Low-intensity laser or light therapy is a system of using light to effect healing. It’s a three-part method of using red light first, then the deeper penetrating infrared light, and lastly laser. The home unit uses only the first two for safety reasons. Dr. Fred Kahn, who developed low-intensity laser therapy, has been finetuning over the past several years a three-part red-infrared-laser individualized concussion protocol that is used on the cervical spine (neck) and back of the head below the occipital bone. A Korean group is developing a protocol of using a helmet that reads EEG to also deliver red light via LEDs. And American companies use fairly constrained near-infrared light through the nose or over the head in a non-individualized device or infrared and red lights in standardized protocols.
Research shows that individualized low-intensity light therapy on the cervical spine, including the brain stem and cerebellum, “facilitates ATP production providing the necessary energy for healing and repair of tissues.” It may also alleviate inflammation and pain and may promote neuron regeneration. [Fred Kahn, M.D. Concussion – A Therapeutic Solution and the Presentation of Two Classic Case Profiles.]
This passive method of healing requires the person to simply lie there. Then rest in between therapy and the activity you’re trying to improve.
Principles of Treating the Brain
Three principles guide most techniques of neurostimulation or brain training. Most take time to see results. CES works within six minutes.
The first principle is to reboot, repair, or rewire the brain.
The second principle is to train the brain to the edge of its ability through intensity and frequency of training over time with rest breaks. When training begins to become easier, increase the difficulty so as to continue to train to the edge of ability. Reassess regularly through feedback and progress discussions with the client and by using the same objective tests at the end of the treatment cycle. Exhaustion is a given, and so build in rest in between brain training sessions. Research shows learning works best with breaks in between.
The third principle is to engage in desired activity during or immediately after neurostimulation in order to stimulate rewiring of the neural networks involved in that activity.
Low-Intensity Laser Therapy and the Principles
Low-intensity laser therapy (LILT) meets the first principle by repairing the brain. LILT pushes the edge of ability as in the second principle by how much cellular activity the body and brain can endure. Although generally you can’t do anything during therapy, you can rest afterward and then do the activity or do LILT about 15 minutes or so before the activity. It depends on whether the protocol chosen energizes or not, and that can be individual or change over the course of treatments.
The specialist will begin with minimal therapy to allow time for you to adapt to it, while at the same time requiring frequent clinic visits. Then they will gradually increase the prescription while decreasing frequency of clinic visits. For some clients and specific therapies, they may prescribe a home unit with standardized protocols developed over years of research and clinical experience. For others, they may prescribe a unit that includes individualized prescription protocols. And for others still with complex concussion protocols, in order to maintain safety and efficacy, they may prescribe clinic visits only.
What Is Low-Intensity Laser Therapy
Pain is a symptom of pathology. Low-intensity laser therapy doesn’t target pain; it targets the cause of the pain.
Laser Therapy, also known as Low-Intensity Laser Therapy (LILT), Photobiomodulation, Cold Laser, etc. is a light-based technology proven to be highly effective in the treatment of musculoskeletal problems, and wound healing.
The technology is non-invasive, non-toxic, and is currently utilized in many countries world-wide.
BioFlex Laser
Superluminous and laser diodes placed against the skin via specially designed arrays and laser probes send photons into the skin and through to deeper layers of fat, muscle, and bone. Cell membranes and intracellular molecules in these tissues selectively absorb the photons. The photons then initiate a cascade of physiological reactions that restore normal cell structure and function, effecting healing of traumatized and diseased tissue. The diodes do not burn the skin nor produce significant tissue temperature changes.
LILT initially causes the body to produce beta-endorphins, which controls pain. It increases cortisol production, which alleviates the stress associated with trauma.
Over time, LILT stimulates mitochondria, the little engines that power our cells. Increasing mitochondrial activity results in more cells being replicated to replace, repair, and regenerate abnormal cells. In concert with this activity, LILT causes the cells to increase output of ATP (adenosine triphosphate), which in turn improves cellular metabolism. With concussion, ATP drops, and so a treatment modality that increases ATP will both help with cellular repair and energy levels.
LILT motivates cells to produce much more DNA — the protein building blocks of skin, fat, muscle, bone, nerves, and so on. And LILT elevates serotonin and acetylcholine levels. Serotonin modulates mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vasoconstriction. Better levels of serotonin leads to improvement in these areas. Acetylcholine is the parasympathetic nervous system’s main neurotransmitter. The parasympathetic arm of the autonomic nervous system calms the body, contracting smooth muscles, dilating blood vessels, increasing bodily secretions, and slowing heart rate. Stress from brain injury increases the sympathetic arm of the autonomic nervous system, and so rebalancing by increasing parasympathetic activity improves stress levels and so reduces the deleterious effects of sympathetic overactivity. And like most neurostimulation therapies, LILT increases blood flow. Improved blood flow will both provide nutrients and take away waste, in addition to all the other benefits of better blood flow.
LILT over time eliminates or mostly eliminates the symptoms of tissue damage or disease, including pain. Results will not be as good for brain injury that’s been left untreated for years, but I’ve had significant, life-changing results nevertheless. And it stimulates the body’s natural healing, the immune system. LILT is approved for use for musculoskeletal conditions and wound healing. It’s still being investigated clinically for cosmetic (aging), skin, and brain such as concussion, Alzheimer’s, and so on.
photons motivate cells to replace, repair, and regenerate themselves, to heal at source
The Procedure
Assessment
The specialist will gather together test results that you may have had done elsewhere and a history. They will examine you physically to determine range of motion and strength and locations of pain. They may order further tests like X-rays or MRIs to determine conditions such as osteoarthritis that may be in their nascent stages.
Traumatic brain injury like concussion usually includes damage to muscles, ligaments, and perhaps skin and bone. It’s important to treat these areas as much as the brain, and LILT is significantly more effective in healing such damage than physiotherapy, acupuncture, or other modalities, I’ve found. Brain injury can impair movement, and scarring from inadequate healing of muscle tissues impedes daily activities. Chronic pain usually sets up. And so even if you don’t wish to try concussion LILT therapy, it’s still effective for the accompanying physical problems.
The Results Point to What to Treat
LILT is prescribed. Think of the red- and infrared-diode array as a tablet, and the light the array emits as the ingredients in the tablet. The specialist will use their knowledge of LILT combined with your test results to determine the ingredients or parameters of the light emitted by the arrays and laser probes.
The parameters comprise frequency in Hertz; duty cycle or width of the pulse, the percentage of time the light is on; power density in mW/cm2, that is, the amount of light delivered over the treated area; energy density in J/cm2; duration of the treatment, usually a few minutes; and the waveform, square, sine, or triangle. You can see that the specialist needs to understand the physics of light and its bioactivity just like physicians need to understand biochemistry in order to prescribe chemical-based medicines.
The Treatment
At the clinic, the technician administering the prescribed treatment will input your prescriptions into a computer. For the first treatment, they will show you the array with the superluminous red and infrared diodes. And they will turn it on briefly to demonstrate that it’s safe to touch and you can see what the lights look like. Since the array does warm up, this step will reassure you that the lights will not burn you. They will then show you what the laser probes look like and how they’re applied to the skin but will not turn them on because lasers damage the eyes.
Next, you’ll be asked to lie down, either face up or face down with supportive pillows and your face in a face holder like a massage table. Once they’ve adjusted pillows and holder to your comfort level and placed over you a sheet or blanket, they’ll place the array(s) where the specialist has prescribed. (They may treat multiple areas at the same time.) They may place fabric-covered weighted materials over the array(s) to ensure good contact between the diodes and skin without causing undue pressure. Beeps will indicate when the arrays switch from red to infrared and when the treatment cycle ends.
The technician will remove the array(s) and hand you a pair of green-lensed glasses to protect your eyes from the laser probe. I recommend keeping your eyes closed as an extra precaution because with brain injury you neve know what stupid thing you could do. For about 10 seconds at a time, they will place the probe(s) on the main area of damage or pain, to the relevant nerve roots that exit the spinal cord, over the spinal cord, trigger points, and right over affected joints. They will move the probe to the next area or root and back again. For the concussion protocol, they’ll place the probe(s) on either side of the spine just underneath the skull bottom and aim up as well as over the spine, muscles, and/or painful vertebrae (from whiplash).
At the end of treatment, they’ll offer heat and time for rest. Like with brain biofeedback, food, rest, and water is essential. Fatigue is the main “side effect.” Fatigue comes from healing. The more trauma, the more cellular activity LILT will stimulate and thus the more energy your cells will demand. And so the specialist has to take a cautious approach to ensure they don’t stimulate too much activity all at once. It requires patience when you have a lot wrong and want it all healed right away. However, the healing can be dramatic and/or complete.
A Caveat
Clinical practice shows LILT does not cause cancer. However, by stimulating cellular activity and improving blood flow, the current approach with respect to cancer is that LILT could stimulate tumour growth. Research is only just beginning to determine if that’s true or not. So responsible specialists will advise against using it in any areas close to a tumour or to not use it at all.
Research into using LILT to heal lymphedema and mouth sores from chemo has had promising results.
References
Javad T. Hashmi, Ying-Ying Huang, Bushra Z. Osmani, Sulbha K. Sharma, Margaret A. Naeser, Michael R. Hamblin. Role of Low-Level Laser Therapy in Neurorehabilitation. PM R. 2(12 Suppl 2): S292–S305. Dec 2010. doi: 10.1016/j.pmrj.2010.10.013
Margaret A. Naeser, Anita Saltmarche, Maxine H. Krengel, Michael R. Hamblin, and Jeffrey A. Knight. Improved Cognitive Function After Transcranial, Light-Emitting Diode Treatments in Chronic, Traumatic Brain Injury: Two Case Reports. Photomedicine and Laser SurgeryVol. 29, No. 5. May 2011. https://doi.org/10.1089/pho.2010.2814
Asli Demirtas-Tatlidede, Andrew M. Vahabzadeh-Hagh, Montserrat Bernabeu, Jose M. Tormos, and Alvaro Pascual-Leone. Noninvasive. Brain Stimulation in Traumatic Brain Injury. J Head Trauma Rehabil. 27(4): 274–292. Jul 2012. https://dx.doi.org/10.1097%2FHTR.0b013e318217df55
Margaret A. Naeser, Ross Zafonte, Maxine H. Krengel, Paula I. Martin, Judith Frazier,
Michael R. Hamblin, Jeffrey A. Knight, William P. Meehan III, and Errol H. Baker. Significant Improvements in Cognitive Performance Post-Transcranial, Red/Near-Infrared Light-Emitting Diode Treatments in Chronic, Mild Traumatic Brain Injury: Open-Protocol Study. Journal of Neurotrauma 31:1008–1017. June 2014. DOI: 10.1089/neu.2013.3244
Margaret A. Naeser, and Michael R. Hamblin. Traumatic Brain Injury: A Major Medical Problem That Could Be Treated Using Transcranial, Red/Near-Infrared LED Photobiomodulation. Photomedicine and Laser Surgery Volume 33, Number 9. 2015. https://doi.org/10.1089/pho.2015.3986
Maria Gabriela Figueiro Longo, Can Ozan Tan, Suk-tak Chan, et al. Effect of Transcranial Low-Level Light Therapy vs Sham Therapy Among Patients With Moderate Traumatic Brain Injury. A Randomized Clinical Trial. JAMA Netw Open. 3(9):e2017337. 2020. doi: 10.1001/jamanetworkopen.2020.17337
Low-intensity laser therapy certification and webinars: https://bioflexlaser.com/events