Low Level Laser Therapy for Arthritis - Dosage guidelines

Low Level Laser Therapy is an effective adjunct modality for the treatment of both osteo and rheumatoid arthritis. Studies show that it not only reduces pain but also improves the underlying pathology, increase joint flexibility and improves range of motion. Laser has also been shown to improve bone and cartilage production through cellular mechanisms. This is a guide that will show you how to use LLLT in your clinic for the treatment of arthritis and arthritic disorders.

Types of lasers, wavelength and power

When treating arthritis a number of different types of lasers or laser attachments can be used. The most useful are the cluster probe, the multi lead and the handheld lllt unit

A cluster probe (shown above) laser allows you to irradiate a large area in a relatively short time especially when using a high power probe such as the Aconite Laser Shower unit. A cluster probe however does not allow you to address a specific area of pain or trigger point and it will not penetrate to deeper structures and tissues easily since it is held away from the skin in most cases. 

A multi lead laser unit (shown above) allows you to place a laser diode over the specific area of pain or over a trigger point to get better penetration depth of the laser and also be more specific in the point being treated.

A handheld laser unit has the benefits of both a multi lead unit and a cluster probe but will have to be used for a much longer time to get the same effects since it is not high power and only one point can be treated at a time.

The ideal unit for practice that sees arthritis and other musculoskeletal complaints is a combined cluster and multi lead unit as shown above. This unit can be specified in different wavelengths, we recommend the cluster at 660nm and the multi lead at 780nm for the treatment of arthritis and musculoskeletal conditions.

Wavelength

The ideal wavelength for treating arthritis is 660nm. 780nm can be used when one requires greater depth of penetration. Ideally the use of a cluster probe at 660nm and a multi lead consisting of 780nm diodes provides the best results.

Power

Individual diodes should be at least 50mw true lasers, LED diodes are not as effective since they have very low penetration depth.

Dosage and treatment guidelines

• General dosage is 10 to 20J/cm2, refer to the dosage table below for specific therapy times for each type of unit

• Treat directly over the areas of pain. Schedule once or twice weekly for 2 to 8 weeks or longer in chronic cases. If the patient is amenable then daily treatment for 2 weeks can also be administered with a break of 1 week thereafter.

• Small joints respond quicker than larger joints.

• Higher end of the dosage range gives better results, however in long standing conditions start with 1/3 to 1/2 the effective dosage

• Hands/fingers: Treat 4 points per joint, 4-5 joules per point. Measure grip strength before and after

• Wrist: 7 j/point around circumference of the joint, repeat once with a different pulse rate

• Elbow: Identify areas of tenderness to laser, also over the lateral and medial epicondyles and along the affected meridians/tendons. 3 sets at 7j/point with changing pulse rates (eg. 20Hz, 100Hz, CW)

• Shoulder: Causes may be very complex, involving joints, muscle insertions and origins, tendons, ligaments and bursae. Choose 5 to 10 points based on your diagnosis and treat with moderate to deep pressure at 7j/point for 2 to 3 sets with varying pulse rate.

• TMJ: 7j/point directly into and around the joint with the mouth open and closed. Also treat tender points on the jaw, neck and upper back

• Hip: Always treat with the patient lying on their side. Treat tender points and directly over the hip joint, higher dosage is preferred in order to achieve penetration depth, 7 to 15j/point for 2 to 3 sets at varying frequency and if possible wavelength

• Knee: 6j/point on and around areas of pain, repeating with different pulse rates

• Ankle: 7j/point around the circumference of the joint, repeat with different pulse rates

• Foot/Toes: 4-5j/point . Also use bafeng points If a result is not achieved the first time, use a higher dosage in the following session. It is sometimes necessary and possible to give doses as high as 120j/cm2 for good effect

   

   

  Disease Name	Therapy Time (Minutes)			Frequency(Session/Week)	Recommended Dose (Joule/cm²)
  	Laser Effective Area = 22 cm²	Laser Effective Area = 3.14 cm²
  	Laser Shower	Multi Lead Laser	Handheld Laser
  	AM-102A	AM-100A780	Klas-S81
  	780nm	780nm	808nm
  	500mW	LD: 80mW End: 74.4mW	LD: 110mW End: 66mW
  	Laser Intensity 22.7 mW/cm²	23.7 mW/cm²	22 mW/cm²
  Arthritis	8~15	7~14	8~16	3	10~20

  
  
  

  WALT Recommended Dosages:

  Diagnoses	Points or cm²	Joules	Notes
  Arthritis
  Finger PIP or MCP	1 ~ 2	4	?
  Wrist	2 ~ 4	8	?
  Humeroradial joint	1 ~ 2	4	?
  Elbow	2 ~ 4	8	?
  Glenohumeral joint	2 ~ 4	8	Minimum 4 Joules per point
  Acromioclavicular	1 ~ 2	4	?
  Temporomandibular	1 ~ 2	4	?
  Cervical spine	4 ~ 12	16	Minimum 4 Joules per point
  Lumbar spine	4 ~ 8	16	Minimum 4 Joules per point
  Hip	2 ~ 4	12	Minimum 6 Joules per point
  Knee medial	3 ~ 6	12	Minimum 4 Joules per point
  Ankle	2 ~ 4	8	?

  Remarks:
  	Daily treatment for 2 weeks or treatment every other day for 3~4 weeks is recommended.
  	Start with energy dose in table, then reduce by 30% when inflammation is under control.
  	Therapeutic windows range from typically ±50% of given values.
  	If the treatment area is larger than the irradiation area, the treatment time should be recalculated.