What is Low Level Laser Therapy (LLLT) and Does It Work?

low level light (laser) therapy - lllt

Low level laser therapy represents a solution for a number of medical issues, which is based on the application of low power laser, on various parts of the body. This type of laser differs from the one used for surgical interventions, in the sense that it does not generate any heat.

What is LLLT or Photobiomodulation?

LLLT is the abbreviation used for low-level laser therapy, and it is also known as photobiomodulation (PBMT), cold laser therapy, low-intensity light therapy, and soft laser therapy. Studies have confirmed that such kind of applications has excellent pain-relieving properties, as well as the ability to improve the functioning of various cells.

The desired effect will be obtained, as long as one stays within specific wavelengths of the light. If low-level light therapy is applied at an inferior dose and range, it will not be effective (we will get to what they are shortly). As you will see below, this type of therapy can support healing as a process in numerous acute and chronic conditions.

In order to understand how low level laser therapy works, we must refer to photochemistry and one of its most important laws. The law states that a chemical substance should absorb light, which would leads to the production of a photochemical reaction. With red light therapy, as LLLT is identified as, the chemical substance is represented by an enzyme, which is involved in mitochondria activity.

History tells us that it was the Hungarian physician and surgeon, Endre Mester, who discovered the biological effects of the low power laser. As time passed, and research evolved, the equipment used for the application of the low level laser therapy became more advanced. Today, infrared light can be used on a wide range of injuries and lesions, helping with pain management and wound healing, reducing inflammation as well.

The first actual cold laser therapy device was developed in 1967, and the machine used both red and near red infrared light. The wavelengths varied between 600 nm and 1000 nm, the red light can be produced by the actual laser or high-intensity LEDs. The difference from a surgical laser was that there was no heating effect, due to the fact that its intensity was not that high. We will touch on EMF later on as well. (R)

This form of therapy has photochemical effects. What does this mean?

Provided that one chooses the adequate intensity and duration of treatment, using red light will decrease the level of oxidative stress and improve the metabolism of various cells, with any existent inflammation being reduced.

The devices used for this purposes are equipped with additional possibilities, for example, a pulsing light can have pain-relieving properties (same benefit guarantees by the use of a continuous beam, of higher strength). The power delivered by this type of laser varies between 10 mW and 500 mW. As for the power density, this ranges between 0.005 W/Cm2 and 5 W/Cm2.

It is important to understand that this type of therapy has guaranteed safety, as it is a non-invasive procedure. A single wavelength of light is generated by the device in question, with no heat or other disturbing factors. There are different wave lengths used by each device, in accordance with the medical issue it addresses.

For instance, if one suffers from a musculoskeletal disorder, the wavelength chosen to treat this issue might vary between 632 and 904 nm. As a general rule, wavelengths that vary between 660 and 905 nm can penetrate the skin and may provide benefits for both soft and hard tissue.

The low level light emitted by the device is absorbed, as said, by the mitochondria (responsible for the production of energy in the body). As this occurs, the cellular energy production will be increased and the surrounding tissues will be stimulated to heal. In a way, the process can be compared to plant photosynthesis. (R)

When Should LLLT Be Used?

There are numerous medical conditions and associated symptoms for which the low-level laser therapy has been found to be effective. Regardless of the condition for which it is used, LLLT has pain-relieving and anti-inflammatory properties, it helps with edema and promotes faster healing.

It has been demonstrated that this therapeutic solution could relieve short-term pain in acute and chronic conditions, including rheumatic disorders (rheumatoid arthritis, osteoarthritis), neck pain, joint disorders (chronic) and tendinopathy.

It has also been proven to be effective in the treatment of various musculoskeletal conditions, such as the carpal tunnel syndrome or fibromyalgia. In those who suffer from a temporomandibular joint disorder, LLLT is capable of improving overall function.

The low level laser therapy offers pain relief in those who suffer from chronic low back pain and it can stimulate wounds to heal faster. It helps with acute conditions, such as the frozen shoulder and it eliminates the muscle pain associated with intense physical training (exercise-induced muscle fatigue). LLLT is effective for conditions such as plantar fasciitis, providing relief from both pain and inflammation.

A number of orthopedic conditions can be successfully addressed through the use of low level light therapy. Faster healing is guaranteed in case of sprains and strains, as well as pain relief. The therapy can reduce the severity of postoperative pain, it can improve functioning after whiplash injury and it can help with the manifestations of radiculopathy (cervical or lumbar). Other conditions that can be treated with LLLT include chronic regional pain syndrome, tendinitis, post tibial fracture surgery, and epicondylitis.

Conditions associated with neuropathic pain can be treated and improved with the help of this form of therapy. This includes trigeminal neuralgia, postherpetic neuralgia and diabetic neuropathy. Degenerative conditions affecting the central nervous system, injuries involving peripheral nerves and spinal cord injuries can benefit from the use of LLLT as well. (R)

Diabetes is one of the major conditions in which low level light therapy can be used. Aside from helping in case of diabetic neuropathy, it can stimulate the healing of diabetic foot ulcers (a common complication of diabetes mellitus. The procedure is pain free, stimulating the existent wounds to heal faster. LLLT might also help improve the neurovascular function, and thus the overall quality of life for the patient in question. This was recently demonstrated by the CEO of Novothor James Carroll’s at WHO. (R)

In oral applications, LLLT might prevent oral mucositis, especially in those who have suffered a stem cell transplant with associated chemotherapy. The therapy might be useful in case of chronic periodontitis, as well as in case of dental implants (it might stimulate the healing process, and prevent infections from occurring). However, more research is needed to confirm these specific benefits.

Other oral applications might include dentin hypersensitivity and the extraction of wisdom tooth extraction. This form of therapy is beneficial for recurrent aphthous ulcers, infections with herpes simplex, burning mouth syndrome, pain caused by implants and other orthodontic treatments, xerostomia and lichen planus. (R)

In those who suffer from lymphoedema associated with breast cancer, the use of low level light therapy might offer temporary relief from the pain. In some cases, this therapy has proven to be an effective alternative to surgical intervention or medication. Scientists are considering the use of LLLT for traumatic brain injuries and stroke.

Research at the moment is focused primarily on new use cases for low level light therapy. It is hopeful that the therapy could be used for hair loss (including the one caused by chemotherapy and other types of alopecia), cell regrowth and in various dentistry applications.

It might be a solution for those planning on quitting smoking or those who suffer from chronic lung conditions, such as tuberculosis. Some studies have even concentrated on biophotomodulation for the brain, taking into account the possibility of cognitive improvement.

Additional Benefits of Photobiomodulation

LLLT can increase the potential of the mitochondrial membrane, as well as the ATP synthesis (energy production). It contributes to mitochondria health, preventing the effect of reactive oxygen species.

As previously mentioned, low level light therapy is beneficial for those suffering from ulcerations caused by diabetes. These affect commonly the feet and they are the result of circulatory problems induced by diabetes. Healing is a long and difficult process and, oftentimes, limb amputation is necessary. With the help of LLLT, such complications might be avoided or delayed.

Given the fact that low level laser therapy can support healthy cell growth, circulation wound healing and tissue regeneration, it should come as no surprise that it can be used on medical conditions such as the reflex sympathetic dystrophy, repetitive stress injury, rotator cuff tear, faces syndrome, bulging and herniated discs.

With powerful anti-inflammatory properties, it can work wonders in case of capsulitis, myositis, bursitis and synovitis. In those with scar tissue, the application of this therapy form can reduce the formation of fibrous tissue. It might be applied in case of cuts and scratches, as well as burns and as a post-operative solution. (R)

Those with hematomas and pressure sores can benefit from the application of low level laser therapy. A number of dermatological conditions can be treated with LLLT as well, including dermatitis, shingles, herpes, psoriasis, rosacea, acne vulgaris and eczema. LLLT has a stimulating and healing effect at the same time, restoring the health aspect of the skin. It contributes to increased tissue repair and healing, bringing down any existent inflammation. Those who suffer from herpes virus infections might benefit from this form of therapy as well.

In cosmetic applications, the cold laser therapy can help with common signs of aging, such as wrinkles and fine lines. It might also help in case of reduced tissue elasticity (saggy skin) and telangiectasia. Studies have confirmed that it can increase the production of collagen, helping with skin elasticity.

It can soften the skin and offer excellent photoprotection. It can improve the aspect of photoaged skin, and it can be used for prophylactic purposes. As mentioned above, it can be useful in case of acne scars and other hypertrophic scars, as well as for healing burns.

When it comes to skin disorders such as vitiligo, the low level laser therapy can increase pigmentation. It can stimulate the proliferation of melanocytes and reduced depigmentation, improving the overall appearance. It can be successfully used for cellulite and fat deposits, contributing to the fat-burning process. (R)

What are the different lights used in LLLT?

The light used in this form of therapy has a narrow spectral range, with red (600 – 700 nm) and near-infrared (700 – 950 nm) lights being used most frequently. Red light, at 640 nm, can improve the appearance of the skin, in case of cuts and scars. The depth of penetration in this case is under 10 mm. The infrared light, at 880 nm, has a deeper effect, reaching not only deep tissue and muscle, but also bones and tendons.

In general, the wavelength between 600 and 700 nm is reserved for the treatment of superficial tissue, while the one varying between 780 and 950 nm is recommended for deep ones. Some devices will combine red light with the infrared one, as it is believed the effect will be more powerful. Thus, the device in question could be used for the treatment of a wide range of medical issues.

LLLT either uses a coherent light source (laser) or a non-coherent one, such as filtered lamps or LEDs, or a combination of both. In consequence, the tissues are exposed to red and near infrared light (low-level exposure).

Acne & Skin Conditions

In those who suffer from acne, phototherapy with visible light can improve the appearance of the skin. Blue light, sometimes in combination with red light, is used for the treatment of acne. The absorption of blue light, for example, can actually destroy the bacteria accumulated on the surface of the skin.

Red light, on the other hand, can penetrate the skin and reach deeper tissues, especially in comparison to the blue light. It has also been shown to influence the activity of the sebaceous glands, and thus the sebum production, as well as to bring down the associated inflammation.

In case of acne vulgaris, for instance, the red to near infrared spectral range is preferred (630 – 1000 nm). This might be used as a sole form of therapy or in combination with other treatments. The combination of blue and red light has also been proven to have a synergistic effect.

The infrared exposure has been demonstrated to have a protective effect against the damage caused by UV rays. The standard choice is the non-coherent near infrared radiation, with a spectrum varying between 700 and 2000 nm. This offers a strong form of protection against the UV effect, reducing the risk of photoaging and even skin cancer.

By combining blue and red light, researchers have managed to reduce the melanin level and, thus, achieve depigmentation. The near infrared light and visible red light can be combined to treat the skin plaques in cases of recalcitrant psoriasis.

The low-intensity red light was used for the first time in the 1960s, with the invention of the first device of its kind. Today, there are several different types of light employed for the treatment of various medical issues. The debate between the use of lasers and LEDs remains heated, with the future being represented by OLEDs (organic light-emitting diodes).

The wavelength used for LLLT includes mainly red and near infrared light, with a range varying between 600 and 1070 nm; within this range, the tissue penetration is at its maximum power. Hemoglobin and melanin, the main absorbers, cannot absorb light under the wavelength of 600 nm. The power of light will also vary between 1 and 1000 mW, depending on the application.

Each light has its own spectrum: blue light – 400 – 520 nm; green light – 520 – 560 nm; yellow light – 560 – 600 nm; mid-infrared light – 1100 – 3000 nm; far-infrared light – over 3000 nm. The wavelength covering the red and near infrared spectrum can penetrate tissue without difficulty. For deeper tissues, a higher wavelength is necessary. For example, a wavelength of 808 nm is necessary to reach the brain, meninges, skull and scalp.

In analyzing the efficiency of an LLLT device, one should also take into account other factors, such as the power, beam area, power density, type of beam (for example, pulsed), coherence, polarization, energy, irradiation time and treatment interval. (R)

Popular LLLT Devices in the Market

Joovv

Joovv is one of the leading brands in the LLLT industry, offering both targeted and modular design. The devices made by Joovv allow for a short treatment time, while delivering clinical-grade irradiance. They guarantee both safety and quality, being registered as medical devices, and they are easy to set up (customizable).

With Joovv, one can choose between targeted and full-body, select the desired number of devices according to size and opt for a particular setup (tabletop stand, door mount, mini, setup stand, mobile stand, wall, etc.). The devices work with red and near-infrared wavelengths, or a combination of both; the irradiance level is over 100 mW/cm2.

Joovv is different from other brands, it has devices which can cover a larger treatment area, while delivering optimal results. It has a modular design, allowing one to build a system to cover the entire body. The portable devices have clinical power and the manufacturers take pride in the total light output being measured (not just the irradiance).

Wireless and rechargeable, they come with a 2-year guarantee and flexible purchase options. One is also offered as a 60-day free trial at the time of writing, with a no-hassle return policy.

Their devices use clinically-proven wavelengths of light, varying between 600 and 1000 nm. They mix and match the red and near infrared spectrums, the product specifications are transparent and all devices are FDA approved.

The prices for targeted devices begin at $295 USD, with both red and near infrared spectral output. Modular devices are more expensive, with the prices varying between $695 and $5995. The price, in case of modular devices, is influenced by the desired type of setup (see above).

Platinum LED (Therapy Lights)

According to the manufacturers, Platinum LED delivers the highest amount of irradiance on the market. It also delivers enhanced power, as well as deeper penetration. The main purpose of such devices is to bring the clinical-grade LED therapy to regular medical practices, helping patients forget all about pain and inflammation. They guarantee an improved recovery, as well as improvements with regard to blood circulation and skin health.

With two lines of devices – BIO and BIOMAX Series – they combine five powerful wavelengths of light, covering the red and near infrared spectrum. For red light, they use the 630 nm and 660 nm wavelengths; for the NIR, they opt for a blend of the following wavelengths: 810 nm, 830 nm and 850 nm.

Platinum LED devices have a wide range of therapeutic applications to offer, deep penetration being the number one reason for which results so effective are obtained. They can penetrate through skin, as well as muscle and the subsequent connective tissue, supporting the regeneration of cells and the healing process in general (up to the bone).

For the red spectrum, the output is of 20% 630 nm and 80% 660 nm. For the NIR one, the wavelengths are as follows: 10% 810 nm, 10% 830 nm and 80% 850 nm. The red light spectrum, which varies between 620 and 750 nm, has proven to be most beneficial at the 630 nm and 660 nm values. The near infrared spectrum, with values between 750 nm and 1200 nm, is beneficial at 810 nm, 830 nm and 850 nm.

The manufacturers include the mounting hardware, door hanging kits and protective eyewear with the devices (black safety goggles). One has the option to choose between targeted and full-body devices. The prices for the BIO Series vary between $369 and $949, offering an economical solution. The ones for the BIOMAX Series vary between $569 and $1149.

All devices come with integrated digital control and a timer system. They are approved by the FDA, have a 60-day trial and a 3-year guarantee.

Red Therapy CO Lights

This brand is another leading name when it comes to red light therapy. The devices belonging to this brand can be used for the whole body, promising a higher endurance performance and faster recovery. They might also bring improvements to general health, beauty and other areas (health and wellness).

The machines use both red and near infrared light, with the 660 nm red wavelength being suitable for skin rejuvenation & surface smoothing, and the 850 nm near-infrared wavelength being recommended for issues regarding tissues, joints and muscles. The irradiance levels vary between 15 mW/cm2 and over 250 mW/cm2, depending on the application and the purpose (for reaching deep tissues, increasing energy levels or healing the skin).

The prices for the devices coming from this manufacturer vary between $479 and $1199. The machines are offered with free shipping, a 60-day trial and a 2-year warranty. Heavy-duty door hanging hooks, protection goggles and other items are part of the package.

Joovv vs. Platinum LED vs. Red Therapy CO Lights comparison

When it comes to intensity, Platinum LED Therapy Lights occupies first place, followed by Red Therapy CO Lights and Joovv. The warranty is the same for Joovv and Red Therapy – 2 years, while the first brand comes with a 3-year warranty. Platinum LED is also the oldest brand in the industry, with 8 years in business. By comparison, Joovv has an experience of 3 years and Red Therapy of 1 year.

Platinum LED is the only brand which offers multiple LED configurations. Full-body coverage is guaranteed by both Platinum LED and Joov, as well as various coverage options. In terms of price, Joovv is the most expensive, with prices being similar for both Platinum LED and Red Therapy Co Lights. Platinum LED is also the only one to have USA and EU warehouses, offering global shipping and a toll-free phone (customer support).

LLLT – benefits & potential side-effects

Low-level laser therapy has healing properties, helping tissue regenerate, reducing inflammation and in fighting pain. It can also increase immunity, promoting faster recovery. The treatment can be used for rheumatic and orthopedic conditions, as well as for those who train on a regular basis, those who suffer from skin conditions or suffered a stroke (just to name a few examples).

The therapy can stimulate wounds to heal faster, it helps athletes recover faster from various injuries they sustained and it is a wonderful solution in case of chronic pain. It represents a standard treatment choice when it comes to musculoskeletal pain, reducing the risk of disability caused by chronic pain. In case of injuries, it can relieve pain and accelerate recovery at the same time.

Perhaps the biggest advantage is that allows the body to heal without medication. So, if you are allergic or sensitive to various medication, you can resort to LLLT as a safe, natural and effective alternative (stimulate the healing process). Pain medication, on the other hand, has negative effects, often leading to addiction.

Studies have confirmed that LLLT can reduce the level of pro-inflammatory enzymes, thus helping with both inflammation and pain. Dentists, for instance, rely on the cold laser to treat inflamed oral tissue and heal ulcerations. The cold laser is beneficial for skin rejuvenation and dermatological conditions, such as acne, psoriasis and burns. It might also be used to treat wounds that heal with difficulty, as it happens in case of diabetes. (R)

When used properly, LLLT does not lead to side effects. It can happen that a mild discomfort appears after the laser treatment, but this is only determined by a re-stimulation of the inflammation phase. It should disappear within 24-48 hours.

Avoiding the Side Effects and Dangers of LLLT

There are certain guidelines that should be followed when trying LLLT. For example, the cold laser should never be applied over the thyroid gland, as it can compromise its function. Moreover, one should always wear protective goggles, as to avoid retina damage.

LLLT is not recommended to be administered to pregnant women, this being one of the major contraindications to consider. Despite extensive research, the effects of the cold laser on the fetus have yet to be determined.

Potentially-cancerous lesions or carcinomas should not be treated with laser, as there is the risk of cancer cells proliferating. The only exception to this rule is in case of terminally-ill patients, where the cold laser might be used for palliative relief.

Epilepsy is another contraindication to think about before recommending LLLT as a treatment solution. The low-frequency pulsed visible light can trigger a seizure in patients who suffer from photosensitivity associated with epilepsy. A complete medical history should be taken before such treatments being used. (R)

The laser therapy is safe when it is performed by a trained professional. It is a non-invasive procedure, which does not cause any pain. Moreover, it can be used as such, without any preparation and medication. Even though it might take up to a month before the results are seen, it is an excellent treatment solution. As it restores the normal functioning of the body, it can also improve the overall quality of life.

The intensity of the laser is low, which makes it safe to be used directly on the skin. It can accelerate the regeneration of tissue, as it stimulates the proliferation of beneficial cells, such as keratinocytes, lymphocytes, fibroblasts and endothelial cells. It requires no downtime post-intervention and it can be applied even when the patient followed other treatments, such as for example, taking blood thinners.

Using CareClinic To Track LLLT Treatments/Sessions

If you are being treated with the cold laser, you might benefit from keeping track of your treatment. CareClinic can be used for such purposes, allowing you to track the treatment duration and its effects.

Let’s say you have started treatment with the cold laser for acne. All you have to do is go to your CareClinic account and start logging this information.

You can create a post in which you will describe the treatment session. Be sure to mention the duration, which type of laser was used and the purpose for which it was recommended. You can later return to this post and describe the effects of the treatment, or write a new post altogether.

The diary of the application allows you to keep track of your health journey, and you can rely on it to obtain a comprehensive view of your treatment, and how effective it was. At the end of each month, based on your entries, you will receive a report regarding the LLLT. You can share this report with your doctor and make any necessary adjustments.

The calendar is another interesting feature of the application (also a web version available, which is shown here). You can use it to record your LLLT appointments and even set up reminders, to make sure that you will not forget about them.

The calendar view will show you any appointments, ensuring the desired treatment adherence.

As the application allows you to record the symptoms of the conditions you are suffering from, you can also use it to determine how effective LLLT was (with regard to these manifestations).

The first step would be to record your symptoms, followed by diary entries in which you are describing the effects of the laser treatment.

You can also add conditions which might be treated with the help of low-level laser therapy.

CareClinic is a health app which was developed by a team of experts, dedicated to helping people improve their health and well-being. You can trust it to record every detail related to your LLLT treatment.

Other things you need to know about LLLT

Eye protection is a must

Whether you are the person receiving the treatment, or if you are one administering it, wearing protective eyewear is a must. This is because looking at the laser directly can cause retina damage. Even the diffuse reflection of a laser can damage the eyes, in case of certain laser types.

Lasers can be classified into four categories, with class 1 and class 2 being the least dangerous. Class 1 poses no dangerous whatsoever, while class 2 would require a long period of time to have an effect. Class 3 lasers must be handled with care and direct eye contact avoided, while class 4 should be avoided at all times (protective goggles are required no matter what). (R)

Treatment duration & purpose

The duration of the treatment depends, in general, on the application. A session might last between 5 and 20 minutes, with a total number of sessions that might vary between 8 and 15. The physician will determine the total treatment duration but one has to understand that it might take up to a month, with four treatments per week, for the first results to become noticeable.

Also, just because pain relief has been obtained, this does not mean that the condition has improved. If the physician has suggested that the treatment should be continued, you should be in complete agreement, as this will guarantee a positive outcome on a long-term basis.

It is important to understand that low-level laser therapy has a healing effect. LLLT differs from other treatments, in the sense that it does not address only the symptoms experienced but also the root problem. It heals the body and offers more than temporary relief from the symptoms experienced. The treatment has a cumulative effect, so more sessions will only help you feel and get better. The results might be long-lasting or you might even be cured altogether.

Distance of application

Depending on the application and the device itself (modular, handheld, full-body), the laser can be applied directly to the surface of the skin or it can be kept just above the skin surface if direct contact causes too much discomfort. One should remember, however, the low-level laser does not cause any heat, sound or vibration.

Electromagnetic field (EMF)

The spectrum of electromagnetic radiation includes light. Light has a number of properties, such as amplitude, wavelength and polarization. The first refers to how bright the light actually is, the second to the color it has, and the third to the vibration angle. The laser emits light as photons are stimulated and a process of optical amplification occurs. Coherence, both spatial and temporal, defines the light emitted by the laser.

What parts should it be used on

The LLLT can be applied on the face, arms, legs, back, neck and other areas where pain and inflammation are present. It is suitable for oral applications, and it can also be applied on trigger points. The cold laser can be applied on damaged joints, inflamed muscles and even wounds.

Do athletes use it?

As it was mentioned above, the LLLT treatment is often preferred by athletes, as it guarantees faster recovery after intense periods of treatment (exercise-induced muscle fatigue). From another perspective, the low-level laser therapy can offer more rapid healing in case of various injuries. (R)

Does it hurt?

No, the cold laser therapy does not hurt. As previously said, it can cause a mild discomfort but this is only at the beginning of the treatment. If excess pain is present, the symptomatology should be reviewed and the treatment adjusted.

What should you expect right away?

This is not a miracle treatment. As a general rule, and as already mentioned, several sessions might be required for the first results to become noticeable. You should be patient and follow the treatment as instructed.

Bone regeneration – fat or myth

It is true that the low-level laser therapy can help the bone regenerate. This is also dependent on the chosen dose and the associated output power. It has been determined that the low-level laser therapy can stimulate cellular metabolism, as well as increase the synthesis of proteins – all of these changes contribute to bone regeneration. (R)

Mainstream media appreciates LLLT as an effective treatment solution

The articles written about LLLT have positive opinions with regard to this being a treatment for a number of acute and chronic conditions. The procedure is appreciated for being non-invasive, painless and effective.

We hope this clarifies what LLLT can and can not do and have provided guidance on how best to use it. It would be best if you visited a clinic that owns a device so you can learn more and receive a few treatments before considering buying your own device.

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Alexandra V.
Alexandra V.
Alexandra V. holds a degree in Physiotherapy from the University of Medicine and Pharmacy Carol Davila. She holds an additional degree in Journalism and writes in English and German. She is passionate about preventative health care and an undergrad in Medicine.
Alexandra V.