Laser Therapy for Pain: Should You Add this Tool to Your Massage Practice?

Laser therapy is the most powerful, noninvasive therapeutic modality for pain relief, tissue regeneration and the promotion of general wellness—a statement I base on my many years of using laser therapy in my practice.

Laser therapy for pain is efficient and easier for the provider to implement than manual techniques, and it provides accelerated clinical outcomes.

The first known laser was developed in 1960 and was based on Albert Einstein, PhD’s work on stimulated emission, which lead to his receiving the 1921 Nobel Prize. In 2002 the FDA first gave clearance for a laser in a therapeutic application for human use.

The first FDA clearance was for the treatment of a common neuromusculoskeletal pain disorder. Since then, laser therapy and its therapeutic applications have evolved greatly, and the use of laser therapy is becoming increasingly common in many types of health care settings.

What is Laser Therapy?

Laser therapy uses specific wavelengths of coherent and focused beams of light energy. In contrast, general heat therapy or light therapy, such as light-emitting diode (LED) therapy, use either heat generated by electricity or chemical reactions, or noncoherent, unfocused light energy.

The advantages of laser therapy are, first, that lasers can produce significantly more healing energy per square centimeter than any general heat or light therapy (LED) can ever produce, which is extremely important for tissue penetration and target-tissue dosages for long-lasting clinical outcomes related to tissue repair and healing.

If a massage therapist has ever used general heat or light therapy on a client and noticed only a temporary response, then for that client correctly implemented laser therapy could yield superior outcomes.

Second, professional, high-peak power lasers that can be pulsed in the low microseconds, nanoseconds or faster have been shown to penetrate the deepest and the fastest, which allows for the most efficient transmission method of healing energy to affect such deep structures as ligaments and joints.

One research study concluded that super-pulsed lasers had the least energy loss due to the skin barrier compared with non-super-pulsed lasers.¹ Another study indicated that super-pulsed lasers, particularly lasers pulsed in the nanoseconds range, penetrate the deepest, and the energy absorption increases in the target tissue as the treatment time continues, due to the very rapid pulsing photobleaching the skin². Photobleaching of the skin means the temporary photochemical alteration of the skin, usually from the application of rapidly pulsed lasers.

Glossary of Terms

• Biophotonics: The interdisciplinary field of study combining biology and the science of light waves. Laser, LED, light and photobiomodulation therapy are within the field of biophotonics.
• Cellular ATP energy production: Adenosine triphosphate (ATP) is the compound that provides energy for the many natural processes within our body. Laser therapy increases the production of ATP.
• General heat therapy: The electrical or chemical method of producing heat for therapy, such as an electrical heating pad or hot water bottle, without the use of laser, LED or sources of light in the visible or infrared spectrum.
• Laser therapy: LASER stands for light amplification by stimulated emission of electromagnetic radiation. The use of coherent beams of light, in the visible or infrared spectrum, for photobiomodulation therapy, also known as cold laser therapy or low level laser therapy, which delivers a power output at or below 500 milliwatts average power or high intensity laser therapy. All lasers devices require FDA compliance.
• High Intensity Laser Therapy: The use of coherent beams of light, in the visible or infrared spectrum, in high amounts of energy above 500 milliwatts average power, also known as hot laser therapy, as this type of laser therapy usually produces heat, unlike cold laser therapy. All lasers devices require FDA compliance.
• LED therapy: The use of non-coherent beams of light from light-emitting diodes (LED), in the visible or infrared spectrum, for photobiomodulation therapy, also known as low level light therapy. Some LED devices require FDA compliance.
• Light therapy: The use of non-coherent beams of light, other than LEDs, in the visible or infrared spectrum, for photobiomodulation therapy, also known as low level light therapy. Some light therapy devices require FDA compliance.
• Photobiomodulation: A non-thermal process involving endogenous chromophores eliciting photophysical and photochemical events at various biological states. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.
• Photobiomodulation Therapy: A form of light therapy that utilizes non-ionizing forms of light sources, including LASERS, LEDs, and broad-band light, in the visible and infrared spectrum for photobiomodulation.
• Mitotic potential of cells: The ability of cells to replicate.
• Photobleaching the skin: The temporary photochemical alteration of skin, usually from the application of rapidly pulsed lasers.
• PRP (platelet rich plasma) regenerative injection therapy: The process of drawing a small amount of one’s blood and then using a specific extraction process to concentrate the platelets, growth factors and other elements to be re-introduced by needle to the site of an injury or degeneration for healing and repair.
• Prostaglandin synthesis: Prostaglandins are lipid/fat compounds that are found in almost all tissue in the body, and they have diverse hormone like effects. Laser therapy increases the synthesis or production of prostaglandins, which cause the observable effects of decreased inflammation and re-growth of damaged tissue.

Laser Therapy for Pain

Correctly modulated laser therapy has numerous beneficial effects, including pain reduction, lymphatic drainage, swelling reduction, inflammation reduction, muscle relaxation, improved circulation and stimulation of tissue repair and healing, for neuromusculoskeletal conditions.

Laser therapy is homeostatic in nature, which means it helps restore the body’s natural tendency towards balanced physiological state, which optimizes our self-healing processes.

Research studies over the last seven decades indicate this therapy’s beneficial effects are achieved by promoting many cellular reactions. These include increasing cellular ATP energy production, increasing tissue regeneration through enhancing mitotic potential of cells and stem cell recruitment, proliferation and differentiation, prostaglandin synthesis, normalizing protein synthesis and fibrinogen, decreasing membrane permeability of nerve cells and blocking sensorial innervation, which causes immediate pain reduction after laser treatment.

In one article, the authors note pain is the most common reason for health care consultation in the U.S. and one out of three people are affected by chronic pain annually.³ I believe that if the American health care system would accept and use laser therapy, also frequently referred to as low-level laser therapy, we could reduce prescription pain medication use, elevate the quality of life of clients and reduce treatment costs.

Laser therapy has been shown to create clinical outcomes in sports injuries equal to those of invasive medical procedures. For example, researchers have concluded that the 30 participants who were enrolled in two study groups recovered equally. Participants in the laser group received laser treatments three times per week for two weeks with a dosage of only one Joule/cm² per treatment point.

In another study, results demonstrated that irradiating both tibias on 15 volunteers could significantly increase the concentration of CD-34+ cells and macrophages in the circulating blood.⁵

How to Add Laser Therapy to Massage

Almost any manual technique a massage therapist practices, including Swedish, sports or lymphatic massage, trigger point therapy or injury-specific massage, can be achieved with an accelerated clinical outcome by adding laser therapy.

For instance, when working on clients who present with stubborn myofascial trigger points, quick and effortless application of laser therapy could be used instead of wearing out the therapist’s hands. One study concluded that low-level laser therapy can effectively treat myofascial trigger points and significantly reduce pain.⁶

A massage therapy career may not last as long as the therapist desires, due to repetitive stress on the therapist’s body. Correctly implemented professional laser therapy is the ultimate pain buster—not only for massage clients, as it will also save the therapist’s hands and body, which may extend the longevity of a career.

Is Laser Therapy in Massage Scope of Practice?

Before adding laser therapy to massage sessions, the massage therapist should consult their state-specific scope of practice. Also keep in mind that if one practices in a state that will not allow massage therapists to use laser therapy directly on clients, the therapist still has two options:

• The massage therapist can become a professional affiliate or influencer for a professional laser company by recommending lasers to clients for a commission, which is an option to expand a business and increase revenues effortlessly; and
• If the massage therapist works in an integrated health care facility, a supervising health care provider may be able to legally delegate any laser treatments to the massage therapist with properly documented training. The facility should seek legal counsel first, as this is state-specific.

For self-care, FDA-compliant, over-the-counter lasers that do not need a prescription can be used by anyone for personal use.

How to Choose a Laser

What is the right laser for a massage therapist to purchase? I suggest only purchasing a professional, FDA-compliant laser, whether for personal use and especially for clinical use.

Super-pulsed lasers are my favorite because they provide very high peak powers, which enable deep penetration and efficient treatments. Many super-pulsed handheld lasers are FDA-compliant for over-the-counter use. These types of lasers cannot burn or hurt the massage therapist or their clients, and they come with a designated FDA safety rating due to their sophisticated nanosecond pulsing algorithms.

All therapeutic lasers sold in the U.S. require initial and annual verified reports to verify their stated specifications and safety. Unfortunately, some lasers sold online do not adhere to these standards and do not provide the stated output power and pulsed functionality that they claim. Some cheap lasers are not pulsed, so they significantly underperform and actually can be a safety concern or liability issue within a health care practice.

The World Association of Laser Therapy, which presents the Photobiomodulation World Congress, provides internationally accepted dosages and guidelines for neuromuscularskeletal conditions, so the massage therapist should verify that the laser they are looking to purchase can actually deliver the results they are looking for, and operates at the safety level their clients deserve.

Laser therapy will be one of the best career decisions a massage therapist will make, as it will save their hands and body, enable them to extend their career, increase revenue—and most importantly, quickly provide a rapid pain reduction and very powerful healing solution for their clients.

Footnotes

1. Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren AE. “A Systematic review of lower level laser therapy with location-specfic doses for pain from chronic joint disorders.” Australian Journal Physiotherapy. 2003;49(2)107-116.
2. Joensen J, Ovsthus K, Reed RK, Hummelsund S, Iversen VV, Lopes- Martins RA, Bjordal JM. “Skin penetration time-profiles for continuous 810nm and super pulsed 904nm lasers in a rat model.” Photomedicine Laser Surgery. 2012;30(12):688-694.
3. Cotler HB, Chow RT, Hamblin MR, Carroll J. “The use of low level laser therapy (LLLT) for musculoskeletal pain.” MOJ Orthop Rheumatol. 2015;2(5):00068 doi:10.15406/mojor.2015.02.00068. Epub 2015 Jun 9. PMID: 26858986; PMCID: PMC4743666. ncbi.nlm.nih.gov/pmc/articles/PMC4743666. Accessed 9/29/2023.
4. Hagag OM, Al-Balah OFA, Balbaa AA, El-Azizi HM, Eid GS. “905nm laser diode and platelet rich plasma in the treatment of the second-degree hamstring tear.” Journal of Adv Pharm Ed & Research. 2020;10(4):43-47.
5. Oron A, Efrati S, Doenyas-Barak K, Tuby H, Maltz L, Oron U. “Photobiomodulation Therapy to Autologous Bone Marrow in Humans Significantly Increases the Concentration of Circulating Stem Cells and Macrophages: A Pilot Study.” Photobiomodulation Photomedicine Laser Surgery. 2022;40(3). doi.org/10.1089/photob.2021.0123. Epub 2022 Mar 17. liebertpub.com/doi/10.1089/photob.2021.0123. Accessed 7/20/2023.
6. Shahimoridi D, Shafiei S A, Yousefian B. “The Effectiveness of the Polarized Low-Level Laser Therapy (LLLT) in the Treatment of Patients with Myofascial Trigger Points in the Trapezius Muscles.” J Laser Med Sci. 2020 Winter;11(1):14-19. doi: 10.15171/jlms.2020.04. Epub 2020 Jan 18. PMID:32099622; PMCID:PMC7008735. pubmed.ncbi.nlm.nih.gov/32099622. Accessed 10/1/2023.

About the Author

Ryan Novak, DC, is the chief scientific officer for a laser therapy device manufacturing firm that has developed such FDA-compliant devices as the 25,000mw high peak power, over-the-counter PainBuster Super Pulsed Laser.