Musculoskeletal pain is the number one reason for people to miss days at school or work. Many interventions for decreasing pain are over the counter analgesics, non-steroidal anti-inflammatory medications, cortisone injections, narcotics and opiate pain medication and muscle relaxers prescribed by medical doctors, and finally surgery. Chiropractic is making a great impact as a non-invasive means of decreasing or eliminating musculoskeletal (MSK) pain by manipulating soft tissues and joints of the musculoskeletal system to help patients recover from MSK pain from overuse and underuse injuries, personal and car accident injuries, and acute and chronic pain. Chiropractors often use Low-Level and High-Level Laser Therapy in their offices for the purpose of decreasing pain in joints and musculoskeletal tissue, reducing edema and increase healing of the patient. (1)
It has been known for over 40 years that laser therapy has been used to decrease pain in joints and musculoskeletal tissue, reduce edema and increase healing of the patient. Low-Level Laser Therapy produces a photochemical effect by photobiomodulation, or a release of photons from the laser. Photobiomodulation causes a biochemical reaction in the cells of the body that cause chemical reactions that increases release of macrophages, cytokines, neutrophiles and other chemicals that take care of the damaged cells and increases blood flow to move damaged cells and tissues to the lymphatic system to be eliminated and excreted by the body. This causes a decrease in swelling and inflammation as well as decreasing pain in the patient faster than just by utilizing massage or lymphatic drainage. (2)
The international Engineering Consortium identifies four laser classes. Class I lasers are lasers that are used in CD players that are not so much in common use these days due to streaming music services. Class II lasers are used in laser pointers. These laser pointers can cause eye damage if pointed directly at the eye over time. Class III lasers are the low level and high-level lasers used for therapy as well as CD and DVD writers. Low-level lasers emit 10mW-500mW of energy, whereas high-level lasers emit >500mW. Class IV lasers are the lasers used in medicine for surgical applications. (2)
The class III lasers emit photons to the tissue and cause an increase in cellular respiration through the mitochondria of the cell which increases oxidative phosphorylation producing ATP production. It has been documented that pain is associated with a COX (cytochrome c oxidase) receptor and NO (nitric oxide), which bound together produces hypoxia in the cell, hence decreasing oxygen bound to the mitochondria for ATP production. When the laser emits photons, the light, or photons, photo-dissociate NO from COX causing vasodilation and increase oxygen absorption and healing. Laser therapy also reduces production of pro-inflammatory peptides and reactive oxygen species, also known as free radicals. Further, laser therapy has been documented to elicit a neurotransmitter effect by increasing production of serotonin and endorphins thus decreasing musculoskeletal pain. (2)
Low-level laser therapy can be utilized in a variety of orthopedic conditions such as acute whiplash or strain/sprain injuries, tendonitis, tennis elbow, golfer’s elbow, post-surgery recovery, post-dental procedures, neck and back pain, radiculopathy, trigeminal neuralgia, frozen shoulder, and diabetic neuropathy to name a few. Pain relief and decreased edema can be immediate to several hours and days. Laser is utilized on scar tissue to promote healing and remodeling, on lymph nodes to reduce swelling and inflammation, on trigger points to relax the muscle, and on nerve endings to reduce pain or analgesia. (2)
High Intensity Laser Therapy or HILT has been used for musculoskeletal pain in the past few years. HILT can penetrate deeper into the tissues in less time. HILT has been successfully effective for plantar fasciitis, disc protrusions, osteopenia in males, and juvenile rheumatoid arthritis. Chiropractic, exercise, and laser therapy combined has been shown to increase healing and decrease the recovery time of patients. (3)
Chiropractic has been successful at helping the body heal from acute and chronic injuries, whiplash and motor vehicle accidents, various strain/sprain injuries, and other joint and musculoskeletal ailments. Laser therapy can help decrease the healing time for patients with these diagnoses and get them back to working, school, and activities of daily living. 2)
REFERENCES:
1. Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low-Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5):00068. doi: 10.15406/mojor.2015.02.00068. Epub 2015 Jun 9. PMID: 26858986; PMCID: PMC4743666.
2. Salehi A, Hashemi N, Imanieh MH, Saber M. Chiropractic: Is it Efficient in Treatment of Diseases? Review of Systematic Reviews. Int J Community Based Nurs Midwifery. 2015 Oct;3(4):244-54. PMID: 26448951; PMCID: PMC4591574.
3. Ezzati K, Laakso EL, Salari A, Hasannejad A, Fekrazad R, Aris A. The Beneficial Effects of High-Intensity Laser Therapy and Co-Interventions on Musculoskeletal Pain Management: A Systematic Review. J Lasers Med Sci. 2020 Winter;11(1):81-90. doi: 10.15171/jlms.2020.14. Epub 2020 Jan 18. PMID: 32099632; PMCID: PMC7008744
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