tion. Areas of referred pain and corre- sponding dermatomes can also be treated for these patients. Contraindications: It is important to note that contraindications to laser use include suspicious or cancerous lesions, pregnancy (relative contrain- dication), recent steroid injection sites, and direct use over the thyroid gland or eye area. When it comes time for health-care Theralase: the probe has 5 X 100 mW LDs (905 nm) and 4 X 25 mW LDs (660 nm) for a total of 700 mW. regardless of whether it is coherent or non- coherent. Therefore, the SLD would only require longer treatment times to match the dose delivered by a laser source. GUIDE TO INCORPORATING LASER INTO PRACTICE Enormous variations in the parameters reported throughout the literature make comparisons and conclusions very dif- fi cult. A literature review has assisted us in assessing this research. There are more than 2,500 published articles on LLLT, as well as 1,200 references in Tuner & Hode’s Laser Therapy Handbook. Among these articles, there are approximately 100 double-blinded studies. Upon review of this literature, the following treatment principles were identified: Conditions Involving Soft Tissue: For acute soft tissue injuries, treatment should be initiated as early as possible, using low dosages of 4-8 J/cm² applied directly to the injury and other areas of palpable pain. Within the fi rst three to 18 • CANADIAN CHIROPRACTOR |FEBRUARY 2008 four days after injury, frequency of care using this laser dose can be up to three times a day. There is no risk of harm to the patient, as this modality is non-thermal and would not enhance the inflammatory response. As the condition improves, the frequency of laser treatment may be re- duced and dose increased up to 30 J/cm². It is important to note that since dose in- creases with longer pulse durations, initial treatments should use a low pulse rate of less than 100 Hz and later treatments can increase into the kilohertz range as the condition resolves. Overall, laser therapy can be very effective in accelerating the healing process for these types of injuries, allowing the patient to complete activities of daily living sooner. Patients Presenting with Neuro- genic Pain: With chronic neurogenic pain, LLLT is generally applied along the length of the affected nerves with a mid- range dose of 10-12 J/cm². Once again, this modality can be used on trigger points to desensitize the point to palpa- providers to research the options and purchase a laser therapy device, there are many choices. It is important to remem- ber that the power density of the unit will determine the treatment time for your patients and infl uence the suitability and practicality of the unit in your practice. The more user-catered properties of the devices, such as unit aesthetics and asso- ciated training and seminars, are unique to each company and allow practitio- ners to choose a device that most closely meets their needs. Overall, laser therapy can be a very powerful tool in the chiro- practic toolbox. In Canada, laser therapy is beginning to make some small waves in the world of healing. With continued research and increased understanding of laser therapy, we believe that it will be- come one of the most effective healing modalities for our patients.• Bibliography: Brosseau, L., Robinson, V., Wells, G., de- Bie, R., Gam, A., Harman, K., et. al. (2005). Low level laser therapy (Classes I, II and III) for treating rheumatoid arthritis. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD002049. DOI: 10.1002/14651858. CD002049.pub2. Fitz-Ritson, D. (2001). Lasers and their therapeutic applications in chiropractic. JCCA, 45(1):26–34. Kitchen, S. (2002). Electrotherapy: Evi- dence-based practice (11th ed.). Melbourne, Churchill Livingstone. Tuner, J. & Hode, L. (2004). The la- ser therapy handbook: A guide for research scientists, doctors, dentists, veterinarians and other interested parties within the medical fi eld. Grangesberg: Prima Books. Yousefi -Nooraie, R., Schonstein, E., Heidari, K., Rashidian, A., Akbari-Kamrani, M., Irani, S., et. al. (2007). Low level laser therapy for nonspecifi c low-back pain. Cochrane Data- base of Systematic Reviews, Issue 2. Art. No.: CD005107. DOI: 10.1002/14651858. CD005107.pub2. www.canadianchiropractor.ca
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