upcoming Manual Medicine Workshops, Seminars, Lectures.

Mind-Body Conference Philippines

The Manual Medicine Group 
is extending an invitation 
to join us at 

“HORIZONS,” 
the 4th Philippine 
Mind-Body Conference.

November 27 - 28, 2010

Legend Villas, Mandaluyong City.

Neuro-Linguistic Programming 2:15pm; Nov 27, Sat

Manual Medicine for Pain Mgmt 3:45pm; Nov 27, Sat

Cranial-Sacral Therapy 10:45am; Nov 28, Sun

To book with us, or If you have any questions, clarifications, or suggestions; 

please DO get in touch with us either through landline: +6324287602, 

mobile: +639228593562, or email: fitwerks2003@yahoo.com.

An open invitation for a workshop on manual medicine

This is an open invitation to a talk and a Workshop with the Manual Medicine Group in November 2010.

We will have an esteemed colleague, on break from his Doctoral studies, join us for a kindly volunteered talk on "Listening Skills:"

Valentin C. Dones III, MSPT, PTRP, DMS, CMT
 

Assistant Professor

College of Rehabilitation Sciences

University of Santo Tomas

 

Graduate School
University of Santo Tomas

Core Group Researcher
Center for Research and Movement Science

University of Santo Tomas

Please RSVP with Rheysonn Cornilla on Facebook to confirm your interest in joining us.

Treatment for Hip Joint Pain

Acetabulo-femoral (Hip Joint) Capsulitis, Acute

History:

·         Night pain at hip joint, unresponsive to traditional physiotherapy.

·         Pain along buttocks.

·         On and off groin and / or anterior thigh pain.

Findings:

·         Limitation in ranges of motion is in capsular pattern:

o   limitation in medial rotation > flexion and abduction > extension.

·         Passive testing shows hard end-feel.

Intervention Done:

·         Local infiltration with 40mg triamcinolone plus 1% lidocaine, to complete 5 ml total volume, using a 23 guage 3.5 inch spinal needle.

Aftercare Instructions:

·         Limit weight-bearing x 2 weeks.

·         Surgery should be avoided for up to six weeks from date of intervention.

·         Repeat infiltrations may be attempted in three months.

·         Annual X-rays should be done, monitoring for degenerative changes.

Manual Medicine Interventions:

·         No hard “adjustments” or chiropractic intervention at this joint for at least two weeks, please.

·         Osteopathic and PT intervention:

o   Range-of motion pain-free activities may be started immediately, but should be graded, and may be gradually increased in frequency and end-range attempted. 

o   Stretching may be done, gradually encouraging further motion end-ranges. 

Excerpted, with copyright maintained by author, from:

Orthopedic Medicine Interventions Dissected

Sandro Strix S. Toledo, M.D., Dip. OMI

What is Craniosacral Therapy?

What is 

Craniosacral Therapy?

Cranial-Sacral Therapy (CST)

The cranial-sacral (craniosacral) system addresses bones and membranes that surround the central nervous system. Restrictions here can pull on and strain neural tissues, and affect correspondingly innervated somatic areas, organs, or tissues.  Craniosacral Therapy or CST uses very light hands-on techniques. These techniques deal with pressures and movements of and between brain structures. Hands-on application of CST resistance to certain tissue pressures or movements are often meant to induce responses that decrease, unwind, or remove neural tissue strain. CST Induction techniques are meant to propagate proper movements between brain structures. 

CST, while particularly effective for treatment-resistant headaches, also has positive bearing on varied cases of unresolved chronic muscle and joint pain. Case studies have shown usefulness in helping resolve some digestive and neuro-endocrine disorders. Learning curves, attention spans, and memory retention are often reported improved.

An urgent call exists for strong Randomized-controlled-blinded studies on both the mechanism of action and effectiveness of CST. While ardent practitioners and patients attest to its wondrous effects, strong scientific validation is still lacking.

In the very least, a profound relaxation response is almost always possible with CST. For those for whom "nothing else has worked," CST may be of some help. My biggest concern with CST is the large inter-practitioner discrepancy in in both the rhythm and amplitude of the movements they say they notice in patients. Two different practitioners may read the number of "cycles of flexion-extension" very differently -- even when "readings" are taken a few seconds apart.

My personal advice: find a CST practitioner you are truly comfortable with. Hopefully that practitioner has also had at least a year of successful interventions. As with surgical interventions, the more experience, the better. 

Personal caveat: If you find a practitioner who says they always have a 100% success rate with CST, i would suggest you run away, very quickly, in the opposite direction. That doctor is either extremely gifted or downright scary. (On the off chance that they've developed a system that absolutely always works, for any indication, please send me their contact numbers. I need to learn what they are doing. My magic isn't that good yet.  So i'm sticking to my science, and letting God do the rest.)

Looking for a CST Practitioner?

POSITION STATEMENT ON LASER ACUPUNCTURE by the Australian Medical Acupuncture College

POSITION STATEMENT ON LASER ACUPUNCTURE

LASER, an acronym for Light Amplification by Stimulated Emission of Radiation, was developed in the early 60s. It is a form of electromagnetic radiation, in the visible or infrared region of the light spectrum, generated by stimulating a medium, which may be solid or gaseous, under special conditions. The beam of light thus generated has uses in almost every area of technology which exist today.

Laser was first used in the medical field as a focussed, high power beam with photo thermal effects in which tissue was vapourised by the intense heat. During the early phase of its use as a surgical tool, it was noted that there appeared to be less pain and inflammation following laser surgery than conventional surgery.
It was postulated that this effect was related to the use of surgical lasers with a Gaussian beam mode (see fig) In this mode the power of laser is highest at the centre of the beam with the power then falling off in a bell-shaped curve with the weakest power at the periphery of the beam diffusing out into the undamaged tissues (2). This phenomenon was called the "alpha-phenomenon" (35). Thus the "low power" segment of the beam was postulated to be responsible for the decreased pain and inflammation in the wound. Workers in the field recognised this effect. Laser devices were manufactured in which power densities and energy densities of laser were lowered to a point where no photo thermal effects occurred but the photo-osmotic, photo-ionic and photo-enzymatic effects were still operative. Thus the use of "cold" laser or "soft" laser, as it was first known, came into medical use.

The earliest experimental application of low power laser in medicine was first reported in 1968 by Endre Mester in Hungary. He described the use of Ruby and Argon lasers in the promotion of healing of chronic ulcers. In 1974, Heinrich Plogg of Fort Coulombe, Canada, presented his work on the use of "needleless acupuncture" and pain attenuation. The first clinical applications of the GaAIAs diode laser appeared in the literature in 1981.

Since then a multitude of devices, from many different countries, generating a variety of laser beams of varying power, wavelengths, frequencies and claims of clinical effects have been brought onto the market.

Its use is now widespread in almost every medical speciality, especially dermatology, ophthalmology and medical acupuncture.

Japan and several Scandinavian countries are at the forefront of clinical research work with laser. Low Level Laser Therapy (LLLT) is also used in Australia, Canada, France, Korea, People's Republic of China, U.K. and many other countries. A tissue repair research unit, examining the effects of laser, now exists at Guy's Hospital, London. Many centres of research are now developing around the world.

It is to be noted that lasers machines are used widely by physiotherapists, veterinary surgeons (3) as well as practitioners of alternate therapies. It is unregulated by any authority at the present time, apart from the need for the equipment to conform to Australian standard safety regulations.

The aim of this position paper is to present the current views, on the use of laser, of the Australian Medical Acupuncture College.

The photo-chemical effects of light in medicine are well known e.g. blue light is absorbed by bilirubin and thus undergoes photo-chemical change. THis is the basis of the treatment of neonatal jaundice. Another use is that of ultraviolet light to treat psoriasis in PUVA treatment. The use of a laser as a mechanism to induce photo-chemical changes in tissues is an extension of this effect.

Laser has three characteristics which make it different from ordinary light. It is monochromatic, parallel and coherent. It is the last characteristic which is the most significant factor in skin penetration, thus allowing a photo-chemical effect to occur in deeper tissues. Absorption spectra (1) can be plotted for any chemical or biological system. In any clinical setting the absorption of laser and hence its biological effect depend upon skin pigmentation, amount of fat, water and vascular congestion of tissues.

Penetration of laser into tissues falls off at an exponential fashion. Thus increase of laser power applied to tissues does not result in a linear increase in biological effect.

Once absorbed a photochemical effect can be induced by the following mechanisms

1. Neural: Laser causes in vitro changes in nerve action potentials, conduction velocities and distal latencies. Experimental evidence includes Bishko's work in Vienna where he demonstrated significant pain relief following low power HeNe and infra-red laser stimulation of acupuncture points. Walker demonstrated increased levels of serotonin in chronic pain patients after treatment with low power HeNe laser (46).

2. Photoactivation of enzymes: one photon can activate one enzyme molecule which in turn can process thousands of substrate molecules (1). This mechanism provides a theoretical framework in which a very small amount of energy can cause a very significant biological effects.

Primary photoacceptors, which are activated by laser, are thought to be flavins, cytochromes
(pigments in the respiratory chain of cells) and porphyrins (14,15). They are located in mitochondria. They can convert laser energy to electro-chemical energy.

It is postulated that the following reaction is activated by laser (1):

Low doses of laser stimulation ATP in mitochondria activation of the Ca++ pump Ca++ in the cytoplasm (via ion channels) cell mitosis cell proliferation. Higher doses of laser stimulation hyperactivity of the Ca++/ATPase pump and exhaust the ATP reserves of the cell failure to maintain osmotic pressure cell explodes.

3. Vibrational and rotational changes in cell membrane molecules: Infra-red radiation results in rotation and vibration of molecules in the cell membrane leading to activation of the Ca++ pump as in the cascade above.

Different wavelengths may stimulate different tissue responses which may be synergistic and thus produce better clinical effects.

It is essential that basic parameters of laser physics are understood by the practitioner in order to achieve the best results in any given clinical setting.

Wavelength The wavelength of a laser is determined by the medium from which it is generated. Wavelengths of low power lasers in common clinical use in Australia today are 632.8nm ( Helium Neon, gas) in the visible light range, 810nm (Gallium / Aluminium / Arsenide, diode) and 904 nm (Gallium / Arsenide, diode) in the infra red region of the light spectrum. Other wavelengths are used more commonly in surgical settings. The wavelength is the prime determinant of tissue penetration. Lasers which penetrate less deeply are suitable for acupuncture point stimulation and biostimulation. Infra red lasers penetrate more deeply and are used in deeper tissue stimulation such as trigger points.
Energy
Energy is a measure of the dose of laser given in any treatment
Laser energy, in joules, is calculated from the formula:
Joules = Watts x Seconds
It can be seen from this formula that energy, expressed as joules, is related to the power of the laser and the duration of irradiation so that a higher power laser takes less time to generate the required number of joules than a lower power laser. The range of powers of laser devices used in Australia varies from 1.5 to 100 mW. Principles of laser dosing should be understood by users as some clinical effects, especially with higher power lasers, appear to be dose related. Acupuncture points are stimulated with energy ranging from 0.01-0.05 joules/point while trigger points may be stimulated with 1-2 joules/point or higher, depending on the tissue depth.
Energy Density
This parameter is used in the calculation of doses for biostimulation of wounds and is calculated as:
Energy density (J/cm2) = Watts x Seconds/Area of laser spot size (cm2)
4J/cm2 is regarded as the optimal dose for biostimulation, based on empirical findings.

Power Density
This is a measure of the potential thermal effect of laser and is fixed by the characteristics of the machine for any given power output and spot size. It is calculated from the formula:
Power density (Watts/cm2) = Waifs/area of the probe tip (cm2) 1 0,OOOmW/cm2 will produce a sensation of heat
A wide range of conditions are amenable to management by Iaser, (3,4,5, 42). Many of these include conditions not amenable to or unresponsive to current drug or physical therapies such as osteoarthritis (16,18), back pain (17), post-herpetic neuralgial (9,20) , chronic pelvic inflammation (44) and rheumatoid arthritis (22,31).

Laser may be used in three different ways

1. To stimulate acupuncture points

Laser is used to stimulate acupuncture points using the same rules of point selection as needle acupuncture. Laser acupuncture may be used solely or in combination with needles for any given condition over a course of treatment.

2. To treat trigger points

In some musculo-skeletal conditions higher doses of laser may be used for the deactivation of trigger points. Trigger points may be found in muscles, ligaments, tendons and periosteum. Direct irradiation over tendons, joint margins, bursae etc may be effective in the treatment of conditions in which trigger points may play a part. Children and the elderly may require smaller doses. Areas of thick skin or muscle may require higher doses for penetration than finer skin areas e.g. ear.

3. To promote healing

The biostimulatory effects of laser have been widely investigated both in vivo and in vitro.

In vitro experimental evidence has demonstrated acceleration of collagen synthesis in fibroblast cultures due to acceleration of mRNA transcription rate of the collagen gene. Superoxide dismutase activity is increased (this decreases prostaglandins). This is postulated as one mechanism of pain and oedema reduction. Other effects are: inhibition of procollagen production in human skin keloid fibroblast cultures and stimulation of phagocytosis by macrophages, increased fibroblast proliferation, as well a wide variety of cellular responses.
In vivo effects demonstrated in animals include increased formation of granulation tissue and increased rates of epithelialisation in laser irradiated wounds, stimulation of suppressor T-cells, increased collateral nerve sprouting and regeneration of damaged nerves in rats and tendon and ligament repair in race horses.
Bio-stimulatory effects of laser are governed by the Arndt-Schultz Law of Biology i.e. weak stimuli excite physiological activity, strong stimuli retard it. The implication of this for wound healing is that, as treatment of a wound is continuing and there appears to be a slowing down of healing, a reduction of the laser dosage may be needed. By virtue of the Arndt-Schultz Law and the changed responsiveness of the tissues, what was originally a stimulating laser dose may have become an inhibitory dose of laser. The optimal energy density for biostimulation, based on current clinical experience, is 4J/cm2. Dose must be adjusted according to individual response.
Biostimulatory effects of laser may be used in the following conditions:

1. the promotion of healing of wounds e.g. venous and arterial ulcers, burns, pressure sores.
2. treatment of skin infections such as herpes zoster, labialis and genitalis.
3. treatment of apthous ulcers.

Laser may have an enhancing effect on healing wherever inflammation is present.
Bio-inhibitory effects of laser may occur at higher doses e.g. 8J/cm2. Treatment of keloid scars has been successful at these doses. Class 4 Lasers are used.
Reprinted with permission of Standards Australia from Australian Standard: Laser Safety AS 2211-1991

References

1. Smith K. C. Light and Life: The Photobiological Basis of the Therapeutic Use of Radiation from Lasers. Progress in Laser Therapy Selected Papers from the first meetmg of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R.G. pp 11-18.
2.Oshiro T. An introduction to LLLT. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, OkThawa, 1990. Ed. Oshfro T and Calderhead R. G. pp 36-47.
3.Motegi M. Low Reactive Laser Therapy in Japan. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. C. pp 75-80.
4.Chow R. T. Results of Australia-wide survey into Laser use. The Journal of the Australian Medical Acupuncture Society: Vol IZ No 2, 1994: 28-32
5.Greenbaum, G.M. The Bulletin of the Australian Medical Acupuncture Society; Volume 6, No.2,1987.
6.Cassar E.J. LLLT in Australia. Progress in Laser Therapy. Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. C. pp 63-65.
7. the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. G. pp 66-70.

8.Goepel Roland, MD. Low Level Laser Therapy in France. Progress in Laser Therapy. Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 71-74

9.Motegi Mitsuo Low Reactive-level Laser Therapy in Japan. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 77-80

10.Professor Jae Kyu Cheun. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 81-82.

11.Professor Yo-cheng Zhou. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 85-89.

12.Moore, Kevin C. Low Level Laser Therapy in the United kingdom. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 94-101.

13. Dyson, M. Cellular and Subcellular aspects of Low Level Laser Therapy Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. 0. pp 221-224.

14. Lubart, R., Friedmann, H., Faraggt A. and Rochkind, 5., (1991). Towards a mechanism oflow energy phototherapy Laser Therapy 1991; 3:11-13.

15. Smith, kendric C. (1991). The photobiological basis of low level laser radiation therapy Laser Therapy 1991; 3:19-24.

16. Gartner C (1992). Low reactive-level laser therapy (LLLT) in rheumatology a review of the clinical expedence in the author's laboratory. Laser Therapy 1992; 4:107-115.

17. Ohshiro, T and Shirono, Y (1992). Retroactive study in 524 patients on the application of the 830nm GaAlAs diode laser in low reactive-level laser therapy (LLLT) for lumbago. Laser Therapy 1992; 4: 121-126

18. Trelles, M. A., Rigau, J., Sala, P. Calderhead, 0. and Oshiro. T. (1991). Infrared diode laser in low reactive-level laser (LLLT) for knee osteoarthrosis. Laser Therapy 1991, 3:149-153.

19. Kemmotsu, 0., Sato, K., Furumido, H., Harada, K., Takigawa, C., Kaseno, S., Yokota, S., Hanaoka, Y and Yamamura, T. (1991). Efficacy of low reactive-level laser therapy for pain attenuation of postherpetic neuralgia. Laser Therapy 1991; 3: 71-75.

20. Mckibbin, Lloyd S. and Downie, Robert. (1991). Treatment of post herpetic neuralgia using a 904nm (infrared) low incident energy laser a clinical study Laser Therapy 1991, 3: 35-39.

21. Rigau, J., Trelles, MA., Calderhead, R. 0. and Mayayo, E. (1991). Changes on fibroblast
proliferation and metabolism following in vitro Helium-neon laser tradiation. Laser Therapy 1991; 3: 25-33.

22. Asada, K., Yutani, Y., Sakawa, A. and Shimazu, A. (1991). Clinical application of GaAlAs 830nm diode laser in treatment of rheumatoid arthritis. Laser Therapy, 1991; 3: 77-82.

23. Zheng, H., Qin, J-Z, Yin H. and Yin S-Y (1993). The activating action of low level Helium neon laser radiation on macrophages in the mouse model. Laser Therapy, 1993, 4: 55-58.

24.Lubart, R., Friedmann, H., Peled, I. and Grossman, N. (1993). Light effect on fibroblast proliferation. Laser Therapy 1993; 5: 55-57.

25. Karu, T. (1992). Derepression of the genome after irradiation of human lymphocytes with He-Ne laser Laser Therapy 1992, 4: 5-24.

26. Calderheadj R. Glen (1991). Watts a Joule: on the importance of accurate and correct reporting of laser parameters on low reactive-level laser therapy and photobioactiva don research. Laser Therapy 1991; 3:177-182.

27. Solton, P., Young, S. and Dyson, M. (1991). Macrophage responsiveness to light therapy with varying power and energy densities. Laser Therapy 1991; 3:105-111.

28. Matsumura, C., Murakami, F. and Kemmotsu, 0. (1992). Effect of Helium-Neon laser therapy (LLLT) on wound healing in a torpid vasculogenic ulcer on the foot a case report. Laser Therapy 1992; 4:101-105.

29. Smith, Kendric C. (1991). The photobiological basis of low level laser radiation
therapy. Laser Therapy 1991; 3:19-24.

30. Wolbarsht M.L. & Sliney D. H.: Safety in LLLT. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R.G. pp 31-35

31. Asada K., Yasutaka, Y, keniirou Y, Shimazu A. Pain Removal of Rheumatoid Arthritis and Application of Diode Laser Therapy to Joint Rehabilitaion. Progress in Laser Therapy Selected {Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. G. pp 124-129.

32. T, Wang Li-shi, and Yamada H. A Review of Clinical Applications of LLLT in Veterinary
Medicine. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. G. pp 162-169.

33. Terashima y, Kitagawa M., Takeda 0., Sago H., Onda T and Nomuro K. Clinical Application of LLLT in the Field of Obstetrics and Gynaecology Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R.G. pp 191-196

34. Pontinen Pekka J Low Level Laser Therapy as a Medical Treatment Modality Art Urpo Ltd. pp 37-38 1992

35. Calderhead R. Glen. Simultaneous Low Reactive-Level Laser Therapy in Laser Surgery: the alpha-phenomenon" explained. Progress in Laser Therapy Selected Papers from the first meeting of the International Laser Therapy Association, Okinawa, 1990. Ed. Oshiro T and Calderhead R. G. pp 209-213.

36.Mikhallov, VA., Skobelkin, O.K., DenisovI, I.N., Frank, G.A. and Voltchenko, N.N. (1993). Investigations on the influence of low level diode laser irradiation on the growth of experimental tumours. Laser Therapy 1993; 5: 33-38

37. Schindl, L., kainz, A. and kern, H. (1992). Effect oflow level laser irradiation on indolent ulcers caused by Buerger's disease; Literature review and preliminary report. Laser Therapy, 1992, 4: 25-29.

38. Matsumura. C.. Ishikawa. F., Imai M. and Kemmotsu. O.,. (1993). Useful effect of application of 43-46.

39. Mester Andrew F. M.D. and Mester Adam M.D. Laser Biostimualtion in Wound Healing. Lasers in General Surgery. Williams & Williams PubI.
40.Mester End re et al. The Biomedical Effects of Laser Application. Lasers in surgery and Medicine 5:31-39 1985

41.Bischko Johannes J. M.D. Use of the Laser Beam in Acupuncture. Acupuncture & Electro-therapeut. Res. ....... Vol 5, pp.29-40, 1980.
42.Choi Jay J. M.D. A Comparison of Electro-acupuncture, TENS and Laser Photo-Biostimulation on Pain Relief and Glucocorticoid Excretion. A Case Report. Acupuncture & Electro-therapeut. Res. Int. J.. Vol 11, pp.45-51,1986.
43.Kreczi T. M.D., Kingler D. M.D. A Comparison of Laser Acupuncture vs Placebo in Radicular and Pseudoradicular Pain Syndromes as Recorded by Subjective Responses of Patients. Acupuncture & Electro-therapeut. Res. ....... Vol 11, pp.207-216,1986 1980.
44. Xijing Wu & Yu Ian Cui. Observations on the effect of He-Ne laser Acu point Radiation in Chronic Pelvic Inflammation. Journal of Traditional Chinese Medicine 7(4): 263-265, 1987.
45. Walker J. Relief from Chronic Pain by Low Power Laser Irradiation. Neuroscience Letters, 43 (1983) 339-344.

Position paper reposted for discussion purposes only. May be removed from site at any time.

What can Laser Acupuncture Do?

Acupuncture Research

Photomedicine and Laser Surgery. Volume 27, Number 2, 2009 

Study of Autonomic Nervous Activity of Night Shift Workers Treated with Laser Acupuncture 

Jih-Huah Wu, Ph.D.,1 Hsin-Yang Chen, M.S.,2 Yu-Ju Chang, M.S.,3 Hung-Chien Wu, M.D.,4 Wen-Dien Chang, M.S.,5,6 Yi-Jing Chu, B.E.,5 and Joe-Air Jiang, Ph.D.5 

Abstract 

Objective: The aim of this study was to evaluate the impact of laser acupuncture on the autonomic nervous system (ANS) of the night shift worker. 

Background Data: Many articles have demonstrated that levels of affective disorders and stress are high in night shift workers. We applied laser energy to the Neiguan point (PC6) to examine the impact of laser acupuncture on the ANS of 45 healthy young males who were night shift workers and evaluated their heart-rate variability (HRV). # 

Materials and Methods: The laser group (n 15) received laser acupuncture (9.7 J/cm2, 830 nm) for 10 min, and the placebo group (n 15) received sham laser treatment. 

The effects before and after this intervention on the HRV of the subjects were assessed, along with those seen after 30 min of lying down. 

Results: After treatment and after the 30-min rest period, the independent sample t-test showed that both groups exhibited statistically significant differences in high-frequency (HF) HRV, low-frequency (LF) HRV, and the LF:HF ratio of HRV (p 0.05). Compared with the placebo group, the paired samples t-test showed that after laser treatment the treatment group had a statistically significant improvement in HF HRV (p 0.001), LF HRV (p 0.001), and the LF:HF HRV ratio (p 0.02). 

Conclusions: Laser acupuncture stimulation applied to the Neiguan point increased vagal activity and suppression of cardiac sympathetic nerves. This effect was positive and could be used to help patients who have circadian rhythm disorders. 

Lasers in Medical Science 

ISSN: 0268-8921 (printed version) ISSN: 1435-604X (electronic version) 

Abstract Volume 15 Issue 1 (2000) pp 57-62 

Specific Effects of Laserpuncture on the Cerebral Circulation 

G. Litscher (1), L. Wang (1), M. Wiesner-Zechmeister (2) 

(1) Biomedical Engineering, Department of Anesthesiology and Critical Care, University of Graz, Graz, Austria

(2) European Forum for Lasertherapy and Fractal Medicine 

Paper received 10 May 1999; accepted after revision 23 August 1999. 

Abstract. Acupuncture is a form of traditional Chinese medicine that has developed over thousands of years. We studied the effects of laser puncture, needle acupuncture, and light stimulation on cerebral blood flow in 15 healthy volunteers (mean age 25.0±1.9 years, 5 female, 10 male) with non-invasive transcranial Doppler sonography. In addition 40-Hz stimulus-induced brain oscillations, heart rate, blood pressure, peripheral and cerebral oxygen saturation, and the bispectral index of the EEG were recorded. Stimulation with light significantly increased blood flow velocity in the posterior cerebral artery (p>0.01, ANOVA). Similar but less pronounced effects were seen after needle acupuncture (p< 0.05, ANOVA) and laserpuncture (n.s.) of vision-related acupuncture points. Furthermore both, laserpuncture and needle acupuncture, led to a significant increase in the amplitudes of 40-Hz cerebral oscillations. Stimulation of vision-related acupuncture points with laser light or needle acupuncture elicits specific effects in specific areas of the brain. The results indicate that the brain plays a key intermediate role in acupuncture. However, brain activity of itself does not explain anything about the healing power of acupuncture. 

Keywords: Acupuncture; Brain; 40 Hz brain oscillations; Cerebral blood flow velocity; Laserpuncture; Light stimulation; Middle cerebral artery (MCA); Posterior cerebral artery (PCA); Transcranial Doppler sonography (TCD) 

Therapy of cervical tendomyosis 

A randomised controlled double-blind trial comparing dosed lasertherapy on acupuncture points and classical acupuncture 

Ulf Seidel, Christine Uhlemann 

Klinik für Orthopädie Klinikum Neustadt
Institut für Physiotherapie Friedrich-Schiller-Universität Jena 

Aim of this randomised controlled, concerning lasertherapy double-blind study was to investigate therapeutical efficacy of a dosed lasertherapy (low level laser therapy, LLLT) on acupuncture points and conventional acupuncture in influencing symptoms of cervical tendomyosis. 

Methods:
48 patients (43 f, 5 m) with relevant neck pain were treated twice weekly for 4 weeks (8 treatments), randomised into four groups of different kinds of therapy: LLLT, output power 0 mW (placebo), 7 mW, 30 mW or needle acupuncture (4 ×n = 12). 

Acupuncture was performed as a conventional meridian acupuncture, 15 minutes per session to a maximum of 15 needles. 

LLLT was done as a stimulation to the same meridian points, 1 minute per point, totally 15 points. Laser parameters: cw-IR-GaAlAs-Laser, 830 nm, energy density 0 J/cm2; 21 J/cm2; 90 J/cm2, irradiation area 0.02 cm2, laser-skin-difference 8 mm. Subsequent evaluation was done four weeks after treatment (follow up). Assessment of outcome measurements comprised: Primary outcomes: 1. pain: pain intensity (visual analogue scale, VAS), pain sensation (pressure pain threshold, PPT); 2. cervical mobility: range of motion (ROM) (clinical distance measure, three-dimensional analysis of cervical spine, Zebris®). Secondary outcomes: 1. mental health (questionnaire); 2. subjective assessment (pain, mobility); 3. clinical autonomic parameters (blood pressure, heart rate, skin temperature). 

Results:
Acupuncture and LLLT showed a significantly reducing of pain intensity, this effect could be proved four weeks after the end of the series (follow up): reduction in VAS by acupuncture 82.2 %, by LLLT 7 mW 55.4 %, 30 mW 29.1 %, 0 mW 26.1 %. PPT was significantly increased by all kinds of therapy. 

There was a significant improvement of cervical mobility caused by acupuncture, LLLT 7 mW and LLLT 30 mW in contrast to placebo (0 mW LLLT).

Mental health was influenced positively by all therapy modes, significant only by LLLT 7 mW. With regard to subjective assessment (pain, mobility) there was no complaint aggravation. An increased (systolic and diastolic) blood pressure by decreased heart rate and increased skin temperature post each procedure with either method was measured. 

Conclusions
Acupuncture is a therapeutical option in the treatment of common neck pain. Dose dependent effects of LLLT seems to be relevant, outcome power and energy density has to be considered as important parameters in efficacy of this method. LLLT 7 mW (energy density 21 J/cm2) seems to be more effective but also placebo influences pain and mental health positively. 

Keywords
Acupuncture - Low level laser therapy (LLLT) - Dosed lasertherapy - Cervical tendomyosis - Clinical trial 

Source
Dt Ztschr f Akup 2002; 258-269
DOI: 10.1055/s-2002-36555 

LASERACUPUNCTURE 

Pekka J. Pöntinen, M.D, Ph.D, F.I.C.A.E., Tampere University, Tampere, Kuopio University, Kuopio, Finland E-mail: pontinen@sci.fi 

Traditionally acupuncture means stimulation of specific points on the surface of the body in order to produce mainly regulatory effects on the functions of the internal organs. The same points have been used to increase or decrease the functional state of different organs. In Traditional Chinese Medicine (TCM) the acupuncture points (AP) are connected by channels or meridians in and under the skin and have deep connections to the internal organs. The selection of the proper points has been as important as the correct type of stimulation, either reinforcement or sedation. In the traditional Chinese medicine the human model has been mainly energetic, physiological, not anatomical. The changes in the energy flow induced by the blocks in the channels or acceleration of the flow leading either to the deficit or excess of the vital energy, Chih, were believed to be the origin of diseases. The APs were the loci to balance the energy flow through needle stimulation. Modern acupuncture has a different nature. For the consensus conference arranged by the National Institutes of Health (NIH) and held in Bethesda, Maryland in November 1997 the term acupuncture was defined as stimulation, primarily by the use of solid needles, of traditionally and clinically defined points on and beneath the skin, in an organized fashion for therapeutic and/or preventive purposes. Application of stimulus to the reactive points (by needle, heat, massage, transcutaneous electric nerve stimulation/TENS, laser, etc.) according to TCM can influence the pathophysiological function of the affected organ-meridian systems. 

In modern Chinese AP therapy, a combination of local tender points (AHSHI) and classical peripheral APs is common. Laseracupuncture (LAP) Today LAP provides a noninvasive and low risk alternative to needle stimulation. A combination of local reactive (tender) points or Ahshi points and active muscle TPs form a practical and effective basis for LAP in pain treatment. LAP can replace needles in the treatment of functional disorders and is then directed to classical APs. As a painless modality of acupuncture LAP is well accepted by children and other sensitive patients. LAP provides excellent possibilities for clinical studies on acupuncture. Recently Schlager and coworkers confirmed the efficacy of AP Neiguan (PC6) in the prevention of postoperative vomiting in children undergoing strabismus surgery. In another randomized, double-blind placebo-controlled study low-intensity laser therapy effectively prevented the recurrence of Herpes simplex infection. 

Our study groups at the Universities of Kuopio and Tampere have studied the analgetic effect of peripheral stimulation (needle acupuncture, transcutaneous electrical stimulation/TENS, massage, electric stimulation, low energy laser) applied on APs or TPs using pressure algometry . We have conducted a series of experiments using different wavelengths (633-904 nm) and both coherent and noncoherent irradiation. LEPT was given directly to TPs (1-2 J/TP) or local tender spots. 

In blind, cross-over studies both HeNe- and IR-diode (904 nm) lasers elevated pressure pain threshold (PTH). In a follow-up study on 54 MPS patients LEPT (820 nm, 1-2 J/TP) PTH increased from 2.94+1.44 tp 6.56+0.96 kg/cm² (p<0.001) and MGF from 0.60+0.28 to 1.03+0.29 bar (p<0.05), whereas VAS decreased from 44.6+11.3 to 9.3+6.4 (p<0.001). In this and other series we have found that the effect is greater on the side where PTH and MGF values are initially lower. As in our earlier studies with low and high freguency TENS one sided HeNe-laser irradiation elevated PTH of the corresponding, contralateral nontreated TPs in addition to the response on the treated side. More recently the main emphasis has been turned to the central mechanisms and pathways. In a pilot study LED-light (880 nm, 1J/cm2) given to TPs in trapezius muscle (TE15) bilaterally and upon proc. spinosus of C7 (DU14) significantly altered regional cerebral blood flow e.g. in thalamus, caudate nucleus and prefrontal cortex. 

In our experience less than 1 J/point or 100-200 J/cm² given in a contact mode is mainly ineffective in clinical practice when treating musculoskeletal disorders and myofascial pain through TPs. In many well controlled, blind and double-blind cross-over studies showing insignificant results the actual radiant exposure to the target site has been a mere fraction of the dose normally used in clinical practice. When treating APs of low resistance and high sensitivity the irradiation dose should be reduced to about 0.1-0.2 J/point (10 per cent of the normal dose [1-2 J/point] used at muscle TPs). 

Treatment of the acute Periarthritis humeroscapular with laserpuncture. 

Odalys Gonzáles Álvarez, Main Educational Clinic of Urgencies "Antonio Maceo", Cerro Municipality, Havana City. 

The periarthritis humeroscapular is a syndrome that contains very precise affections: the bursitis, the calcified tendinitis of supraespinoso, the bicipital tendinitis, among others. Pain and limitation of the joint movements of the shoulder characterize it. The treatment with laser of low power can produce resolution of the lesion, whenever it is made in early phases of the disease. In this study we propose the use of the laserpuncture, due to our accumulated experience in the treatment of these affection in acute phase, with acupuncture. 

A prospective study was carried out during 2 years (1997 - 1999), where 62 patients were selected because they accomplished the Approaches of Inclusion for the study. The sample was divided by aleatory assignment in 2 Groups of Treatment. Th study Group I was treated with laserpuncture, using Cuban laser equipment of HeNe of 632,8 nm and a dose of joule/cm2 was applied, and the Control Group II was treated with acupuncture needles. The conventional medical treatment was suspended. Daily sessions were given from Monday to Friday, for two weeks, until a total of 10. Both techniques demonstrated to be effective in the treatment of these affections, improving the clinical and radiological symptoms significantly when the treatment sessions was concluded. The patients accepted the laserpuncture better because of its painless character, less time of application, and the absence of bleeding and stress. 

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