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Y.-Y. Huang and others (NIR) spectrum (600nm – 1000nm), with a power density (irradiance) between 1mw-5W/cm2. It is typically applied to the injury for a minute or so, a few times a week for several weeks. Unlike other medical laser pro- cedures, LLLT is not an ablative or thermal mechanism, but rather a pho- tochemical effect comparable to photosynthesis in plants whereby the light is absorbed and exerts a chemical change. The phenomenon was first published by Endre Mester at Semmelweis University, Budapest, Hungary in 1967 a few years after the first working laser was invented (Mester et al. 1967). Mester conducted an experiment to test if laser radiation might cause cancer in mice. He shaved the hair off their backs, divided them into two groups and irradiated one group with a low powered ruby laser (694-nm). The treatment group did not get cancer and to his surprise, the hair grew back more quickly than the untreated group. He called this “Laser Biostimulation”. 1.2. Evidence for effectiveness of LLLT Since 1967 over 100 phase III, randomized, double-blind, placebo- controlled, clinical trials (RCTs) have been published and supported by over 1,000 laboratory studies investigating the primary mechanisms and the cascade of secondary effects that contribute to a range of local tissue and systemic effects. RCTs with positive outcomes have been published on pathologies as diverse as osteoarthritis (Bertolucci and Grey 1995; Ozdemir et al. 2001; Stelian et al. 1992), tendonopathies (Bjordal et al. 2006b; Stergioulas et al. 2008; Vasseljen et al. 1992), wounds (Caetano et al. 2009; Gupta et al. 1998; Ozcelik et al. 2008; Schubert et al. 2007), back pain (Basford et al. 1999), neck pain (Chow et al. 2006; Gur et al. 2004), muscle fatigue (Leal Junior et al. 2008a; Leal Junior et al. 2008b), peripheral nerve injuries (Rochkind et al. 2007) and strokes (Lampl et al. 2007; Zivin et al. 2009); nevertheless results have not always been positive. This failure in certain circumstances can be attributed to several factors including dosimetry (inadequate or too much energy delivered, inadequate or too much irradiance, inap- propriate pulse structure, irradiation of insufficient area of the patholo- gy), inappropriate anatomical treatment location and concurrent patient medication (such as steroidal and non-steroidal anti-inflammatories which can inhibit healing) (Aimbire et al. 2006; Goncalves et al. 2007). 1.3. The medicine and the dose As with other forms of medication, LLLT has its active ingredients or “medicine” (irradiation parameters) and a “dose” (the irradiation time). Table 1 lists the key parameters that define the medicine and Table 2 defines the dose. It is beyond the scope of this paper to exhaustively list and discuss every conceivable aspect of laser radiation or other lightPDF Image | BIPHASIC DOSE RESPONSE IN LOW LEVEL LIGHT THERAPY
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