What is LLLT?

Low-Level Laser Therapy (LLLT), also commonly referred to as photobiomodulation (PBM) or low-intensity laser therapy, uses specific wavelengths of light to stimulate biological responses within cells and tissues. 

 

Unlike lasers designed primarily to cut, ablate or thermally heat tissue, LLLT uses relatively low powers of light to influence cellular and physiological processes through photochemical and photobiological mechanisms.

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At Optimize Sports Chiropractic, we use Erchonia® low-level lasers, including the Erchonia GVL™ and Erchonia EVRL™, as part of an individualized, multimodal approach to rehabilitation and patient care.

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How does LLLT work?

Photobiomodulation occurs when light is absorbed by biological tissues and interacts with cellular and molecular targets.

 

One of the best studied mechanisms involves the interaction of light with components of the mitochondrial respiratory chain, including cytochrome c oxidase. Depending on the wavelength, dose, irradiance and tissue being treated, this can influence cellular signalling and mitochondrial function.

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Potential downstream effects include changes in:

• Cellular energy metabolism and ATP production

• Reactive oxygen species (ROS) signalling

• Nitric oxide signalling

• Local blood flow and microcirculation

• Inflammatory signalling

• Oxidative stress

• Cellular proliferation and migration

• Tissue repair and remodelling

• Neural and neuromuscular function

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Importantly, PBM is dose dependent. More light is not necessarily better. The biological response can follow a biphasic or hormetic pattern, meaning that an appropriate dose may produce a beneficial response while an insufficient or excessive dose may produce a smaller response.

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This is why factors such as wavelength, irradiance, energy density, treatment time, pulsing parameters and treatment location all need to be considered when using photobiomodulation.

 

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What is the difference between LEDs, Class 4 Lasers and LLLT?

Light from LEDs (Light Emitting Diodes) cannot achieve the same narrow band of wavelength as a laser. Instead LEDs produce light that is disorganized or incoherent. Laser light is more effective in producing photochemical effects than LED. This is evident in numerous, double-blind, placebo controlled clinical trials using LLLT, where test subjects established both statistical significance and clinically meaningful results over the placebo group which received LED treatment.

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Devices with a laser output above 500mW are not LLLT. Instead, they are classified as High Intensity Laser (HIL) or Class 4 Lasers. These are thermal lasers which - according to FDA clearance - are intended to “provide topical heating for the purpose of elevating tissue temperature for temporary relief of muscle and joint pain and stiffness, arthritis pain, or muscle spasm, the temporary increase in local blood circulation and/or promoting relaxation of muscle”. LLLT is a powered light-based laser non-thermal instrument with non-heating effect for adjunctive use in pain therapy or other indicated conditions. ​

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At Optimize Sports Chiropractic, our choice of Erchonia low-level laser technology reflects the specific characteristics and treatment parameters of the devices we use within our clinical protocols.

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What wavelengths are used in Photobiomodulation?

Photobiomodulation generally uses wavelengths within the visible light spectrum of 380-700nm. Another type of electromagnetic radiation is infrared (IR) which includes wavelengths higher than 750nm. The infrared light spectrum exhibits strong absorption from vibrations of the water molecule. The result of infrared absorption is heating of the tissue, since it increases molecular vibrational activity. Put simply, while visible light can produce photochemical effects, infrared produces molecular rotations and vibrations (photothermal / photophysical effects).​​

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There is no single wavelength that is universally "best" for every tissue or condition. Different wavelengths interact differently with tissue because absorption and scattering vary according to wavelength and the biological structures encountered. The therapeutic response is therefore influenced by more than wavelength alone.

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Factors including: Wavelength + irradiance + dose + treatment time + treatment area + pulsing + tissue characteristics all contribute to the biological response.

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For this reason, simply choosing a higher wavelength (e.g. infrared), or higher power (e.g. >500mW) does not automatically mean that treatment will penetrate deeper or produce better clinical results.

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Why does dose matter?

One of the most important concepts in photobiomodulation is that the dose-response relationship is not necessarily linear. Photobiomodulation can demonstrate a biphasic dose response, sometimes described as hormesis. This means:

• Too little light → insufficient biological stimulation

• Appropriate dose → potentially beneficial biological response

• Excessive dose → response may plateau or diminish

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Consequently, increasing the power or energy delivered does not necessarily improve the outcome. This is one reason why modern PBM research considers both irradiance (mW/cm²) and energy density (J/cm²) rather than simply looking at total energy.

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Potential effects of LLLT

Research into photobiomodulation has investigated a wide range of biological effects. Depending on the tissue, condition and treatment parameters, reported effects include potential modulation of:

Cellular energy production

• PBM influences mitochondrial function and cellular energy metabolism, including ATP production. This is particularly relevant to tissues with high metabolic demands.

Inflammation and immune signalling

• PBM has been investigated for its ability to influence inflammatory signalling pathways and cellular responses associated with inflammation. This includes research involving microglia and neuroinflammatory signalling within the nervous system.

Oxidative stress

• Appropriately dosed PBM may influence reactive oxygen species and cellular antioxidant responses. Importantly, ROS are not simply "bad". They also act as important signalling molecules, meaning that PBM may modulate oxidative signalling rather than simply eliminating all ROS.

Blood flow and circulation

• PBM has been investigated for effects on nitric oxide signalling, vascular function and local microcirculation.

Tissue repair

• Research has investigated PBM in relation to cellular proliferation, migration, collagen production, angiogenesis and tissue remodelling. These mechanisms may be relevant to the rehabilitation of various musculoskeletal injuries.

Nervous-system function

• Photobiomodulation has and is also being investigated in neuroscience and neurorehabilitation. Research has explored potential effects on mitochondrial function, neuroinflammation, oxidative stress, cerebral blood flow and neuronal signalling.

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LLLT and neurorehabilitation

At Optimize Sports Chiropractic, we may incorporate LLLT/PBM into selected neurorehabilitation programs.

 

The nervous system has a very high metabolic demand. Following neurological injury, concussion or systemic illness, changes in cellular metabolism, inflammatory signalling, oxidative stress, autonomic regulation and blood flow may contribute to persistent symptoms in some individuals. Photobiomodulation has, and is, being investigated as one potential adjunctive strategy for influencing some of these biological processes.

 

Importantly, we do not view LLLT as a replacement for neurological assessment or active rehabilitation. Instead, it may be incorporated alongside an individualized rehabilitation program designed around the person's objective findings. Depending on the individual, this may include:

• Vestibular rehabilitation

• Oculomotor and visual rehabilitation

• Balance and postural control training

• Cervical sensorimotor rehabilitation

• Proprioceptive and coordination exercises

• Autonomic rehabilitation

• Exercise-based rehabilitation

• Motor-control training

• Reaction-time and cognitive-motor exercises

• Other targeted neurological or musculoskeletal rehabilitation strategies

 

The goal is to address the underlying impairments identified during assessment, rather than simply treating symptoms.

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LLLT at Optimize Sports Chiropractic​

At Optimize Sports Chiropractic, we use Erchonia® low-level laser technology, including the GVL™ and EVRL™, as part of our individualized multimodal approach.

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LLLT may be considered as an adjunctive treatment for selected patients with conditions including:

• Musculoskeletal pain and injury

• Tendinopathies

• Muscle strains

• Ligament and joint injuries

• Neck and shoulder pain

• Low back pain

• Plantar heel pain and plantar fasciitis

• Overuse and biomechanical injuries

• Selected nerve-related conditions

• Concussion and neurorehabilitation

• Other conditions where photobiomodulation may be clinically appropriate

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Treatment is individualized according to the patient's presentation, assessment findings and rehabilitation goals.

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One of the key principles of our approach is that passive treatment alone is rarely the whole solution. For many musculoskeletal and neurological conditions, long-term improvement requires the nervous system and body to adapt to appropriate movement, sensory, cognitive and physical demands. LLLT may therefore be used as an adjunct to active rehabilitation, rather than as a replacement for it.

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This multimodal approach allows treatment to address both the biological environment and the functional impairments contributing to the patient's symptoms.

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For this reason, LLLT at Optimize Sports Chiropractic is incorporated into an individualized assessment and management plan, rather than being used as a generic "one-size-fits-all" treatment. If you would like to know whether LLLT may be appropriate for your condition, contact our clinic to arrange an assessment.

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References

• https://www.erchonia.com/research-articles/

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