- Dr. Jason Rountree
Why didn't laser therapy work for me?
We spend a lot of time here talking about things that patients want to know. This is one that I have been asked before, not too often, but it is an important question to get an answer to:
Why did laser therapy not help me?
This question is becoming more common as we see more laser and light therapies being done by inexperienced therapists, often with insufficient devices. Now is a good time to dig into this somewhat difficult topic of why laser therapy does not always work for every patient.
A few weeks ago, we addressed the frequently asked question of: how much does laser therapy cost? That is an important factor here. Now, if you are going to commit to a course of laser therapy, or you are investigating this for yourself or a loved one, it is good to know what you can reasonably expect out of laser therapy. Laser is not a magic wand that just makes all of your problems go away. While I do not think anybody consciously thinks that, sometimes there is the underlying idea that this "magical" light will just take any problems away. As with anything, laser therapy has success and failure rates. Laser therapy generally has pretty high success rates for a lot of different conditions, but there is always going to be a small percentage of people who do not have the same success.
Make Your Laser Therapy Care Successful
So, what I want to do today is talk about why that failure may happen and what you can do as a patient or as the loved one of someone who is receiving laser therapy care. There are a number of things for you to understand, such as what is going on behind the scenes and what you can do to make sure that you are doing your part to help this process move ahead.
What can you do to help give this process the best chance of success?
One factor that I see all the time is: activity modification. This means changing the things you are doing that might be feeding into or aggravating the problem. For example, if you come in to our clinic with carpal tunnel syndrome (burning, stinging and numbness in the hand) in some cases it may be because you are utilizing a bad setup at your desk and you are overworking the wrist. There is swelling and the nerves become irritated. We have to change that, right? We cannot just laser that wrist, send you out the door, have you keep using the same poor ergonomics at your desk, and think that the problem will go away. No, it is going to keep happening until you remove the cause. Similarly, the same thing applies for things like diabetic neuropathy. If you have diabetic neuropathy, the nerves have been damaged from high levels of sugars. Laser therapy can have amazing results with diabetic neuropathy. but not if your sugars stay high. If you are drinking alcohol and you are partaking in uncontrolled sugar binges every night, you are not going to get better. At best, we may prevent you from continuing to get worse but, really, you have to address whatever is creating the problem.
That is the biggest factor that I see with patients. Either they cannot or will not address what has created the condition and has further agitated it in the first place. So, whatever the condition is that you are looking to get evaluated or looking to treat with laser therapy, you need to look at the causative factors as well. What is creating this problem for you? Have you removed those factors from your lifestyle?
2. Am I being treated by the right type of laser?
The next thing you should look at is the light therapy device that is being used. There are a large number of therapeutic light and laser therapy devices out there and they are not created equally. There are differences in laser vs. non-laser light sources, the power, the way that the settings are used, and in the way the light is actually delivered, as well as the wavelength (color). The color of the laser that is being used is a massive factor because if you are not using the right wavelength of light, you are not going to get the results that you are looking for.
Near-Infrared vs. Red Light Therapy
Now, if you have been reading this blog for any amount of time, you know that I love to go back to the research. So, today, I am going to give you a quote on wavelength and we are going to refer to this source a couple of times throughout this blog. This paper was published in February of 2020, published in Lasers in Surgery and Medicine, titled: Microcirculatory Response to Photobiomodulation-Why Some Respond and Others Do Not: A Randomized Controlled Study. These authors say that, when it comes to wavelength, "near-infrared light was found to induce greater stimulation of skin blood flow and arteriolar blood volume pulse compared to the red light." So, the near infrared light that is invisible to the human eye produced greater results while the visible red light was not giving that increase in blood flow that they were looking for.
They go on to say that "it is well-established that near infrared light has greater penetration of depth compared with red light, which might explain the superior effects on the microvascular response found in this study." What they are saying there is that visible red light or laser is not going to have the same deep tissue effects as near infrared light - that is light that is in the 700 to about 1100 nanometer wavelengths. Again, this is outside the visible spectrum and is invisible. Therefore, there is not really a difference you can tell with the human eye, but the tissues respond differently to wavelengths in that near infrared spectrum than they do to visible light. The same thing goes for visible blue light or green laser. You have to have the right color of laser light to get the work done.
The Right and Wrong Way to Laser
The next factor here is the technique that is being used and the importance of how the laser is applied. The technique that the doctor or laser tech uses while applying that therapeutic light matters. If the provider does not know what they are doing, if they are using the wrong application pattern, or if they are not staying perpendicular to the tissues with the actual laser handpiece then that can and will lead to very poor results.
Here is another big one that I run into: the number of treatments. Look, laser is not a "one and done" type of treatment. Typically, most cases are going to need a series of treatments - maybe a few times a week for a number of weeks, and then some more depending on the case. It is important to have that repetition so that the tissues can respond over time and you can see good results. We know that laser therapy is an additive treatment, which means that each treatment builds on the ones before it. So, if you have a significant condition that needs significant tissue repair and regeneration, it is going to take time. That also depends on the type of tissues, right? If we are talking about neuropathy again, nerve tissues are slow to heal and they are slow to rebuild. Therefore, if you do one treatment for diabetic neuropathy and you do not immediately feel better, you should not necessarily just quit. You should not really expect any success after just one or two treatments with neuropathy. Now, there are outliers and I will say that there are people who notice a difference just after one or two treatments. However, in the vast majority of cases, you have to have multiple treatments in a row. That does not mean you have to have treatment for forever, necessarily. That just means that it takes a series of treatments to get the job done in a lot of cases. In most cases, if a healthcare provider tells you that it is going to be X number of treatments, they have reasons behind that. You can ask,
How do we measure success?
How do we make sure that I am actually getting better and going to stay better?
What are the benchmarks?
Are we doing re-exams to make sure that I'm better?
Are we retesting anything?
Are we redoing any imaging such as x-rays?
It is important that you are informed and that your provider is taking the necessary steps to give you the best care available.
Nutrition and Laser Therapy
Another big factor that ties into the success rate of laser therapy is nutrition. If you have the best carpenter in the world and you bring them into your kitchen and say, "I want you to make me some awesome new cabinets," Yet, you do not give them anything to work with, your cabinets are not going to look awesome. Matter of fact, nothing is going to happen, right? Even a master craftsman has to have the raw materials to work with. However, if you bring in the right materials - the glue, the nails, the wood - and then you let them go to work, you can expect a great product. It is the same type of approach with laser therapy and nutrition. If you are going to expect to have any kind of lasting benefit from laser with pain relief and healthier tissues then you have to put in the right ingredients to have that process supported.
There are several important factors there and your doctor will go over what those are for you. I cannot make any recommendations on this blog as everyone has varying needs, but it does matter what you put into your body. You have to pay attention to the nutrition factors here. If you are eating one meal a day because you just do not have the appetite, you are not going to have enough intake to be successful. That is not enough input in most cases. If you are not taking any level of supplements then, in some cases, you are not going to be successful there either. You have to realize that you are going to be using laser therapy to help the body accelerate its natural healing process. Hence, you are going to need more nutrition to get that job done. For more details on that, ask your doctor, due to the fact that you will need to have a personalized approach for your condition.
As for the last factor, I would like to talk about what the study I mentioned in the beginning looks at. The authors of the aforementioned study say that "photobiomodulation induces arteriovasal dilation that results in both immediate and long lasting increased capillary flow and tissue perfusion." While that means that you get more, better blood flow, they found these results specifically in healthy individuals. So, light therapy results in better circulation - in healthy individuals. Why did they say that? Well, what they found in this study is that the more unhealthy individuals, in particular those with metabolic conditions, did not respond nearly as favorably as the healthier subjects did. Metabolic factors can be things like thyroid disorders or those with diabetes, and that can limit laser therapy effects. Even so, I am not saying that if you have a thyroid condition or a diabetic condition that you cannot have good improvement with laser therapy, just that it is going to potentially impact the speed at which you can improve. Since we know that laser therapy relies on getting more blood flow to damaged areas, if you have a metabolic disorder, then you could see a difference in the way that you respond versus somebody else. This can help to explain some of the success and failure rate we see.
7 Factors for Laser Therapy Success
To quickly recap what we just talked about:
There is always going to be a success and failure rate. In laser therapy, there is typically less than 20% that will not benefit from a laser therapy care plan. At Montana Laser, it is likely to be less than 10% that will not have success in their care.
You cannot keep doing the same thing that caused the problem and expect laser therapy to turn things around for you.
Seek out the correct laser device - typically a professional grade piece of equipment like we use at Montana Laser and at Laser Therapy Institute clinics.
Make sure you entrust you care to someone who knows what they are doing and applies the correct technique.
Get a care plan that makes sense. Laser is not "one and done." It will require a treatment plan of several treatments linked together.
Have a doctor review your nutritional needs, develop a plan, and do your best to stick to it.
Understand your condition and other disorders, and how this may affect the way and the speed laser therapy works for your body. Slower results does not mean no results!
3 Things You Can Do to Get the Best Laser Results
So, given all of that as a patient, what can you do to ensure success with your laser therapy care plan? Well, I have three specific things for you that will be helpful in achieving the best chance of success.
You need to have a laser therapy expert!
You need to have someone who knows what they are doing. Not your cousin Bob who bought a laser pointer off of eBay and is ready to help you out. You need to have a professional level of training in delivering light therapies. If you come to Montana Laser or go to a Laser Therapy Institute clinic, we have already covered this as we know we have the right laser devices, good technique, and we always set up a personal care plan for you. If a clinic does not have those pieces in place, then your success rates are going to be much less than they should be.
If you're not in the Flathead Valley area, you'll need to find a good laser provider near you.To guarantee you find an expert, one of the first things you should do is go to lasertherapyinstitute.org, look at the map, and see if you have a provider near you. If you do not, there is a link you can click on that says "I do not see someone near me" and we will help you try to find someone near you. The next thing you can do is try an internet search. Type in 'laser therapy near me' or 'laser therapy' in whichever town or zip code you have and see what shows up. In most cases, you are going to see chiropractors and physical therapists who can utilize laser to help patients out. Explore those websites and make sure it looks like they know what they are doing. If they brag about their success with laser therapy, that is usually a good sign! If there are testimonials, that is even better. That gives you a better chance of landing a laser therapy proficient provider. The next thing is, when you go see that person, they need to do a thorough exam and get a history of what your problem is. They also need to give you some idea of what that plan of care looks like. You may not get that until the second day but, either way, they should be able to talk to you about what they believe is going to work.
You need to find a good laser therapy provider (like Montana Laser!).
You need to completely describe all your additional health conditions and concerns. This sounds obvious to a lot of people, but frequently we will have patients come to us, talk to us about their foot pain only, and we will start working on that. Then, come to find out a couple of treatments or weeks later, they have major problems with their lower back and hips. All along, that was what was actually throwing things off. If we had known sooner and if they had disclosed that earlier to us, we could have been more successful more quickly. So, make sure you completely describe all those additional things going on with your health and what could be impacting the condition - even if you think it may not be related.
You have to follow your provider's instructions. That might include things like not going to the gym or avoiding foods that are problematic for you. You have to follow those nutrition recommendations. If that means controlling sugars or if that means you have to stop drinking, then you have got to do it or your success rate is going to go down.
If you can do those three things, then you will be addressing everything that you can do on your end, as a patient, to have the best chance of success here at Montana Laser and Medical Center. Remember, we do free consultations with our case manager if you'd like to find out more about laser therapy!
Thank you for joining us this week. I hope this was helpful to you and, if you have questions, please get ahold of us right here!