LASER and

its
application
 The earliest medical LASERs
developed in the 1960s & 1970s
used for tissue destruction and
coagulation.

 Laser is an acronym for

“Light Amplification by Stimulated
Emission of Radiation.
 It describes any device that creates
and amplifies a narrow, focused
beam of light whose photons are all
traveling in the same direction,
rather than emitting every which way
at once.
Uses:

Barcode reading
In eye surgeries
For the therapeutic application,
Low intensity laser therapy or low
level laser therapy is used for the Rx
of diseases and injury given in low
dosage.
As this modality does not produce
heat in the tissue, it is sometimes
called as the cold or soft laser.

The biological mechanism involved to

get the beneficial effects of this
modality is called laser
photobiomodulation.
INTENSITY:
The commercial and industrial lasers
have an intensity with the range of
thousand and millions of watts, which are
used for cutting, drilling, and destructive
applications.

In physiotherapy, low intensity lasers are

used with the intensity of 1mW, which is
less than the power of 60w light bulb.
Laser beam exhibits the
physical characteristics of :

1) Monochromaticity

2) Coherence

3) Collimation
Physical characteristics of
laser
1) Monochromaticity:
Mono means single and chromaticity
means colouration.
Lasers are of single specific
wavelength and hence of defined
frequency. in this case of visible laser a
single pure colure is produced
E.g. Ruby laser give red light
Laser light contains only one specific
color, or wavelength.

Because every photon is traveling in the

same direction, the light is tightly
focused into a concentrated beam,
unlike the light emitted from a other
source, where the atoms release their
photons randomly in all directions
2) Coherence:
coherence means simultaneous
behavior of laser beam.
Laser radiations are of same
wavelengths and also in same phase,
that means the peaks and troughs of
the electric and magnetic fields all
occur at the same time, which is
known as ‘temporal coherence’
They are traveling in the same
direction is called ‘spatial
coherence’.

The distance over which the

wavelengths stay in the phase is
called coherence length.

spatial
coherence

Temporal coherence
3) Collimation:

Due to spatial coherence, laser

radiations remain in the parallel
beam without divergence, and can
propagate for a long distance.
Production of laser
 The basis of production of laser is
based on, spontaneous emission,
absorption, and stimulated emission
of light.

 This property makes it invaluable for

measurement and aiming purposes.
Principles of Production of
laser
 Electron remains as a cloud of negative
charge around the positive nucleus.
 According to the quantum theory,
electrons can only occupy certain
energy levels around the nucleus.
 When an external energy is applied,
electrons can be made to occupy higher
energy level and they are capable of
free themselves from the nucleus.
 So the electron becomes as a free
negative charged ion and the atom
becomes a positive charged ion.
 when the outer electrons are in one
of the higher energy states, they will
tend to return to a lower energy
state, sometimes to the most stable
or ground state.
 An electron may do this either by
cascading down from one energy
level to next or it may jump directly
to the ground state.
  In both case the additional energy
must be given up and this is done by
giving off a photon of emission.
(spontaneous Photon
emission) Stimulating
Emitted
Photon photons
emitted photon
absorbe
d

An excited
Electron raised electron falls
to a lower Stimulating photon
to higher
B) level C) hits an excited
A) energy level
electron which falls
to a lower level

.
 Each step from one energy level to
next is known as a transition and
the wavelength of the emitted photon
depends on the energy difference
between the two energy level.

 The more the energy difference ,the

shorter the wavelength and higher
the frequency.
 When an electron is in a higher energy
state the atom is said to be exited and
this state will last a very short time
characteristically about 10-8 s, before
the electron falls to lower energy level
emitting a photon.
 There are some excitation levels in all
atoms from which electrons can not
easily leave spontaneously but need to
give up their energy state much longer
times,e.g.0.001s and referred to as
being metastable states.
 The photon is absorbed by the resting
electron, which moves to the higher energy
level (absorption )

 The emitted photons collide with other excited

electrons causing more photon emission.
(stimulated emission)

 This chain reaction produces laser light.

 In order to produce stimulated emission
of radiations, the laser Rx devices rely
upon the three essential components:
1) A lasing medium:
2) A resonating cavity:
3) Power source:
1) A lasing medium: The medium
capable of being pumped with energy
to ultimately produced stimulated
emission is called as lasing medium.
 it can be of any state, includes solid
crystal, liquid , gas .
 The 2 media used are:
gaseous mixture of helium – neon
(He-Ne) at a wavelength of 632.8 nm.
galium arsenide(Ga- As)/ gallium
aluminium arsenide (Ga-Al-As)
semiconductors typically producing
radiations at 630 -950 nm.
 For therapeutic systems the source of
energy is electrical and delivered to the
medium from the mains or battery.

 The He –Ne Laser is known ‘first

generation’ of laser therapy , but less
commonly used now a days due to the
relative expense and low power output.
 2)A resonating cavity:
 This is a chamber that consist of a structure
to contain the lasing medium and
incorporates a pair of parallel reflecting
surfaces or mirrors .

 Within the chamber the photon of light

produced by the medium is reflected back
and forth between the mirrors to produce
an intense photon resonance.
 As one of the surface is not a pure mirror
and so does not reflect 100% of light , so
some of the rays are allowed to pass
through an out put of a device.

 The resonating cavity for the He- Ne laser

unit can be relatively large and for diode
based units are tiny, being the lasing
medium itself, the ends of which are
polished to form the reflecting surfaces.
 The diode based units are called ‘
second generation’ of laser therapy.
 Used in clinical practice due to the rx
head or probe is small like a pen.
 The multisource cluster array , made
from a number of diodes , used for
Rx of large lesions. Called ‘third
generation’ laser therapy.
 Recently, ‘fourth generation’ flexible
multisource array devices nowadays
introduced to allow more efficient
delivery of light to the tissues.
 3) Power source: To pump the lasing
media to produce stimulated
emission a power source is used.
 In most cases, mains are used.
 Recently , re-chargeable and battery
powered units r used if the device is
portable.
CLASSIFICATION OF LASER
 According to the international classification laser
has been classified into :
Class 1:
Low power devices < 0.5 mW devise operating in
the visible and invisible region of the
electromagnetic spectrum
 Do not cause harm to the eye or skin and not used
for the therapeutic application
 Used for black board pointers, super market
barcode reader, etc..
 Class 2: Power output 1mW
Placed in the visible region of EM spectrum
Safe for skin and for accidental momentary
viewing but hazardous for extended intra
beam viewing.

 Have limited clinical applications.

 He – Ne lasers with output of 1mW
 Class 3 : Mid power lasers
placed In visible and
invisible range of EM spectrum
Output from 1mW to
500mW
Safe for skin but harmful for eye.
So needs protective goggles by
both therapist and patient
Used for therapeutic purposes
 Class 4: High power lasers
 Output of > 500mW
 Unsafe for eye and skin

Not suitable for therapeutic

purposes
Used for surgical applications.
Types of laser
 Ruby laser
 He-Ne laser
 Diode laser or infrared laser
 Super luminous diodes
RUBY LASER:
 Consists of a synthetic Ruby rod made up of
Aluminum Oxide.
 Helical Xenon flash tube is wound around it
which gives an intense flash of white light.
 Both the ends of the rod are made flat and
silvered from inside, one end being totally
reflecting and the other partially transparent for
the radiation to come out.
RUBY LASER(CONT..):
RUBY LASER(CONT..):
RUBY LASER:
 This brief light pulse (0.5 msecs) excites the
ruby molecules and raises many electrons to
higher levels which they occupy for a very
short time before falling to the metastable level
where they remain for much longer average
times.
 Thus, for a time, there are more electrons in the
metastable level than the ground level and so
population inversion has occurred.
RUBY LASER(CONT..):
 When the transition form metastable to ground
state does occur, a photon with a wavelength of
694.3nm is emitted.

 This photon would have exactly the right energy

to raise a ground state electron to the metastable
level and be reabsorbed, but as there are
relatively few ground-state electrons the photon
is much more likely to interact with other
metastable electrons, causing them to return to
the ground state and so emitting an identical
photon.
 RUBY LASER(CONT..):
 The process rapidly accelerates as more and more
photons are released; i.e. stimulated emission of
radiation occurs.
 HELIUM-NEON LASER:
 Consists of a long tube containing Helium and
Neon gases at low pressure surrounded by a
flashgun tube.
 Excitation of these atoms leads to different
energy levels between them and the transfer of
energy, giving off a photon of wavelength
equivalent to the energy gap.
HELIUM-NEON LASER
(CONT..):
HELIUM-NEON LASER
(CONT..):
 The photons are reflected to and fro along the
tube giving rise to further photon emission and
emerging as a narrow beam from the partially
transparent end.

 He-Ne lasers give radiation in the visible

region at 632.8nm.
HELIUM-NEON LASER (CONT..):
 Works continuously, but can be pulsed
 Typical output 1-10mW,
 Sent directly(parallel beam) or via fiber optics
to a treatment probe
 Most coherent, monochromatic
 Depth of penetration is upto

10mm with 3.5 mW out put,

10-12mm with 7mW output, and
12-16mm with 10mW out put
DIODE LASER:
 These are specialized LEDs, based on
semiconductor p-n junctions.
 Various kinds, e.g. Gallium Aluminium
Arsenide (GaAlAs).
 In these, electrons can flow more easily in one
direction than in the other.
 The electrons are excited by the application of a
suitable electrical potential and their occupation of
‘holes’ in the crystal lattice arrangement may lead
to the emission of a photon which may then
stimulate identical photons.
 The photons are reflected to and fro and emitted as
a laser beam from one partially transparent end.
DIODE LASER (CONT..):
 Diode lasers are conveniently small, relatively
cheap and robust devices.
 By varying the ratio of gallium to aluminum,
such devices can be built to emit specific
wavelengths.
 These lasers can give either a continuous or a
pulsed output.
 Emit wave length within the 780-890nm
 Depth of penetration is usually 2-3cm
DIODE LASER (CONT..):
Indium-Gallium-Aluminium-
Phosphide lasers (InGaAIP)
 Semiconductors lasers
 Emit wave length range of 630-700nm
 Shorter coherence than gas lasers
 Less biological effects
Gallium-Arsenide laser (GaAs)
 It emit infra red(invisible) beam with
wavelength of 904nm
SUPER LUMINOUS DIODES:
 Diode lasers are not fully coherent and it is
cheaper to produce super luminous Diodes
(SLDs).
 SLDs are fully monochromatic and collimated
but non-coherent.
 SLDs are not strictly Lasers, but they are widely
used in therapy.
 Semiconductor Lasers can be applied directly to
the tissues in a hand-held applicator due to their
small size.
 SUPER LUMINOUS DIODES
(CONT..):
Sometimes several laser diodes of assorted
wavelengths are mounted together to form an
emitter which can be used to treat a larger area.
These are known as “Cluster or Probes”. They
may also contain SLDs.
SUPERLUMINOUS DIODES
(CONT..):
Effect of laser radiation on the
tissue

 Reflected
 Absorbed
 Refracted (Transmitted)
 Scattered
LASER-TISSUE INTERACTION
CONT…
 Reflected
Dependent on Tissue Type & Laser
Energy has No Effect on Tissue
 Absorbed
Dependent on Laser Wavelength,
Tissue Composition, Pigmentation
and Water Content.
LASER-TISSUE INTERACTION
CONT…
 Refracted (Transmitted)
Energy Travels w/No Effect.
Dependent on Tissue Type,
Dependent on Wavelength.

 Scattered
Dependent on Wavelength.
Absorption May Obscure.
Physiological Effects
 It must be kept in mind that, laser behaves in the
same way, as other radiations do, i.e. it may be
reflected from the surface of the body or may
penetrate into the deeper parts depending upon its
wavelength, nature of the tissue surface and the angle
of incidence of the beam.
 Once the beam enters the tissue, it gets attenuated
(tapered), which is partly due to absorption and partly
due to scattering from divergence, reflection or
refraction.
 The effect of scattering in the tissues are much more
complex, which can lead to local intensities actually higher
than the applied beam, at a point just below the skin
surface. Due to the marked scattering in the tissues, areas
between the diodes in a cluster probe are also treated. To
treat very large areas scanning devices are used.
 The penetration depth of red visible and short infrared
radiatian is considered to be a few millimeters, 1-2 mm for
the red light of He-Ne laser and 2-4 mm for the IR of 800-
900 nm in soft tissues (King, 1989).
 The energy that are absorbed by the tissues lead
to greater kinetic energy at the molecular and
cellular levels. Though no mechanism of action
has yet been established for the biostimulative
effects of low intensity laser, the limited depth of
penetration, and the athermal nature of the
modality indicate that the physiological effects are
produced by the photochemical means.
 The effects produced are:
 Cellular Effects
 In vitro cell studies have demonstrated short-term activation of
the electron transport chain, increased ATP synthesis and
reduction of cellular pH with the application of therapeutic
laser. It has also been proposed that low level laser radiation
can initiate reactions at the cell membrane level, via the
photophysical effects on the calcium channels. These
biochemical and cell membrane changes are believed to
cause the increase in macrophage, fibroblast and lymphocyte
activity. These cellular reactions are thought as the basis for
the clinical benefits of low level laser therapy.
 Effect on Nerve Conduction and Regeneration
 Studies done to find the effect of laser on the nerve
conduction and regeneration reveal that there is
increased rate of nerve conduction, increased frequency
of action potentials, decreased distal sensory latencies,
and accelerated nerve regeneration in response to laser
application. These effects indicate increased activation of
the nervous tissue due to low intensity laser.
 However, certain studies also demonstrate decreased
activation of nervous tissue due to laser therapy.
 Some other studies fail to demonstrate any
change due to the effects of laser on nervous
tissue.
 Effect on Vasodilatation
 As has been claimed by certain authors about the
vasodilatating property of laser, the effect is not
thoroughly investigated. However, the increase in
microcirculation, due to laser, can help in
acceleration of wound healing
Therapeutic Effects and Uses of Low intensity Laser
The low intensity laser therapy has a wide scope for clinical
application due to its photobiomodulation properties. The two
major uses of laser therapy are for tissue healing and pain
control.
Because of its positive effects on tissues, it is used for
promotion of wound healing and for treatment of different types
of soft tissue injuries such as sprain, strain, hematoma,
tendinopathies, and wound and fracture healing. As the tissues
get healed by the effect of laser, it also reduces pain associated
with the injury.
 The therapeutic effects and uses of laser are as follows:
Wound Healing
 Healing of tissues is one of the claimed clinical effects of laser.
 Though evidences available suggesting the efficacy of this
modality for wound healing are limited, a survey that compared
different electrical modalities for wound healing ranked low
intensity laser therapy as the best
 An animal study where in He-Ne laser at a dose of 1.5 J/cm2
applied to the surgically cut wound in rabbit showed better
outcome after 14 days of treatment (Reddy et al. 1998).
 In one human study where low level laser at a dose of 48 J/cm?
applied for 10 minutes to oral herpes simplex lesion, increased
the duration of nonrecurrence of oral herpes simplex lesion
(Schindl and Neumann, 1999).
 Dyson and Young, (1986) found that when a mixed laser
(combined infrared at 904 nm, and He-Ne at 632.8 nm) was
applied to surgical skin lesions of mice, there was a greater
wound contraction at 700 Hz infrared pulse frequency compared
to 1200 Hz by 11th day of injury, there was greater cellularity
and more better organized fibroblasts in the 700 Hz group.
 There is also a suggestion that 16 Hz pulse frequency is an
effective pulse frequency for tissue healing. The author in his
unpublished comparative study compared the effects of low
intensity laser (combined infrared and He-Ne at an intensity of
1221 at a frequency of 16 Hz, applied through the scanning
mode at a distance of 30 cm from the wound bed) with
therapeutic ultrasound and plain wound dressing and found
significant healing in the group treated by laser.
 The possible mechanisms could be that laser accelerates
wound healing by stimulating the phagocytosis and proliferation
of the fibroblasts and increasing the collagen and procollagen
 RNA synthesis, as well as increasing the circulation and inhibiting the
growth of bacteria.
 The tensile strength of the wound is also increased due to the increased
collagen content.
 Uses: Surgical wounds, pressure ulcers.

Arthritic Conditions
 The potential benefits of laser for the management of such conditions as
rheumatoid arthritis and osteoarthritis and arthrogenic pain has been
assessed by a number of groups with varying degrees of reported
success. Using the more commonly available He-Ne and diode based
units, a number of groups have reported significant decrease in pain with
concomitant (simultaneous)
improvements in function as a result of laser treatment to
these patients. Patients with rheumatoid arthritis treated by
laser in five placebo controlled trials found laser reducing
pain and morning stiffness (Brosseau et al. 2004). The
effects of low level laser and exercise on outcomes for
patients with painful osteoarthritis of knee, showed better
improvement in the laser treated group as compared to
control (Gur et al. 2003). Laser applied to patients with
cervical osteoarthritis resulted in significant reduction of
pain and improvement of function (Ozdemir et al. 2001).
It is proposed that, improvements in arthritic conditions are the
results of reduced inflammation due to changes in the activity of
inflammatory mediators, or the result of reduced pain due to
changes in nerve conduction or activation.
Uses: Osteoarthritis, rheumatoid arthritis.

Musculoskeletal Disorders
À number of groups of researchers have assessed the efficacies
of low intensity laser in the management of a wide variety of
musculoskeletal disorders, and the results obtained were both
positive and negative. A few researchers have studied the effect
of this modality in the management of musculoskeletal
Disorders such as myofascial pain
syndrome and lateral epicondylitis and some
have got positive results while others have
got negative result. The negative results
obtained in some cases could be due "to the
inappropriately low dose.
Uses: Myofascial pain, lateral epicondylitis.
Pain
A number of studies have found that, low level laser
therapy is helpful in producing analgesic effect in various
types of chronic pain as well as in naturopathic and
neurogenic pain syndromes, musculoskeletal pain such as
lateral epicondylitis (tennis elbow).
Given the said limitation of not having a definite
mechanism on pain relief, this modality has become a
popular treatment method with physiotherapists for the
relief of pain.
 Uses: Myofascial trigger points, carpal tunnel syndrome.
Edema Relief
 Though not used commonly for the relief of edema, studies
done reflect that this modality is helpful in reduction of edema,
associated with musculoskeletal injuries.
 A study of 47 soccer players with 2nd degree ankle sprain
investigated the contribution of laser (820 nm, 7.5 J/cm2) for
reduction of edema in the acute state (Stergioulas, 2004)
revealed laser is effective for reduction of edema in acute
musculoskeletal injuries.
 Uses: Edema in knee joint following ACL injury.
Raynaud's Disease
Studies performed using laser (670 nm) reveal
that laser is helpful in relieving symptoms of
Raynaud's disease (Al-Awami et al. 2004),
however, the effects were realized 3 months after
treatment.
Uses: Raynaud's disease.
Therapeutic Effects:
1. Reduction of Pain:
• MUSCULOSKELETAL –
o Laser therapy is used for the relief of pain in many acute
and long-term conditions, e.g. R.A., O.A., Bursitis and
various aspects of back pain.
• NEUROGENIC –
o Neurogenic pain (Trigeminal, post herpetic neuralgia and
others) has been found to be relieved in some patients by
laser applications.
• TRIGGER POINTS / ACUPUNCTURE POINTS –
o Laser source is applied to trigger or acupuncture points
both on their own and in conjunction with local treatment.
2. Stimulation of Tissues Healing:
 Tissue healing is one of the main claimed clinical effect of
lasers.

 The photobiostimulation of the healing processes remains

the cardinal indication for the use of low intensity laser
therapy, including wound healing, soft tissues healing and
nervous tissue regeneration.

 Both types of laser were found to be successful in

promotion of healing with preference of using He-Ne laser
in superficial lesion and IR laser in more deep lesions.
3. Carpal Tunnel Syndrome:
Researches have shown that laser irradiation over the
median nerve increases nerve conduction latencies.
4. Odema:
It has been seen that laser do affect the volume of odema in
the ankles by reducing it.
5. Lymphoedema:
Laser has been used to treat limbs affected by post-
mastectomy lymphedema though it’s effects are not clear yet.
6. Raynaud’s phenomenon:
Researches suggest that laser can decrease the severity of
symptoms of Raynaud’s phenomenon.
7. Tuberculosis:
 One claimed effect of laser is its value in treating
tuberculosis.
 Lasers of many types are used including, He-Ne, Ga-As,
particularly in Russia and India .
Contraindications
 Apart from direct treatment of the eyes (for
whatever reason), the use of low intensity laser
therapy is contraindicated in the following cases:
 In patients with active or suspected carcinoma:
Taking into considerations of the potential bio
stimulatory effects of laser radiation; it is possible
that therapeutic laser application could accelerate
carcinogenesis in patients where carcinoma is
present.
 With in 4-6 months following radiotherapy: It is recommended that
lasers not be used after recent radiotherapy, because radiotherapy
increases tissue susceptibility to malignancy and burns
 Areas of hemorrhage: This represents an absolute contraindication
to laser treatment due to the possibility of laser induced
vasodilatation, which would exacerbate the condition.
 Locally to the endocrine glands: Given the wide variety of reported
cellular level effects of laser therapy, there is concern that, such
treatment may alter the functions of the endocrine glands. Therefore,
low intensity laser should not be applied over the endocrine glands.
 Direct irradiation over the pregnant uterus: In the absence of hard
evidence to show no associated hazards to fetus or mother, avoiding
treatment directly over the pregnant uterus still need to be followed.
Precautions for the Use of Low Intensity Laser

 Although, there are no published report of adverse effects of treating

patients with the following conditions, it is recommended that laser
therapy be applied in these conditions, with precautions
 Epilepsy
 Fever
 Epiphyseal lines in children
 Confused or disoriented patients
 Areas of decreased sensation
 Infected tissues
 Sympathetic ganglia, vagus nerve, or cardiac regions in patients
with heart disease.

 Dangers of LILT: Though low intensity laser therapy (LILT) is

athermal in nature, focusing of the beam over a pointed surface
may produce thermal changes. The expected dangers in LILT are:
 i. Damage to eye: If the laser beam falls on eye, it
passes through the cornea and lens and get focused
on a small point producing heat. The heat so
produced may cause a total or partial loss of vision.
 Electric shock: As with any other electrical
treatments the possibility of shock cannot be ruled
out, if the rubber insulation of the power cable is torn
or the outer cover of the device is not connected to
earth.
Contraindications
 Carcinoma: active or supected
 Radiotherapy: Within 4-6 months of radiotherapy
 Haemorrhage
 Locally to the endocrine glands
 Direct irradiation over pregnant uterus
Precaution
 Epilepsy
 Eye protection
 Fever
 Epiphyseal lines in children
 Confused or disoriented patients
 Areas of decreased sensation
 Infected tissue
 Cardiac regions in patients with heart disease.
Principles of application of LASER
 Most low intensity sources are applied to the skin with a
hand held applicator about size of a large marker pen.

 Direct application to the skin ensures maximum transfer

of energy and light pressure by squeezing blood from
superficial vessels can increase the penetration further.

 In other types of laser applicator may held in a rigid but

mobile stand and applied about 30cm away from the
patients, which cover a relatively large areas.
 Most low- or medium-power laser sources are applied to the
skin by one or three methods:
- Probe
- Cluster probe
- Scanning system

1) A probe is a hand held applicator the size of a larger

marker pen or normal pen.

 It has one laser diode, close to the tip, which is a small lens
which is used in direct contact with the skin and can treat
only a small area, less than 1 mm² but its area of effect may
be larger, up to 0.5cm² (50mm²).
Pen Probe
2) A cluster probe, is a collection of individual laser
diodes which all emit at different wavelengths.

The advantage of a cluster diode is that it can be used to

treat a larger area, approximately 25cm².

This depends of the size of an individual probe.

3) Scanning system, in which laser applicator is

attached to a stand up to 30 cm away from the skin.

The applicator can have several sources of laser output

and is moved either mechanically or manually is a
systematic path over the area to be treated.
Cluster probe
Technique of Application
Preparation of the patient:
 Nature of the treatment and the need to wear goggles or
spectacles are explained to the patient in order to prevent
any risk of accidental application of laser beam into the
eye.
Apparatus:
 Position the laser apparatus and have goggles ready for
the patient and operator.
 Local lesion, intact skin- probe
 Large area, intact skin – cluster probe
 Open wound, damaged skin- laser scanner
Preparation of the part:
Clean the surface of the skin to be treated with an alcohol
or spirit wipe to remove material that might absorb or reflect
the radiation.

Support the part being treated so the patient is comfortable

throughout and not like to need to move.
Application:
Turn on the main switch.

The laser applicator is then applied to the skin surface

before switching on the output.

The applicator usually has a switch and an indicator light to

show when there is an output.

The laser applicator is kept in contact with the tissues and

held so that the beam is applied at right angles to achieve
maximal penetration.

There is also a timer so that the output ceases once the

preset time is reached.
 If contact by the probe (pen or cluster) is not desirable, for
example directly over a wound, the applicator may be held
just above the surface or covered with transparent non-
reflective film.

 The technique of application are as follows:

- contact technique
- non-contact technique
1. Contact technique:
 This technique is used for the optimum laser treatment
using diode systems (hand held probe).

 The tip of the probe is held perpendicular in contact of

the skin.

 This technique allow deeper penetration of laser and

maximize the power density on the target tissues as
reflection is minimized.
2. Non-contact technique
 This technique is used in treatment of open wounds.

 The distance between the laser probe and wound bed

should be 0.5-1 cm. The probe also should be held
perpendicular to the site of radiation
Non-contact and contact technique
Methods of Application
 Methods of application
1. Point application
 It is used to irradiate localized painful spot.

 Using hand held probe, one can use contact and non-
contact technique.

 It is commonly used in treatment of localized painful site,

trigger points, and acupuncture points.

 Single probe or Cluster probe

2. Scanning application
 Scanner technique is used for treatment of large area such
as anterior surface of a limb specially in wound healing.

 It is scanning device which has been offered with some

laser equipment usually in conjunction with He-Ne units.

 In this technique the laser beam is automatically scanned

across a predefined area. Automatic scanning allow easy
& uniform application of laser treatment over large area
instead of using manual scanning.
Scanning
 Usually used in case of wound healing.

 When the laser machine is not offered with automatic

scanners, manual scanning is applied using single hand
held probe (non contact).

 This technique is achieved by the motion of the operator’s

hand. Considerable care is required to ensure that a
reasonably uniform dosage is delivered to all wound area.
3. Grid application:

 A more practical and less time consuming alternative

method to manual scanning for treating wounds.

 This method is used to cover a larger area.

 The single or cluster probe is moved and repositioned on a

new site after each single dosage is completed.

 Make sure that there is no output while the probe is moved.

 For this the area of the wound bed is visualized as being
covered with a grid work of squares measuring 1cm X
1cm.

 Each square is systematically treated with a single diode

probe.

 The position is maintained for the necessary time.

Gridding
Scanning and grid technique laser to periphery of
wound
Termination of the treatment
 Switch off the device before removing the applicator
from the skin.

 Note the dosage, and response of the patient such as

increase or decrease of pain.
 LASER PARAMETERS
 Type and wavelength of laser
 Power
 Power Density
 Energy Density
 Mode either continuous or pulsed
 Wavelength–visible red laser is recommended
for superficial condition such as wound ,ulcer
and skin condition

 And IR for deeper musculoskeletal condition

Power density
 Power density(I) can be calculated by
PD =Mean Power/Area of Beam (W/cm2)
Energy Density
 The treatment dose is usually given in J/ cm 2 and called ED
or some time radiation exposer

 The mean power output in mW is usually fixed, Eg.10 mW,

20mW, 30mW

 When divided by the fix area of beam its gives the PD

 When multiplied by the number of seconds for which the

treatment is applied, its give ED
The incident dose is measured as either
Power density or Energy density.

 Power density is given in watts per centimeter squared

(W/cm2).

Power density (W/cm2) = mean power (W)

Surface area(cm2)

 Energy density given in joules per centimeter squared

(J/cm2).

Energy density (J/cm2) = Mean power (W) X time(sec)

Surface area(cm2)
 Dose vary from type of tissue

 It is a matter of wave length, type of tissue, condition of

tissue, chronic or acute, pigmentation, treatment
technique

 The recommended dosages typically range from 1 to 10

J/cm2. But doses as low as 0.5 J/cm2 and up to 48 J/cm2
have been suggested.
 Initial treatment- start with a dosage less than 4 J/cm2 , adjust
in next treatment according to patient response

 Acute lesion- start with a lower dosage, less than 4 J/cm 2 and
adjust in next treatment according to patient response

 Chronic lesion- dosage between 4 and 50 J/cm2

 Deeper structures- higher dose to ensure some energy is

remaining at the required depth of treatment
Pulsed output(cont..):
 Acute condition: Low pulse frequencies and long
pulse durations

 Chronic conditions: Higher pulse frequencies and

short pulse durations
Progression of Treatment:
Ifthere is no response after one treatment then the
dose should be increased.

No response after 2 or 3 treatments usually suggests

that selecting an alternative method of treatment is
appropriate.
 Thank
you