13 The #1 Modality to Add to Your Practice in 2023
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Dynamic Chiropractic – April 1, 2023, Vol. 41, Issue 04

The #1 Modality to Add to Your Practice in 2023

By Phil Harrington, DC, CMLSO, FASLMS

Managing a chiropractic office is a challenging task. As the doctor and practice owner, you are responsible for a myriad of personnel, regulatory and fiscal issues; and none of these should get in the way of excellent patient care.

What are your plans for practice growth in 2023? Are you leasing more space, adding staff, increasing your clinic hours? Are you considering adding products or services?

If you are considering adding a modality that is scientifically and clinically proven, delivers consistent results, and can be administered by your staff.1 and you are not offering laser therapy yet, now is the time. Doctors of chiropractic are in a unique position to offer this healing modality, as it complements the patient care already being delivered; and can facilitate improved pain relief, injury healing and patient satisfaction.

How Other Professions Are Using Laser Therapy

Before investigating how laser could work in your office, let's look at two interesting ways that other professions are utilizing laser therapy, or photobiomodulation (PBM).2 It is estimated that 40% of cancer patients undergoing standard chemotherapy may develop oral mucositis, and those receiving radiation, especially in the cases of head and neck cancer, have 30%-60% chances of developing mucositis.3

Photobiomodulation treatments delivered with a class 4 therapy laser were shown to result in "improving oral mucositis lesion healing, reducing the inflammatory burden, and preserving tissue integrity."4 Clinical practice guidelines now recommend PBM for the prevention and treatment of oral mucositis secondary to cancer treatment.5

A pilot study assessed the feasibility and efficacy of class 4 laser therapy on postoperative pain following a surgical procedure called "off-pump coronary artery bypass graft (OPCABG)." PBM was used as a component of multimodal analgesia (MMA) technique, which combines drugs and modalities with various mechanisms of action, striving for the most effective pain relief. It concluded that PBM with a class 4 laser can be an effective technique for postoperative analgesia.

What Can Laser Do for Your Patients?

These novel uses of PBM indicate its ability to aid in tissue healing and pain relief. But what can PBM do for the patients in your office?

Consider the patient dealing with upper- or lower-extremity trauma or sports injury. What is your current treatment plan? Ice and complete rest are shown to delay healing,6 so put away the ice cup and slings.

PBM for the treatment of acute and chronic musculoskeletal disorders is proven to provide pain control and improved tissue repair. Enhancing circulation (arterial and venous) promotes healing by regulating postinjury ischemia, hypoxia, edema, and secondary tissue damage. Laser therapy is shown to increase blood flow in the soft tissues, and improved circulation is considered one of its greatest benefits to soft-tissue healing after injury.7

Low back pain affects most individuals at some point in their lives. Up to one in 10 of cases will develop chronic low back pain (CLBP), which leads to high treatment costs, sick leave and individual suffering.8 Are chiropractic adjustments working to your and your patient's satisfaction?

Patients with chronic low back pain treated with PBM have significantly reduced low back pain, reduced disability, and improved range of motion, and the positive effects are maintained for several months.9

Safe, Effective, Painless and Noninvasive

Therapeutic lasers have been FDA cleared as prescription class 2 medical devices10 for more than 20 years.11 The complex mechanisms of photobiomodulation are becoming well-understood, with significant advances in recent years.12-13

A significant advance in photobiomodulation science was the recognition that optimization of parameters should be based on the dose reaching the target tissue, which often requires higher doses of light at the skin surface to reach deeper tissues.14

Photobiomodulation is a painless, non-invasive treatment that can be used in the treatment of most clinical conditions in the chiropractic office. Treatments can reduce acute and chronic pain associated with conditions as varied as low back pain, chronic osteoarthritis, carpal tunnel syndrome, fibromyalgia, knee injuries, pain in the shoulders and postoperative pains.15

In other words, your strategy for practice growth in 2023 should include the addition of laser therapy equipment.

References

  1. Low-level laser can be administered by staff in most states; check your state scope-of-practice laws.
  2. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomed Laser Surg, 2015 Apr;33(4):183-4.
  3. Singh V, Singh AK. Oral mucositis. Natl J Maxillofac Surg, 2020 Jul-Dec;11(2):159-168.
  4. Ottaviani G, Gobbo M, Sturnega M, et al. Effect of class IV laser therapy on chemotherapy-induced oral mucositis: a clinical and experimental study. Am J Pathol, 2013 Dec;183(6):1747-1757.
  5. Lalla RV, Bowen J, Barasch A, et al. Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO). MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer, 2014 May 15;120(10):1453-61.
  6. Mirkin G. "Why Ice Delays Recovery." DrMirkin.com, Sept. 16, 2015.
  7. Larkin KA, Martin JS, Zeanah EH, et al. Limb blood flow after class 4 laser therapy. J Athl Train, 2012 Mar-Apr;47(2):178-83.
  8. Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica, 2015;49:1.
  9. Gocevska M, Nikolikj-Dimitrova E, Gjerakaroska-Savevska C. Effects of high-intensity laser in treatment of patients with chronic low back pain. Open Access Maced J Med Sci, 2019 Mar 25;7(6):949-954.
  10. Classify Your Medical Device. U.S. Food & Drug Administration.
  11. 510(k) Premarket Notification. U.S. Food & Drug Administration.
  12. Hamblin MR, Liebert A. Photobiomodulation therapy mechanisms beyond cytochrome c Oxidase. Photobiomodul Photomed Laser Surg, 2022 Feb;40(2):75-77.
  13. Hamblin MR. Mechanisms and mitochondrial redox signaling in photobiomodulation. Photochem Photobiol, 2018 Mar;94(2):199-212.
  14. Anders JJ, Arany PR, Baxter GD, Lanzafame RJ. Light-emitting diode therapy and low-level light therapy are photobiomodulation therapy. Photobiomodul Photomed Laser Surg, 2019 Feb;37(2):63-65.
  15. Gocevska M, et al. Op cit.

Dr. Phil Harrington is a certified medical laser safety officer and serves on the subcommittee reviewing the ANSI Standards for Safe Use of Lasers in Health Care Facilities. He is a 1996 Palmer graduate and also holds a bachelor's degree in physics. He is the medical director, clinical manager and laser safety officer for Summus Medical Laser (www.summuslaser.com).

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