Advanced Laser Treatment for Musculoskeletal Healing and Relief

Advanced Laser Treatment for Musculoskeletal Healing

Abstract

In this educational overview, I will take you on a journey into the world of advanced laser therapy, with a focus on Multiwave Locked System (MLS) Laser Therapy. Drawing from my clinical experience and the latest evidence-based research, we will explore the profound physiological mechanisms behind this technology. I will explain how we use it to manage both acute and chronic musculoskeletal conditions, such as joint pain, stiffness, and facet issues. We will discuss the concepts of energy density versus total joules, the importance of specific wavelengths like the 808 nm and 905 nm, and the clinical rationale for our treatment protocols. Furthermore, I will detail how we integrate MLS Laser Therapy with other modalities, including orthobiologics like Platelet-Rich Plasma (PRP) and hands-on integrative chiropractic care, to optimize patient outcomes. This post aims to provide a comprehensive, easy-to-understand guide for both patients and practitioners on the power of photobiomodulation in modern regenerative medicine.

Understanding the Patient Experience: A Practical Demonstration

When a patient comes to my clinic, our first priority is always their comfort. This is not just a matter of hospitality; it is critical for treatment efficacy, especially when using advanced robotic technology. For a treatment to be successful, the patient must be relaxed and still, allowing the laser to target the precise area of concern with unwavering accuracy.

Let’s walk through a common scenario. A patient, whom we’ll call John for this example, presented with low back stiffness and joint pain, which he described as originating in the L4-L5 facet area, with some radiation down his right side. This is a classic presentation I see regularly in my practice.

1. Positioning: We begin by having the patient lie face down on the treatment table. Proper positioning ensures we have direct access to the skin over the target area, as the laser energy must be delivered without obstruction.
2. Identifying the Target: I ask the patient to pinpoint the epicenters of his discomfort. In John’s case, it was a specific spot slightly medial on his right lower back. This patient feedback is invaluable for centering the treatment.
3. Setting Up the Technology: Using the robotic MLS laser system, I zero out the X and Y axes on the interface. This creates a stationary starting point, allowing me to precisely center the laser over the exact spot John identified.

Once centered, I can then expand the treatment perimeter. This is a key aspect of our clinical multimodal approach. We are not just “spot treating” the pain. Pain is a symptom, but its source often lies in a network of interconnected tissues. By expanding the treatment area, we address not only the primary site of pathology but also the surrounding connective tissues, ligaments, and musculature that are contributing to the dysfunction. This global approach is fundamental to achieving lasting results.

The Science of Dosing: Energy Density and Wavelengths

A common point of confusion in photobiomodulation (laser therapy) is the concept of dosage. Many focus on “total joules” delivered, but modern, evidence-based research emphasizes the importance of energy density, measured in joules per centimeter squared (J/cm²).

Think of it this way: total joules is like the total amount of water in a bucket. Energy density is like the pressure of the water coming out of the hose. You can have a lot of water (joules), but if it’s spread too thin (low density), it won’t have the desired biological effect. The goal is to deliver a concentrated, effective dose to the target tissue.

• Optimal Therapeutic Window: The World Association for Laser Therapy (WALT) and a vast body of literature support an optimal therapeutic window of approximately 4-10 J/cm². For a condition like John’s joint and facet pain, our protocol targets a density of around 6 J/cm².
• Wavelengths and Their Roles: The MLS system is unique because it synchronizes two specific wavelengths:
  • 808 nanometer (nm) Wavelength: This is a continuous wave that primarily targets inflammation and edema. It works by enhancing local blood circulation and lymphatic drainage, helping to clear out inflammatory byproducts.
  • 905 nanometer (nm) Wavelength: This is a super-pulsed wave that is excellent for analgesia (pain relief). It delivers very high power in extremely short bursts (nanoseconds). This high peak power can penetrate deeper into tissues to reach nerve fibers and trigger points, but the short duration prevents thermal (heat) buildup, making the treatment safe and comfortable.

This patented, synchronized delivery of both wavelengths allows us to address pain and inflammation simultaneously. The robotic arm is positioned at a precise distance (about six inches) from the skin, a focal point calculated to ensure the energy cone covers the intended area with the correct density. You can actually see the treatment area at the 808 nm wavelength—a distinct triangle of light—if you look through a smartphone camera during the treatment. The pulsed 905 nm wave is too fast for the camera to capture.

Combining Robotic and Manual Applications for Comprehensive Care

While the robotic arm delivers a broad, consistent dose over the primary region, I often augment the treatment with a manual laser handpiece. The robotic unit and the handpiece operate on separate channels, allowing me to use them simultaneously.

The handpiece, which must be in direct contact with the skin, is perfect for targeting very specific structures. I use it to address:

• Trigger Points: These are hyperirritable knots within a taut band of skeletal muscle. In my practice, I often use the analogy of “cooked meat vs. raw meat.” Healthy, relaxed muscle feels soft and pliable like raw meat. A trigger point feels dense and firm, like cooked meat. The handpiece allows me to apply concentrated energy directly to these knots, releasing them.
• Joint Spaces: I can angle the handpiece to direct energy specifically into a joint capsule or along a particular facet joint.
• Nerve Pathways: For radicular pain, I can trace the affected nerve’s pathway to reduce inflammation and modulate pain signals.

This dual approach is a cornerstone of integrative chiropractic care. The robotic laser provides the foundational anti-inflammatory and circulatory effects over the broader dysfunctional area. I can then use my palpatory skills, honed through years of chiropractic practice, to identify specific trigger points and joint restrictions. While the robot works, I can perform manual techniques or use the laser handpiece to address these specific points, creating a powerful, synergistic effect that accelerates healing far beyond what either modality could achieve alone.

The Physiological Cascade: From Acute Relief to Chronic Healing

Patients often ask what they will feel during the treatment. The answer is, typically, nothing at all. Because of the super-pulsed 905 nm wavelength, there is no significant heat generated at the skin’s surface. The energy is delivered in powerful punches, with periods of thermal relaxation, allowing the tissue to absorb it without becoming “overcooked.”

The real magic happens at the cellular level in the hours and days following the treatment. This is how the therapy addresses both acute and chronic conditions.

The Immediate and Short-Term Effects (Acute Phase)

When we apply laser energy, we are initiating a cascade of biological events. In the short term, the effects are primarily anti-inflammatory and analgesic.

• The 808 nm wavelength stimulates vasodilation, improving blood flow to deliver oxygen and nutrients, while the lymphatic system is activated to drain inflammatory fluids and waste products.
• The 905 nm wavelength directly affects nerve cells. It can temporarily block pain signals and stimulate the release of endogenous opioids like endorphins, providing rapid pain relief.

This is why we often see a noticeable improvement in pain and mobility within 4 to 6 hours after the very first treatment.

The Long-Term Effects (Chronic Healing and Regeneration)

The true power of this therapy for chronic conditions lies in its effect on cellular metabolism, particularly within the mitochondria. The mitochondria are the powerhouses of our cells, responsible for producing Adenosine Triphosphate (ATP), the body’s energy currency.

• Mitochondrial Optimization: Photons from the laser are absorbed by a molecule within the mitochondria called cytochrome c oxidase. This absorption energizes the electron transport chain, leading to a significant increase in ATP production.
• Cellular Repair and Regeneration: This surge in available energy powers all cellular repair processes. It boosts DNA and RNA production, increases protein synthesis, and accelerates cell proliferation. Essentially, we are giving the damaged cells the energy they need to repair themselves and function optimally.

This is why we structure our treatment plans in packages of 6 to 12 sessions. The effects are cumulative. Each session builds upon the last, progressively reducing inflammation, improving circulation, and, most importantly, enhancing mitochondrial function in the cells of the treated area. A typical protocol might be three times a week (e.g., Monday, Wednesday, Friday) to allow for 24 hours between sessions while still clustering the treatments closely enough to build therapeutic momentum.

Integrating Laser with Orthobiologics: The Future of Healing

One of the most exciting frontiers in regenerative medicine is the combination of MLS Laser Therapy with orthobiologics like Platelet-Rich Plasma (PRP) injections. PRP involves concentrating platelets from a patient’s own blood and injecting them into an injured area to stimulate healing.

However, the success of PRP depends on the health of the “soil”—the cellular environment into which the “seeds” (the platelets) are planted. This is where laser therapy becomes a game-changer.

Our progressive protocol involves:

1. Priming the Tissue (Pre-Injection): We recommend two or three laser sessions before the PRP injection. This “prepares the soil” by reducing inflammation, increasing local blood circulation, and initiating mitochondrial optimization. We are creating a healthier, more receptive environment for the incoming growth factors from the PRP.
2. Day of Injection: A laser treatment on the day of the procedure can help manage immediate post-injection inflammation and pain.
3. Enhancing the Repair Process (Post-Injection): We follow up with approximately six laser sessions after the PRP injection. This provides the newly stimulated cells with the massive amounts of ATP they need to carry out the complex repair and regeneration processes initiated by the PRP.

Clinical observation and emerging research suggest that this combined approach can significantly enhance outcomes. We estimate a 15-20% increase in efficacy when adding MLS laser therapy to a PRP protocol compared with PRP alone. It augments the pro-inflammatory healing phase initiated by PRP, not by blunting it, but by providing the cellular energy required to make that phase more efficient and effective.

In my practice, I also consider the patient’s overall metabolic health. Since statin medications can negatively impact mitochondrial function, optimizing cellular energy becomes even more critical. We can have conversations about nutritional support—such as CoQ10, creatine, and NAD+ precursors—to further enhance mitochondrial biogenesis and function, creating a truly holistic and optimized healing plan.

By understanding the deep physiological underpinnings and leveraging a multi-faceted, integrative approach, we can move beyond simply managing symptoms. We can facilitate true healing, delay or even avoid the need for surgery, and help our patients return to an optimized, pain-free lifestyle.

References

1. Cotler, H. B., Chow, R. T., Hamblin, M. R., & Carroll, J. (2015). The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthopedics & Rheumatology, 2(5). https://doi.org/10.1002/lsm.22348
2. de Andrade, A. L. P., Viana, S. D. S. G., & Frade, M. A. C. (2020). Effects of low-level laser therapy on the expression of inflammatory mediators and growth factors in a wound healing model. Lasers in Medical Science, 35(5), 1165–1172. https://doi.org/10.1007/s10103-019-02941-6
3. Ferreira, D. M., Zângaro, R. A., & Villaverde, A. B. (2013). Analgesic effect of 904-nm laser radiation on orthopedic-postoperative pain. Lasers in Medical Science, 28(4), 1147–1154. https://doi.org/10.1007/s10103-012-1249-1
4. Hamblin, M. R. (2017). Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophysics, 4(3), 337–361. https://doi.org/10.3934/biophy.2017.3.337
5. Zein, R., Selting, W., & Hamblin, M. R. (2018). Review of light parameters and comparative studies for low-level laser therapy: The path to standardization. Photobiomodulation, Photomedicine, and Laser Surgery, 36(10), 541–542. https://doi.org/10.1089/photob.2018.4481