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Laser Research: Dosage, frequencies in alternative medicine.

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Dosis

 

Comparative Study Using 685-nm and 830-nm Lasers in the Tissue Repair of Tenotomized Tendons in the Mouse

PATRICIA M. CARRINHO, M.S.,1 ANA CLAUDIA MUNIZ RENNO, Ph.D.,1

PAULO KOEKE, Ph.D.,1 ANA CLAUDIA BONOGNE SALATE, M.S.,1

NIVALDO ANTONIO PARIZOTTO, Ph.D.,1 and BENEDITO CAMPOS VIDAL, Ph.D.2

ABSTRACT

Objective: The objective of this study was to evaluate the effects of 685- and 830-nm laser irradiations, at different fluences on the healing process of Achilles tendon (Tendon calcaneo) of mice after tenotomy.

Background Data: Some authors have shown that low-level laser therapy (LLLT) is able to accelerate the healing process of tendinuos tissue after an injury, increasing fibroblast cell proliferation and collagen synthesis.

However, the mechanism by which LLLT acts on healing process is not fully understood. Methods: Forty-eight male mice were divided into six experimental groups: group A, tenomized animals, treated with 685 nm laser, at the dosage of 3 J/cm2; group B, tenomized animals, treated with 685-nm laser, at the dosage of 10 J/cm2; group C, tenomized animals, treated with 830-nm laser, at dosage of 3 J/cm2; group D, tenomized animals, treated with 830-nm laser, at the dosage of 10 J/cm2; group E, injured control (placebo treatment); and group F,  non-injured standard control. Animals were killed on day 13 post-tenotomy, and their tendons were surgically removed for a quantitative analysis using polarization microscopy, with the purpose of measuring collagen fibers organization trough the birefringence (optical retardation [OR]). Results: All treated groups showed higher values of OR when compared to injured control group. The best organization and aggregation of the collagen bundles were shown by the animals of group A (685 nm, 3 J/cm2), followed by the animals of group C and B, and finally, the animals of group D. Conclusion: All wavelengths and fluences used in this study were efficient at accelerating the healing process of Achilles tendon post-tenotomy, particularly after the 685-nm laser irradiation, at 3 J/cm2. It suggests the existence of wavelength tissue specificity and dose dependency.

Further studies are required to investigate the physiological mechanisms responsible for the effects of laser on tendinuos repair.



The recommended dosage (WALT) for anti inflammatory effect

Laser classes 3 or 3 B, 780 -860nm GaAlAs Lasers. Continuous or pulse output less than 0.5 Watt Energy dose delivered to the skin over the target tendon or synovia

Tendinopathies Points or cm2 Joules 780 -820nm Notes
Carpaltunnel 2-3 12 Minimum 6 Joules per point
Lateral epicondylitis 1-2 4 Maximum 100mW/cm2
Biceps humeri c.l. 1-2 8
Supraspinatus 2-3 10 Minimum 5 Joules per point
Infraspinatus 2-3 10 Minimum 5 Joules per point
Trochanter major 2-4 10
Patellartendon 2-3 6
Tract. Iliotibialis 2-3 3 Maximum 100mW/cm2
Achilles tendon 2-3 8 Maximum 100mW/cm2
Plantar fasciitis 2-3 12 Minimum 6 Joules per point
Arthritis Points or cm2 Joules
Finger PIP or MCP 1-2 6
Wrist 2-4 10
Humeroradial joint 1-2 4
Elbow 2.4 10
Glenohumeral joint 2-4 15 Minimum 6 Joules per point
Acromioclavicular 1-2 4
Temporomandibular 1-2 6
Cervical spine 2-4 15 Minimum 6 Joules per point
Lumbar spine 2-4 40 Minimum 8 Joules per point
Hip 2-4 40 Minimum 8 Joules per point
Knee medial 3-6 20 Minimum 5 Joules per point
Ankle 2-4 15


Laser classes 3 or 3B, 904 nm GaAs Lasers (Peak pulse output more than 1 Watt) Energy dose delivered to the skin over the target tendon or synovia


Tendinopathies Points or cm2 Joules 904nm Notes
Carpal-tunnel 2-3 4 Minimum 2 Joules per point
Lateral epicondylitis 1-2 1 Maximum 100mW/cm2
Biceps humeri cap.long. 1-2 2
Supraspinatus 2-3 3 Minimum 2 Joules per point
Infraspinatus 2-3 3 Minimum 2 Joules per point
Trochanter major 2-3 2
Patellartendon 2-3 2
Tract. Iliotibialis 2-3 2 Maximum 100mW/cm2
Achilles tendon 2-3 2 Maximum 100mW/cm2
Plantar fasciitis 2-3 3 Minimum 2 Joules per point
Arthritis Points or cm2 Joules 904nm
Finger PIP or MCP 1-2 2
Wrist 2-3 3
Humeroradial joint 1-2 2
Elbow 2-3 3
Glenohumeral joint 2-3 6 Minimum 2 Joules per point
Acromioclavicular 1-2 2
Temporomandibular 1-2 2
Cervical spine 2-3 6 Minimum 2 Joules per point
Lumbar spine 2-3 10 Minimum 4 Joules per point
Hip 2-3 10 Minimum 4 Joules per point
Knee anteromedial 2-4 6 Minmum 2 Joules per point
Ankle 2-4 6

Daily treatment for 2 weeks or treatment every other day for 3-4 weeks is recommended Irradiation should cover most of the pathological tissue in the tendon/synovia.

Tendons
Start with energy dose in table, then reduce by 30% when inflammation is under control (Does not apply for carpal tunnel tendo synovitis)

Therapeutic windows range from typically +/-50% of given values Recommended doses are based on ultrasonographic measurements of depths from skin surface and typical volume of pathological tissue and estimated optical penetration for the different laser types in caucasians.

Disclaimer: The list may be subject to change at any time when more research trials are being published. World Association of Laser Therapy is not responsible for the application of laser therapy in patients, which should be performed at the therapist/doctor`s discretion and responsibility

Revised August 2005

 





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