#74 - Therapeutic Laser for Treating Pain, Part 2

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Hi guys, Welcome to a new
episode of The Factor podcast. I'm your
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host, Jessica Riddle. If this
is your first time tuning in, welcome
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and thank you for listening. When
you're faced with a decision to add a
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new therapeutic device or piece of equipment
to your practice, it's easy to get
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overwhelmed with a variety of options currently
on the market. Whatever choice you make
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must have a positive impact on patient
outcomes and provide a great return on your
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investment. But much like a hammer
or a screwdriver in your garage toolbox,
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any device you implement into practice is
only useful if you know how to leverage
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it to achieve your goals. In
Part one of this two part training,
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our guest presenter, doctor Mike Callanan, gave an overview of the evidence that
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supports laser therapy's impacts on everything from
nerve function and tissue repair to collagenformation and
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even the perception of pain. In
today's episode, we cover laser therapy dosing
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protocols and talk a little bit more
about how to target varying tissue depths for
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specific conditions, and if you're a
healthcare provider with doubts about wearable laser technology.
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Stay tuned. We'll give you the
low down on red flags to watch
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out for and how to assess the
veracity of the technology you might be considering.
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So, whether you currently use laser
therapy in practice or just kind of
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intrigued enough to want to learn more, this episode will certainly give you a
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better understanding of this powerful therapeutic intervention. Let's cue the intro music and get
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started. So when you think about
light going into tissue, the topic or
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the term that we like to use
as therapeutic depth, and think about that
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as a higher power light is like
a brighter light. So if you have
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a twenty watt laser versus a ten
wat laser, it's the same impact as
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if you were in a dark room
and you had a twenty watt light bulb
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versus a ten WTT light bulb.
So the brighter the light, the more
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photons you're going to put into the
tissue per second, and that's basically going
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to help get light through all the
tissue that you're trying to reach. So
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that's why having more power makes it
easier to treat things at depth. So
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this side just shows the difference of
an infrared camera. Here you wouldn't be
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able to see this with your naked
eye. But basically they put the laser
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on the palm of that person and
then they put one, five and ten
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watts of power on the palm,
and you can see how that changes the
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amount of light that goes through.
So having more power will help improve your
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ability to get to depth. So
when you're talking about area, you need
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to have a an estimate of how
much tissue you're gonna treat so that you
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can put in the right amount of
energy. If you put in a thousand
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jewels of energy into say a low
back versus one thousand jewels of energy in
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the back of somebody's hand, the
density or the energy density that's gonna be
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very different. So when you're doing
this, what we recommend generally is the
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palm in your hand or a three
by five card is about one hundred centimeter
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squared. You estimate how much area
you're going to treat. So if you're
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going to treat somebody's forearm, the
vular part of their forearm would be about
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three palms of your hand worth.
The area you would say, okay,
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my area I'm going to treat is
three hundred centimeter you're squared, and then
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if you do that you add a
dose that you were shooting for of say
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ten juels percent of me you're squared, you would have to deliver three thousand
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jewels of energy. So most companies
sell devices that have software that helps you
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with this math Light Force does because
it can be sort of tedious, so
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we've come up with some clever ways
to help with that. So don't get
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freaked out if that doesn't all add
up right out of the gate. So
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this is designed to just show you
also how power impacts time. Jewels are
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energy, and that is watts,
time's time, and seconds. So basically,
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the more power you have, the
more watts, the less time you
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need to deliver the same amount of
energy. So it just goes to show
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if you had a one whtle laser, then you wanted to dose that forearm
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that's three hundred cent of your squared
at ten jels percent of your squared,
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it would take fifty minutes of treatment, versus if you had a ten wht
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laser, you could cut that treatment
time down to five minutes. So that's
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a real important concept to understand when
you're shopping around and looking for things because
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time is money, So being able
to get effective treatments in is important.
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And the corner you don't want to
cut, which a lot of people do,
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is they say, oh, well, what if I took one WHT
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laser or a lower power laser and
I just sort of applied it for five
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minutes and hope for the best.
You will probably be underdosing that condition by
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quite a bit and you will not
get very good outcomes. So that is
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not a good strategy. If you're
thinking about trying to go down the road
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of a low power device and then
treat the same amount of time you were
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on a high power device. It's
not an apples to apples comparison from just
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a general dosing perspective. These are
from the basis of the protocols that light
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Force is using. For superficial tissues, you'd want to use around six jewels
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per centimeters weired. For intermediate tissue
like a muscle, belly of an arm,
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or a leg, you could use
ten, and then for deeper tissues
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and say the spine or the hip, you'd want to be more around fifteen
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jewels percent of your squared You can
increase or decrease that a little bit based
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on if there's inflammation present as acute
or chronic, you generally want to you
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need less energy for acute problems and
you need more for chronic ones. And
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then for how if you want to
try to impact pain as significantly as you
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can, you want to use higher
power when you're treating that person. So
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just remember powers, watts, and
energy as jewels. So dose and power
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are slightly different, but they are
interrelated. So next phase of this is
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to kind of get a sense of
some of the recent endorsements that are based
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on literature that's out there for laser. So when you take a look at
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basically what's out there to see that
JOSPT has started to endorse in their different
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clinical pathways on a number of fronts, including two for the neck. Just
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last year in twenty twenty one,
because that's two years ago now, they
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endorsed laser for use on addressing pain
for acute ankle springs, which is pretty
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exciting. American College of Physicians they
endorsed the use of laser. It was
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the only modality endorsed for use on
chronic glow back pain. And we'll talk
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about that more in depth here in
a second. And then some of the
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different review databases, PEDRO and the
Cochrane reviews. They're very stingy as far
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as what they endorse as far as
good science and saying, hey, this
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is a good paper and you should
do that. But there's been something that
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have come out recently. We're going
to talk about one of those here in
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a second. But exciting to see
that the literature is really starting to support
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the use of laser for a number
of different things. So last year,
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the CDC put out a draft report
on opioid reduction, and what was interesting
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is that they recommended the use of
laser BELLLT among several other therapies to help
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reduce the need for opioids. And
the thing that was pointed out, which
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I think was an excellent point they
made, is that there's synergistic benefit when
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you use laser and other things as
a treatment approach. Because a lot of
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people when they start talking about modalities, they think of it as a passive
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treatment and they throw a lot of
shade on it to say, hey,
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passive treatments no good. But they
point out here very wisely, that when
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you use laser or another modality to
help passively impact pain, it opens the
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door for more active treatments, because
if somebody's hurting too much, they can't
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put weight on their leg, but
if you can treat it, whether it's
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with a laser or with shockwave or
with eastem unit or something to help impact
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pain, all of which they can, and then you were going to then
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do some more active work with that
person, you're going to get better outcomes.
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And that's what they're supporting here.
So those people that are sort of
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naysayers about modalities, that's definitely a
point you want to keep in mind,
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is that it's not that you just
want to do passive stuff with folks,
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just helping maybe get the ability to
do more active things to create a better
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outcome. The other thing they point
out is just that there's not enough access
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to these tools in our health system. So they really were trying to support
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health insurance and health providers and systems
to try to get these modalities so that
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they can apply them to patients.
Because they are successful and they work really
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well and there's very low risk,
but because of the reimbursement problems that they're
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generally not reimbursed. There's the pacity
of it. When you look at across
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the entire landscape of our healthcare system
and access was mirrored in a twenty twenty
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one recommendation from the American Academy borth
There Insurgents for using laser for NEOA.
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They liked the idea of laser firm
decreasing pain and increasing function, but they
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said they downgraded it two levels because
of access and inconsistent findings in their LID
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search. But when you look at
their recommendations from twenty thirteen, their recommendations
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were inconclusives, so it didn't really
match. They had done that to several
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of the different modalities that they listed. I think it was more of a
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sort of a copy and paste thing
because it didn't really make sense when when
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I dug that up. But nonetheless, and their most recent recommendations, they're
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supporting the use of laser for NEIOA
to help with pain and function. So
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this is a study that was done
with Pedro, which is the database out
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of Australia that looks at rehab papers, and they looked at carpal tunnel treatments
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with both high power and low power
lasers. And what was great about this
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paper is they were starting You're starting
to get a sense that people are really
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getting how this works. So they
basically treated they had four different categories,
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and it is control group where they
said, hey, let's do us a
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high power laser with low dose and
a high power laser with high dose.
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And then they said let's use a
low power laser with low dose and a
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low power laser with high dose,
and then a control group that just did
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exercises. And what they concluded was
that the high power group with the low
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dose got the best outcomes. They
all were improved, but that's the one
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that improved the most. So it
gives you a nod that using high power
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is different than using low power with
how it impacts tissue. So those folks
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that like to just sort of paint
a very broad brush and say they're all
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the same, it doesn't matter.
That just isn't the case. So what
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I wanted to go over next was
just the recommendations from the American College of
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Physicians, because this is a pretty
powerful paper and they were trying to give
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their two cents on how to address
back pain, low back pain to be
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specific, and so they had recommendations
for acute, subacute, chronic, and
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low back pain with ridicular complaints.
So for the acute and sub acute.
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They basically were stating on a strong
recommendation not to use opioids up front.
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They state that most of these patients
are going to get better on their own
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regardless of what intervention is. But
they like the idea of using heat,
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and the classicore lanser does create some
superficial heat that would seem to be a
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good choice as well. In addition
to the thought of what we were talking
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about earlier about how it imp tacks
paint with the CEA fibers for chronic pain
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as well as the adelta fibers for
a cute paint, it would also sort
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of lend to think that it might
have a good space here. But they
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didn't list laser specifically. If they
do need meds out of the gate,
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they recommend just some end sets for
chronic low back pain. Another strong recommendation
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was multidisciplinary approach. They listed lots
of different active type things and different interventions
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that you might be using in your
clinic, but the only modality that they
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stated on there was the low level
laser, and I guess if you consider
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biofeedback a modality that was listed as
well, but there was any other modalities
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that they listed on here, which
I thought was very interesting as far as
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if they're not responding to any of
those things, they recommended going back to
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end SAIDs and these meds to help, and only to go down the road
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of opioids if the risk reward factor
is there and everything else is basically failed.
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So at this point, this isn't
a huge, huge newsflash. But
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the real takeaway from here is some
of the options that they're recommending as far
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as intervention, which included laser.
They went on to sort of do a
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review on a handful of different modalities
too, So these are their conclusions.
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But they did not recommend ultrasound for
low back pain in any of the phases.
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They didn't feel that there was enough
research to support that. So it's
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just something to think about if you're
using ultrasound on a regular basis for low
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back pain. Not a ton of
support for that use. As far as
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cold goes similar findings, they didn't
recommend it for any category of low back
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pain, so whether it was a
cute, sub acute, or chronic.
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Remember that they did endorse heat for
use of acute low back pain. When
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it comes to electrical stem tens NMS
interferential for low back pain. Again,
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didn't really find enough research there to
really support it, so they weren't too
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high on that either. There's obviously
studies out there to support use of tens
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for chronic pain and such, so
don't take away that there's no support for
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it. It's just that this group
didn't come across enough evidence to support it.
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So switching gears to JOSPT in twenty
seventeen their Clinical GUIDEE for neck pain
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with they had two different categories that
they endorsed. Laser for the chronic pain
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with mobility deficits, so essentially that's
your OA type of neck the wear and
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tear folks, you can see they
are what they did recommend. As far
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as laser driving, lean pulse culture, sound intermitt attraction, tends and ems.
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Those all had a place for it, but they didn't recommend use of
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continuous traction, static magnetic necklaces or
drily did not outweigh wet needling, so
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when they were using light a kine
to inject, it didn't create the same
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amount of relief. As far as
neck pain with radiating pain, they also
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recommend a laser for that person,
so your ridicular patients as well as intermittent
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traction for your chronic patients. What
they didn't support was use of a semi
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rigid collar. Again continuous traction the
thought that they could put too much stretch
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on the nerve and irritated. And
then for chronic folks, they also did
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not support continuous traction or electric muscular
stem or modified gal galvanic current. So
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for conclusions from these different groups,
you can take away this. They're supporting
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laser for the use of chronic low
back pain, neck pain that's basically your
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OA next, as well as ridicular
complaints, heal pain and plantar fash itis
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that's been supported by JOSPT Acute ladder
ankle pain, you can use the laser
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to help with that, and then
NEOA was endorsed by the American Academy of
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Wards be Exurgons for pain and function. On that front, what's not supported
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for laser is lumbar pain with ridicular
complaints, and that's probably most likely due
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to it's just difficult to get light
down to the level of the nerve root.
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It can be done if you really
know what you're doing and you have
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the right equipment, but especially with
lower power devices. They just have a
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tough time getting enough light down to
that three or four centimeters of depth at
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the nerve roots. And then neck
pain with movement coordination that was not supported
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in JOSPT. But those are people
that are more like fearful of motion.
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They're people that need more pain counseling
and muscular re education as far as how
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to reintroduce normal patterning. So it
didn't surprise me that that was not a
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category that was supported. So how
do you fold this into a normal planet
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care. There's no perfect answer to
it, but just put a couple of
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pearls here for you guys to take
home. So with superficial heat that was
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shown to help with acute low back
pain, and so a lot of people
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ask me, hey, should I
use it? Should use heat first or
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after I use my laser? And
generally we recommend not doing anything that's going
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to impact the skin. So you
don't want to do anything that's going to
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lower sensation or numb it. You
don't want it to be wet. You
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want generally dry, cool, clean
skin that you're gonna treat when you have
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a laser, because it can get
warm and you want to make sure that
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that sensory feedback is intact. The
other thing I'd point out is that if
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you do use the laser first,
you might find that because of all the
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different mechanisms that it helps with pain, that you get done with the laser
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treatment and the patient gets up and
goes, hey, I feel a lot
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better, and they're movie differently and
they have different subjective complaints at that point,
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and you might be able to not
do the pat if you choose to
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do so, But if you were, I would recommend doing it after.
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So after you treat with the laser, if you wanted to follo up with
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some heat, I would do it
as the second treatment option. Yeah.
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I pretty much leave it at that
as far as that slide goes. As
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far as like incorporating the manual therapy, there's benefits to use the laser before
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you do manual therapy, just because
it can help basically quiet down muscle guarding
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and splinting and spasm. So if
you have less of that, it's going
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to be a lot easier to mobilize
the joint and get tissue stretched on things.
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There's going to be just less fighting
that you're gonna have to do or
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prep work you're gonna have to do
to get that muscle to relax. So
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generally, if you do the laser
first, that would be great. If
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you use it afterwards to help improve
circulation of the tissue and do things to
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help with tissue repair. If they're
stiff and things of that nature, it's
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not going to be a bad thing
to treat them after the treatment. Might
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actually help with some of the soreness
and perfusion issues that might be present after
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the manipulation so that they have less
pain, But it's not going to help
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you with that work you're going to
have to do on the front end to
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get that tissue to relax so that
you can get to the joint that you're
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looking for. Same thing, if
you're dealing with a stiff joint, you
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might treat that with the laser first, just going to help take the pain
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down. As you remember, the
pain blocking mechanism that has just might make
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it a lot easier to pick up
range of motion with that patient and don't
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have to fight quite as much.
And so generally, how do you combine
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the laser. You just need to
think about what you're trying to address.
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So you're trying to address pain you
can be trying to focus on a specific
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nerve path they have a ridicular complaint, or for other factors that might be
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involved, and you're charging the nerve, make sure you're just dosing that nerve
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properly and that you're traveling the path
of that nerve. The more of it
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you innervate or excite with the light, probably the better result you're going to
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get. If you want to address
the capsule and the snovium, because you're
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trying to address the pain or tightness
around a joint, make sure you're trying
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to address the entire snovium, so
treat all the way around that joint on
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the top, bottom, and sides. Same thing with muscle tissue. Try
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to incorporate as much of this of
the muscle as you can, so when
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you're figuring out your area. If
you're treating a quadrucep try to make sure
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that you're calculating the majority of that
muscle belly. It'll help impact more of
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those cells that are in the muscle, which will have a lot of benefit
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as far as pain and potentially decreasing
bombs and things of that nature. After
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an exercise session. Tendons same way, you want to make sure that you're
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treating those with high energy level.
Tendonts generally have lower mitochondrial density than say
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nerves or muscles, so they have
less sponges to absorb the light, so
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they often require a little bit more
dose. I want to make sure that
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you're definitely treating the muscle at least
third of the way up that's attaching to
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that tendon, just because that's all
one big system and you'll probably get better
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outcomes if you do that. What's
the treatment goal? Say you had somebody
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that had a chronic stiff joined and
you wanted to do your best to get
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pain relief, you'd probably want to
treat with higher power. If you had
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a really acute like a post op
patient, you're trying to just help overall
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address some of the acute circulatory issues
that are present in those cases, you
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might want to use lower power and
lower dose because you wanted to reduce the
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chance of maybe some rebound pain or
something that can happen sometimes when you treat
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the higher dose and higher power for
an acute condition. So have to have
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your thinking cap on. You got
to understand what you're doing, and if
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you do that, you're going to
generally get better outcomes and get better results.
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So if you wanted any more information
on laser's we know we kind of
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did a sort of a big broad
overview of this science. There's a lot
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00:19:18.559 --> 00:19:22.240
more information that's out there. Obviously, you can connect with us by just
286
00:19:22.240 --> 00:19:25.519
scanning this QR code, and I'd
be happy to answer any other questions you
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00:19:25.599 --> 00:19:27.799
might have, or something pops in
your mind later so we can answer that,
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that'd be great, But otherwise,
just want to thank you for your
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00:19:30.720 --> 00:19:36.039
attention. The last couple slides are
the references, So if you wanted to
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get a sense of some of these
papers you can look at. You can
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just take a screenshot that guy or
this guy, and that is all I
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00:19:44.480 --> 00:19:49.000
have. Jessica, how would you
like to get even more great content from
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00:19:49.079 --> 00:19:55.039
Factor in your inbox each week?
Things like early access to exclusive free trainings,
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00:19:55.319 --> 00:20:00.240
coupons and promotional offers from our online
store, and timely updates on research
295
00:20:00.240 --> 00:20:03.559
and news you can use to grow
your practice and improve your patient care.
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00:20:03.680 --> 00:20:07.519
If I've piqued your interest, you
should be sure to click on the Factor
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00:20:07.599 --> 00:20:11.039
five Things Friday link in our show
notes. Simply give us your contact details
298
00:20:11.039 --> 00:20:17.079
and start getting our weekly Factor five
Things Friday email in your inbox. It's
299
00:20:17.079 --> 00:20:21.079
a simple bullet point style format with
no fluff, just tons of great content
300
00:20:21.400 --> 00:20:26.160
and resources you can use for continual
professional growth. So be sure to visit
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00:20:26.160 --> 00:20:29.640
the show notes click that link and
keep an eye on your inbox each Friday.
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00:20:30.160 --> 00:20:37.640
Now back to the show. So
that being said, let's begin our
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Q and A segment. We've had
a few questions that have come in here
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about incorporating laser therapy into practice because
we do have a few on our webinar
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today that are novices that have not
used the laser before. Doctor Mark,
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how do you guys recommend your practitioners
after they purchase a laser, how do
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they go about getting started with introducing
this to patients? What type of support
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or marketing materials do they receive when
they purchase a device like this, and
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really how do they get going.
There's sort of two families to that question,
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is how do you get the word
out to the general public that you
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have this great technology, and then
how do you execute once they get in
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your front door. So for light
Force, we have a lot of different
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materials to help with that. As
far as outreach goes digital and printed assets
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that you can use to get the
word out, and then as far as
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coaching up your therapists or your clinicians
on how to have these discussions with the
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patient and how to set up an
introductory session with someone so they can experience
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00:21:37.440 --> 00:21:40.960
it, and how you can maximize
revenue. Generally, it's a cash transaction
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with those patients, so it is
a special type of conversation. I noticed
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in the chiropractic space. You guys
are excellent at talking to patients about cash
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and your services and you're not.
You don't generally shy away from that,
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so it's usually a very easy conversation
for you folks to pick up physical therapy
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00:21:57.519 --> 00:22:02.759
side, that's very much the oppt
that they are very bad at asking for
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copays and dollars for their services,
and so it's it's usually a little bit
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tougher on that front. But either
way, whether you're got a skilled group
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on that or not, we have
great resources to help with those discussions so
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that you can have that formula from
the time they walk in the front door
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to the treatment to when they're walking
out on how to capitalize on a package
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of purchases. I mean, the
nice thing about laser is that it generally
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requires a couple treatments, so usually
somewhere around the mean is about six visits.
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So it's a very nice add on
to a plant care for a package
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price, say normally this much for
a single visit, but with your problem,
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I'm recommending six. So if you
were to purchase the whole package today,
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we could discount that by ten percent
or fifteen percent, and that usually
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works out great, wonderful, And
I think i'd imagine you would echo this
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sentiment that once a patient has the
treatment, they see the benefits of it,
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they see that pain relief. It's
a lot easier for them to kind
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00:23:00.599 --> 00:23:03.680
of realize that even though this may
not be covered by my insurance, if
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it's effective, it's worth doing and
investing in. Yeah, and there are
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clinics that do sort of demonstrations.
They don't charge for the first session,
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or they wait and see how they
respond to it and then come back and
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say, hey, if you like
that, then that would be your first
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session from your package, Or if
they're really confident with it and they can
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treat and get pain to change,
they just charge for the service right out
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of the gate. There's benefits and
plus and minus with any of those approaches,
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and we're very skilled in those conversations. So however you want to set
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up your own practice, we can
help you with them. Wonderful. Now,
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when it comes to laser therapy and
those first encounters with a patient,
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when you're first kind of introducing them
to what this is, could you talk
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a little bit about the type of
language that you use with a patient.
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Someone who may be in acute pain, might be a little hesitant to try
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something that they think may flare things
up or cause more pain. What are
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some talking points that practitioners could use
for having those conversations. Yeah, the
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important thing for that person rut of
the gate is to be well versed enough
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on the mechanism of the plaser.
And like we provide a cheat sheet for
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our clinicians. It's a two page
document which just talks about generally how it
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impacts them a variety of different things, and you don't have to know all
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of them, and you don't have
to be able to give a two hour
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talk on it, but you need
to have at least enough information to talk
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about how it impacts pain and circulation
and tissue repair, and by doing so,
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you put it into the patient's perspective, say, hey, you're here
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because you strained your back and you
picked up that fifty pound box strain some
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of the soft tissue in your lower
back. It's going to take a few
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weeks for that to fully heal.
While we're doing that, these devices we
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have are excellent and helping you get
out of the pain you're in right now
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and moving forward so you can move
better and get back to sitting at your
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desk and doing all the things you
want to do that you're in here for.
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The thing that we really remind clinicians
of is that those people are in
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your waiting rooms because they're in pain. So if you have solutions, whether
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it's a great manual take technique,
or a laser or attraction table or whatever
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it might be, that's going to
get them to feel better when they walk
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out the door. That's the secret
to get people to want to come back.
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So the nice thing about the laser
is that it doesn't require years and
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years of training like your manual skills
are to manipulate joints and to do those
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higher level functions. You can have
extenders in most cases provide this treatment and
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get people feeling a lot better.
So it's a really nice add to a
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lot of clinics where you might as
the clinician the lead doc, do the
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initial treatment. Just to make sure
you get the outcome you want to.
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You'll explain it, answer the questions, and we generally recommend that because it's
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important for them to get to buy
in and have all those boxes checked.
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But then once you set up the
protocol or the treatment parameters, you can
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usually hand that off to one of
your extenders in the office for the subsequent
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treatments. But that's the key,
is that you can explain it without because
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they might like that first slot I
put up. They might be thinking of
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00:25:56.119 --> 00:26:00.440
Skywalker with his lightsaber when you mentioned
laser. You have to build get them
385
00:26:00.440 --> 00:26:02.640
off of that cliff and say no, no, no, no, this
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00:26:02.680 --> 00:26:04.759
isn't that at all. This is
what it's going to do. And then
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knowing how to apply it, dose
it right and get the outcome. That's
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when it all comes together. You
can be great at explaining it but not
389
00:26:11.799 --> 00:26:15.680
understand how to treat and you're going
to probably have lukewarm results. Or if
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you don't know how to explain it, but you know how to treat with
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people same thing, but we can
put those together and basically check the boxes
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00:26:22.119 --> 00:26:25.880
of having that patient understand what it's
doing and how it's going to help them,
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00:26:26.039 --> 00:26:29.680
and then actually follow through and let
that happen. Then usually it's a
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pretty easy process, absolutely, And
that kind of flows into another question,
395
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what type of training do you recommend
for practitioners that want to have their office
396
00:26:38.880 --> 00:26:45.359
staff assist them with utilizing laser in
practice. So different companies have different levels
397
00:26:45.359 --> 00:26:51.440
of training anywhere from here's your box
good luck with an instructional manual to like
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what we do, which is more
white glove full service. So we understand
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that it's complicated. A lot of
companies have salesforces that maybe sell a lot
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00:26:59.400 --> 00:27:03.880
of different product and they're not experts
in this space, and it's quite technical
401
00:27:03.960 --> 00:27:07.519
when it comes down to getting good
outcomes for all the different conditions that you
402
00:27:07.599 --> 00:27:11.640
treat. So we have a series
of asynchronous like videos you can watch and
403
00:27:11.759 --> 00:27:15.680
get certified from that, so that
gives you sort of a lot of just
404
00:27:15.720 --> 00:27:18.720
the general background and how the machine
works. And then if that's not enough
405
00:27:18.759 --> 00:27:22.279
to cover it, we come in
and do training live on the first day
406
00:27:22.319 --> 00:27:26.920
that is set up, so you're
gonna have a live person helping answer questions
407
00:27:26.920 --> 00:27:27.759
and show you how to treat,
and then they're gonna sit there and treat
408
00:27:27.799 --> 00:27:30.839
some patients with you to make sure
that you understand it, your staff understands
409
00:27:30.880 --> 00:27:34.640
it, and then on the back
end, there's still questions a month or
410
00:27:34.640 --> 00:27:37.960
two down the road, and if
you feel like any more help, then
411
00:27:37.960 --> 00:27:41.039
there's that's where my team comes in. We can get on a screen like
412
00:27:41.079 --> 00:27:44.720
this and help talk through some of
those questions and get you up to where
413
00:27:44.720 --> 00:27:47.480
you need to be. But our
goal is to just make sure that there
414
00:27:47.519 --> 00:27:51.720
is any questions and there's no stones
unturned so that whether it's on the marketing
415
00:27:51.759 --> 00:27:55.160
front or it's on the treatment front, we answer those questions that you can
416
00:27:55.200 --> 00:27:57.400
be successful, because if you're not
successful, we're not going to be successful.
417
00:27:59.200 --> 00:28:03.000
Absolutely, and that I think it's
really important, especially when you're making
418
00:28:03.039 --> 00:28:07.559
this type of investment in a modality
to incorporate into practice, that you have
419
00:28:07.599 --> 00:28:11.359
that support and you have that team
that can kind of help answer those questions
420
00:28:11.440 --> 00:28:15.319
as they inevitably will come up.
When it comes to the conditions that are
421
00:28:15.359 --> 00:28:19.839
really effective and can have really great
results when treating with laser therapy, if
422
00:28:19.880 --> 00:28:25.400
you had to kind of name the
top three after pouring through all of the
423
00:28:25.400 --> 00:28:27.480
research that you have over the years, what would you say are kind of
424
00:28:27.480 --> 00:28:33.599
the three main conditions that laser is
showing very quick and effective results with.
425
00:28:36.079 --> 00:28:40.799
So as a big picture, the
deeper the tissues you're trying to address,
426
00:28:40.799 --> 00:28:44.519
the harder it is. So it's
if you think about your deepest tissues,
427
00:28:44.519 --> 00:28:45.400
like, hey, I want to
try to treat nerve roots in the low
428
00:28:45.480 --> 00:28:48.680
back, or I want to try
to treat glute bead tendons in the hip
429
00:28:49.079 --> 00:28:52.519
that are many many centimeters deep.
In larger patients, those are going to
430
00:28:52.519 --> 00:28:56.559
be the ones that are going to
be harder to get results with. But
431
00:28:56.880 --> 00:29:00.720
the more superficial the target tissue is, the easier it is. So when
432
00:29:00.759 --> 00:29:04.079
you start talking about like a knee, an arthritic knee that has a capsule
433
00:29:04.160 --> 00:29:08.160
that's providing pain that's only a couple
millimeters blow the surface of the skin,
434
00:29:08.640 --> 00:29:12.960
very easy to address that with a
laser to make changes in that tissue as
435
00:29:12.960 --> 00:29:17.599
well as the pain from a single
treatment. So I would say pretty much
436
00:29:17.640 --> 00:29:23.000
any appendicular joint elbows, wrists,
knees, ankles, and they're getting support
437
00:29:23.319 --> 00:29:27.880
from these different groups like the APTA, they support it for planter faschitis,
438
00:29:27.960 --> 00:29:33.960
heel pain, achilles tendonot with the
ankle sprains. Shoulder is one of those
439
00:29:33.079 --> 00:29:37.359
ones that's sort of a tweener,
Like if you are using the right equipment
440
00:29:37.480 --> 00:29:41.200
and you know what you're doing,
and it's for a pathology that isn't something
441
00:29:41.240 --> 00:29:45.559
that requires surgery or is it something
like a frozen shoulder that is going to
442
00:29:45.640 --> 00:29:48.480
just require time. Because of the
nature of the pathology, you can move
443
00:29:48.480 --> 00:29:52.720
the needle on those pretty well.
So like if you have general stiffness or
444
00:29:52.759 --> 00:29:56.440
guarding in a muscle, because they
say it's more of an acute pingement and
445
00:29:56.480 --> 00:29:59.119
you're going to treat some of those
muscles that are in the front of the
446
00:29:59.119 --> 00:30:03.279
shoulder that could be guarding that aren't
allowing normal mechanics, you can see range
447
00:30:03.559 --> 00:30:07.839
proved dramatically with those people because of
just the mechanism of that problem. So,
448
00:30:08.119 --> 00:30:11.000
I know that's kind of a long
answer, but when you look at
449
00:30:11.079 --> 00:30:15.680
research, the superficial things have a
lot of support. So like TMJ is
450
00:30:15.680 --> 00:30:21.599
one need a lot of power energy
to reach the muscles of mastication or impacts
451
00:30:21.880 --> 00:30:25.160
the facial nerves that are involved with
that. So those people tend to do
452
00:30:25.200 --> 00:30:27.599
really well with laser. There's lots
of research in the dental space that talks
453
00:30:27.599 --> 00:30:33.480
about how effective it is to help
with they're doing dental implants or healing after
454
00:30:33.559 --> 00:30:37.279
dental procedures. That's a whole sort
of separate market. Our devices aren't really
455
00:30:37.279 --> 00:30:41.279
set up to do that. But
find that when you're thumbing through the journals,
456
00:30:41.319 --> 00:30:45.680
there's a lot of that, but
the backs the next because it's not
457
00:30:45.759 --> 00:30:51.799
as deep. That's where the JOSPT
endorsement comes for treating neck problems, because
458
00:30:51.799 --> 00:30:56.319
you're dealing with tissues that are maybe
two centimeters deep as opposed to two to
459
00:30:56.400 --> 00:31:00.200
threefold when you get in the lower
back. So I would say, or
460
00:31:00.519 --> 00:31:03.119
the average outpatient person, if you're
using it to help with neck patients,
461
00:31:04.119 --> 00:31:08.000
anything in the periphery, and if
you had a specially interested possibly like PMJ
462
00:31:08.160 --> 00:31:12.599
or something like that, you're probably
gonna love the laser absolutely. Now.
463
00:31:12.680 --> 00:31:17.359
I remember a few years ago,
light Force came out with one of the
464
00:31:17.599 --> 00:31:22.680
first lasers that had a wand that
could kind of help you since depth of
465
00:31:22.720 --> 00:31:26.119
penetration. Tell me a little bit
about how that technology has evolved over the
466
00:31:26.440 --> 00:31:30.839
past few years, and what are
some exciting things on the horizon, what's
467
00:31:30.839 --> 00:31:33.519
ahead. That's a good question.
So the smart hand piece, which I
468
00:31:33.519 --> 00:31:37.640
think you're referring to, that was
designed when we launched our forty watt laser
469
00:31:37.640 --> 00:31:41.960
a couple of years ago, and
with forty watts of power, it creates
470
00:31:41.960 --> 00:31:45.400
more heat on the surface of the
skin, so we wanted to make sure
471
00:31:45.440 --> 00:31:48.640
that we had a way to help
make it easy to apply in a safe
472
00:31:48.680 --> 00:31:52.480
way for the clinician and the patient. So our smart hand piece has an
473
00:31:52.480 --> 00:31:56.200
accelerometer in it, so it judges
the speed that you're moving that and if
474
00:31:56.240 --> 00:32:00.720
you're too slow, it will basically
a light on the hand piece will turn
475
00:32:00.799 --> 00:32:04.559
red, which will alert you to
hey, you're going too slow. It'll
476
00:32:04.559 --> 00:32:08.079
also vibrate too. It's got haptic
feedback, so it helps the clinician you
477
00:32:08.079 --> 00:32:09.960
know, hey, I got to
speed up or slow down, basically because
478
00:32:09.960 --> 00:32:14.680
you don't want to be so fast
that you're not getting enough light to penetrate,
479
00:32:14.839 --> 00:32:15.880
and you don't want to be too
slow because it gets too hot.
480
00:32:16.720 --> 00:32:20.279
So that was from feedback we got
from users over the years. They were
481
00:32:20.319 --> 00:32:22.799
always like, how fast should we
do it? This sort of helps take
482
00:32:22.839 --> 00:32:25.200
care of that question. The other
thing it does on the heat front is
483
00:32:25.240 --> 00:32:30.119
that it is connected, it's a
smart hand piece, and that it knows
484
00:32:30.279 --> 00:32:35.000
that tells the laser what head you
have on there. Our devices have five
485
00:32:35.079 --> 00:32:38.000
to six heads when you purchase the
unit of different sizes. Some are on
486
00:32:38.119 --> 00:32:42.480
contact, some are off. And
when you're using our protocols on our newer
487
00:32:42.519 --> 00:32:45.400
machines, that'll actually tell you,
hey, you're supposed to use either that
488
00:32:45.480 --> 00:32:47.200
head or that head. We'll let
you do the protocol unless you got the
489
00:32:47.279 --> 00:32:51.599
right head attached. And part of
that is so you'll get the best treatment
490
00:32:51.640 --> 00:32:54.440
for that problem, but also make
sure that the power settings that are appropriate
491
00:32:54.480 --> 00:32:59.119
for the head that you use,
so we try to make it as idiot
492
00:32:59.160 --> 00:33:02.000
proof as possible. So these things
make it much easier to if you are
493
00:33:02.000 --> 00:33:05.279
going to use high power, you
have the right head attached so that it
494
00:33:05.279 --> 00:33:07.759
doesn't get too uncomfortable for the patient
and that you're going to get the best
495
00:33:07.759 --> 00:33:13.119
results. Essentially, as far as
future, can't get into that too specifically,
496
00:33:13.200 --> 00:33:15.599
but we're definitely looking at a handful
of different things. You could possibly
497
00:33:15.640 --> 00:33:21.119
treat some different populations, possibly help
some folks at home. But we haven't
498
00:33:21.559 --> 00:33:23.680
launched any new product announcements, just
yet, so you'll have to stay tuned
499
00:33:23.720 --> 00:33:30.200
for that. That was actually my
next question. Or we've heard a lot
500
00:33:30.240 --> 00:33:36.839
in the healthcare industry about wearable laser
technology, about treat it home laser technology.
501
00:33:37.400 --> 00:33:39.599
You'll go to any healthcare trade show
and see tons of vendors out there
502
00:33:39.640 --> 00:33:45.400
selling different patches or booties you can
wear or things of that nature. What
503
00:33:45.480 --> 00:33:50.039
are some things to look for when
you see something like that that kind of
504
00:33:50.440 --> 00:33:53.279
would be a red flag to say, Okay, isn't this isn't quite what
505
00:33:53.359 --> 00:33:57.200
they're saying. It is, like, what should we as consumers and as
506
00:33:57.240 --> 00:34:00.720
practitioners look out for to make sure
that the technology, if it's really not
507
00:34:00.759 --> 00:34:05.519
there yet, that we're not buying
into something that's not able to deliver.
508
00:34:06.240 --> 00:34:09.360
Yeah. Yeah, it's definitely a
buyer beware category for sure. I would
509
00:34:09.400 --> 00:34:14.119
point out the discussion we had I
pointed out here on LEDs there's certain things
510
00:34:14.159 --> 00:34:16.360
that they can do quite well,
but there's other things that they can't do
511
00:34:16.440 --> 00:34:20.039
so well. So I would take
a look at what they're purporting. If
512
00:34:20.039 --> 00:34:22.719
you have an LED red device that
you're going to shap onto your thigh or
513
00:34:22.760 --> 00:34:28.840
something, and your intent is to
try to increase blood flow at the very
514
00:34:29.039 --> 00:34:34.199
superficial levels of the skin and that
muscle. Okay, you could probably make
515
00:34:34.239 --> 00:34:37.800
that argument. You definitely want to
know what wavelengths they're using though, if
516
00:34:37.800 --> 00:34:42.280
they're solely using red and that's it, or they're using things that are shorter,
517
00:34:42.440 --> 00:34:47.119
like I've seen these patches that have
blue or yellow wavelengths and purporting the
518
00:34:47.159 --> 00:34:52.360
greatness of that, like, for
example, like in the four hundred and
519
00:34:52.559 --> 00:34:54.800
thirty range, which is in the
blue range, there's been some studies that
520
00:34:54.840 --> 00:34:59.920
have shown that that helps with bacterial
infection. You can help with bacteria,
521
00:35:00.480 --> 00:35:01.639
So everybody goes, oh gosh,
that'll be great and put that all over
522
00:35:01.679 --> 00:35:07.880
everything. But the downside of that
is that that blue range gets absorbed almost
523
00:35:07.920 --> 00:35:12.519
completely at the skin. So if
you were buying devices to help with say,
524
00:35:12.559 --> 00:35:15.400
wound treatments, and you got something
that was in that four hundred range,
525
00:35:15.679 --> 00:35:17.679
okay, there might be something to
be said for that. But if
526
00:35:17.760 --> 00:35:22.679
you are sold a blue patch,
which I saw one that was made that
527
00:35:22.760 --> 00:35:24.639
was designed to go on backs and
things of that nature, it's probably going
528
00:35:24.639 --> 00:35:29.079
to be very little to help out
anything that's going on in depth as far
529
00:35:29.079 --> 00:35:31.920
as the muscle strain or problemata facet
joring the things that nature just doesn't have
530
00:35:31.960 --> 00:35:36.920
the ability with those wavelength ranges to
get there. So I would check the
531
00:35:36.960 --> 00:35:39.960
wavelength. Ideally, if it's in
between the eight nine hundred range, that's
532
00:35:40.199 --> 00:35:44.880
giving it some credence like Okay,
they're in the right ballpark. The next
533
00:35:44.920 --> 00:35:49.840
piece is how intense that light is, So the irradiance, you'd probably want
534
00:35:49.840 --> 00:35:52.440
to take a look at a few
studies that have shown that an LED works.
535
00:35:52.679 --> 00:35:55.320
You want to see what the intensity
of that light was, or basically
536
00:35:55.360 --> 00:36:01.559
the brightness or the Milla Wats percentimeter
squared. There are certain thresholds that need
537
00:36:01.599 --> 00:36:05.960
to be reached for those to be
effective. And the analogy you can think
538
00:36:06.000 --> 00:36:08.480
of is that if you sit out
on the beach getting the sun tan for
539
00:36:08.519 --> 00:36:14.480
several hours, you're getting thousands of
jewels of energy put onto your skin.
540
00:36:14.840 --> 00:36:20.360
But because the intensity of that light
is low and you're getting barraged with all
541
00:36:20.400 --> 00:36:23.400
sorts of wavelengths in the visible spectrum, it's not just say eight ten or
542
00:36:23.480 --> 00:36:28.480
nine eighty, generally you're not creating
any photo biomodulation below the skin. It
543
00:36:28.559 --> 00:36:30.800
might create some issues at the skin. That's how you can get a sunburn.
544
00:36:30.920 --> 00:36:35.199
You're out there too long. But
as far as changing things, say
545
00:36:35.199 --> 00:36:38.480
at your knee joint by setting out
the sun from a true sort of photobimodulas
546
00:36:38.519 --> 00:36:43.639
to saypoint, that's probably not going
to happen. So intensity of the light
547
00:36:44.239 --> 00:36:46.920
and the wavelength of the light are
two keys that you'd want to know what
548
00:36:46.960 --> 00:36:51.760
that device has before you you plunk
down your hard earned money, because if
549
00:36:51.760 --> 00:36:54.039
they're off on either one of those, probably not going to be super effective.
550
00:36:54.440 --> 00:36:58.519
Again, thank you, doctor Callanan, and thank you to Aenovus for
551
00:36:58.639 --> 00:37:02.320
participating in our webin today and we'll
see all of our attendees next month.
552
00:37:02.599 --> 00:37:16.000
Thanks guys, Gat Jessco. That's
it for today's episode. Be sure to
553
00:37:16.039 --> 00:37:22.239
tune in next time where we feature
a new training on integrating Master Acupuncture points
554
00:37:22.280 --> 00:37:25.679
with doctor Jeanette Kurban. You won't
want to miss it. Episode seventy five
555
00:37:25.760 --> 00:37:30.880
drops in two weeks. If you
enjoy listening to The Factor podcast, be
556
00:37:30.960 --> 00:37:34.239
sure to like, download, and
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558
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best cutting edge education to healthcare providers. And of course, be sure to
559
00:37:43.400 --> 00:37:45.760
check out the show notes for a
link to the full webinar training featured in
560
00:37:45.800 --> 00:37:50.840
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561
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offers from our sponsors. We'll see
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562
00:37:57.039 --> 00:38:00.559
you like what you heard today,
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563
00:38:00.719 --> 00:38:07.679
Hyphenstore dot com that's spelled fa k
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564
00:38:07.719 --> 00:38:12.199
information about all that we have to
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565
00:38:12.239 --> 00:38:15.960
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566
00:38:15.960 --> 00:38:20.519
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567
00:38:20.559 --> 00:38:23.519
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