Wrist Injuries and Treatments

By Dr Wayne Weil 

 
 

Wrist Sprains
The most common sporting injury to the wrist is a wrist sprain. There are many ligaments in the wrist that can be torn or stretched, resulting in a sprained wrist. This commonly occurs when the wrist is bent forcefully or in a fall onto an outstretched hand. Sprains to the wrist can range from mild to severe and are graded depending upon the degree of ligament injury that exists.
Grade 1 - mild sprain where the ligaments are stretched but not torn
Grade 2 - moderate sprain where the ligaments are partially torn
Grade 3 - severe sprains that occur when there is significant complete tearing of ligaments
With grade 1 sprains, there is some mild discomfort and decreased range of motion. With grade 2 sprains there is more serious loss of function. Grade 3 sprains result when the ligament tears away from the bone and require surgical treatment. Many times this tearing leads to a small chip of the bone being torn away with the ligament. This is known as an avulsion fracture.
The most common symptoms of a wrist sprain include:
Swelling of the wrist
Bruising or discoloration of the skin around the wrist
Pain at the time of the injury
A feeling of popping or tearing inside the wrist
Persistent pain when you move your wrist
Tenderness at the injury site
A warm or feverish feeling to the skin around the wrist
Most sprains can be treated with immobilization and rest. However, your orthopedic specialist may have to perform surgery to correct your wrist injury. This all depends on the severity of the sprain and intensity of the torn ligament. Surgery involves reconnecting the ligament to the bone. This procedure is followed by a period of rehabilitation with exercises to strengthen your wrist and restore motion. Although the ligament can be expected to heal in 6 to 8 weeks, rehabilitation for a full recovery could take several months.
Other Injuries of the Wrist
Tendinosis - This is a syndrome that involves a series of very small tears (called microtears) in the tissue in and around the tendon. Common symptoms are pain, tenderness, decreased strength of the wrist, and limited movement.
De Quervain's Tendonitis - This can occur in the hand and wrist when the thumb extensor tendons and the sheath covering these tendons swells and becomes inflamed. This leads to pain, tenderness, and decrease in motion of the wrist.
Carpal Tunnel Syndrome - This is caused by pressure on the median nerve in the wrist. The symptoms of this syndrome include numbness, tingling, weakness, and pain in the fingers, hand and wrist areas.
Colles' Fracture - This type of fracture is a break across the radius that occurs when the hand is extended out during a fall. The break occurs causing the wrist to become shortened and extended. Teens that enjoy outdoor sporting activities often develop these types of fractures because falls often occur.
Symptoms of a Colles' fracture include inability to straighten the wrist or to hold heavy objects, distortion in the shape or angle of the forearm above the wrist, and pain and swelling of the injured area. Many of these fractures are not severe and you can be placed in a splint and sling. Sometimes, the orthopedic specialist applies a fiberglass cast. More severe fractures may require surgery including placement of pins or plates and screws. Recovery from this injury ranges from 6 weeks to 6 months depending on the severity of the fracture.

Visit Dr. Weil's website to learn more about the procedures he offers, including treatments for carpal tunnel and trigger finger release.
http://handandelbowsurgery.com/

Article Source: http://EzineArticles.com/?expert=Dr_Wayne_Weil

Make Pain in the Back An Extinction With These Idea

By Jon J Nestor 

Many a times back pains are induced by back injuries. This could occur from sporting activities, work, and an auto crash or really anything that you are doing that places stress on your spine. Below are some suggestions concerning back pain to help you get on the road to getting well.
Use over the counter painkillers, such as ibuprofen and acetaminophen, to lessen pain in your back. Taking oral discomfort medicines can allow you to work generally while experiencing back pains. Be sure to comply with the guidelines for good and quick results.
It is important to make sure you're keeping an appropriate weight. If you're obese, more especially if that weight concentrates in your top physique, you'll be placing a lot more stress on your spine. By keeping a required amount of weight, you'll be sure of not placing way too much tension on your spine.
Consider switching your most frequent chair into an ergonomic. There are several ergonomically created chairs presently that are made for those that are sitting at a desk or resting up all day. These chairs enable you to sit at a better position giving you the comfort you need to avoid much strain on your spine.
To prevent injuring your spine while working out, always have a rest immediately after your exercise. Many people only set aside enough time to do their actual exercise. Nonetheless, working out for some hours and not considering setting aside sometime to have a rest will be straining your spine. You only need a few minutes after the actual workout to remove tension that is already in the body.
You must be careful when raising things. When raising a nursing child it is also good to be careful to avoid back injuries.. A lot of parents hurt their backs when taking care of their little babies. Likewise, many new moms stress their spines while nursing. Pain from these traumas is quickly created when lifting your babies from your knees up to old them closer to your hearts.
If you are experience back pain, first try warming and icing your spine. In the very first a couple of days of back pain, you need to place ice on it to minimize the swelling. After the first three days of icing your back, use warm to release and unwind your muscles.
To stop getting back pain, you should make sure that you exercise regularly. This will assist raise and reinforce muscular tissues in your spine. You simply have to avoid lifting weights that are heavy and also you are avoiding anything that can injure your back.
Just as there are many causes of back pains there are a lot of remedies that you can take to be free of the pains. You can try to treat your back a home by attempting some of the methods of treating back pains. Be sure of stopping immediately when the pain persists while trying to heal your pain.

If you are in Mississauga and is actively looking for a Mississauga Chiropractor, you can visit The Chiropractic Office and learn more about Back Pain and other Chiropractic procedures.

Article Source: http://EzineArticles.com/?expert=Jon_J_Nestor

Article Source: http://EzineArticles.com/7818308

5 Foods That Boost Metabolism

By Alecia James  
 

It was in February of 2011 that I made the life-changing decision to revamp my diet. This was in conjunction with my decision to start working out so I could achieve those coveted muscles that I longingly sought. Growing up, I was always considered super-skinny

 I could eat just about anything, without gaining a single pound. So much for my fast metabolism. With this, came many misconceptions. I thought that because there was no weight gain, it meant that my body was free from all medical afflictions; this couldn't be further away from the truth-"You are what you eat." My goal was to adopt a more wholesome approach to healthy living, by gradually eliminating certain foods. With the help of online resources, and apps like "Fooducate," I channeled my inner Sherlock Holmes by scanning every food label for harmful ingredients. Revamping my diet meant making critical changes for which my entire being would be eternally grateful. Candy was out, fruits were in. I swapped sugary drinks and soda for water. My body cheered with delight and thanked me even more. The likes of MacDonald's, Burger King, KFC and Popeye's soon became a thing of the past.
Thus began my quest for healthier and more wholesome foods. I was faced with buzz words like "sugar-free," "fat-free," "low-carb," and "no-carb," which continue to inundate food labels, our television screens and just about every nook and cranny where food is displayed. With so many choices presented to us, how do we navigate this conundrum to ensure wise selections, and that we are not falling victims to false advertisements or unsubstantiated claims?
It's really not difficult if we were to take it back to the basics. Let's go back to the days when food was natural and unadulterated. My search for healthier living, ironically led me to simplicity. There are many foods, sans additives, trans-fats and preservatives, which when eaten will endow your body with perpetual bliss. What's great about this is that these foods are accessible, affordable, and beneficial all at the same time. Are they on your plate?
1. Avocado
Touted as nature's butter, it's unique essence and creamy texture infuses just the right amount of zest to any dish. They are also power-houses of vital nutrients. Avocados are rich in carotenoids such as lutein, beta-carotene and alpha-carotene. Carotenoids are compounds that contribute to the pigmentation in most fruits and vegetables. They help to protect the cells against the damaging effect of free radicals, enhance immune system functioning, and are a good source of Vitamin A. Oleic acid is a monounsaturated acid found in avocado in high amounts that helps to lower the risk of heart disease. Not only is avocado rich in heart healthy fats, it is a source of 18 essential amino acids making it an excellent protein choice for non-consumers of animal protein. The unique combination of nutrients found in this creamy goodness also endows powerful ant-inflammatory properties.
2. Nuts
Cashews, peanuts, almonds, pistachios, walnuts, and pecans... Nuts can never be too much for me. Perhaps I have some amount of squirrel DNA, but I can eat unlimited quantities. Eat them raw or roasted, salted or unsalted. Another power-food containing high amounts of heart-healthy fats and are a good protein source. They contain antioxidants such as carotenes, resveratrol, and lutein which help to protect against cancer and heart disease. Other notable properties are the presence of Vitamin E and Vitamin B. Vitamin E is a fat soluble antioxidant that protects the cells against the harmful effect of free radicals, and Vitamin B is essential for cellular processes. Finally it is an excellent source of omega-3 fatty acids. These fatty acids stupendously reduce triglyceride levels and boost heart health. Awesome taste, great benefits, another win-win.
3. Kale
As a child, we were forced to eat them. We cried because we couldn't bear the taste, and surreptitiously tossed them out when no one was watching. I'm referring to the "green stuff"- vegetables. My idea of vegetables were lettuce, carrots, or cabbage, which also have their share of health benefits. However, these days if you're not toting a bottle of thick green hulk-like liquid, then you're so 2012. Kale is a vegetable; it is great in salads and is also a fixture in many green smoothies you see now. The main benefit lies in its powerful antioxidant properties. It packs flavonoids such as beta carotene, lutein and zaexanthin. (By now you'll be able to recite the definition of "antioxidant" in your sleep.) The fiber found in this veggie supports our digestive health, yet another reason to make room on your plate. But it doesn't stop here. This super food is rich in Vitamins and Minerals. There's Vitamin A for vision support, healthy mucus membranes, and skin. It contains Vitamin C, which boosts the immune system, and Vitamin K for bone health. You'll also add some minerals to your body when you consume this veggie: iron, calcium, and potassium. Potassium is an important component of cells and body fluids. It also controls hear rate and blood pressure. You'll never have to force me to eat my veggies anymore.
4. Berries
I grew up eating fruits and my love has only intensified. Eat as is, no special preparation required. That is as good as it gets. Berries are rich in fiber, minerals, antioxidants, and vitamins such as Vitamin A and C. Vitamin C boosts the immune system and helps to prevent heart disease and stroke. Vitamin A is essential for your vision. Another vital function is that berries help to fight urinary tract infection... drink up your cranberry juice. Anthocyanidins are phytochemicals found in berries that enhance brain function and boost memory.
5. Salmon
Packed with heart healthy fats such as omega-3 fatty acids, this power-food decreases the risk of cardiovascular related problems such as high blood pressure and stroke. It is also believed to lower the risk for certain cancers like breast cancer, colorectal cancer and prostate cancer. Other benefits include a decreased risk of eye disorders like macular degeneration. Salmon also has selenium which lowers the risk of joint inflammation. It is high in protein for those concerned with achieving those coveted muscles. A 4 oz serving of salmon is enough to satisfy a full day's Vitamin D requirement.
These are just some of the many power-foods that are affordable, accessible, and exceptionally beneficial. Make room on your plate for them. Why go for "processed" when you can enjoy the awesome benefits of natural foods? Nature loved us and blessed us with these delectable goodies. Let's show our gratitude by enjoying these gifts that Mother Earth bestowed.

Alecia James is the Founder and Editor-in-Chief of http://creativeajay.com. CreativeAjay.com is a lifestyle magazine that is focused on health and wellness, beauty, makeup artistry, fashion, and natural hair. Connect with us: http://Facebook.com/thecreativeajay

Article Source: http://EzineArticles.com/?expert=Alecia_James

HEART ATTACKS AND WATER!!!!!!

posted by SACPROS

HEART ATTACKS AND WATER !
How many folks do you know who say they don't want to drink anything before going to bed because they'll have to get up during the night.
Heart Attack and Water - I never knew all of this ! Interesting.......
Something else I didn't know ... I asked my Doctor why people need to urinate so much at night time. Answer from my Cardiac Doctor - Gravity holds water in the lower part of your body when you are upright (legs swell). When you lie down and the lower body (legs and etc) seeks level with the kidneys, it is then that the kidneys remove the water because it is easier. This then ties in with the last statement!
I knew you need your minimum water to help flush the toxins out of your body, but this was news to me. Correct time to drink water...
Very Important. From A Cardiac Specialist!
Drinking water at a certain time maximizes its effectiveness on the body
2 glasses of water after waking up - helps activate internal organs
1 glass of water 30 minutes before a meal - helps digestion
1 glass of water before taking a bath - helps lower blood pressure
1 glass of water before going to bed - avoids stroke or heart attack
I can also add to this... My Physician told me that water at bed time will also help prevent night time leg cramps. Your leg muscles are seeking hydration when they cramp and wake you up with a Charlie Horse.
Mayo Clinic Aspirin Dr. Virend Somers, is a Cardiologist from the Mayo Clinic, who is lead author of the report in the July 29, 2008 issue of the Journal of the American College of Cardiology.
Most heart attacks occur in the day, generally between 6 A.M. and noon. Having one during the night, when the heart should be most at rest, means that something unusual happened. Somers and his colleagues have been working for a decade to show that sleep apnea is to blame.
1. If you take an aspirin or a baby aspirin once a day, take it at night.
The reason: Aspirin has a 24-hour "half-life"; therefore, if most heart attacks happen in the wee hours of the morning, the Aspirin would be strongest in your system.
2. FYI, Aspirin lasts a really long time in your medicine chest, for years, (when it gets old, it smells like vinegar).
Please read on...
Something that we can do to help ourselves - nice to know. Bayer is making crystal aspirin to dissolve instantly on the tongue.
They work much faster than the tablets.
Why keep Aspirin by your bedside? It's about Heart Attacks.
There are other symptoms of a heart attack, besides the pain on the left arm. One must also be aware of an intense pain on the chin, as well as nausea and lots of sweating; however, these symptoms may also occur less frequently.
Note: There may be NO pain in the chest during a heart attack.
The majority of people (about 60%) who had a heart attack during their sleep did not wake up. However, if it occurs, the chest pain may wake you up from your deep sleep.
If that happens, immediately dissolve two aspirins in your mouth and swallow them with a bit of water.
Afterwards: - Call 911. - Phone a neighbor or a family member who lives very close by.- Say "heart attack!" - Say that you have taken 2 Aspirins.
Take a seat on a chair or sofa near the front door, and wait for their arrival and ...DO NOT LIE DOWN!
A Cardiologist has stated that if each person after receiving this e-mail, sends it to 10 people, probably one life could be saved!
I have already shared this information. What about you?
share your views on this please. It may save lives!
"Life is a one time gift"

Entrapment of Medial Calcaneal Nerve

Posted by satyajit mohanty

Entrapment of medial calcaneal nerve (MCN)

Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2).

The medial calcaneal nerve (MCN)

The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior and median part.

How entrapment occurs?

A nerve can become entrapped on its way through the tissue planes. Usually in case of entrapment, the nerve gets compressed between a static and a mobile surface. As the body moves, the nerve is subjected to repeated sliding or friction, leading to compression and trauma. This trauma may damage the outer sheath of the nerve that helps with signal transmission and cause other structural alterations that eventually lead to pain and loss of function.

Causes of MCN entrapment: The medial calcaneal nerve may become entrapped between the tight fascia at the origin of the abductor hallucis muscle and the heel bone (calcaneus). An excessive pronation of the foot may lead to medial calcaneal nerve entrapment. This can occur as a postoperative complication during the release of the lateral plantar nerve branch (4).

S/S of MCN entrapment:
 
Stages of nerve entrapment (2):Clinically, any nerve entrapment is divided into three stages. 
Stage I: patients feel rest pain and intermittent paresthesias which are worse at night.
Stage II: continued nerve compression leads to paresthesias, numbness, and, occasionally, muscle weakness that does not disappear during the day.
Stage III: patients describe constant pain, muscle atrophy, and permanent sensory loss.

There is pain and parasthesia (burning or tingling) in the areas supplied by the nerve, that is below the inner bony projection of the ankle and under the heel. The pain usually initiates on the inside of the heel and travels towards the center. Any activity may further aggravate the pain.
When the medial calcaneal nerve is trapped the Tinel’s sign is positive. This test is performed by lightly tapping the skin over the nerve, which leads to tingling in the area supplied by the nerve.
Medial calcaneal nerve entrapment should not be confused with other causes of heel pain, such as plantar fasciitis and tarsal tunnel syndrome. Accurate diagnosis is important to achieve the desired results.

Palpation of MCN:
A thorough understanding of the causes of peripheral nerve entrapment, the anatomic course and variation of the peripheral nerves, the diagnostic modalities, and the treatment options can simplify this complex problem (2).
According to Tang et al anatomical position of MCN is relatively constant with 95% accuracy, MCN can be palpated at the following site:

MCNs arises from the tibial nerve at 3.3 cm up the horizontal plane of the tip of medial malleolus. They sent out anterior branches and posterior branches from 0.3 cm below the horizontal plane of the tip of medial malleolus on average.

Physical Testing:

Although diagnostic confusion abounds because of the multiple etiologies of peripheral nerve entrapments and their complex physical and temporal relation David Butler’s neural tension testing is very important to assess the reduced mobility of the nerve within the tissue plane.

Electrophysiological testing:

Electrodiagnosis is a powerful tool for evaluating lower extremity disorders that stem from the peripheral nervous system. Electrodiagnostic testing can help differentiate neurogenic versus non-neurogenic causes of complaints such as pain, weakness, and paresthesias. It can help practitioners pinpoint the anatomic location and reveal the underlying pathology in peripheral nerve lesions.

Treatment:

The first line of treatment includes rest and supportive therapies. Avoid activities that lead to pain; immobilization may also help. Use cold compresses and anti-inflammatory painkillers to reduce the symptoms. Massage or ultrasound therapy is also useful.
If rest and conservative treatment fail to eradicate the symptoms, surgical decompression of the nerve may be required. Surgical treatment usually produces good results.

Author’s comment:

Try Butler’s nerve gliding exercises & Neurodynamic techniques. I have personally tried alternative digital compression-relaxation at the site where the nerve takes a sharp angulation at heel with varied success rates but it is worth trying.  

References:
1. Tang J et al; Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010 Apr;35(4):386-9. (Anatomic characteristics and clinic significance of the medial calcaneal nerve).
[Article in Chinese]
2. Hirose CB et al; Foot Ankle Clin. 2004 Jun;9(2):255-69. (Peripheral nerve entrapments).
3. Roy PC; Foot Ankle Clin. 2011 Jun;16(2):225-42. (Electrodiagnostic evaluation of lower extremity neurogenic problems).
4. http://docpods.com/medial-calcaneal-nerve-entrapment

LASER therapy in physiotherapy

Posted by satyajit mohanty

 

LASER therapy in physiotherapy

Synonyms: 
•    Therapeutic Laser
•    Low Level Laser Therapy
•    Low Power Laser Therapy
•    Low Level Laser
•    Low Power Laser
•    Low-energy Laser
•    Soft Laser
•    Low-reactive-level Laser
•    Low-intensity-level Laser
•    Photobiostimulation Laser
•    Photobiomodulation Laser
•    Mid-Laser
•    Medical Laser
•    Biostimulating Laser
•    Bioregulating Laser

4 categories of lasers
–    Crystal & Glass (solid - rod)
•    Synthetic ruby & others (synthetic ensures purity)

–    Gas (chamber) – 1961
•    HeNe, argon, CO2, & others

–    Semiconductor (diode - channel) - 1962
•    Gallium Arsenide (GaAs under investigation)

–    Liquid (Dye) - Organic dyes as lasing medium

–    Chemical – extremely high powered, frequently used for military purposes

Types of laser:

Lasers are of 3 different type soft laser, mid laser, power laser. Soft lasers are used for dermatological purposes where depth of penetration is only superficial, Physiotherapy lasers are mid lasers where depth of penetration is from .5-2cm for class III lasers up to 10 cm in type IV lasers. Power lasers are destructive lasers used in different medical & dental surgery.
There are 4 different classes of laser i.e. Class I-IV. All 4 class are used in physiotherapy. However class I-III lasers are commonly used. Class IV physiotherapy & surgical lasers are not to be confused with each other.

Class of lasers:

Class I: Low power lasers
Class II: Power out put up to 1mW (400-700 nm wavelength).
Class IIIa: Power out put up to 5mW.
Class IIIb: Power out put up to 5-500mW.
Class IV: Power out put up to 500-7500mW.

* All lasers can cause eye damage except Class I laser. As the power increases the potential of causing eye damage is more.

* Class III lasers are also known as LLLT i.e. low level laser therapy.

* Class IV lasers are also known as high power laser therapy.

* High-power lasers (class IV) have power output of up to 7,500 mW; and supposedly offer more power, deeper penetration (can penetrate up to 10 cm instead of 0.5 to 2.0 cm for class III lasers) and a larger surface treatment area (cover up to 77 cm2 instead of 0.3 to 5.0 cm2 for class III lasers) 

Modes of Laser:

Either it is continuous or Pulsed. In pulsed laser frequency is a key area for therapeutic efficiency.

Why red or IR lasers are used?
•    Red light affects all cell types
–    Absorbed by the mitochondrial present in all cells
–    Cytochromes (respiratory chain enzymes) within the mitochondria have been identified as the primary biostimulation chromophores (primary light-absorbing molecules).
–    Since enzymes are catalysts with the capability of processing thousands of substrate molecules, they provide amplification of initiation of a biological response with light.

•    Infrared light is more selective absorbed by specific proteins in the cell membrane & affects permeability directly

Tissue response:

•    Magnitude of tissue’s reaction are based on physical characteristics of:
–    Output wavelength/frequency
–    Density of power
–    Duration of treatment
–    Vascularity of target tissues

•    Direct effect - occurs from absorption of photons
•    Indirect effect – produced by chemical events caused by interaction of photons emitted from laser & the tissues

Patient & Laser parameters:

•    Patient parameters
–    Need medical history & proper diagnosis
•    Diabetes – may alter clinical efficacy
–    Medications
•    Photosensitivity (antibiotics)
–    Pigmentation
•    Dark skin absorbs light energy better

 Laser Parameters

–    Wavelength
–    Output power
–    Average power
–    Intensity
–    Dosage

Laser Wavelength: This is measured in Nanometers (nm). Longer wavelength (lower frequency) imparts greater penetration. Wavelength is affected by power.

Laser output: It is measured in Watts or milliwatts (W or mW). It is important in categorizing laser for safety. It is not adjustable.

Power Density or Laser intensity: Beam diameter determines power density. Units of measurement is W or mW/cm2.It takes into consideration actual beam diameter. If light spread over lager area then there is there is lower power density.

Average Power: It is dependant on the mode of laser beam delivery i.e. Continuous or pulse-train (burst) frequency mode. Knowing average power is important in determining dosage with pulsed laser. If laser is continuous laser then avg. power = peak output power. If laser is pulsed (burst) then avg. power is = to peak output power multiplied by duty cycle (frequency).

DOSAGE: Laser dosage is amount of energy applied per unit area. It is measured in Joules/square cm (J/cm2). Joule is unit of energy &1 Joule = 1 W/sec. Dosage is dependent on:
–    Output of laser in mW
–    Time of exposure in seconds
–    Beam surface area of laser in cm2
Various dosage ranges per site (1-9 J/cm2).

Recommended Dosage Range
–    Therapeutic response = 0.001-10 J/cm2
–    Minimal window threshold to elicit response
–    Too much – suppressive effect
–    Open wounds – 0.5-1.0 J/cm2
–    Intact skin – 2.0-4.0 J/cm2
–    Average treatment – 6 J /cm2

Different common lasers in physiotherapy:

1. Helium-Neon Lasers

•    Uses a gas mixture in a pressurized tube
•    Now available in semiconductor laser
•    Emits red light
•    Wavelength:  632.8 nm
•    Power output: 1.0-25.0 mW
•    Energy depth: 6-10 mm
•    The higher the output of the lasers (even though they are still low power) lower the delivery time

2. Indium-Gallium-Aluminum-Phosphide Lasers

•    InGaAip
•    Replacing HeNe lasers
•    Semiconductor
•    Wavelength:    630-700 nm
•    Power output:  same as HeNe
•    Energy depth: superficial wound care

3. Gallium ArsenideLasers

•    Semiconductor - produces an infrared (invisible) laser
•    Wavelength:  904–910 nm
•    Power output: may produce up to 100 mW
•    Energy depth: 30-50 mm
•    Short pulse-train (burst) duration (100-200 ns)

4. Gallium Aluminum ArsenideLasers

•    GaAIAs
•    Semiconductor
•    Wavelength: 780-890 nm
•    Power Output: 30-100 mW (up to 1000 mW)
•    Energy Depth: Very high more than the above said laser

Laser Application techniques:

•    Gridding Technique
•    Divide treatment areas into grids of square centimeters
•    Scanning Technique
•    No contact between laser tip in skin; tip is held 5-10 mm from wound
•    Wanding Technique
•    A grid area is bathed with the laser in an oscillating fashion; distance should be no farther than 1 cm from skin
•    Point Application (On acupuncture point)

Treatment techniques for contact treatment:

Dosage is the most important variable in laser therapy & may be difficult to determine. However it may be simplified i.e. for general application, only treatment time & pulse rate vary. Usually there is a handheld applicator & tip should be in light contact with skin while laser is engaged for pre-calculated time. Maintain laser perpendicular to treatment surface. Put firm contact unless open wound. Clean area prior to treatment.

Always begin with minimal treatment and gradually increase (Better to underexpose than to overexpose). Check for pre/post-treatment changes. Ask the patient how they are doing prior to next treatment because you may have to adjust dosage.

Avoid direct exposure into eyes (If lasing for extended periods of time, safety glasses are recommended). May experience a syncope episode during treatment during chronic pain, but it is very rarely reported.

Application of heat & cold with LASER: If icing – use BEFORE phototherapy because it enhances light penetration. If using heat therapy – use AFTER phototherapy because it decreases light penetration.



Use of Laser therapy in different field of medicine

1. Vascular condition: Venous ulcer (Ref: M.E. Sugrue et al; Annals of Vascular Surgery, Volume 4, Issue 2 , Pages 179-181, March 1990). Results of this pilot study are encouraging. Raynaud's phenomenon is also treated by Laser therapy (Hirschl et al, 2004). Popularly pressure ulcers are treated by laser therapy in neurorehab words.

2. Neurological condition: Stroke (Ref: Int J Stroke. 2012 Feb 2. doi: 10.1111/j.1747-4949.2011.00754.x.). This study named transcranial laser therapy for acute ischemic stroke: a pooled analysis of NEST-1 and NEST-2, support the likelihood that transcranial laser therapy is effective for the treatment of acute ischemic stroke when initiated within 24 h of stroke onset. If ultimately confirmed, transcranial laser therapy will change management and improve outcomes of far more patients with acute ischemic stroke.

Similarly laser therapy is also reported to be beneficial in number of other neurological conditions both in animal & human subjects. Examples are closed-head traumatic brain injury (mice)( In mice it is reported that there is less neurological deficits in post-traumatic brain injury treated with laser for traumatic brain injury.), neurodegenerative diseases (humans) example Alzheimer’s disease. 

3. ENT conditions: Tonsillitis (Vestn Otorinolaringol. 2006;(3):19-22. Russian.), Tinnitus (FrankW et al; GMS Health Technol Assess. 2006 Aug 30;2:Doc17).

4. Surgical conditions: Chronic wound healing, Kaviani and colleagues (2006) examined the effects of low level laser therapy (LLLT) in the treatment of post-mastectomy lymphedema & concluded that LLLT has encouraging results on this condition. LLLT can be used as a conservative therapy for arm lymphoedema secondary to breast cancer treatment (BC Cancer Agency; 2007). Mastodynia is also treated successfully. Lymphangitis is also reported to be treated successfully

5. Dental conditions: post-operative pain after endodontic surgery (Kreisler et al; 2004). Markovic and Todorovic (2007) found after lower third molar surgery laser therapy can be recommended to minimize swelling & oedema. TMJ conditions also show encouraging results.

6. Musculoskeletal conditions: Bursitis, Tendinitis, Ligament injuries, CTS, Neck pain, LBA, myofascial pain syndrome (MPS), Post exercise pain (to treat plyometric induced pain), planter heel pain(Crawford and Thomson, 2003; Landorf and Menz, 2007).

7. Rheumatological conditions: RA (most studied) other rheumatologic pain

8. Other conditions: After effects of tuberculosis, Smoking cessation, Dysmenorrhea etc.