Laser Treatments, Power, Performance, Frequencies and Dosage in joules/cm2

Laser Treatments, Power, Performance, Frequencies and Dosage in joules/cm2

The PowerLaser PRO 500 and PowerLaser PRO 1500 are top performing cold lasers that outperform nearly every other class 3b cold laser on the market. The PowerLaser PRO 1500 allows the user to choose between 9 custom preset settings with power outputs from 300-1500mW and up to 3000mW HyperPulsed, to quickly and effectively treat a wide range of symptoms and conditions. The gentle haptic vibration waves integrated into the this handheld Class 3b Laser Therapy Device make it a joy to use, providing a rewarding feedback loop for the patient and practitioner. The laser diodes are Near Infrared (NIR) lasers with an output of 1500mW (1.5 Watts) and 3000mW of peak power (3 Watts) of hard tissue healing and pain reducing power. This type of cold laser will support superior healing, pain relief and regeneration like a pro. Training and protocols are provided at no additional charge.

The PowerLaser PRO 1500 covers 1 inch of surface area with 3 808nm IR laser diodes. Many protocols are based on joules of energy delivered to a given point or location (energy = power x time, and the units are joules = watts x seconds.) a 1 watt continuous wave laser would deliver 60 joules in one minute. (1 watts x 60 seconds = 60 joules) then divide the total energy by the area to arrive at the energy density in joules per centimeter squared.

The PowerLaser PRO 1500 has up to 15 times the power of the ML830™ AND up to 200 times the power level of an Ercho... laser system. This means you can either shorten your treatment times by 15X (by targeting the same dosage) or give your patients the higher dosage that often makes the difference between success and failure.

Treatment Area, Treatment Depth, Density and Treatment Times

One of the complexities of laser therapy is that there are huge variations in the size of the treatment area and the depth of the treatment area. As treatment depth increases, the target energy at the surface must increase because most of the energy is absorbed on the way to the area where it is needed. Larger treatment areas also include the dosage requirement.  These factors have a major effect on the total therapy dosage. As the dosage increases, the treatment time increases. If the dosage is less than optimum, the recovery time increases.

DEPTH

Really, the biggest concept that is causing poor suboptimal dosages is the effect of depth of the treatment. The most universally accepted standards for dosage were developed by the World Organization of Laser Therapy (WALT). Their recommendations are 4-12j/cm2 for the target tissue.  This is NOT 4-12j/cm2 at the surface. Experience shows that to get this level of photon density at  the target depth, the laser has to put 5 to 10 times that density at the surface to get the recommended dosage at a depth of 2 inches.  Larger patients can require much more. Smaller patients will require less. That is because 70 to 90% of the energy is absorbed on the way down to the target area.  This means that the surface energy should be in the range of 24 to 100 j/cm2 based on the WALT standards for optimal results.

AREA

The following table illustrates the difference between 2 conditions typically treated with a laser. The first condition is arthritis in one finger. This is a shallow, small treatment area. The second condition is Neuropathy based on a pinched nerve in the lower back OR hips. This is a deep therapy that requires treating a larger area to make sure that the damaged area gets the desired energy density. We will then calculate the treatment times for 3 different target energy densities for 3 different power level lasers. The target energies listed are at the surface so the density at the desired depth could be up to 90% less.

This analysis is based on simple energy dosage calculations. The general consensus is that pulsing a laser provides an additional benefit beyond the total dosage of energy. Many people get great results with a lower power pulsing system but, at this point, we cannot quantify (put it into numbers) the benefits of pulsing so it is left out of this analysis. Pulsing the laser also helps keep the laser cooler which reduces the cost of the system so lower power pulsing and super-pulsing lasers are still a great option even if they must target lower treatment dosages.

Treatment Times for Arthritis (depth = 1cm, area = 6 cm2*) Based on Laser Power


Surface Density
Total Dosage (j) 100mW System 1000mW System 10,000mW System
10j/cm2 60j 600 sec
(10 minutes)
60 sec 6 sec
24j/cm2 144j 1440 sec
(24 minutes)
144 sec 14.4 sec
48j/cm2 288j 2880 sec
(48 minutes)
288 sec 28 sec

* This protocol is treating approximately 1 square inch but we are using it as an illustration of the minimum energy requirements. From this chart we can see that any laser will treat this condition. We also see that a class 4 laser is overkill. A 100mW laser is the lowest cost option and it will work fine for this condition, but treatment time will probably be more than 10 minutes as compared to just 1 minute with a 1000mW laser.

Treatment Times for Neuropathy (depth= 3cm, area = 300 cm2) Based on Laser Power


Surface Density
Total Dosage (j) 100mW System 1000mW System 10,000mW System
4j/cm2 1200 (3.3 hours) (20 minutes) (2 minutes)
12j/cm2 3600 (10 hours) (60 minutes) (6 minutes)
24j/cm2 7200 (20 hours) (120 minutes) (12 minutes)

From this chart we can see that even the class 4 laser would have long treatment times if you want a higher dosage. We can also see that very lower power lasers, which worked perfectly for arthritis, will never get anywhere near the desired energy density at depth in a reasonable amount of time.

At ColdLaserSupplies.com and Class4Lasers.com we understand that most people only want to buy as much laser as they really need to get the job done. We are committed to work with our customers to match each laser to each buyer's specific needs. Our business is built on your satisfaction and success. Consequently our goal is to find you the best laser for your needs.

IF YOU WOULD LIKE ASSISTANCE, CALL LASER SPECIALIST TOLL FREE AT 888-824-7558

Power and Protocols

Good protocols will target an energy density over the damaged area and this will equate to a total light energy dosage for the entire area measured in Joules. Since we know that 1 Joule = 1 watt per second, we can easily calculate treatment times and compare systems.

Using an average class 3b dosage of 500 joules, we can calculate that a 900mW (.9w) laser in continuous mode will deliver that dosage in about 9 minute. If we pulse the laser with a 70% duty cycle, the time will be about 12 minutes. If the laser has a 100mW (.1w) max continuous output, the treatment time should be 83 minutes. If the laser is pulsing at 70%, the time will be about 2 hours. As a professional practitioner, treatment times can play a huge role in your target dosage. Therefore you must target dosages in the 40 to 100 joules if you are using a 100mW system in order to get a reasonable treatment time.

These energy levels are the output from the laser, not the delivered energy to the damaged tissue. If you divide the laser output energy level by the area, you get the energy density at the surface. In most cases, the user is trying to get energy down deep into the damaged tissue. In the cases above with a total output of 500 joules over the entire treatment area, this protocol might only produce about 4 to 8 joules/cm3 deep in the tissue.

Treatment Areas

To begin our discussion of power, we must first review the 2 basic types of cold laser therapy, pinpoint and broad coverage. In Acu-point therapy the practitioner will use a narrowly focused beam (such as PowerLaser PRO 500) to treat a trigger point or acupoint to correct problems in the body through the application of Acupoint therapy protocols. Because the treatment area is extremely small, the power levels can be very small too. If you want to do trigger point or acupoint therapy, read Kalon Prensky's book, Cold Laser Therapy, the 22 acupoint healing system with over 250 protocols made easy.

The second type of therapy, broad coverage, includes large areas of damaged tissue like knees, hips and spines. Treating a large-scale leg injury using a single focused beam would be like trying to color a piece of notebook paper with a colored pencil. It could take all day and the results would not be that good. For this reason many manufacturers combine together multiple laser beams or diverge the beam so that a larger treatment area is evenly covered. This partially explains why power levels in the industry keep going up. For general tissue therapy, emitter outputs go up to 50,000mW (50W).

Laser Technology

Another reason why power levels are rapidly growing in new products is the quality of laser diodes has improved significantly. 20 years ago, the life of a 50mW laser diode was relatively short. Now, it is commonplace to have a 500mW or even 50,000mW laser modules that lasts for 10 years or more. Since the power level is a controlled variable in the FDA clearance, it can be expensive to update older products to the new technology so we still see some super low power devices on the market. Also, there can be a big difference in cost between low and high power lasers (and LEDs). In order to keep the price down, some manufacturers are still using very low power diodes.

Wavelength / Power Interaction

From other research on the site, we know that it is mainly the wavelength that controls penetration. There are 2 schools of thought about what is the best wavelength. The main 2 ranges are:

  • 600nm to 660nm - The 600 nm group says that you don't need deep penetration to fix the root cause of the problem and you don't need huge power requirement since most of the energy is being absorbed near the surface.
  • 800nm to 980nm - This group says that the upper wavelength has much deeper penetration and then they disagree on how much power you really need.

Both groups consistently get good results. Companies like Erchonia™ have been getting good results with at little as 20mW in the 600nm to 660nm range for many years, but treatment times are longer, depth of penetration is limited and the cost is extreme ($12K to $16k in many cases). They tend to put the emphasis on the pulsing frequency and not the power.

The real controversy is in the higher wavelength (800nm to 980nm) range in treating large area problems. In this wavelength range, we are targeting deep tissue, ligaments and bone damage like in knee injuries. Products for this application range from 40mW to 45,000mW. To best illustrate the complexity of this set of treatments, let's look at a specific comparison.

Dosage versus Realistic Treatment Times

From the previous analysis, we can see higher power devices shorten treatment times and give practitioners more flexibility to get more energy deeper in the tissue. When comparing lasers, this issue is complicated by the fact that different manufacturers have different specifications of the optimum power density. Since treatment times are also a big selling point, manufacturers of lower power devices may target a much lower power density than industry standards because no one will buy their product if they really had to leave the laser on one spot for 40 minutes. Products that never achieve the optimum power level can still help patients with small issues but they might not help with larger problems.

Optimum Power

Most of the major brands produce a benefit in cellular stimulation but the gray area is why and what dosage provides the best healing? 

  • Higher dosages provide increasingly better pain relief but there must be a maximum level where adding more energy is just a waste of time. There is no worldwide consensus where this point is and dosages vary widely from manufacturer to manufacturer.
  • At first, you get more and more cellular stimulation. Then there is an inflection point and adding more energy reduces the stimulatory effect it starts inhibiting the cellular activity.
  • Many smaller doses are probably the best for long term cellular regeneration but most patients will not stick with a therapy that is not producing noticeable results. This is why most practitioners would prefer to deliver a higher dosage than the WALT typically recommends.

Continuous and Pulsed Power

Most of the best lasers offer both Continuous Wave (CW) and Pulsed Wave (PW). In continuous wave, the laser beam is on 100% of the time. In pulsed and super-pulsed lasers, the beam is turned on and off at a fixed rate (typically around 1000 to 5000 times per second). In sweeping mode the frequency of the pulsing is changed over the period of the treatment. If you do not know exactly what is the best pulsing frequency, sweeping will at least hit the optimum pulsing frequency some of the time.

Based on my experience, pulsing the laser offers an additional benefit in stimulating the body and this benefits more than offsets the reduction in the speed of delivering the photons. For higher power systems, pulsing also has the benefit of allowing higher power levels without the risk of burning. Both the laser emitter and the tissue can cool down during the short periods that the laser is off. One application where I typically recommend using continuous wave is for someone who needs maximum pain relief. This allows the practitioner to reach the plateau faster and saturate the area to inhibit pain. In general, it seems like both CW and PW have advantages and it is best to have both if you can afford it.

Dangerous Power Levels

Up to this point, it seems like more power is better because it can reduce treatment times and in some cases, it is required to get optimum dosage in a reasonable amount of time. So why doesn't everyone buy class 4 lasers? The answer is cost and fear. The price of the cold laser is a limiting factor for many and safety for others. Unfortunately, "with great power comes great responsibility". Class 4 products by definition are the most dangerous products on the market. If used improperly, they can cause permanent damage to the eye and, in some cases, cause minor burns. If the individual using the product is properly trained and disciplined, there products are totally safe and can be a great revenue generator. It should also provide the most consistent results to the widest range of applications. If the class 4 lasers are misused, they can be a great revenue generator for the lawyers.

Conclusion

I hope this article helped shed some light on the conflicting theories about power requirements for cold laser therapy. In general, all the major products on the market have a beneficial effect, however higher end lasers have more flexibility, allow for higher dosages and they allow for shorter treatment times.

  • Shallow areas can easily be treated with lower wavelengths and lower power lasers. Large damaged areas are best treated with higher power laser in the IR range. Deeper injuries require more power to achieve optimum photon density in a reasonable amount of time.
  • Laser technology is evolving so it is now possible to have affordable reliable high-power lasers that were not possible before now.
  • In many cases, power level is mainly used to shorten treatment times.
  • In some case, low power lasers will never achieve the optimum level of energy in a reasonable amount of time. Lower power level manufacturers adjust for this by targeting less than optimum power densities.
  • You get what you pay for; more expensive machines offer more flexibility which can help practitioners get more consistent results. Buy the best that you can afford and you will be able to help a widest range of patients.
  • Some class 4 lasers can be dangerous if used improperly but these machines allow for treatment of larger and deeper areas in a reasonable amount of time.

HERE IS SOME GOOD INFORMATION ABOUT CHOOSING A LASER FROM DR AMY

The Six things that you want to look for in a laser are:

  1. Is it a true laser(s)?
  2. Does it have the optimal wavelength(s)?
  3. Does the laser have the ability to pulse and input frequencies?
  4. Can you vary the power?
  5. Is it easy to use and will it work for my office and my patient’s?
  6. How do I get the best bang for my buck when buying a laser?

What is a TRUE Laser?

The Avant Laser is a TRUE LASER, fully compliant to the definitions set forth by those great men of science such as Bose and Einstein who predicted LASER in 1924 and the contemporary physicists Schawlow and Townes who brought LASER into the modern age.

LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. Light created in this way, is then culminated and directed into an intense beam of coherent light through the use of cathode and anode reflecting components in order to produce a single stable frequency. According to Webster's Dictionary, Lasers are coherent or marked by logical consistency.

The Avant Laser meets all the scientifically defined attributes of a laser and is therefore classified as a TRUE Laser. We assure and maintain this classification, through our unique and patented process, which produces the emission of coherent light, generated at a precise and stable frequency, and in a focused direction.

Light Emitting Diodes (LED) vs Laser = Bicycle vs Lamborghini

There are many light emitting products on the market today, claiming to be lasers that do not meet all scientifically defined attributes. For example, products that use Light Emitting Diodes or LEDs as they are more commonly known, do in fact produce light, however the light is not intense, producing very little energy and are non-coherent, similar to light produced by common household light bulbs.

Non-coherent or non-culminated light is the result of photons moving in random directions at random times, generating random frequencies. Most LEDs are cheap and easy to reproduce (Pontinen 1992, Lasers in Surgery and Medicine). Obviously, these devices are NOT lasers and this misconception is in large part a by-product of marketing.

Optimum Wavelength

There are thousands of Peer review research that supports optimal wavelengths for tissue repair and healing. In doing my research, I found that 630-640nm in Red and 808nm in Infra-Red wavelengths supported the greatest biological effects for laser therapy.

The 2 research articles from back in the 1990’s that really stuck with me were:

An article showed that when the DNA of a healthy cell replicates it admits light between 630-640nm. Laser therapy using the Red 637nm wavelength will create a bio-modulation effect to the cells that are out of balance. Thus, a cell that has a heightened state will decrease and normalize and a cell in a lower state will increase and normalize thus the bio-modulation effect.

The second article was by J.J. Andrews, United Arms Services, where she and her Team took rats and crushed CN VII to cause Bell’s Palsy in the rats. They then lasered the rats for 14 days in a row on the area of the crushed nerve. Not only did the peripheral nerve regenerate 35% faster than normal eliminating the Bell’s Palsy, but when they dissected the rats to check the brainstem for CNS cell loss, they found that almost 66% of the cells that normally died off were intact. This was a PROFOUND insight into laser therapy, that when you laser a peripheral nerve it not only increases that nerve signal, but it also has stimulation to the Central Nervous System. Low-Level Laser research articles conclude:

  • DNA replication emits light between 630-640nm
  • Cell Biomodulation
  • Increases ATP production
  • Increases phagocytosis
  • Peripheral Nerve regeneration
  • Promotes proliferation of fibroblasts and keratinocytes
  • Increases skin circulation and microcirculation
  • Increases enzyme activity
  • Increases antioxidant activity
  • Decreases Pain and Inflammation
  • Pulsed lasers have a greater biological effect

Coherent Light, Frequencies and the Body

Laser frequencies or Hertz’s is when there is a pulsing that switches the laser light on and off repetitively. The frequency or speed of pulsing can be very slow and observable, or much faster than the eye can detect.

Devices that support pulsing typically cover the range of 1-10,000Hz (10,000 pulses per second). Clinical evidence has demonstrated that pulsing the laser light improves outcomes over a continuous illumination, and that the frequency of pulsing also effects treatment outcomes.

Coherent energy is critical when treating the body. Energy Medicine, The Scientific Basis gives several examples as to the importance of coherence.

The following are excerpts from this book: In the late 1960s, Herbert Frohlich, a Doctor of Physics, specializing in Biological Coherence predicted, on the basis of quantum physics, that the living matrix must produce coherent or laser-like oscillations. Dr. Frohlich's prediction was confirmed in a number of laboratories.

Of course, energy therapists of many schools have always recognized the importance of vibratory phenomena (including light) in healing, but academic molecular science was focused on other matters.

Dr. Frohlich's research goes on to report that coherent vibrations recognize no boundaries, at the surface of a molecule cell, or organism — they are collective or cooperative properties of the entire being. As such they are likely to serve as signals that integrate processes such as growth, injury repair, defense and the functioning of the organism as a whole.

Each molecule, cell, tissue and organ have an ideal resonance frequency that coordinates its activities. By manipulating and balancing the vibratory circuits, complementary therapists are able to directly influence the body's systemic defense and repair mechanisms.

I have repeatedly referenced Frohlich's hypothesis and the subsequent independent validation of findings that support, his prediction that crystalline molecular arrays should vibrate strongly and coherently. For an entertaining account of coherence and its biological significance, read The Rainbow and the Worm (Ho 1993).

Research on electrically polarized molecule arrays reveals that interactions repeated by the millions of molecules within a cell membrane, tendon, muscle, bone, nerve cell or other structure, give rise to huge coherent or laser like vibrations. James Oschman, author of Energy Medicine states "Crystalline components of the living matrix act as coherent molecular antennas, radiating and receiving signals.

Research on coherence in biological systems, is attracting much attention around the world. One important conclusion is that the water in the spaces between parts of the highly ordered systems is also highly organized. Vibrations of the water molecules can couple to the coherent energy patterns within the protein array.

The resulting coherent water system has laser —like properties, and is likely to retain and release electromagnetic information, i.e. have a form of memory (Del Guide et al 1988, Preparata 1995).

Frohlich (1978) An assembly of cells, as in a tissue or organ, will have certain collective frequencies that regulate important processes, such as cell division. Normally these control frequencies will be very stable. If, for some reason, a cell shifts its frequency, entraining signals from neighboring cells will tend to install the correct frequency. However, if a sufficient number of cells get out of step, the strength of the system's collective vibrations can decrease to the point where stability is lost. Loss of coherence can lead to disease or disorder.

While pathology may manifest as chemical imbalances, the underlying problem is electromagnetic. Hence providing the correct or healthy frequency, and entraining the oscillations back to coherence can often restore balance. These are profoundly significant concepts for all therapeutic approaches to the body. The whole field of chemical analysis by spectroscopy shows that there is a fundamental duality between chemical structure and coherent oscillations. Coherent vibrations in living systems are as fundamental as chemical bonds (Smith 1994).

Power: Laser Class 3 and Class 4

Laser power is without a doubt the most controversial and confusing arena in laser therapy.

The laser class is purely a risk rating and does not equate to therapeutic performance. The higher the Class, the higher the Power and  the higher chance for injury and burning due to increased heat production.

A Class 3 laser ranges from 1mW to 500mW.

A Class 4 laser is anything above 500mW. However, this is an old definition and currently there are several laser on the market that have figured out, by using multiple diodes, how to deliver much more power and still remain in the Class 3b realm of lasers, such as the

PowerLaser PRO 1500

Class 4 therapeutic lasers will often state that more power is better because higher, but lasers work best by their ability to stimulate the proper biological effects!

Therefore, I feel that it is essential to be able to control the power output of the laser to give you a larger treatment spectrum.

When the 1st FDA clearance clinical trials were conducted for chronic neck and shoulder pain, they used a low power 5mw, 635nm laser and it was revealed that when the laser was applied to the neck and shoulders for 10 minutes, the patient had a Decrease in Pain, Increased ROM and Increased Myotome Muscle strength.

A treatment dose using laser is the total energy delivered to the tissue and is calculated as the product of average power and time. Dose is measured in Joules (J). Sometimes dose is specified with respect to the surface area treated (usually in cm2) and this version of dose in J/cm2 is often referred to as fluence.

Although, J/cm2 is a very important way to calculate the amount of laser to be used for a certain area, it is equally as important to look at clinical changes throughout the laser treatment.

Conclusion:

The

PowerLaser PRO 1500 gives you the most power and surface coverage with variable power output of 300 to 1500 with the added benefit of up to 3000mW

  1. True lasers
  2. Optimal IR wavelength of 808nm which is ideal for PhotoBioModulation (PBM)
  3. Variable power output of 300 - 1500 - 3000mW
  4. Portable and easy to use, you will love it and so will your patients!
  5. The PowerLaser PRO 500 and PowerLaser PRO 1500 are extremely versatile, well made, professional Class 3b cold lasers that you can rely on for consistent performance and results.
  6. If you want even more power than a PowerLaser pro, and are looking for a high quality Class 4 laser with all the power, features, wavelengths and so fourth of expensive name brands such as SUMMUS, K-LASER and ASPEN, at half the price, then visit Class4Lasers.com

At ColdLaserSupplies.com and Class4Lasers.com we understand that most people only want to buy as much laser as they really need to get the job done. We are committed to work with our customers to match each laser to each buyer's specific needs. Our business is built on your satisfaction and success. Consequently our goal is to find you the best laser for your needs and budget. We also include training and protocols and customer service so that you can receive the most value from your investment.

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