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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. We used to sell 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. 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 just 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 (including Terraquant, Thor, Avant, Laserex, Apollo, Nexus, PowerMedic, Erchonia, VetroLaser, K-Laser, LiteCure and Microlight) even if we do not sell these products. 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. ColdLasers.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. If it looks like a laser pointer, it just might be a laser pointer. Always check the specs.

Comparing cold lasers can be a challenge since every manufacturer will tell you that their product is the only true solution. Since we sell the widest variety of products, we can help you get through all the "our way is the best way" marketing and find the best product for your application.

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. Studies have shown that cold lasers use light energy to reduce pain and help the body heal itself. 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 since there have been so many studies that show that the laser can help with pain control. 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 lasers or LLLs 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 to 60,000 milliwatts. This energy can be created using one laser beam or an array of laser beams. In less expensive devices, it is generated using LEDs or SLDs. For treating damaged tissue, bone and cartilage, an array of laser beams can increase the speed of the treatment and allow a wider treatment area. Since finding the optimum treatment spot deep inside the tissue is somewhat of an "educated guess", it can be very useful to cover a larger area with an array. This increases the probability of getting the photons to the problem area and larger arrays also also help increase the energy in the area surrounding the main target area. Emitters that use a combination of different wavelength source 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:

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 too much?

Many of the lower power laser manufacturers claim that you can put too much power into the tissue with class 3 and 4 lasers and get bad results. At the same time, class 4 manufacturers are calling for dosages as high as 20,000 joules in a single treatment and getting great results. The class 4 lasers are 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 professional 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 damaging them. Many years ago, when the most power therapy lasers on the market were 5mW, everyone thought that a 500mW laser was way to powerful. These days 500mW is mid to low power and there are clinics that have 60,000 mW systems. With the recent advances in laser technology, we know that higher dosages are not a problem. It does seem like there is a plateau in the return on the time you spend dosing a patient. At some dosage level, all the cells have reacted with the light and released ATP. If you put more light onto the cell, you get no additional advantage. You are just wasting your time and energy. At this point, we do not know exactly where that plateau is for every condition but on thing seems clear is that the hype about too much power is mainly a way for low power laser manufacturers to win a competitive edge.
  • Pulsing Versus Continuous - Everyone in the industry seems to agree that higher doses [like the ones you get with continuous wave (CW) lasers] are best for pain control. The majority of the market feels that many lower doses over a longer time (like you get with pulsing the laser) are best for long term healing. So for the same laser, we generally recommend using pulsing for most application because it does seem to have some additional benefit but use continuous wave for max pain control (if you are limited by the amount of time available for treatment) . Also, pulsing can be a big advantage because it allow the laser and the treatment area to stay cooler. This means that pulsing the laser allows for higher peak power levels while still being safe. The best systems offer both; pulsed wave (for better efficacy) but have the ability to output in continuous mode without reducing the life of the laser module. This give the user maximum flexibility.
  • 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.
  • Treatment Time - Treatment times range from 7 seconds to 40 minutes. Most therapies require 1 to 6 treatment locations per condition. 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 hands on practitioners like chiropractors and acupuncturist. To make sure that everyone who purchases a laser from us 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, they are one of the best sources for learning more about how to use a laser.
  • 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.

    Other Names for Cold Lasers

    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. and they are not soft, most emitters are metal and hard plastic. There is really no perfect description for the wide range to therapeutic, veterinary and equine lasers so we will 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 'licensed 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 are designed for highly trained professionals while products like the TQ Solo and TerraQuant Pro are great for both home and professional use.

    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 get very high dosage for maximum patient wow factor
    • More dangerous

    Many higher power lasers use a lens to de-focused the beam (typically around 30 degrees). This creates a treatment area about the size of a dime or quarter for each laser beam. By spreading the energy over a larger area, the product becomes easier to use and 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 3 laser that would produce extremely high power densities very quickly but would have no risk of tissue damage.

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

    Treatment Area

    As just discussed, products with larger treatment areas are safer AND more easy to use. To illustrate the effectiveness issue, lets look at it another way. If you have a large bruise (damaged tissue) the size of your hip and you needed to "color in" with ink, would you want to use a ball point pen or a big fat marker? When you are treating damaged tissue, you are essentially "painting" the tissue with light. In many cases, you might not even know where 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 professional) , the larger the cold laser beam the better.

    Pain Control versus Healing

    Although there is a lot of overlap between pulsed wave and continuous wave, the general consensus is that pulsed waves and lower energy doses are slightly better for healing while continuous waves and 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 hype 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) like the Apollo, 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.

    Heating can be a consideration if:

    1. The laser is collimated (not slightly 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

    It is very rare that a practitioner will do everything wrong (static, CW high-power collimated treatment). 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 than a laser. 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 an immediate response.

    For many practitioners and users with serious problems, it hard to deny that the regional heating is not worth the opportunity to deliver thousand of joules in quick therapy session. 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.
    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 that they make unbelievable claims with other wavelengths.

    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.


    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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