apply a light treatment to this patient. Record the settings you would use. What are the contraindications to light? What other treatment would work for this patient? You are treating a patient with acute trigger points in their lumbar spine area. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient. You are treating a patient with decreased peripheral circulation in their LE’s with a lower extremity wound. Apply a light treatment to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with chronic trigger points in their lumbar spine area. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with and acute medial knee sprain. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with chronic wrist pain on the palmar aspect of the wrist. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with lateral epicondylitis on the R elbow. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with supraspinatus tendonitis. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with osteoarthritis in their knee for pain. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with an acute dehisced abdominal wound that is not infected. Apply laser to treat this patient. Record the settings you would use. What other treatment would work for this patient? You are treating a patient with peripheral neuropathy in their LE’s with a lower extremity wound. Apply a light treatment to treat this patient. Record the settings you would use. What other treatment would work for this patient?
