PTs discuss the use of laser/light therapy in their practices.

Physical Therapy Products recently spoke with Susan Goldman-Shaw, MSPT, director of physical therapy at Skypark Physical Therapy, Torrance, Calif; Jeff Busha, PT, MBA, MS, CMPT, OCS, owner of Physical Therapy Specialists (PTS), Indianapolis; and Travis Carlton, PT, MSPT, CLT, owner and lead therapist of Ease the Pain Cold Laser Center, Paradise Valley, Ariz, about the use of low-level laser/light therapy in their facilities.

Tell us about your facility/practice.

Goldman-Shaw: Skypark Physical Therapy is a privately owned physical therapy practice that was established approximately 20 years ago. A number of physicians and disciplines refer to us. Our patients include those self-insured, as well as a Medicare population, workers’ compensation and personal-injury cases. The majority of patients would fall within the discipline of orthopedics. Both acute and chronic conditions are equally addressed. Additionally, we see patients for balance disturbances and some with neuromuscular disorders.

Busha: PTS opened in 2003 and is growing steadily. We specialize in orthopedic and manual physical therapy. Our target clientele experiences orthopedic problems and chronic musculoskeletal problems. Many patients we treat are ones that have not responded to conventional physical therapy.

Carlton: Ease the Pain Cold Laser Center was established in January 2005. Our target clientele are patients who have symptoms that have been unaltered by traditional physical therapy.

What was the catalyst for purchasing a laser/light therapy system for your practice?

Goldman-Shaw: Two major factors influenced our trial of the laser. However, it was our experiences during the trial period that truly influenced the purchase of the machine.

First, a well-respected therapist we work with had been talking about the great results he was getting with the laser, often to the exclusion of other modalities. Second, I had just had the experience of ordering equipment for a physical therapy office that was about to open. I attended a class on the laser and found that it is a modality that is easy to administer with minimal risks/side effects. So, there were several factors contributing to our consideration of adding the laser to our “traditional mix of modalities.” Primarily, it was the ability to effect changes in healing at the cellular level, influencing adenosine triphosphate synthesis, that piqued my interest.

When we had the opportunity to use a unit in the clinic, on a trial basis, we jumped at the chance. I was familiar with the first patient and had a good opportunity to compare previous treatments with the laser option. This was an older patient who would experience recurrent, severe muscle spasms. She got some immediate relief. However, more impressively, 3 days later, she still had not experienced her usual level of pain and had not required any medication. This patient was able to perform the very tasks that were known to aggravate her symptoms, without the severe pain afterward. (The laser treatments were combined with exercises and posture instruction, as we had emphasized before.) These results, and the potential for more rapid healing, influenced the decision to purchase the unit.

Busha: I have always been interested in laser/light treatment and its beneficial effects on soft-tissue healing. When I opened my practice, I did contract work at a local nursing home. A light system was used there for wound healing, but after talking with the representative I soon found out that it could also be used for musculoskeletal problems.

How did you research the best type of laser for your clientele?

Goldman-Shaw: The choice of which unit to purchase was based on our experience with the equipment representative we rely on, as well as word of mouth from other clinics and their experience. In retrospect, I would probably have purchased the unit that has both the handheld cluster probe, as well as the option for the larger, flat pad.

Busha: I did a lot of research online and in journals. Also, the vendor I buy a lot of equipment from does a lot of up-front research on the best units out there.

What factors did you examine when determining how profitable laser therapy would be in your facility?

Goldman-Shaw: Although the value of the laser is evident, we are still struggling with the most appropriate billing codes for reimbursement. We have been talking to different vendors and have been reading articles to find out what other clinics are doing.

The laser is being used in combination with the overall treatment plan. The results obtained by the use of the laser are incorporated into the progression of exercises and ultimately into activities of daily living. Breaking the cycle of pain, posture, exercise, gait, and patient training becomes more effective. Therefore, there is an improvement in treatment efficiency.

Busha: I received information from the vendor I bought it from and also investigated reimbursement rates from the major insurance companies. I didn’t perform a detailed cost-benefit analysis. My largest concern was that there was a reimbursable code that could be used.

How are you marketing the use of laser/light therapy in your facility?

Goldman-Shaw: We are initiating both active and passive advertising. A couple of our physician referral sources had heard about the laser/light therapy. However, they did not have any direct experiences with its use. We received their authorization to use the laser on their patients, and the treatments concluded with great results. Although the laser light itself has trouble penetrating scar tissue, it does have a remarkable effect on speeding up the healing of wounds, including surgical incisions. Additionally, I have obtained great results on old scars that have remained problematic.

One patient had been experiencing persistent pain along the incision of a procedure performed 3 years prior. After one laser treatment, the scar was palpably smoother and was no longer a source of pain. The referring physician was so amazed at the ability to eliminate chronic pain and to change an old scar with laser therapy that he contacted our office requesting additional information about the laser. His patients now come to us eager to begin their rehabilitation and intrigued about the laser/light therapy their physician has been talking about.

The other referring physician had heard about the laser from a physician friend. When our results were as successful as those of his friends, he too began to excite his patients about coming to us for their rehabilitation. I actually called this physician recently about one of his patients who had five major surgeries on the other limb from which the patient was referred. I requested authorization to treat the complications from the significant amount of scarring. In seven treatments, the scars were smoother, the skin dark discoloration began to mottle around the periphery, and the circulation to the area improved.

With our experience (we’ve had the unit less than 6 months), word of mouth will be our best marketing tool. Both the physicians and patients who have seen the effects of laser therapy are spreading the word of its effectiveness. Therefore, the key for us is to not only get the word out that we have the capability of performing laser/light therapy, but to also have an opportunity to provide tangible evidence. Whenever the opportunity arises, I request authorization to use the laser so I can introduce our other referring physicians to its potential. Direct proof is our best advertisement, so it is just a matter of getting to use it on an appropriate patient.

We are also placing materials about the laser in our marketing folders. As we distribute them, we are bringing attention to the fact that there is new material in them regarding the laser therapy.

Busha: I mainly use the marketing materials from the manufacturer and distribute it to physicians when I meet with them. Most are very interested in the use of laser/light therapy for musculoskeletal problems.

Carlton: Radio, television, print, open-clinic nights, free clinics at fitness centers, symposiums, lectures, direct mail, and marketing to physicians. Most of our patients are word-of-mouth and patient referrals.

What tips can you provide to avoid any complications while using laser/light therapy on patients?

Goldman-Shaw: There will always be a percentage of patients who do not respond to the laser/light therapy, as is the case with any treatment. Although I have heard of a few cases of negative responses to laser stimulation, we have not experienced any problems in our clinic. On patients with very sensitive conditions, such as fibromyalgia, I would advise starting small, both low intensity and only a couple of stimulation points.

In terms of the unit itself, knowing we want to keep the cluster probe clean, we generally place a smooth sheet of plastic wrap over the site to be stimulated. We are attempting to keep skin oils and germs off the head itself. Care is taken to keep the plastic smooth under the head. The plastic must also be on the skin and not be allowed to curl up around the fan vents of the probe. We were advised that the use of the plastic was recommended for wound care.

Carlton: To avoid complications, we explain to each patient what the laser is and how it differs from other modalities. We are also very honest with our patients; some ailments take much longer to show any improvement and they must perform traditional therapy with low-level laser/light therapy to really accelerate their healing.

Describe a challenging/interesting patient case in which you administered laser/light therapy for a successful outcome.

Goldman-Shaw: We recently had a female patient who had a long history of back problems. She experienced a severe flare-up in January. She had been going for care elsewhere, three times per week. The patient indicated her appointments would often last beyond an hour. Being a self-employed interior decorator, she continued to work, albeit with pain. Hearing about the months of pain, we encouraged her to come to our clinic and try the laser. At that time, we had the laser pad on trial. During her first few minutes of stimulation, she felt a noticeable decline in pain. By the time the first treatment cycle ended, there were observable, functional, and measurable improvements. Initially, the patient had to use her arms to bring her legs up onto the treatment table and onto the support cushion. After one cycle, she didn’t need the use of her upper extremities to move the legs. She had at least 3 days of improved mobility with decreased pain until she attempted to vacuum her house. Pain relief followed with core strengthening, allowing her to resume her more normal activities.

Busha: We had a young female with chronic right lateral epicondylitis that resulted in surgery. I treated her after surgery. She stated the laser therapy helped a little. However, she still had a lot of pain performing activities. Using the laser in conjunction with other treatments got her feeling almost 100% better by discharge. I don’t believe that her result would have been near what it was without the use of laser therapy.

Carlton: I had a patient who was a power-lifter. His knee pain resolved in five visits and he returned to working out and practicing the shot put and hammer throws. His elbow symptoms resolved in six treatments from previous radial head surgery, and he was able to start power-lifting again.

What are the advantages of offering laser/light therapy in your practice?

Goldman-Shaw: The laser is yet another tool available to us. Unlike ultrasound, it can be used over metal and it is able to be used over fractures. We are currently looking at the laser’s effect on bone growth following a surgical correction of a patient’s toe. A section of bone was excised with soft tissues left intact to contract as the bone heals. While we have seen improved healing of surgical wounds, we are attempting to identify its effectiveness on deeper structures. The ability to stimulate cell proliferation expands our ability to promote tissue repair and pain control.

Carlton: I have created a niche practice and specialty around this treatment. I have become certified through the manufacturer to train clinicians interested in implementing this modality in their practice. Laser therapy brings you patients.

How do you make your patients feel comfortable with the use of this technology?

Goldman-Shaw: I am willing to educate my patients to the levels of their interest. Some patients are happy with a very simple explanation and assurance that the laser uses only light to effect the desired changes, and it is pain free, while other patients enjoy reading the literature—most patients fall somewhere within that spectrum. I find a good introductory stimulation site is the general Eastern medicine pressure point on the hand, within the thumb web space. It is a treatment point, and one that is easy to demonstrate.

Busha: Most people hear “laser,” and they think of a laser used in surgery for cutting and cauterizing. I always explain the cold laser uses light to treat the area to increase circulation. Therefore, it is very safe.

For what conditions have you noticed that laser/light therapy has been uniquely successful in your practice?

Goldman-Shaw: It is difficult to identify that which is uniquely specific to laser/light therapy. Visible healing is evidenced by incision and skin healing. One patient had significant abrasions on his lateral calf from a motorcycle accident. He was very upset by the looks of the scars. The laser rapidly increased healing, and the redness faded within 3 weeks. The patient was able to see a visible improvement after one treatment. Ultimately, the scars were barely evident. We recently had a patient with a skin irritation from the tape used postoperatively around her entire shoulder following surgery. The discoloration and discomfort was reduced in one treatment.

Busha: In our clinics, laser/light therapy has been successful in treating chronic tendinosis problems and as an adjunct in treating trigger points.

Carlton: Tendinous, nerve compressions and irritations, bone pain, neck pain, wounds, scars, and edema reduction.