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2015 Cold Laser Guide Compare Cold Lasers

Can cold lasers heal? Read this USA Today article.

At ColdLasers.Org, we sell a wide range of cold lasers (class 1 to class 4) so we can help you understand all your cold laser options and we can help clarify the advantages and disadvantages of different products and different types of therapy. We sell Avant, Aspen, Apollo, Chattanooga Vectra Genisys, Laserex, PowerMedic, Nexus, Lumix, Pilot and TerraQuant. In the past, we have sold several other leading brands of cold lasers so we know every major brand out there and we can help you learn more about all your options, the technology and the best applications for each device. If you browse our buyer's guides, you can see specific recommendations based on your application including treatment of horses and companion pets. We also make different recommendations based on broad coverage therapy versus trigger point therapy. You options may also be restricted if you require unattended therapy and of course, we have different recommendations for professional therapy lasers versus home laser systems. We also have systems optimized for acupuncture and trigger point therapy. We can help you find a quality laser to meet your budget requirements. We sell to doctors and consumers so feel free to call us at 1-800-388-0850 or use the chat option to get help or ask a question.

Over the years, we have tried to summarize a lot of information about different cold laser technologies and styles of cold laser therapy. The FDA cleared applications for cold lasers (sometimes called low level lasers or therapy lasers) are pain control, inflammation reduction and increased blood circulation. Some manufacturers have extended these claims to include accelerated healing. The National Institute of Health has published a report with positive efficacy of LLLT for Neurorehabilitation and there are thousands of positive studies using cold laser for a variety of applications. But, as far as selling a product, every sales claim must be traced back to the 3 main applications. Because low level lasers allow users to safely control and focus the energy from the laser to deep inside the body, they are constantly being used in new applications.

At ColdLasers.Org we present information and specifications of many different professional grade lasers even if we do not sell these products (including Thor™, Erchonia™, VetroLaser™, K-Laser™, LiteCure™ and Microlight™). Unlike exclusive sales people who must sell you their product even if it is not a good fit, we feel than an educated consumer is a happier customer and we want buyers to understand all their options and help them get the best equipment for their needs even if they buy a product we don't sell. All these products have a good reputation with professionals and practitioners so they are all worth investigating. oldLasers.Org does not promote products that have extraordinary claims that are not based on traditional photobiomodulation. This includes consumer products marketed based on scalar waves/ quantum-waves and soliton waves. These could be good products but they don't really need to add mystical claims to sell a scientifically proven modality and we like to stick to the facts and specs. There are also some people selling very questionable products including stickers that magically boost the power output of a lasers. Our general rule is "if it looks like a laser pointer, it probably is a laser pointer". Always check the specs.

Unlike focused hot medical lasers, which are widely used to cut and burn tissue, Low Level Lasers (LLLs) or cold lasers penetrates the surface of the skin with little heating effect and minimal potential for tissue damage. Studies have shown that laser energy is directed into a treatment area stimulating the body's cells which convert the light energy into chemical energy to promote pain control and natural healing.

In most cases, cold laser therapy is considered an alternative therapy like acupuncture, message therapy, chiropractic, herbal medicine, message, and physical therapy because it does not require expensive surgeries or a life-long prescription for drugs. Practitioners have supported treatment options like Ultrasound and eStim for years and now there is a lot of interest in cold lasers as a supplement to their practice. LLLs have provided relief for many patients over the years and they work best when used in combination with many other modalities like message therapy, acupuncture, chiropractic and physical therapy. In fact, we recommend that you should always follow a cold laser treatment with a moderate message and a glass of water to get the most benefit.

Currently, there are over 25 different cold laser manufacturers that have products that have been cleared by the FDA for various types of treatments. Cold lasers have been in use around the world for over 30 years and have been in use in the US since 2001 when Microlight got the first FDA clearance. Low level laser therapy or soft laser therapy has been proven completely safe in over 3000 worldwide studies.

The power level of therapeutic cold lasers ranges from 20 milliwatts (0.02W) to 60,000 milliwatts (60W). This energy can be created using one laser beam or an array of laser beams. In less expensive therapy devices, it is generated using LEDs or SLDs. An array of laser beams can increase the speed of the treatment while still being very safe. can produce a more even energy distribution and can allow for a larger treatment area. Since finding the optimum treatment spot deep inside the tissue is somewhat of an "educated guess", it can be very useful to have a larger aperture on the treatment probe. This increases the probability of getting the photons to the problem area and larger emitters also also help increase the energy in the area surrounding the main target area. Emitters that use a combination of different wavelengths also have a better chance of treating tissue at different depths since different wavelength have different absorption rates.

The average cold laser therapy session cost from $30 to $120. The average cold laser costs from $2000 - $15,000 so the return on investment (ROI) on purchasing a cold laser can be as little as 4 months.

Because cold lasers help activate human and animal tissue, cold lasers can be used for cervical (neck) pain, lumbar (low back) pain, wrist pain and injuries (carpal tunnel), elbow and joint pain and injuries, lower extremities pain, foot and ankle pain, joint pain and knee injuries, accelerating recovery after surgery and hundreds of other applications

Some products are used for smoking cessation like the Thor systems and Omega. No laser is FDA cleared for smoking cessation so you must form or be a member of an IRB (Investigation Research Board) to legally advertise that you can treat patients for smoking or drug rehab therapy.

There are 2 basic styles for treatment using cold lasers, pinpoint treatments (laserpuncture or trigger point) and broad therapy. Each treatment style has a different goal and different equipment requirements.

Laser Trigger Point And Acupuncture Therapy

In a laser trigger point therapy, the cold laser is used similar to acupuncture or acupressure to trigger a reaction from the body by stimulating an acupoint. In this case, a probe set or focused low level laser beam is used to concentrate all the energy from the cold laser into a very small area. Cold lasers are often compared to "acupuncture with a laser beams". In LLL laser puncture treatments, the laser beam is use to trigger the body's acupoints without the fear or pain of needles. The energy from the laser may penetrate as deep as 5 inches into the body based on the setup of the laser.

Broad Treatment Therapy

In many cases, a practitioner may not be targeting a trigger point, they will choose to use a cold laser to energize a larger area of the body. In this case, a cold laser with a broad focus (larger than the size of a dime) and the correct wavelength are used to penetrate the deep tissue with photons to accelerate natural healing in a large area or to provide localized pain control (as seen in many studies). These large emitters can cover areas up to 4.6 inches square. The larger treatment area increase the chances of stimulating the "hot spots" that needs help. Larger emitters also can reduce the treatment time while eliminating hot spots.

Cold Laser Comparisons

There are several key factor to evaluate when choosing a cold laser. These include:

  • Wavelength- The wavelength controls the depth of the penetration of the laser photons. Lower wavelengths (600nm range ) are absorbed more quickly in the skin so they are targeting a different goal than longer wavelengths (800 to 980nm) which have better penetration.
  • Power - Since the power of a laser usually remains constant during a treatment, the energy of the light is equal to the power in watts multiplied by the time in seconds during which the light is emitted. For a continuous laser, this is simply watts times treatment duration. For a pulsed laser, the calculation is watts x duty cycle x treatment time. A laser with more power (measured in watts) or a higher duty cycle can deliver the more energy (measured in joules) in less time. Delivering joules is where the bulk of the work is done when treating patients. The class of the laser is largely controlled by the power level from each output beam because they are somewhat proportional to the potential for damage.

How Much Power is Enough?

Too Little: Once you review our summary of laser power requirements, you can understand that there are many inexpensive options on the market that are over-the-counter continuous output cold lasers. According to the FDA limitations, these lasers are limited to 1 or 5 milliwatts (mW). If we look at the theoretical treatment times, it is easy to see that these products will never reach the typical dosages that you would get in a doctor's office or clinic in a reasonable time. With a 5mW system, it takes 27 hours to achieve 500 joules and 500 joules over a large area (like a back) or or into a deep area (like a hip) is not delivering very much energy density to the damaged area. These low powered lasers are still more powerful than LED therapy systems but they are massively underpowered.

Target Energy (J)
5
50
500
1500
5000
Power (mW) Rate (J/min)
Treatment Time (minutes)
1 0.06 83 833 8333 25000 83333
5 0.3 17 167 1667 5000 16667
100 6 1 8 83 250 833
1,000 60 0.08 0.8 8.3 25 83
5,000 240 0.016 .16 .5 1.5 4
10,000 600 0.008 0.08 1 3 8

This table illustrates that 5mW lasers will never reach a significant energy level when compared to the systems used in most doctor's offices. Even if you used it 24 hours a day.

Too Much: Many of the lower power laser manufacturers claim that you can put too many joules into the tissue and get bad results. Based on the famous Arndt-Shultz law, they claim that is easy to overdose a patient and inhibit their progress. At the same time, class 4 manufacturers are calling for dosages as high as 20,000 joules (J) in a single treatment and getting great results. The class 4 lasers are most common in clinics that treat tens of thousands of patients with some of the most severe condition every year and there is no evidence that they are over-dosing this huge base of patients. These professionals are not crazy or doing the wrong thing day-after-day. They might be wasting their time putting in more energy than a patient needs but they are not overdosing them as their standard course of business. Many years ago, when the most power therapy lasers on the market were 5mW, everyone thought that a 500mW laser was way too powerful. These days 500mW is mid to low power and there are clinics that have 60,000 mW CW systems. They might be wasting their money buying excess power but with the recent advances in laser technology, we know that higher dosages are not damaging. The best way to rationalize the fact with the theory is that there is a plateau at the top of the curve there is a really big range of dosages before go too far and start inhibition. At this point, we do not know exactly where what level is too much but it seems that the hype about too much power is mainly a way for low power laser manufacturers to get a competitive edge.

Pulsing Versus Continuous - Lasers can be either continuous wave or pulsing output. The core of photobiomodulation is based on delivering a specific dosage that historically was done using continuous wave (CW) laser and CW produces the shorter treatment times. Then the concept of pulsing the laser was developed because it allowed the laser to stay cooler (because the laser is off part of the time) and the treatment is safer because there is less potential for eye damage. As research was done, we have learned that pulsing has another advantage. The human body is adaptive. If you push on one spot continuously, eventually the body adapts and you don't react to that pressure (like wearing cloths). A similar thing can happen with a continuous wave lasers and long term therapies. By pulsing the laser, it is harder for the body to adapt and stop reacting so pulsing can be the superior options in many long term treatment plans. This is less of an issue for acute problems that will be resolved in just a few treatments and for many practitioners, it is just faster and simpler to use a CW laser. If it is within your budget, the best option is to have both pulsing and continuous wave. This gives you maximum flexibility.

Emitter Coverage Area - The larger the coverage area, the faster and more consistent the treatment. A larger emitter will is more likely to hit a trigger spot or damaged area and since many treatments require moving the probe around a damaged area, a larger emitter can significantly reduce the therapy time. Most of the best protocols use a combination of static treatments on the area of maximum pain, surrounded by a sweeping treatment around the entire problem area. Products with larger treatment areas are safer AND more easy to use. If you have a large bruise (damaged tissue) the size of your hip and you needed to "color in" the area with ink, you would want to use a big fat marker and not a ball point pen. When you are treating damaged tissue, you are essentially "painting" the tissue with light. In many cases, you might not even know the exact area that needs treatment the most. By using a larger emitter, you increase the odds that you will illuminate the critical spot. With the exception of trigger point therapy, which is typically done by a highly trained professionals, the larger the emitter the better.

Treatment Time - Treatment times range from 7 seconds to 40 minutes. Most therapies require 1 to 6 treatment locations per condition to see an improvement and an average course is 12 to 15 treatments. For those with 2 bad knees or wide spread arthritis, the total treatment time can really add up. For home use, treatment times are typically not an issue since user can often perform their therapy while relaxing or watching TV. In a doctors office, treatment time can be the biggest issue with cold lasers. It is a common practice in the cold laser market for low-power laser manufactures to specify shorter-than-optimum treatment times because they know that no one would buy a product if they knew it would take 24 hours a day of therapy to reach a reasonable energy level in the deep tissue. The result is that patients never get even close to the optimum energy for photobiomodulation. This is why we like to talk about the key specifications of lasers like wavelengths and power levels. We try to stay away from the marketing hype.

Protocols & Guidelines - A complete protocol (treatment plan) library is key for new cold lasers owners to get the optimum energy into the treatment area without guesswork. Some manufacturers have created "cookbook" style protocol manuals or internal libraries. Others give general guidelines and allow professionals to develop their own optimum treatment plans based on experience. This is a simple task for some hands-on practitioners like, energy healers, chiropractors and acupuncturist. To make sure that everyone who purchases a laser from ColdLasers.Org is successful, we include a free membership in Laser-Therapy.US. With over 150 dynamically-created pictorial protocols (for humans, horses and dogs) and a therapy timer for effortless therapy sessions, it is one of the best sources for learning more about how to use a laser on a wide variety of problems.

The goal of cold laser therapy is to deliver light energy units (in photons) to cells that need healing. Photons are absorbed by the cells, stimulating the mitochondria to accelerate production of ATP. An ATP increase in the cell helps accelerate the bodies healing process by transforming painful damaged cells into stable non-painful cells.

 

There is some confusion about what to call the equipment that is described on this site. Probably the most accurate is photobiomodulation (or PBM) equipment but this name doesn't seem to stick with the average person. Some prefer to call the products low-level lasers or soft lasers. The goal of these name is to distinguish these lasers from the medical lasers that are used to cut and burn tissue. In some publications, you may see the abbreviation LLLT for Low Level Laser Therapy. Many of the cold lasers actually warm the skin during therapy so the name cold laser is not a totally accurate description either. Many low level lasers are not low level, they can go up to 60,000 mW in power. There is really no perfect description for the wide range to therapeutic, veterinary and equine lasers so we just call them cold lasers.

Professional And Home Use

Cold laser are typically sold to practitioners but in most states there are no legal limitations for the use of cold lasers in the home. Home owners can buy a class 1 or class 2 laser without any restrictions and they can purchase a class 3 or 4 laser with a health care provider's recommendation. We can help you find a doctor that will write a recommendation if you need it. Home use systems emphasis simplicity of operation while many higher power products emphasis flexibility and low treatment times. Products like the Aspen Laser include on site training to make sure that the laser is used correctly while lower power products like the TQ Solo and TerraQuant Pro include a training DVD and pictorial manual.

Classes of Cold Lasers

All lasers, hot and cold, are given a classification according to the international specification; IEC 60825. The more dangerous the laser, the higher the classification. The most dangerous cold lasers are class 4 lasers (over 500mW CW per beam) and the safest are class 1. Power level is a key factor in the application of cold laser therapy to deep tissue but this does mean that higher class lasers are always better, it does typically mean that they are:

  • More expensive
  • Able to get the optimum biostimulation in less time
  • Able to deliver high dosages for maximum patient wow factor
  • More dangerous

Many higher power lasers use optics to de-focused the beam (typically around 30 degrees of divergence). This creates a larger treatment area. By spreading the energy over a larger area, the product becomes easier to use, provides for more even energy distribution and the product is safer.

Manufacturers can use multiple laser beams in an array to get to higher total power levels while still being very safe. Using this technique, it is possible to build a 18-watt class 3b laser that would deliver energy very quickly but have very little risk of tissue damage.

We can help you find a balance between power, treatment time, cost and safety.

Pain Control versus Healing

If we look at all the claims made made by all the manufacturers, the general consensus is that lower energy doses are slightly better for healing while higher doses are slightly better for pain control. For this reason, every treatment plan is unique. Since many patients will give up on the therapy if they do not feel a noticeable improvement in the first few sessions, it is a good general rule to start out treating with high enough doses to make sure they notice a change. For a long term treatment plan, some patients may prefer immediate pain relief as the highest priority and others may prefer healing as the main goal. Since long term healing can takes weeks or months of therapy, it is best to develop a reasonable expectation at the beginning of the therapy.

Potential for Heating and Tissue Damage

There is a lot of confusion about tissue heating and the potential of therapeutic lasers to do tissue damage from excessive heating. It can and does happen but much of the risk is fear-based marketing generated by lower power laser manufacturers as a reason to buy their product. The risk of heating with a class 1, 2 or 3 FDA cleared therapeutic laser is negligible. You also don't need to worry about significant heating with a class 4 if it is used according to the laser manufacturer's recommendations. For divergent (energy is coming out of the emitter in the shape of a cone) lasers below about 5,000mW (5W), there is an extremely low chance of significant heating for most skin types. It is unclear if this true for some of the non-FDA-cleared cheap foreign built cold lasers on Ebay and other discount sites. Most class 4 laser with a power of 10 watts or more require that the emitter is moving when the system is on.

Heating can be a consideration if:

  1. The laser is collimated (not divergent)
  2. And the laser is set to continuous wave (not pulsed)
  3. And the power level is above threshold (somewhere around 4 watts)
  4. And the laser is not moving
  5. Or the patient has very darker skin, birth marks or tatoos

It is very rare that a practitioner will do enough things wrong (static, CW max-power collimated treatment) to have a problem. For most therapies, you want to cover an area of 4 to 40 times the diameter of the emitter so you need to move the laser anyway. With higher power class 4 lasers, you simply have 2 reasons to move the laser; better efficacy and safety. Many practitioners also use heat lamps. If used improperly, a heat lamps have more potential for burning. Just like with a heat lamp, you must check with the patient and make sure they are comfortable with their warming level.

In exchange for this potential risk, you get the opportunity to blow patients away with almost instantaneous results. Since a 10-watt system is delivering 600 joules per minute, you simply keep it moving for about 4 minutes and you have 2400 joules into the total treatment area. That level of energy will typically produce much stronger response that you get with a lower power laser.

For many practitioners and users with serious problems, it hard to deny that the option to deliver high dosages when appropriate is worth the slight risk of heating the tissue. If you want instantaneous pain relief, there is no substitute for lots of power. If you really want the maximum wow factor (where patients walk away feeling totally different), a collimated class 4 laser is like no other.

The Main 3 Theories of Cold Laser Effectiveness

If you analyze the entire cold laser market, you will find that there are basically 3 different philosophies of what makes a laser great.

  1. Put high levels of energy (joules) into the tissue. This is the core technology of photobiostimulation.
  2. Pulse the laser to get an additional reaction from tissue. Pulsing adds an extra dimension to lasers and allows lasers to deliver higher peak energy levels while still being safe. In some applications, the pulsing frequency is a big deal. Pulsing can also make it harder for the body to adapt to the therapy so it is very important for longer term treatment plans.
  3. Use different wavelengths to simulate different reactions. Wavelengths below 700nm interact with the body in a different way than those above 700nm. Every manufacturers says they have the best wavelength but they range from 1350nm down into the blue spectrum. 95% of professional therapy lasers operate in the 620nm to 1000nm range. It is really in the hyper-marketed consumer market and out in the less science based fringes of the market that they make unbelievable claims about magic wavelengths and encoding information onto the laser beam.

After years of working with thousands of people, it is obvious that all these theories work but it is up to each individual to determine which style of laser and which theory they want to invest in.

Insurance

Some cold laser therapies qualify for insurance reimbursement using the following Cold Lasers CPT codes. Cold laser therapy performed by a licensed chiropractor or acupuncturist can be paid for using an HSA account. The purchase of cold laser devices is not covered under typical insurance plans.

 

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