DIARY: Laser 3–NSAIDs 0

A friend of mine asked me today whether I thought LLLT (Low-Level Laser Therapy) would ever make physiotherapists redundant. It was an intriguing question because after my last visit I am more convinced than ever that laser therapy must be championed so that we one day have one on every street and going for laser therapy is like going to the dentist: a regular thing you do to enhance your healing processes for any wounds or injuries incurred.

Let me look back on my recent experience and then try to answer the question…

That old left leg…

My leg had deteriorated badly on Tuesday and it felt like my shin was going to explode at time, the walk from the LUAS to Hume Street through St. Stephen’s Green was slow and painful and at times I had to stop just to compose myself and let the throbbing subside a bit before hobbling on.

On hour later I left the clinic with the positive news that I had no tissue damage (e.g. no damage to tendons and muscles) in the affected area and that there was no sign of shinsplints or compartment syndrome (as my physio John Murphy had rightly predicted, without the aid of ultra-sound enhanced images).

“Allergic to running?”

In addition, my gait was somehow better: the laser had not suddenly lifted all symptoms but there was something stirring. I was moving a bit easier and in the following hours the improvement became marked. The terrible pressure went first, and then funny tingling started in my toe. What Dr. Pat Leahy, inventor of the science and a former NASA scientist, had found were large tracts of inflammation running from my big toe into my shin. Why this huge internal river of goo was there when no evidence remained of the original sprain is a mystery but explains why I never felt a loss of strength in my lower leg over the last days.

“Allergic reaction to pounding” is probably as apt a metaphor as any for what occurred on Sunday. Clearly, for whatever reason, my left leg remained vulnerable to irritation and my body triggered an abnormally aggressive inflammatory response in an attempt to immobilise the area on Sunday. I am no expert on inflammation but have read up on the subject in recent days and learned that not only does the swelling cause local irritation but the agents released in the inflammatory mix both heighten the sensitivity of nerve cells and irritate them which could explain why I would feel so much pain for so little damage.

Supplementary treatment

Dr. Leahy also had a look at my right ankle which has improved a lot since my last treatment but still feels like a vice is put around it when I run on my toes uphill (so I don’t do that, in general!). Scans showed that a good blood flow has been restored to the area and it is progressing, but to give it a further boost, he send some lower frequency lasers into the joint. Perhaps this will be the last I will feel of that old injury.

Prognosis

He expected that symptoms should subside within 48 hours so I will be awaiting tomorrow with great excitement. My leg tentatively accepted a hard workout on the Milon circuit where I felt a bit of irritation doing leg extensions, cross-trainer and bike, but I managed to adjust my intensity to a level where there was minimal discomfort. Today all pressure is gone on the area and only some soreness remains on the site of the original subtalar sprain. I am hopeful that if this rate of healing continues I will be back running within three to four days.

In the meantime, to turn back to the question, Could lasers make physios redundant and why is the laser therapy not more prevalent when it is so effective? It has helped me thrice now and anecdotal evidence from friends and runners I know is overwhelmingly positive and staggering in efficacy (several reports of going from injured to “running from the clinic” or close enough…).

Interest groups

Here’s a theory: Electric cars have been technologically possible to manufacture for decades yet they have been regularly suppressed. Standard strategies employed against producers have been to buy out the product and shelve it. Release of many technologies such as the CD where delayed by years until the manufacturers could recoup their development costs on previous technologies (the cassette). Green energy solutions have only become viable because strategic imperatives (we don’t own all the oil) or financial incentives (subsidies to these industries) make them essential or attractive.

Corporate interest groups will suppress anything they cannot control unless they are ensured they can make a bigger profit moving first. But often they don’t have to and often the only way to return expensive research is by selling enough. Cures don’t sell well because they only sell once. There is no better venture than an expensive drug you have to take for the rest of your life, preferably daily.

NSAIDs (Non-Steroidal Anti-Inflammatories are being increasingly shown up by laser technology and were completely ineffectual on my injury (I took 1 every 4 hours as prescribed) as well. That is not to say they are generally ineffectual as I have had good results against tooth ache from them (to mention an anecdote).

Research into laser therapy is so far limited and the studies have generally been poor using lasers well below necessary dosage for effective results.

How does it work?

From my observations and readings of the laser technology, you are basically attempting to trigger certain chemical reactions or accelerate existing processes by matching the ideal frequency of the light (directly related to the energy contained in it) with the type of tissue you are targeting. This requires that you know what frequencies interact best with the tissue in question and that you can measure exactly where to target the laser beams. The Laser Clinic uses high definition ultra-sound equipment to achieve this.

The technology is clearly developing (Pat Leahy mentioned that they receive new frequencies practically daily) but from my limited understanding of physics and physiology, the concepts make sense especially if you consider that all life as we know it was first created by this very concept – light waves from the sun triggering chemical reactions in the primordial soup of the early Earth. Today, most life on our planet is sustained through a very similar process – that of photosynthesis the process by which the energy stored in sunlight converts carbon dioxide into organic compounds such as sugars (and releasing our precious oxygen as a waste product).

Since laser light (like all light) also contains energy it is well within layman’s reason that it should be able to trigger complex chemical processes.

What about doctors and physios?

There is an argument that doctors have not widely embraced the technology because first of all the medical profession is conservative and do not adopt technologies until proven beyond doubt (and I do not think we would want it any other way). Unfortunately, proper research seems slow in the coming and I would not be surprised if that happens to coincide with the fact that so many studies are sponsored by the producers of  drugs and medications. They are hardly likely to bankroll studies that would instantly kill off several of their best cash-cows?

A second argument is that while doctors are well-educated they are not physicists and proper understanding of the laser technology falls outside their area of expertise. This seems a classical example of a new science which does not yet fully map to one profession (that being said European and International group exists for laser surgery specialists and they do not allow random punters to join, so to speak).

As for physios, I do not believe they would become redundant but rather that they would adopt the laser technology as they have adopted the much less efficient ultra-sound and offer it as a treatment to quell any immediate inflammation at their clinics. Their main role would then move that what they already do well: advise on the root cause of your injury and help you correct muscular and biomechanical weaknesses In short, their job would shift more towards prevention and less towards treatment which would be beneficial for the patient while keeping the physiotherapy profession extremely viable if possibly focused more towards areas that are today often associated with strength and conditioning coaches and other rehabilitation specialists.

In any case, my passion for this field has been awoken, and if there is anything I can do to help promulgate this field, I will.

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