A collaborated CME seminar on LLLT for hospitals.

1. SEMINAR ON LOW LEVEL LASERTHERAPY FOR
BEAS HOSPITAL, EDITED BY JAN TUNER, DEVELOPED AND
PRESENTED BY MALINI CHAUDHRI. UNDER THE AUSPICES OF
PUNJAB MEDICAL COUNCIL
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2. LOW LEVEL LASER THERAPY FOR
HOSPITALS
MALINI CHAUDHRI. Ph.D. Dr.Ac
WALT, ISLSM
ISLA, EMLA
NAALT, LASER ANNALS,
Swedish Medical Laser Society.
Has worked with Photomedicine since 1994
with Alma Ata (Hong Kong, Colombo,) Japan,
USA, Czech Republic, and Sweden.
Sponsored to USA in 2003. Based in R&D
from India. Published scientific papers and
developed a course, edited by Jan Tuner,
Editor of Laser Annals.
Specializes in Laser Acupuncture and Physio,
technical training , therapy and research.
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3. INTEGRATIVE MEDICINE. SUPPORT WITHOUT
DRUGS
TOPICS OF DISCUSSION
LLLT APPLICATIONS TO
SUPPORT ALL DEPARTMENTS
IN A HOSPITAL
WOUND HEALING
PAIN MANAGEMENT
INFLAMMATION AND EDEMA
MUSCULOSKELETAL DISORDERS
LASER ACUPUNCTURE
Review: PDT AND SYSTEMIC
THERAPY
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4. MECHANISMS
OF LLLT. LAWS OF
PHOTOCHEMISTRY
.
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ABSORPTION SPECTRA. For a photo reaction
to take place there must be a photoacceptor. This is
mainly cytochrome c oxidase in the mitochondria.
Chromophores receiving light molecules that are
active in photochemistry are melanin and
haemoglobin.
ACTION SPECTRA
Depends on the nature of the photostimulation.
Wavelengths from 600nm to 950 nm are considered
therapeutic.
Coherent laser light involves photo excitation in the
mitochondria that is conveyed to the nucleus.
Increased ATP and DNA synthesis provides scope
for reversing disease and targeting gene therapy.
All cells having mitochondria respond to LLLT.
Recent research has shown the infinite possibilities
of the mitochondria to expand and generate photo
pathways for added photo chemistry
Photo of Malini Chaudhri giving laseracupuncture to Jan Tuner in WALT, Japan
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5. Das wavelength diagram of different light sources
J. Tuner, L. Hode: Laser Therapy

6. LASER EFFECTS AND SAFETY
• Photo thermal effects. Involve significant increase of
temperature in tissue (5 -10 C),and remodelling.
CO2, ND Yag. Hair removal lasers, surgical lasers
etc.
Class 4 laser
• Photo mechanical effects. This develops a steeper
gradient during exposure. Q switch. Removing
tattoos. Class 4 laser
• Photochemistry. No significant thermal effects. LLLT.
Class 3 laser
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7. PHOTOCHEMISTRY
photo absorption -
photo action -
I I I
Wound healing Relief of inflammation neurogenic pain
Tissue repair pain,edema, acute injuries, acupuncture
Prevention of tissue chronic diseases
death
Cellular
photoacceptor in
mitochondria
Low level laser wavelength 600nm- 950nm
IIIIIIII
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8. NOTES ON EFFECTS OF LLLT
• Photoacceptors (Cytochrome c oxidase) can absorb low level lasers
irradiation and transfer it inside mitochondria in order to provide cell energy
(ATP) which is the product cytochrome c oxidase in the respiratory chain of
the mitochondria. The stimulation of ATP synthesis results in increased cell
activity. These changes influences macrophages, fibroblasts, endothelial
cells, mast cells, bradykinin and nerve conduction speed.
• Biomodulatory effects of LLLT comprise the following:
• Macrophages, lymphocytes, fibroblasts, endothelial cells and keratinocytes
proliferation; increase ATP synthesis and cell respiration, growth factors and
• other cytokines release, change of fibroblasts to myofibroblasts; change in
inflammatory mediators level (histamine and prostaglandins); increase in
oxygen transport and improve in glucose consumption; changes in cell
membrane potential and permeability,
• sodium/potassium pump excitation and more calcium removal; vasodilation
and angiogenesis (improve in tissue nutrition); collagen synthesis.
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9. What are the progressed physiological effects
of laser light?
• - Proliferation on immune cells leads to the combat of inflammations and an accelerated
• healing of wound as well as an increased endorphin disbursement, increase of the ATP
• production and increased nervous cell potential.
• - Increased leukocyte phagocytosis, boosted neovascularisation, increased collagen
• formation and protein biosynthesis. It also leads to an improved cell respiration and
• stabilization of the membrane potential.
• - Enhancement of the proton gradient via the mitochondria membrane, generation of an
• increased potential difference with increased phosphorisation of ATP (increase of 150%).
• - No modification of intact cells.
• - Energetic build-up of sick cells.
• - Energy is to a large extent (more than 40%) used for ATP synthesis, in order to increase the
• pump activity for maintaining the membrane potential.
• - Membrane stabilization leads to blocking of impulses, reducing the transmissions of pain
• sensations.
• - The cell’s calcium content is regulated (diminished ATP synthesis leads to a an overflow of
• the cell with calcium and activation of proteinasis, resulting in the death of the cell, the
• necrosis).
• - In the pre-necrotic state, cells suffer from acute lack of energy with sodium and calcium
• streaming in, which can only be removed with the utmost pump activity. This pump activity
• can only be enhanced by radiant energy.
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10. • LASER DOSE SELECTIONS ARE BASED
ON THE ARNDT SCHULTZ LAW
• LOWER DOSES ARE BIOSTIMULATORY
• HIGHER DOSES ARE INHIBITORY
• LEDS ARE IN WIDESPREAD USE. HOWEVER THEY ARE
NOT BASED ON COHERENT LIGHT AND GENERATE
• SUPERFICIAL EFFECTS SUITABLE FOR HEALING WOUNDS
• IN LASERS Areas of high difference in light intensity levels form
• SPECKLES. Local differences in intensity create temperature
and pressure gradients across cell membranes which enhances
permeability of the membrane so that photons may be active
deeper.
•
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11. WOUND HEALING
Lasers in the visible red spectrum
are preferred for wound healing(or
LEDS)
Helium Neon 634.8nm,
670nm, 780nm in Continuous
wave. LEDS. PDT
Supports dramatic healing of
Bedsores
Open wounds
Allergic or contact dermatitis
Infectious and ulcerating wounds
Diabetic ulcers
Surgical wounds
Acne
Burns
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12. Mechanisms of wound healing
• LLLT is beneficial for wounds of various etiologies and affects every molecule
involved. This includes
• Increased ATP levels
• Promotion and proliferation of migration of keratinocytes, endothelial cell and
fibroblasts.
• Secretion of growth factor from macrophages
• Increasing collagen synthesis
• Increasing phagocytic and bactericidal activities of inflammatory cells.
• Modulation and regulation of secretion of chemokines and cytokines
• These support the 3 stages of wound healing,
• 1) Inflammation (immune cells migrate to the wound and close it to promote healing)
• 2) Proliferation(new granulation tissue is produced to fill in the gaps with more collagen
production and increased epithelialization
• 3) maturation( with wound closure keratins undergo stratification and differentiation to
restore the barrier without which wounds become chronic)
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13. Oral Mucositis. Patients undergoing
chemotherapy need LLLT
Photo: R-J Bensadoun, Nice

14. A Stye. The following
day after HE NE laser
Photos courtesy Jan Tuner

15. TECHNIQUES FOR
WOUND HEALING
Apply a probe to points in contact
mode along the periphery of the
wound to stimulate contraction.
Incase of scanner apply over the
wound at .5 cm distance from skin
Along the open area use the
techniques drawn on the left or
apply along the surface of the
wound as a grid as below.
Dose. 2-6J/sq cm
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These applications improve
the effects of laser therapy
on wound healing with
lasers in the visible
spectrum
Recommendations are
from Tuner Hode

16. PAIN MANAGEMENT
• Pain management involves the use of lasers from the
634nm to 950nm.
• The IR lasers may be Superpulsed, SP, (difficult to
calculate joules) and achieve a deep tissue response
• Recent literature favors Continuous wave, CW, laser for
technical control of dosimetry and for progressive
photochemical effects during a laser session and
management of cummulative effects as per FDA
requirements.
• In pain management, Professor Pontinen, has established
a Pontinen Principle, which emphasizes the ethical
responsibilty and capacity to treat pain in a single session
of lasertherapy by maximizing the laser dosage and
palpating the pain points to assess improvement.
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17. APPROACHES
Laser
irradiation/
scanning.
Trigger
point release
Laser
acupuncture
Laser
auricular
acupuncture
Interstitial
laser
treatment
Increases
synthesis of
endorphins
and
bradykinin,
decreased
activity of C
fibers,
reduction of
serotonin and
nociceptors.
Increased pain
threshold
Relaxes
muscles
bands and
reduces
referred pain
based on
treatment of
hyper-irritable
points located
in muscles
that are
shortened
This is an
approach
through the
CNS to
activate
acupuncture
pathways and
create
homeostasis
This is a photo
pathway
through the
auricular
nerves to
stimulate a
somatotopic
representation
of the human
fetus in the
ear, with
respect to
embryonic
tissue
This is an
invasive
procedure in
which a 5 mw
laser fiber
needle
penetrates
deep into the
skin to deliver
photons in a
injured
musculosketal
condition
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18. MECHANISMS TO TREAT PAIN WITH LLLT
• a possible stabilization of nerve cell membranes, probably due to the more stable conformation
of the lipid bilayers induced by LPT, and the associated integral proteins of the nerve cell
membrane, the enhanced redox systems of the cell and an increase in ATP production have
also been shown to restore neuronal membranes and decrease pain transmission.
• - Reduction of Inflammation and edema (-releasing of inflammatory cytokines like prostaglandin
E2 and plasminogen activator could be reduced- less inflammatory cells were present in
irradiated samples-
• - Reduction of inflammatory cell migration,
• - Reduction of edema and inflammatory cytokines like TNF-α, interleukins 1 and 6
• - The laser acts by inhibiting cyclooxygenase,
• - Interrupting the conversion of arachido prostaglandin and also increases the production of B-
endorphin.
• .
• In addition to these, analgesic effects of lasers can be explained by the increase synthesis of
endorphin and bradykinin which results in decreased activity of C fibers and change in pain
threshold, and also in reduction of serotonin and suppression of nociceptors
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19. PAIN MANAGEMENT
• evidences exist on the treatments effects of low level lasers on the
synthesis, release and metabolism of various chemical nervous
mediators like
• serotonin and acetylcholine in central nervous system, and
• histamine and prostaglandin in peripheral nerves. The
• increase in production of endorphin, the reduction of C fibers activity,
the decrease of bradykinin and the change in pain threshold can also
explain the effects of low level lasers on pain
• The anti inflammatory effects of LLLT can be due to the
augmentation of phagocytosis and increase of number and
diameter of lymphatic vessels, decrease in permeability of blood
vessels, repair of capillary flow and reduction of edema
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20. 20
LYMPHEDEMA
LLLT has been noticed to reduce histamine release and
accumulated lymph edema even at Stage 3.
This application is useful for lymphedema of patients who
have surgically removed nodes, or after chemotherapy
-It is not proven in conditions that are genetic.
- In treatment of wounds and sports injuries, the lymph
pathways have to be cleared through laser application
techniques that are specific. This involves irradiating nodes,
applying a technique called ‘woodpecker, and managing a
dose that regenerates lymph vessels if needed. As with injured
skin, injured lymph vessels may also be repaired with laser.

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22. TREATING PAIN THROUGH
TRIGGER POINTS IN
ORTHOPEDIC CONDITIONS
Sports injuries, surgeries, visceral organ
diseases and orthopedic conditions
including spinal curvature,
Spondylosis, lumbago etc, will require
an approach with laser to treat trigger
points.
Pontinens Principle should be applied to
maximize the dose till the painful trigger
point is removed. The therapist may
palpate the tender point to assess pain
score, and determine effects before and
after lllt.
Also manage referred pain
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23. Trigger Point therapy is an essential
technique used in Physical therapy
to manage pain.
There is a large database of
research from World Association of
Laser therapy on precise dosimetry
for each condition and muscle or
tendon group.
The therapist must be acquainted
with
1) the laser wavelength,
2) anatomy of muscle and
3) location of trigger point
4) Recommended dosimetry in
joules
Photo is of sternal division trigger points
and referred pain in the eyes and face
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24. CHUKUKA
ENWEMEKA. WALT
EDITOR
Manual on WALT doses
and trigger points is
published online based on
meta-analysis of scientific
data
http://se-led-belt.com/wp-
content/uploads/2012/10/Li
ght_Therapy_by_Chukuka_
Enwemeka_PhD.pdf.
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25. muscle or area no of joules
points
Biceps humeri 1-2 8
Supraspinatus 2-3 10
• Minimum 5 Joules per point
Infraspinatus 2-3 10
Minimum 5 Joules per point
Cervical spine 2-4 15
• Minimum 6 Joules per point
Lumbar spine 2-4 40
• Minimum 8 Joules per point
Hip 2-4 40
• Minimum 8 Joules per point
Knee medial 3-6 20
• Minimum 5 Joules per point
RECOMMENDED
DOSES FROM
WALT Using 780nm to
830nm single lllt probes
in Physical therapy
Chronic and acute
conditions must be
differentiated
Stages of healing must be
differentiated
Local and referred pain
musat be differentiated
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26. LASER
ACUPUNCTURE
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27. 27
-LAP must be differentiated from needle
acupuncture.
-LAP treats single command points, wheras
acupuncture approaches a yin and yang points
related to 5 element disorders.
-LAP must be differentiated from Trigger points
which treat the fascia and PNS. LAP treats the
CNS and may speed up treatment effects.
-Refer to Laser acupuncture trial on women
golfers, published in Laser World.

28. LASER AURICULAR
ACUPUNCTURE.
LASER FREQUENCIES.
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29. NOGIER FREQUENCIES AND
CORRESPONDENCES
• Frequencies Body Ear (external face)
• A Orifices: mouth, eyes, nostrils, navel, anus and
genitals Internal face of tragus, auricular meatus
• B Trunk: face and back Concha
• C Limbs: arms and legs Anthelix andhelix root
• D Median line front and back, trunk and head
Pre-tragus area
• E Skull, neck and vertebral column Descending
part of helix
• F Face except nose and forehead Isthmus
• G Forehead (projection of frontal lobes) Lobule 29

30. Frequencies and Value (Hz)
• A 292 E 4672
• B 584 F 73
• C 1168 G 146
• D 2336
• Definition of frequencies by Drs Paul and Raphaël Nogier:
Extract from "The man in the ear", Maisonneuve, 1979, 255 p.
• The "A" frequency is associated, in the animal kingdom, with non-organized, embryonic structures. It is
the frequency of the primitive living being; it is in sympathy with the cell in the crude, undifferentiated state.
This frequency, the most archaic, can also be considered to be the most anarchic.
• The more elaborate "B" frequency is specific to the nutritional visceral system and is related to the
primitive gastrointestinal apparatus.
• The "C" frequency indicates motor elements of the body. It reflects movement, the limbs, the renal
system, the genital tract.
• The "D" frequency leads us to a higher level of organization, as it introduces the concept of symmetry, by
selectively affecting certain unpaired organs, presenting the characteristic of being solitary, but
anatomically symmetrical; for example the corpus callosum or the white commissure, two symmetrical
cerebral structures, situated between the right hemisphere and the left hemisphere [...]
• The "E" frequency is that of the spinal cord and central nervous system, which perceives and
communicates between functional units situated at different levels.
• The "F" frequency represents subcortical cerebral regions. These structures are found in the brain of
higher animals, dogs, for example.
• The "G" frequency resonates with the most elaborate structures of the body, those of the cerebral cortex,
the typically human part of the brain, which gives man the capacity to think, create and imagine.
•
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31. EXTRA. RUBACH. MECHANISMS OF PAIN
CONTROL OF ACUPUNCTURE
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32. EXTRA. RUBACH. EMBRYONIC ORIGIN
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33. 33
EXTRA.
RUBACH

34. 34
AXEL RUBACH. EXTRA. BK PRINCIPLES OF EAR
ACUPUNCTURE

35. EXTRA. RUBACH
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36. 36
Extra. RUBACH

37. • ENSURE THAT YOU ARE CERTIFIED
OR TRAINED TO APPLY LASER FOR
A SPECIFIC PROTOCOL
• MANAGE APPLICATIONs THAT ARE
DIAGNOSIS SPECIFIC : WHERE THE
PROTOCOL IS DESIGNED
• ENSURE THAT YOU BELONG TO A
LEGITIMATE AUTHORITY FOR
INSTRUCTION
• DO NOT MAKE CLAIMS OR PROMISE
TO CURE
• DOCUMENT ALL PROCEDURES AND
RECORDS
• MANAGE ORGANIZATIONAL SKILLS
• MANAGE COMMUNICATION SKILLS
TO INFORM THE CLIENT
• STAY UPDATED IN RESEARCH AND
SCIENTIFIC LITERATURE
FDA.
APPROVAL
FOR
PRACTISE
37

38. KEEP YOUR
PRACTISE
SAFE.
WEAR
PROTECTIVE
GOGGLES
AND PUT UP
SAFETY
SIGNS
38
• READ YOUR LASER
MANUAL
• FOLLOW SAFETY
GUIDELINES
• ENSURE THAT YOUR
LASER IS CERTIFIED
• FOLLOW OSHA AND
ANSI SAFETY
GUIDELINES FOR
LASERTHERAPY

39. RECENT CONCERNS
In a recent editorial published by Tina
Karu in Photomedicine and Laser
surgery, she has communicated that the
time has come to consider LLLT a drug
based equivalent.
She has been accountable in presenting
the large and specific database of
scientific achievements in all fields in 40
years.
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40. Laser blood irradiation in biological cancer therapy
EXTRA
WEBER

41. 41
MALINI CHAUDHRI THANKS ISTE AND JAN TUNER
AND THE BEAS HOSPITAL MANAGEMENT FOR
THEIR SUPPORT

42. 42
LINKS
www.laserannals.com
www.walt.nu
www.laser.nu
www.centerforwellness.net
With European
medical Laser
Assoc.
EMLA parliament