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Laser dosages, minimum and maximum

Hi, I am wondering about threshold and ideal doses for laser treatment. I was taught, that to achieve 'bio-stimulation' requires a minimum of 1J/cm2, and 'bio-inhibition' occurs at dosages over 25J/cm2. And there are various suggestions for dosages in-between, depending on the lesion type, chronicity, depth, etc., and the laser's parameters.

My reason for asking, is that I saw one of the expert responses in a different thread, described using 30J/cm2 for scar tissue. This is well over the dose I would ever consider using, based on my previous training. I would like to know more, please! I've not been able to clearly find answers elsewhere.

Many thanks

Helen Robartes

8 months ago

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helen117
helen117

Oh my goodness, a heap of responses that I didn't see, only showed up now! Please ignore my previous comment, except for the bit where I apologise for taking so long to respond! Very grateful to all of you :) I will read this all properly and look up the references, and come back with any further questions :)

In direct response to Prof. Laakso...I hadn't actually made the distinction in my head, but I guess I was considering established scarring.

Again, many thanks :)

helen117
helen117

Thank you both for your responses and references, and apologies for taking so long to reply.

So the WALT recommendations for dosage are generally pretty low...the K-laser manual that we have recommends much higher spot dosages, especially for deeper conditions than wounds. Is that appropriate?

My clinical experience with the K-laser has always been really positive, but I guess I want to make sure that I am using it 100% optimally.

Dr Ethne Nussbaum
Dr Ethne Nussbaum

Hello Helen. I absolutely agree with the comments by Profs. Laakso & Liebano. Here is my approach to incorporating published evidence into my practice. I search for studies in the same or comparable soft tissue condition (or for pain or wound healing, etc.) that first, use wavelengths available to me, and second, that have similar beam apertures to my lasers; if the match is reasonable I then try the study energy dose (J). (As noted by the other Profs, the greatest factor in determining outcomes may be the laser spot size - penetration reduces with spot size). If the match is poor I use a titration approach, i.e. get the best possible match from the literature and over a few treatments increase or decrease J per point to see if I can get a positive outcome. I have success with this approach & hope it might work for you. BTW on scar tissue I have had very obvious softening and area reduction (measured) using an 830nm, 50mW laser with 4 mm diameter aperture (0.126 cm^2) and 30J/cm^2.

L.Laakso335
L.Laakso335

Dear Helen, You have made some good observations. General guidelines such as the ones you have cited are gradually being replaced with the increasing evidence base for laser therapy (a MESH term now officially replaced by photobiomodulation (PBM) therapy). We are seeing greater detail on dose ranging and responsiveness (including factors such as wavelength) over time. As mentioned by Prof Hoehns, the WALT guidelines are very good although it only has details on a range of musculoskeletal conditions and only for certain wavelengths. Prof Liebano is correct in that the WALT guidelines do not currently include evidence-based dose guidelines for scar tissue / wounds. Can I ask exactly what kind of scar tissue are you referring to? Do you mean scar prevention in wound treatment? Or established scarring? Regards, Liisa Laakso

Prof Richard Liebano
Prof Richard Liebano

Hi Elen, The suggested doses are currently in Energy (J) and not Energy Density (J/cm2) anymore because there is a large variation in spot sizes between laser devices. Therefore it is not true that dosages over 25J/cm2 will cause bio-inhibition, specially if the spot size is small. Unfortunately WALT reccomendations donĀ“t include scar tissue or wounds. For open wounds it has been suggested 0.5-1.5 J for acute and 1.0-4.0 J for chronic (McLeod et al). I am aware of a study that used 1.04 J per point in scar tissues after inguinal herniation surgery and they had positive results (Carvalho et al., 2010).

Prof Alison Hoens
Prof Alison Hoens

Hi Helen I suggest that you use the WALT recommendations: https://waltza.co.za/documentation-links/recommendations/dosage-recommendations/

Kind regards, Alison Hoens

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