Too little, or too much laser photonic energy produces suboptimal results. There is an 'Optimal Window' of therapeutic dosage. According to the World Association of Laser Therapy (WALT), current recommended dosage standards for optimal effects are 4-6 J/cm² for superficial structures, 6-8 J/cm² intermediate, and 8-10 J/cm² for deep tissue.

For example, a deep tissue structure such as the hip may require up to 1000 J/cm². A 10 watt laser will deliver this dose in less than 2 minutes. A 500mw laser will take up to 45 minutes. The subject of correct dosage is intricate, since a number of factors must be taken into account including laser wavelength, power density, type of tissue, condition of tissue, acuteness or chronicity, skin pigmentation, treatment technique, and depth of target tissue.

The primary factors in laser therapy that determine dosage is power and time. DOSAGE = Laser Power x Therapy Time While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin and target tissue. Dosage may also be referred to as energy density or fluence.

65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption:

• Hemoglobin in blood
• Melanin in skin, hair, moles, etc.
• Water (present in all biological tissue)

In order to overcome these factors one must start with large quantities of energy to reach the deeper target cells and myofascial structures with a required dose. If you are going to be treating deep tissue spinal injuries, hips, shoulders and neuropathies your target tissue dose must be higher. Therefore, higher power lasers are optimal in achieving correct therapeutic dosage in minimal time. Superficial conditions such as carpal tunnel, sprains, strains, wrists, elbows, etc can be treated effectively with lower doses. Due to the lower dose, a less powerful laser may be used with good success. Hitting the target dose recommendation is critical.

Laser power delivers deep penetration, high therapeutic dosages, and decreased treatment times. You cannot make up for insufficient power by increasing treatment time. Depth of tissue penetration will not increase with more application time. Positive results require more than increasing time. Can you make a positive change on deep structures with low power? Yes you can, however, more positive results will occur with optimal dose. Think of prescription medication. The dosage of medication is critical for success and is based on the individual. Bigger people need more. Smaller people need less. Bigger body part needs more laser. Smaller part needs less. You may have the right medication, but if the dose is too low you will not get maximum intended benefits.

What type of training and support does the manufacturer provide?

A tool is only as effective as the skill of the craftsman using it. You can have the best laser in the world and yet still experience sub-maximal results if you use it incorrectly. There is an art and science to chiropractic; and laser therapy is no different. High end medical equipment must be used with precision and integrated into each practice depending on the current modalities offered. When considering a laser purchase, ask the manufacturer questions regarding training and support. If they can't provide you with an answer, you should seriously reconsider your intent to purchase. It is very important to have training available for future staff members who will not be experienced with laser therapy techniques.

Sample questions are…

1. Is there on-site clinic training available for you and staff?
2. Do you have access to someone for clinical questions and protocols after laser purchase?
3. Is there a user and safety manual?
4. Do you offer continuing education training?
5. What marketing and patient education materials do you provide?

Who will be administering the laser therapy?

Determining who will administer the therapy may play a part in your decision of which type of laser to choose. Some lasers are unattended therapies and others are attended. Unattended therapy lasers can be set to a specific protocol and administered while the doctor or staff is not in the room. This allows you to see other clients or take care of other duties while the patient receives the laser therapy. Attended lasers must be administered by hand. The patient is never left alone with the laser therapy. Pre-set treatments are programmed into the laser for conditions and average treatment times range from 2-10 minutes.