Source: "The Laser Therapy Handbook" by Tuner and Hode
What is Laser?
Laser is an acronym for
L - Laser
A - Amplification by
S - Stimulated
E - Emission of
R - Radiation
The correct internationally recognised term is low level laser for therapeutic laser that is non thermal (no heat is produced). This is quite different from laser used in general and eye surgery, which are very high powered units designed to remove or "cut" tissue.
Different types of lasers will produce different types of light or wavelengths.The units used in lymphoedema management and musculoskeletal treatments produce wavelengths of laser between 632 and 904 nanometers. Some lasers such as the scanning units used in our clinic use 2 wavelenghts of light at the same time. Different wavelengths have different depths of penetration and can have slightly different effects on the tissue.
Scanning units cover large areas of tissue (up to 10cm x 10cm) in a session.Hand held units are also frequently used by lymphoedema practioners as they are much cheaper to purchase, and there is reduced risk of eye damage if there is accidental beam irradiation
into the eyes. They can also be used at home. They have a small aperture and so treat small areas at a time (1cm x 1cm).
Our clinic can advise clients on renting or purchasing handheld units
if this is appropriate to augment their treatment outcome.
Lasers were first used for wound healing in Europe in the 1960's,
and there is a large body of research to illustrate how laser light enhances healing and reduces pain. Research papers have been published indicating positive effects can be achieved in many areas, such as healing diabetic ulcers, reducing pain associated with shingles and reducing plantar warts.
Use in Lymphoedema
Its use however in the management of lymphoedema was pioneered at this clinic in 1988 on the basis that previous research had shown that laser increases lymphatic function and regeneration.(Lievens, 1985)
The first clinical trial in 1995 (Piller et al, 1995) showed that laser alone caused an average volume reduction of 19% in 10 women with
breast cancer related lymphoedema. A randomised double blinded trial was then performed in 2003 using a hand held unit (Carati et al, 2003).
No immediate changes in volume occurred, but at 1 and 3 month follow ups, 31% of subjects had at least a 200ml reduction compared to only 4% of those who did not receive laser (control subjects). Significant softening of hard fibrosis was also measured.
How is it used at our Clinic?
Our laser treatments consist of about 45 minute sessions in which several segments of up to 10cm x 10cm areas of a limb are treated directly with the laser light. In this way much of an arm or leg can be treated in one session. Hand held units can be used concurrently, particularly on areas of fibrosis and tightness as these further
obstruct lymphatic return.
There is usually no sensation during laser treatment and it produces no ill side effects when used by experienced practioners. Many of
our clients report immediate softening of hard areas and will describe a reduction in symptoms such as heaviness, aching and tightness.
This improvement can continue for several weeks in many individuals and further treatments appear to have a cummulative effect so that treatment times can be extended to 4-6 weekly or even longer as conditions stabilise.
There is no such thing as one treatment plan fits all, as we seek to encompass individuals differing needs and social situations.
Carati CJ, Anderson SN, Gannon BJ, Piller NB (2003) Treatment of post-masectomy lymphoedema with low level laser therapy: a double blind, placebo controlled trial. Cancer 98(6): 1114-22
Kaviani A, Fateh M, Noooraie RY, Ataie-Fashtami L, Alinagi-Zadeh MR (2006) Low-level laser therapy in management of post mastectomy lymphedema. Lasers Med Sci 21: 90-4
Lievens PC (1991) The effect of combined HeNe and I.R. laser treatment on the regeneration of the lymphatic system during the process of wound healing. Lasers Med Sci 6: 193-9
Lievens PC (1985) The influence of laser-irradiation on the motoricity of the lymphatic system and on the wound healing process. In: Proceedings from the International Congress on Laser In Medicine and Surgery, Bologna, 26-28 June: 171-4
Piller NB, Thelander A (1995) Treating chronic postmastectomy lymphoedema with low level laser therapy: a cost effective strategy to reduce severity and improve the quality of survival. Laser Therapy 7: 163-8
Piller NB, Thelander A (1998) Treatment of chronic postmastectomy lymphoedema with low level laser therapy: A 2.5 year follow up. Lymphology 31: 74-86
Thelander A (1994) Laser therapy for lymphoedema. J National Women's Health Group (Australian Physiotherapy Assoc) 13: 26-30
Tilley S (2009) Use of Laser therapy in the management of lymphoedema.
J Lymphoedema Vol 4, No 1: 39-43
Oman M et al (2010) Treatment of postmastectomy lymphoedema with laser therapy: double blind placebo control randomised study. J Surgical Research Vol 10 1016