Laser Therapy

The newest therapeutic equipment being utilized at Burlington Equine is the RLT Smart Laser. Following meetings I attended recently in Saratoga, Lexington, KY and San Francisco where some of the benefits were discussed, I was able to pursue its purchase to add it to the therapies we currently use in the treatment and rehabilitation of injured tissues.

The therapy is a technology that has been present in the human and veterinary fields for years. We have finally been able to now produce some science behind the perceived benefits. Yes, technological innovations like laser therapy sound exciting, but does it work?

The answer is clearly yes, I will explain:

First of all, we have to delve into a little science. What does it mean when we treat with a laser? A laser generates a light wave, but not one that’s typically associated with light therapy. Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. The wave that’s generated is designed to pass through the skin and deep into the tissue. There are multiple examples of lasers that all of use now such as Class I models that read CD’s or are used in Laser printers. These are definitely at the lowest end for any penetration and their purpose is for superficial use.

More commonly employed therapeutic lasers in veterinary and human medicine are Class IV and all have the potential to cause “photobiomodulation” - essentially a way to stimulate deeper tissues to create a chain of events:

1. Increase blood flow/circulation = vasodilation. Important to get blood and healing factors to an injured area.

2. Reduce inflammation - begins the repair process as anti-inflammatory effect reduces swelling and soreness

3. Pain reduction and analgesia

4. Stimulation of fibers to initiate repair process

5. Collagen production

6. Cell proliferation

A more detailed explanation of it's biological effects follows for those interested. Essentially the enhancement of the body's healing process, ability to regenerate damaged connective tissue, reduction of scarred and calcified tissues along with its anti-inflammatory plus pain modulating effects makes it unique in what can be offered.

Biological Effects of Laser Therapy:

1. ACCELERATED TISSUE REPAIR AND CELL GROWTH. Photons of light from lasers penetrate deeply into tissue and accelerate cellular reproduction and growth. The laser light increases the energy available to the cell so that the cell can take on nutrients faster and get rid of waste products. As a result of exposure to laser light, the cells of tendons, ligaments and muscles are repaired faster.

2. FASTER WOUND HEALING. Laser light stimulates fibroblast development (fibroblasts are the building blocks of collagen, which is predominant in wound healing) in damaged tissue. Collagen is the essential protein required to replace old tissue or to repair tissue injuries. As a result, LT is effective on open wounds, scars, and burns.

3. REDUCED FIBROUS TISSUE FORMATION. LT reduces the formation of scar tissue following tissue damage from cuts, scratches, burns or surgery. Scar tissue is the primary source of chronic pain.

4. ANTI-INFLAMMATION. Laser light has an anti-edemic effect as it causes vasodilation, but also because it activates the lymphatic drainage system (drains swollen areas). As a result, there is a reduction in swelling caused by bruising or inflammation.

5. ANTI-PAIN. Laser therapy has a high beneficial effect on nerve cells which block pain transmitted by these cells to the brain and which decreases nerve sensitivity. Also, due to less inflammation, there is less edema and less pain. Another pain blocking mechanism involves the production of high levels of pain killing chemicals such as endorphins and enkephalins from the brain and adrenal gland.

6. IMPROVED VASCULAR ACTIVITY. Laser light will significantly increase the formation of new capillaries in damaged tissue that speeds up the healing process, closes wounds quickly and reduces scar tissue. Additional benefits include acceleration of angiogenesis, which causes temporary vasodilatation, an increase in the diameter of blood vessels. More blood flow equals faster healing and less pain.

7. INCREASED METABOLIC ACTIVITY. Laser therapy creates higher outputs of specific enzymes, greater oxygen and food particle loads for blood cells. The damaged cells can repair and regenerate faster.

8. IMPROVED NERVE FUNCTION. Slow recovery of nerve functions in damaged tissue can result in numbness and impaired limbs. Laser light will speed up the process of nerve cell reconnection and increase the amplitude of action potentials to optimize muscle action. Reduce nerve pain.

9. IMMUNOREGULATION. Photons are absorbed by chromophores (molecule enzymes) that react to laser light. The enzyme is activated and starts the production of ATP, which is the major carrier of cell energy and the energy source for all chemical healing reactions in the cells. Long lasting pain relief occurs.

10. TRIGGER POINTS AND ACUPUNCTURE POINTS. Laser therapy stimulates muscle trigger points (knots) and acupuncture points on a non-invasive basis providing musculoskeletal pain relief.

In the picture above I am using the laser to treat a horse with a chronic, degenerative hind suspensory ligament issue. Once these ligaments start to break down a number of things happen: they lose elasticity, become painful and swollen then over time depending upon how they heal or stabilize there will be some scarring (fibrosis) and possibly calcification when you get more to an "end stage" status at which point the ligaments no longer function as well in their shock absorbing role due to their inability to stretch and rebound. Of course we are trying to intervene before getting to the end stage. Traditionally shoeing, supportive wraps, and shockwave have all been used along with regenerative therapies such as PRP injections depending on the amount of fiber separation. All of these treatments are beneficial and still have a place, it's possible though that this laser will support those treatments and/or replace some of them depending on at what stage an injury is seen.

The procedure takes about 10-15 minutes total and is well tolerated. There's a laptop that controls the laser output so that pre-selected modalities are included which are specific to anatomical locations, the extent of the injury and the type of tissue being treated. All of this, like all equipment utilized by the practice, is portable and works well in this ambulatory practice.

Currently this laser is being used in private practices - none in VT, NH or upstate N.Y. though - and across the U.S. as well as other countries with horses in all types of disciplines. Mostly these newer Class IV Regenerative Lasers are found in referral Sports Medicine based practices - Fairfield Equine and Dr. Brendan Furlong's to name a few - as well as Equine Referral Centers such as Cornell University's Ruffian Center in N.Y. A recent article on its use at the Ruffian Center can be viewed here: Cornell Ruffian Center Laser.