The following is re-post of an article written by Isa Herrera in the September 2014 Advance PT Magazine for Physical Therapists.
Physical therapists deal with chronic pain that can be problematic to treat and manage on a daily basis. There is an arsenal of tools, exercises and techniques at their disposal, but many times using a modality can help accelerate the pain relieving process.
At my healing center in New York City, we treat an extremely difficult type of chronic pain loosely classified under the umbrella term “pelvic pain.” Pelvic pain can express itself as sacroiliac pain, hip bursitis, symphysis pubic dysfunction, vulvodynia, and prostatitis.
Chronic pelvic pain is perceived as a “woman’s issue,” but we treat both men and women who have suffered for years with their conditions. We are challenged to think outside the box to provide relief for these patients.
‘Secret Weapon’ for Pain
Chronic pelvic pain is very different from other types of pain because it’s intimately connected to our emotional, spiritual and psychological states, and can involve many symptoms in the nervous, endocrine, visceral, gynecological, urological and muscular systems. It can be very difficult to treat, and can require from six months to one year of physical therapy, depending on patient presentation and history.
This lengthy course of treatment requires a fresh approach to therapy and modalities. When I started treating this population I had many difficulties when it came to controlling their pain and I had to think differently. Electrical stimulation and ultrasound were not working as well as I’d hoped, and were providing insufficient pain relief to these patients.
I needed a modality that, when incorporated with my pelvic pain treatment protocols, could help produce immediate and long-lasting pain relieving effects. I needed a modality that could significantly decrease pain within one session, and that my patients could believe in because of the results.
Low-level laser therapy (LLLT) proved to be my secret weapon when treating men and women with chronic pelvic pain. (I frequently call it “light therapy,” because many patients are put off by the term “laser.”)
I have been successfully using light therapy for nearly ten years. It helps my patients keep their pain at bay, and many request that I use it as part of their therapy. Of course, light therapy is only as good as the therapist using it. You have to apply this modality correctly, and use the science properly to maximize results.
LLLT was approved by the FDA in 2002. At that time, the modality was hailed by the New England Patriots and the U.S. Olympic Committee, among others, for its ability to help top athletes quickly return from injury. Endorsements from these organizations piqued my interest and I decided to research its principles.
I realized that LLLT could be used on many levels. LLLT is unique: it is a cellular bio-stimulator and is used to increase vitality of cells as well as processes that occur within the cell. Not all lasers are “created equal,” and you have to be careful with the type you purchase.
Principles that must be taken into consideration include wavelength in nanometers, power in milliwatts, and total energy delivered in joules. In my pelvic pain protocols, I use LLLT on sensitive and painful tissues that are unable to tolerate any heat production.
Many lasers claim to be great therapeutic lasers, but actually produce heat within the tissue and cells. Any heat production has the potential to harm cells and destroy them. Heat production indicates the delivery of too many joules of energy per cycle. The goal with LLLT is to stimulate health and vitality within the cell to produce effects such as pain relief, collagen synthesis, resetting nerve potential, anti-inflammatory effects,and endorphin production.
Pointers for Practice
In my ten years of experience with this modality I have developed recommendations that could be useful to practitioners wanting to purchase a laser for their center. A therapist has to be knowledgeable to avoid purchasing the wrong equipment.
The parameters that I list here are what I believe to be the safest for pelvic pain conditions. Wavelength is best between approximately 800-850 nanometers, in the infrared band, and monochromatic and coherent. This range has the deepest penetration into the body. For pain-relieving effects, laser should be of low power when delivering the above mentioned frequency. Power must be low for treating pelvic tissues to make sure no heat is produced. Our cells are equipped to take in small amounts of photon energy (light energy). At 90-100 milliwatts or lower, there is no excess energy, and thus no heat is created in the tissues.
As therapists, we know that any modality that creates heat within our tissues poses a destructive effect on cellular processes, organelles and cellular cytoplasm. The low level power laser allows you to deliver these healing frequencies directly to sensitive areas of the body, such as the spine and the nerves, sacroiliac joint, pubic bone, bladder, and scar tissue, without adverse effects.
Sometimes patients complain of deep pain within the body or within a thick muscle such as the piriformis. A laser has to penetrate deeply into these tissues to elicit a therapeutic effect, and many lasers today cannot penetrate too deeply. To get to the deepest layers of tissue, use a laser with a wavelength between 800-850 nanometers, which penetrates 3-5 centimeters.
Take a good look at all the parameters before you spend thousands of dollars only to discover that the laser you bought is not providing results.
New Look at Modalities
LLLT has changed the way I treat all pain syndromes. It’s had such a positive impact that I’ve created laser protocols for vulvodynia, chronic prostatitis, and scar and bladder pain. I also created a laser certification class for physical therapists who treat chronic pelvic pain. I encourage any colleagues specializing in this population to investigate this remarkable modality.
Medical Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Check with your Doctor before attempting any of the recommendations on this website. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE. Renew Physical Therapy IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE. If you are in acute pain and would like to have a physical therapy program developed for you for your condition please give us a call at 212-213-4660.