Dr. Hagay Amir

Dr. Hagay Amir
MD MSH MSc - Orthopedics
Specialist in Orthopedic Surgery and in Physical Medicine and Rehabilitation
P.O box 249 Tirat Yehuda 73175
Tel. 03-9226964

15 July, 2013

Re: Treatment of IDF Disabled Veterans with Soft Laser Therapy

Greetings,
In the light of my past experience with soft laser treatments during the last 23 years, and my acquaintance with the scholarly literature on the subject, I was asked by Mr. Michael Schlosser to prepare background and indications in order to examine the possibility of introducing home-use soft laser devices for IDF disabled
veterans.

Background

During the long history of medicine, many sages and healers predicted the healing power of the sun, "But for you who revere my name the sun of righteousness shall rise" (Malachi, 3, 20), and many forms of light therapy were proposed.
During the last 60 years, laser treatment techniques evolved meteorically. The lasernow serves in many fields, both in industry and in medicine.
The word ‘laser’ is an acronym of Light Amplification by Stimulated Emission of Radiation. The laser is an electromagnetic monochromatic coherent wave with fixed wavelength, and as such, it has good penetration ability and is able to transfer a large amount of energy to a very narrow beam. The laser use is done by a single beam or a cluster of beams. Repeated studies discovers that in wavelengths of f 600 to 900nm and intensity of 1-1000m W, not only that the laser wave does not cause damages, but it actually has a beneficial effect on the tissues and on the cells function on the systemic level. The term Low Level Laser Therapy (LLLT) is the accepted term to differentiate between soft lasers, which serve for medical treatments, and ‘hard laser’, which is used in several kinds of surgeries. The accepted terminology is therefore, soft laser, LLLT, cold laser, or low level laser.
The laser effect is done on the tissue level by lowering the inflammation factors in the injured area, such as prostaglandin-endoprexide syntheses 2, interleukin 1-beta, tumor necrosis and factor-alfa. This lowers the entrance of the neutrophil granulocytes, oxidative stress, swelling and hemorrhage. On the citoplasmatic
cellular level, the ADP effect on the mitochondrion, and therefore changes the cellular homeostasis, activates enzymes and increases ATP production.

The device

B-cure Laser, an Israeli Company, managed to expand the width of the beam. This innovation enables to illuminate an area of about 4.5 square centimeters in a 808nm monochromatic coherent wave length and in 250m W intensity.
The soft tissue effective penetration depth of laser with such intensity is up to 4 centimeter under skin layer. The energy can reach up to 6 centimeters, though the effectiveness in such depth is low. There are no known side effects. There are, as well, no known damages when treating above the recommended therapeutic window. The only limitation: recommended not to point directly to the eyes and avoid direct eye contact.
In light of the background presented above, the many researches that were done on the subject in the scholarly literature in the last 20 years, as well as my acquaintance with B-cure Laser and the medical needs of IDF disabled veterans, I would like to detail bellow the recommended indications.

Recommended Indications for Treating IDF Disabled Veterans:

Treating Tendinitis

For Example:
Levator scapula Tendinitis, Bicipital tendinitis, DeQuervain's Tendinitis, Trigger
finger, Pez ancerinus Bursitis, Trochanteric Bursitis (in skinny people), runners
knee (Biceps femoris tendinitis), Junper's knee (Patellar Tendon Tendinitis),
Achiles tendinitis, Plantar Fasceitis.

Treating Small Joints Arthritis*

For Example:
Temporomandibular joint, shoulder pain, finger joints, wrist joints, pains after
fracture healing, non-connecting fractures in carpal bones and pains due to
osteoporosis in feet joints.

Treating Hard- to-heal Wounds*

Such as diabetic wounds and neuropathic pains.

Treating Acute Injuries*
Painful and absorbed hematoma, injuries and intramuscular hematoma.

Periodontal Healing*
After periodontal surgeries, dental extractions and dental stitching. (In these cases,
it is recommended to use high-potency laser).

Treating Nonspecific Back and Neck Pains*
Applying to trigger points, sore muscles and pain points.
• It is important to mention that laser treatment does not come instead of
medical diagnosis and treatment by a licensed physician, tough it can, with
no doubt, serve as a symptomatic treatment in many cases of musculoskeletal
pains, as well as adjunctive therapy and prophylaxis.

Treating Bio-mechanical Chronic Injuries
In some cases injuries can cause deformations, traumas and biomechanical
damages which lead to chronic disorders. These disorders cause pain due to
aberrant muscle activation, which in turn cause continuous load on fixed points and
chronic pains. Patients, who suffer from these kinds of problems, tend to consume
pain killers and other prescribed drugs over long periods of time, which can cause
temporary or permanent damage. In these cases it is possible to use the soft laser
each time there is an exacerbation of the pain, as well using it as prophylaxis and
preservative treatment between exacerbations.

Summery:
According to all the above, and according to the EBM criteria, I believe it will be
advisable to use this kind of treatment as an alternative to analgesic symptomatic
treatment that is given currently given to IDF disabled veteran, according to the
indications above.

Sincerely,
Dr. Hagay Amir
I.D number: 055976021

Selected Bibliography:

  1. Roberta T Chow, Mark I Johnson, Rodrigo A B Lopes-Martins, Jan M
    Bjordal. Efficacy of low-level laser therapy in the management of neck
    pain: a systematic review and meta-analysis of randomised placebo or
    active-treatment controlled trials. Lancet (2009) 374, 1897-908.
  2. Abrisham, S.M., Kermani-Alghoraishi, M., Ghahramani, R., Jabbari,
    L., Jomeh, H., Zare M.. Additive effects of low-level laser therapy with
    exercise on subacromial syndrome: a randomised, double-blind,
    controlled trial. Clinical Rheumatology (2011) 30(10), 1341-6.
  3. Alfredo, P.P., Bjordal, J.M., Dreyer, S.H., Meneses, S.R., Zaguetti, G.,
    vanessian, V., Fukuda, T.Y., Junior, W.S., Martins, R., Casarotto,
    R.A., Marques, A.P. Efficacy of low level laser therapy associated with
    exercises in knee osteoarthritis: a randomized ouble-blind study.
    Clinical Rehabilitation, (2012) 26(6), 523-533.