This past Saturday, Dr. Rebekah Martin of Spine and Joint Solutions gave a free presentation at Peak Performance about regenerative medicine. She is a Sports Medicine Physiatrist who has been performing stem cell procedures and platelet-rich fibrin (PRF) for almost a decade.
Welcome to my new blog posting about Low Level Laser (Light) Therapy, or now
called Photobiomodulation. Low Level Laser Therapy is the use of light photons at specific wavelengths that when applied to tissues in the body create a healing response at a cellular level.
I have been interested in the study and utilization of LLLT now for almost three years, along with my business partner in Laser Therapy, Jeff Bickford. Together we have learned a tremendous amount (and continue to learn each day!) about this amazing
technology and are witnessing better and better results in helping people with a
wide variety of conditions.
I decided that I wanted to start posting information as I gather it for the benefit of
others who might be interested.
We have learned that there is much confusion out there surrounding LLLT
(especially in the United States as this technology was only FDA approved in 2003,
so it is newer in this country comparatively).
We are beginning to have a better understanding as to the causes for this
1. All of the valid research performed on the benefits of LLLT are done utilizing
Class3B lasers. This includes research from Europe, Canada, Tel Aviv, and by
NASA, Harvard, Boston University and Mass General in the U.S.
Class 3B lasers are a lower power density: power ranges from a few mW to
500 mW maximum.
Class 4 Lasers are much higher powered – some of them range from 15,000
to 50,000 mW of power!
Research shows that when power densities become too high, there is a DECREASEDeffect of tissue healing at a cellular level.
The research all points to the fact that LOWER POWER, LONGER DURATIONS
yield effectiveness in tissue healing in the body.
Conclusion: Class 3B Low Level Lasers work to stimulate a tissue healing response at a cellular level in the body. Class 4 Lasers do not!
2.Unfortunately, many laser therapy systems manufactured and sold in the U.S. are very high-powered Class 4 lasers. They are heavily marketed to healthcare
practitioners by the laser manufacturing companies as “better” than Class 3B lasers – they espouse that higher power and shorter treatment times yields the best results. But this is simply not the case if you take the time to pick through the research and actually look at the listed power densities, wavelengths and treatment times listed in the studies that are yielding positive results.
I cannot tell you how many people I have now
encountered who had Class4 laser therapy at their chiropractor’s office, PT
clinic, and even at some higher level athletic institutions in the U.S. who feel
like it doesn’t work. That is because it doesn’t!
Class 3 and Class 4 lasers are like apples and oranges.
I recently learned that NASA uses a Class 3B Laser on the Space Station to help
heal astronaut injuries – if NASA felt like Class 4 lasers were superior based on
their own research and clinical use, then they would most likely be using a high-
powered Class 4 on the Space Station! And if they didn’t feel like laser therapy
worked, they would not bother to have one on board at all…
Here is a link to more information on this topic:
Clarification of Controversy – Class III vs. Class IV Lasers | Fred Kahn …
Chris Knierim injured his knee a year ago in January 2017, sustaining a tear to his patellar tendon. He underwent a variety of treatments over the next 10 months, including physical therapy and 3 separate PRP injections, reporting only marginal help with these treatments for this particular injury.
He then decided to try Low Level Laser Therapy at our office for the 4 weeks prior to the U.S. Nationals Competition (the competition that helps determine the Olympic Team).
Laser therapy worked! His knee pain largely resolved and they won the U.S. Championships. Alexa and Chris are now headed to the 2018 Winter Olympic Games in Pyeongchang!
Are you having back pain that’s worse in the morning and/or with prolonged sitting? Does the pain frequently wake you up at night? Does it hurt to sneeze, cough, or laugh? Do you have pain, or numbness and tingling that travels down your leg?
These are symptoms that might indicate a disc bulge or herniation. Small disc bulges are fairly common, especially if you have a job in which you sit all day. Sitting places load on our discs, especially if we do not sit with good spinal alignment (please refer to our blog post on Posture for more information on this topic). Over time the disc begins to sustain micro-trauma and is no longer as stable as it once was. This is when disc bulges begin to occur. Even a small bulge can begin to irritate the nerve roots in our lower back and cause the muscles to tighten up. Small bulges can also begin to create pain.
The good news is that disc bulges and even small herniations are often fixable without steroid injections or surgery!
While it is strongly recommended you see a medical professional such as a physical therapist to thoroughly evaluate and treat you, there are some things you can try on your own to alleviate the pain. An intervention that has been successful in our experience is called the McKenzie Method. It is based on the concept of sustained and repeated spinal extension, or back bending. For those of you who practice yoga, it is akin to upward dog. However, there are some key differences to the McKenzie Method exercises and yoga’s upward dog pose. The movements must start out very small and then become progressively larger with each set versus going up into a large backbend from the get go. It is also extremely important that the exercise be completely pain-free as you do it. If this is not the case, then stop the exercise and consult with a physical therapist.
The McKenzie Method is a progression of ‘poses’ that begin with simply lying on your stomach with a pillow under your hips to relieve pressure off of your back. For those who have more intense pain, this may be all you can initially handle. And you may need to have two or even three pillows stacked up under your hips to alleviate stress from your lower back. This position is maintained for 5-10 minutes, just lying on your stomach and breathing, letting your back muscles relax. You should notice that after several minutes in this position that your back pain begins to diminish. Once your pain has lessened you can move on to the next phase of the exercise (wait at least 5 minutes even if you are not in a lot of pain).
The next position will be a repetitive movement. Place your hands palms flat on the table next to your shoulders and press your upper body off the table about ½ inch to one inch, then relax back down(this is called a press-up). You will perform 8-10 repetitions of this very small movement. Keep your lower back muscles as relaxed as you can – do not use your back muscles to raise yourself up. You are simply hinging yourself up and down slowly using your arms. This creates a small force to help “pump” the disc thereby decreasing inflammation around the disc and perhaps even helping the disc to bulge less.
Next, perform another set of 8-10 press-ups, this time pressing up just a little bit higher than your first set. Make the progression in height very small (about ½ inch to an inch higher than the first set). Let pain be your guide – there should be absolutely no increase in pain. If you do experience any increased symptoms, then try not pressing up as high.
On your third set of 8-10 press-ups, go another ½ inch to an inch higher than your second set. This is how you progress each set. Perform 4-5 sets of 8 total as long as there is no increase in discomfort. You should notice that your pain (or tingling) is decreasing in your leg if you had any radicular symptoms. And you will hopefully also be noticing less low back pain and muscle tightness.
Perform this McKenzie prone press-up progression for 2 to 3 days. If your condition is improving, continue the exercise. If it does not seem to be helping or seems to be aggravating your condition then cease the exercise and consult with a medical provider.
The McKenzie Method extension exercises is also a great exercise for almost everyone to do a few times a week to help maintain good spinal and disc health. This is especially true if you sit a lot during the day or perform activities such as gardening in which there is a tendency to bend forward at the waist (which also places an abnormal load on our spinal discs – see our Posture blog). There are a few conditions such as a spondylolisthesis or spinal stenosis in which extension exercises would be contraindicated. But if you listen to your body and never push through pain or discomfort, you should be ok.
Remember, by seeing a medical professional such as a physical therapist who specializes in hands-on manual therapy, you will get exercises and instruction tailored to your condition. Please do not hesitate to take care of your body!
Here are 4 more Core Stabilization Exercises that are a little more advanced than the previous 6 exercise videos we posted earlier this fall. Please be sure that you are able to perform the Level One Core Exercises that we posted previously without difficulty before you attempt these new exercises. And remember that all exercises should be pain-free. Never push through pain or you might be creating injury! We have recommended starting with 8 repetitions of each exercise during the first several weeks. You may then perform 2 sets of 8 or rotate through the series twice resulting in 2 sets of 8.
Melinda filmed these videos for US Figure Skating, and she thought they would be useful for the general public. They consist of 2 forms of a bridging exercise and 3 balance exercises that are progressive in difficulty. All 6 exercises are aimed at increasing knee, hip and core strength and stability.
Our lives are lived in front of us. We write, read, eat, talk, perform tasks around the house and at work, and type with our hands positioned where we can see them, which is in front of us. As a result, we develop what’s called forward head rounded shoulders posture. It occurs because of muscle imbalances that develop over time. For example, the pectoralis minor, as a result of always pulling the shoulders forward, becomes tight. This leads to weak upper back muscles (lower trap, middle trap and rhomboids) and tight neck muscles (suboccipitals) which causes the shoulder and neck to move differently. These adapted movement patterns can lead to pain in the neck, shoulder, and arm, cause headaches, and lead to a reduction in your quality of life. Therefore, it is important to take steps to prevent this:
Sit with a neutral spine. In neutral, the low back (lumbar) region curves inward (called lordosis) and the upper back (thoracic) region curves outward (kyphosis). This evenly distributes the load of your upper body upon the intervertebral discs. Make sure you are sitting on your “sits bones” and not slumping back onto your tailbone and you will accomplish this.
Be aware that your neck isn’t jutting forward. This will allow your cervical muscles to relax and not tighten up nearly as much. Imagine that a helium balloon is attached to the top of your head gently lifting you up. This gentle movement will help align your entire spine.
Pull your shoulders down and back, but not up. Imagine gently placing the lower angle of each shoulder blade toward your opposite back pocket, and you will have it.
Once you have done the above, perfect your alignment by keeping the tip of your shoulders in vertical alignment with your ear canal. This is neutral anatomic position and imparts the least amount of strain upon joints and muscles surrounding the neck and shoulders.
There are some who cannot make large changes in posture. As you age, there are many reasons for the head to move forward and the upper back to round outward (due to genetics, faulty postural habits over decades and gravity pulling us forward). This creates stability within the neck. If this is you, being aware of future changes and beginning to make small postural changes will help optimize function and reduce pain.
If you have questions or are unsure if you are correcting your posture properly, we encourage you to see one of our physical therapists or our movement expert, Jeff Bickford. Learn more about Jeff and the Feldenkrais Method of Movement and Postural Integration on our website at www.peakperformancept.org. Or go directly to Jeff’s website at www.cosomatics.com.