5 Common Musculoskeletal Laser Therapy Mistakes
Guest Blog by Jeff Smith, DVM, CCRP, Middletown Animal Hospital, Middletown, CA
Not keeping the probe perpendicular: It is important to follow the contours of the body while keeping the probe perpendicular to the tissue. If you are seeing the red aiming beam coming into view as you transit the tissue with the contact head, you are likely not staying perpendicular. When the probe is not perpendicular, much more light is reflected from the tissue. This can be particularly difficult in distal extremities when treating transversely because it requires a ton of wrist movement. To avoid this, treat only 1/4-1/3 of the circumference of the limb at a time! Much easier!
Not treating the area from 360 degrees: Whenever possible treating the entire joint or target tissue from 360 degrees will achieve superior results. Sometimes we become focused on the area of visible or suspected pathology, but the truth is that all of the associated tissue is involved—think of an inflamed joint: the entire joint capsule is involved, not just the particular abnormal area identified on x-rays. Hips especially benefit from being treated from the medial aspect. Most dogs will allow this though it may take some patience and encouragement the first time or two. Backs cannot be treated from 360 degrees, but an effort should be made to administer therapy from 270 degrees.
Not treating the involved spinal nerve root segments: Most animals in chronic pain have a maladaptive or wind-up component that involves the spinal dorsal root ganglia and the associated nerves going to them. Added benefit comes from treating this separate source of pain in these patients. Moreover, the spinal column is often involved in compensatory efforts to guard the injured joint(s) from their normal range of motion, so there is a musculoskeletal benefit as well. Likewise, other joints in the affected limb will likely benefit from therapy since they have also been compensating for the abnormal weight bearing in the affected joints.
Not following an adequate induction period for chronic cases: I advise clients that induction for chronic conditions will take up to 12 treatments when administered 3X per week. I do not mention other numbers—like 6-12 treatments—because clients always remember the smaller number. If induction takes fewer treatments—fantastic! If induction takes 12 treatments, then the prescription was at least accurate. Most case should improve significantly after 3 treatments and remarkably after 6 treatments. Induction is complete once improvement has plateaued.
Not using adjunctive modalities: Pain management, like anesthesia, is much more effective when using a multimodal approach. The new AAFP/AAHA Pain Management Guideline now state that using only pharmaceutical management of pain is no longer adequate. Similarly, using adjunctive modalities to your laser therapy—pharmaceuticals (several may be indicated), cold, PROM, massage, assistive devices, physical exercises, and underwater treadmill—will deliver superior results to your patients.