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Current Orthopaedic Practice www.c-orthopaedicpractice.com | 73 L -- lymph nodes to reduce edema and inflammation.19 I -- site of injury to promote healing and reduce inflammation.17,18 N -- nerves to induce analgesia.20--22 T -- trigger points to reduce muscle spasms.23,24 LLLT is a transcutaneous procedure with no invasive portion. The physician determines the correct synchroniza- tions of continuous or pulsed laser emission. Penetration depth is determined by wavelength and power. The U.S. Navy research determined 810nm to be optimal for penetration.25 Treatment times are in the range of 30s to 1 min, but there are many areas treated for comprehensible protocol, which often takes approximately 30min to perform. For stimulating repair and decreasing inflamma- tion, 2.5Hz pulse is recommended, while a continuous beam is ideal for analgesia and tender points. ADMINISTRATION The Federal Drug Administration (FDA) approved the use of LLLT in 2003. In some states, a prescription is mandatory before treatment. Treatment can be administered by a certified therapist, radiology technologist, or a physician. European sports therapists have used LLLT for over a decade; however, they report only a 50% success rate,26,27 which may be due to inconsistent laser parameters and dose. Recent advances by researchers at Harvard Medical School have clarified the mechanism by which there is biphasic dose response.28,29 Side effects and complications can result from traditional treatments for musculoskeletal pathology. Nonsteroidal antiinflammatories can cause ulcer disease, hypertension, bleeding, and cardiac events. Steroids (oral and/or epidural) can result in infections (including epidural), bleeding, ulcers, avascular necrosis, and tissue fragility. Studies have found LLLT to have no side effects or adverse events beyond those reported for placebo.30 With over 4000 basic science research and clinical studies according to pubmed.gov, and low complication rate, LLLT should be considered as a first-line treatment option for conditions such as acute neck or back pain, tendinitis, plantar fasciitis, mild carpal tunnel sndrome, and ligamen- tous sprains.30--33 Its safety profile provides a persuasive argument, with the added benefits of accelerated healing, tissue remodeling, pain relief, and decreased inflammation. LLLT subsequently has been accepted by both the British and Canadian health services. Although approved by the FDA, LLLT has not been recognized or accepted by Medicare or insurance companies because it is viewed as investiga- tional treatment. Clinical practice guidelines of the American Academy of Orthopaedic Surgeons (AAOS) in 2008 on treatment of carpal tunnel syndrome included laser treatment but carried no recommendations for or against its use because there is insufficient evidence.34 The literature on LLLT for the treatment of lymphedema, wound healing, prevention of oral mucositis, or for pain demonstrates inconsistent results and methodological weaknesses as per the Blue Cross Blue Shield of Kansas Medical Policy, March 12, 2013. More up- to-date, prospective studies, using newer treatment guide- lines by clinicians, are needed to provide a complete picture of efficacy and cost-effectiveness. CONCLUSION LLLT will not replace orthopaedic surgery for structural pathology, but it may be useful as an adjunct therapy for patients seeking noninvasive symptomatic treatment or accelerated wound healing. REFERENCES 1. Wikipedia.http://www.ask.com/wiki/Nasa?01⁄42800&qsrc1⁄4999. 2. Sheuring RA, Mathers CH, Jones RA, et al. Musculo-skeletal injuries and minor trauma in space: incidence and injury mechanism in U.S. Astronauts. Aviat Space Environ Med. 2009; 80:117--124. 3. NASA Tech Brief. Cold laser and LED therapy provide non- invasive treatment options. Medical Design Briegs. 2009; 1--4. 4. Sommer AP, Pinheiro ALB, Mester AR, et al. Biostimulatory window in low-intensity laser activation: lasers, scanners and NASA’s light-emitting diode array system. J Clin Laser Med Surg. 2001; 19:29--33. 5. Whelan HT, Smits RL, Buchman EV, et al. Effect of NASA light- emitting diode irradiation wound healing. J Clin Med Surg. 2001; 19:305--314. 6. Whelan HT, Houle JM, Donohoe DL, et al. Medical applications of space light-emitting diode technology-space station and beyond. CP 458, Space Technology and Applications Interna- tional. In: El-Genk Mohamed S, ed. Forum. ; 1999:3--15. 7. Wong-Riley MTT, Bai X, Buchmann E, et al. Light-emitting diode treatment reverses the effect of TTX on cytochrome oxidase in neurons. Neurochemistry. 2001; 12:3033--3037. 8. Sutherland JC. Biologic effects of polychromatic light. Photo- chem Photobiol. 2002; 76:164--170. 9. Karu TI. Mitochondrial signaling in mammalian cells activated by red and near-IR radiation. Photochem Photobiol. 2008; 84:1091--1099. 10. Ellt Jt. Wong-Riley MTT, Nerhaeve J, et al. Mitochondrial signal transduction in accelerated wound and retinal healing by near- infrared light therapy. Mitochondria. 2004; 4:559--567. 11. Karu T. Mitochondrial mechanism of photobiomodulation in context of new data about multiple roles of DNA. Photomed Laser Surg. 2010; 28:159--160. 12. Ehrreigh SJ, Furchatt RF. Relaxation of mammalian smooth muscles by visible and ultraviolet radiation. Nature. 1968; 218:682--684. 13. Mitka M. 1998 Nobel Prize winners are announced: three discoveries of nitric oxide activity. J Am Med Assoc. 1998; 280: 1648. 14. Palacios-Callender M, Quintero M, Hollis VS, et al. Endogenous NO regulates superoxide production at low oxygen concen- trations by modifying the redox states of cytochrome C oxidase. Proc Matl Acad Sci USA. 2004; 101:7630--7365. 15. Sharma SK, Kharkwal GB, Sajo M, et al. Dose response effects of 810 nm laser light on mouse primary cortical neurons. Laser Surg Med. 2011; 43:851--859. 16. Chung H, Dai T, Sharma SK, et al. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012; 40:516--533. 17. Omar MTA, Shaheen AAM, Zofar H. A systematic review of the effect of low-level laser therapy on the management of breast cancer-related lymphedema. Support Care Cancer. 2012; 20:2977--2984. 18. Stergioulas A. Low level laser treatment can reduce edema in second degree ankle sprain. J Clin Las Med Surg. 2004; 22:125--128.PDF Image | A NASA discovery has current applications in orthopaedics LLLT
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