– Nata News Magazine, October 2002
Bv Valerie Hunt
Two certified athletic trainers are among a handful of people in the United States comprising an initial group of professionals certified to use a new low-Ievel laser. The device, they say, offers amazing relief for people with carpal tunnel syndrome, and it also represents a wealth of research opportunity.
Doug Johnson, ATC, co-owner of Sports and Industrial Rehab in Taylor, MI, and Ray Maleyko, ATC, a Sports and Industrial Rehab employee, both are certified to use the Microlight 830 low- level laser, which gained FDA approval in February for treatment of carpal tunnel syndrome.
The ML 830 remains the only laser with FDA approval for CTS, and fewer than 30 of the machines exist currently, although the Texas-based manufacturer is working to fill a growing demand for the tool. “Canada has had this technology since 1994, but the United States is just now getting it,” Johnson said. “It is scary how well this laser works. It’s the first thing in therapy that can actuallv help heal the tissue.”
Getting results – Johnson began following the development of the Microlight 830 laser after its clinical trials years ago. General Motors and one of Baylor University’s medical centers both tested the device.
GM in 10 years spent $2 billion on carpal tunnel syndrome alone, between lost production, re-education of employees, medical costs and employee replacements,” Johnson said. “They conducted trials of the laser and found it to be 70 to 80 percent effective -nearly 80 percent of the people in the study went back to work full-duty, while the other 20 percent had some improvement but did not have full resolution. “They considered full resolution to be total elimination of pain and limitations, and 80 percent of the people achieved that,” he added. “That’s a big deal. They weren’t testing a small group -they tested every employee who was diagnosed with carpal tunnel syndrome.” Johnson said he and Maleyko have already seen encouraging results from the low-Ievel laser therapy conducted at Sports & Industrial Rehab. “We had a client who suffered carpal tunnel for 14 years as a result of cutting hair and working at Target,” Johnson said. “She was seriously debilitated. After two treatments, she had full range of motion and was sleeping through the night again.
“[Another] patient in our building went from 30 pounds of grip strength to 60 pounds of grip strength in three treatments. We also treated a guy who had flexor tendinitis, and he went from 40 pounds of grip strength to 130 pounds in three treatments.”
Because they wanted to test the laser’s capabilities, Johnson and Maleyko both underwent laser therapy themselves. They were eager to experience the laser from a patient’s point of view. “It’s a lot like ultrasound -you don’t feel it,” Johnson said. “Occasionally you can feel a tingle. There’s no heat. It’s very comfortable. I had tendinitis in my elbow horribly bad, from keyboarding because of a big proposal I’d been working on. The laser eliminated the pain. Ray had tendinitis from playing guitar and baseball, and it worked with him, too.”
Although the laser is approved by the FDA only for treatment of CTS, patients can opt to take part in clinical investigation and undergo low-Ievel laser therapy on other parts of their body. Johnson said he has used the laser on nearly every part of himself and found positive results each time.
Maleyko pointed out what he feels is one of the laser’s most significant achievements: it works on diabetic patients as quickly as non-diabetic patients.
“There’s so much potential here,” he said. “Our short-term and long-term goals are to do solid research on other applica- tions, including lateral epicondylitis as well as the effects of low- level laser therapy on diabetic wound healing.” “This laser is not a cure-all,” Maleyko added. “But it is certainly doing amazing things.” Johnson said the therapy does more than simply relieve pain. “Like any modality, if you continue the insulting activity, you’re going to continue to have the problem,” he said. “But laser causes healing rather than pain blockage. This does have a lasting effect. The problem is if you continue to do the activity that led to your problem and you don’t modify it through ergonomics, you’ll develop it again.”
How it works – Simply put, low-Ievel laser therapy is the application of infra- red light over injuries to improve soft tissue healing and relieve acute and chronic injuries. The light stimulates the cell’s mitochondria into hyperactivity. The Krebs Cycle of metabolism occurs on the inner membrane of this structure, liberating energy from the chemical bonds present in ATP molecules. The cell is provided with more energy and is now in an optimum con- dition to play its part in the healing process. The laser’s effect on the tissue has been termed “photobiostimulation,” a chain of chemical reactions triggered by exposure to light.
“When a cell is actively working to repair itself (and its neighbors), it needs a great deal of energy,” Johnson explained. ” Unfortunately, most cells will continue to plug along at their usual rate, which is why repair of some tissues takes so long. In some instances, the cells stay so busy dealing with the imflammatory cells and products that are present in the injured tissue, they don’t have energy enough left to provide effective repair.
“By stimulating the cells with this specific light source, their activity is hyper activated -sped up -so that they can perform better, faster and more effectively,” Johnson said. “The result is wound and injury healing that is vastly enhanced and that takes dramatically less time to complete. Also stimulated is the function of immune cells and the lymphatic and vascular systems.”
The three Gallium-Aluminum- Arsenide laser diodes in the head of the ML 830 produce a combined output of three joules of energy per 33 second treatment cycle. Driven by 30 milliwatts of power (combined power is 90mW), the 830 nanometer laser can reach tissues at depths of up to five centimeters.
The risks, Johnson added, are minimal. “It has fewer contra-indications than ultrasound and e-stim combined,” he said. “It’s only a 30-milliwatt laser, so it’s a cold laser. It can’t pass through the bone.”
Currently, contra-indications include pregnancy, carcinoma, patients taking immune suppressant drugs, hemorrhages, and direct application to the eyes and thyroid and the ganglia, vagus nerves and cardiac region in patients with heart disease.
Johnson said the laser’s head is applied directly to the skin, and the clinician conducts a trigger-point grid, radiating every half-centimeter. A treatment takes about 15 minutes.
“Individual treatment protocols depend on what’s causing the carpal tunnel.” he said. “You have to have the clinical skills to determine the treatment protocol, to know if you’re treating the muscle, the tendon, the nerves. You have to constantly evaluate.” Patients and clinicians alike wear goggles to protect their eyes.
With a $10,000 price tag and years of research and development behind it, Johnson and Maleyko expected the Microlight laser to look larger than life. Instead, it closely resembles a flashlight. “It’s hand-held and portable, and it runs off a small rechargeable battery,” Johnson said. “It doesn’t look that impressive, but it can work wonders”
Clinicians are not allowed to use the ML 830 laser until they complete a day- long certification course to explain the use, documentation and billing behind low-Ievellaser therapy. With a growing number of companies producing and trying to market lasers, education is important.
“There are several lasers out there, and I’ve used others,” Johnson said. “No matter what you’re using, you really need to know evervthinq vou can about it.”
Cost and reimbursement – Maleyko said the low-Ievel laser therapy falls under physical therapy modality in Michigan. “You do need a doctor’s prescription for the laser,” Maleyko said. “It’s like a typical PT prescription. I’m sure it varies state to state, but most of the prescriptions we get are to evaluate and treat.” Johnson -who has worked hard to develop a good relationship with various insurance companies in the area – said his clinic is reimbursed for the low- level laser therapy, which he bills under the miscellaneous code. The cost is $22.56 for each 15-minute treatment. Because most cases require fewer than 12 treatments, the overall cost is extremely low, compared to alternatives such as surgery.
“We follow fee schedule here in Michigan,” he said. “We bill everybody the same as worker’s comp. There’s no reason to charge much. It doesn’t take that long. We don’t have to stretch the patients. We have them do the Minnesota dexterity test and pain level testing so we have good baseline information to make sure they improve, to make sure we’ve got measurable outcomes.”
Growing clientele – Johnson and Maleyko have been interviewed by numerous television stations and print media. Each day brings an increase in the number of calls from people interested in low-Ievel laser therapy.
“We average between three and five calls a day from people interested in the laser,” Maleyko said. “It’s really keeping us on our toes. We’ve been getting a mix of individuals and companies. We have a lot of automotive companies starting to show interest.” CTS is one of the most prevalent repetitive stress injuries. In 1988, a survey found carpal tunnel syndrome affected approximately 1.3 million people, and the number had risen to nearly 2 million by 1995. Since 1991, more than 60 percent of all non-trauma related work injury claims were for CTS, totaling $51 billion, Johnson said. “This laser is a safe, effective alternative to other methods that don’t have as high a success rate,” he said. “There’s a lot of great potential here, both for patients and for clinicians who want to help people.”
Other research – Johnson said his clinic is now becoming involved in the next generation of low-Ievellasers as well. “We’re starting to formulate research with the Powerlaser 500, which is the next step after the Microlight 830,” he said. ” We’re starting research funded by the National Medical Alliance, and we’ll be studying the effects of low-Ievel laser therapy on joint sprains in college athletes, particularly the knee, ankle, wrist and elbow.”