Laser Report Summer 2011

Laser Report - Summer 2011

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A Historical Perspective of Medicine and Laser TherapyFred Kahn, MD, FRCS(C)

In The News at Meditech

2011 Conference Photos

Achilles Tendon Pathologies and Treatment with BioFlex Laser Therapy SystemDavid Kunashko, DC

In The News at MeditechOur 6th International Conference was an unqualified success. For the first time, the number of registered attendees exceeded 200, which serves as testimony to the quality of the papers presented. All the speakers on the program delivered topics that were meritorious and raised as many questions as answers provided and this is as it should be in the learning process.

At Meditech we take this opportunity to express our appreciation to the attending faculty and the members of the audience, all of whom are integral to the programme. Tentative planning can now begin for the next conference to be scheduled for 2013.

As most of you are aware, our company continues to develop new protocols, along with the engineering group’s endeavors to refine the functionality of the BioFlex devices. Research must always be concomitant with evolution.

In this issue, we include some pictorial mementos from the conference, including both serious and some lighter moments.

Periodically, we receive testimonials from patients and I include one that is particularly well written and typifies the problems that exist in the

real world of healthcare (see page 11). The patient in question had been treated for many years by a rheumatologist without any significant improvement. Following a course of Laser Therapy, she demonstrated immediate and dramatic relief of her symptoms, which she then attempted to relate to her attending physician. �e latter refused to concede the benefit noted and attempted to convince her that only pharmaceuticals would be helpful, despite the many years of failure so clearly recorded. Progress may be slow but we must stand by our convictions and do what is in the best interests of the patient, as exemplified so well in this particular case.

Also included is my presentation at our International Conference, which was requested by a number of attendees and is therefore provided.

At the conclusion of the conference, Meditech International Inc. presented several awards for outstanding contributions to the field of Laser Medicine.

“A Life Time Achievement Award” was conferred upon Dr. Mary Dyson whose erudite presentations at so many international conferences have been of immense benefit to so many participants.

The combination of her extensive knowledge, experience and wisdom, her contributions to the education of laser therapists and to the advancement of the science of laser therapy, are not only invaluable but immeasurable. Her body of work and her many accomplishments form a solid base for this singular recognition. �e Award is the first of its kind in the company’s history.

�e second award was made to Joanna Malinowska our “2011 Laser �erapist of the Year.” Joanna graduated from the Department of Kinesiology at York University in June 2001 and has spent the last decade at Meditech providing Laser �erapy to a diverse number of sometimes problematic patients. Invariably, Joanna bonds with the latter and in a selfless manner contributes to both their physical and psychological state of well-being. Her effectiveness in treating patients is a wonderful thing to behold. We not only appreciate her existence but even more, her presence.

Bryan Milley, who has a Bachelor of Arts Degree – Honours Kinesiology from the University of Western Ontario, has over the past 5 years consistently delivered educational programs to both healthcare professionals and patients throughout our continent.

IN THIS ISSUE BioFlex Vet System

Abstracts of Interest

2011 Training Schedule

SUMMER 2011

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He has bonded with the Chiefs of Indian Reservations and assisted all those who require help at many levels on a daily basis. His contributions to the field of laser technology are more than worthy of recognition.

Dr. Leonard Rudnick of Tucson, Arizona, was awarded the 2009 Award for “Excellence in Clinical Practice”. As the previous Director of the Laser Institute of Southern Arizona, he has probably treated more patients with Laser �erapy directly, than anyone else on this side of heaven. His devotion to this task, his endless quest to expand scientific knowledge and his contributions to the laser field in general, exceeds three decades and fully qualifies him as a recipient of this award.

�e “2010 Award for Excellence in Clinical Practice” was presented to Dr. Benjamin Yuen from Bedford, Nova Scotia. Dr. Yuen built and operates one of the largest laser clinics in the world and accomplished this feat in a period of just five short years. Dr. Yuen has always been a naturally gifted speaker and educator and presents highly relevant dissertations at many educational meetings.

No one is more deserving of this recognition than Dr. Yuen, assisted of course by his wife Elizabeth, an indispensable factor in this equation.

Dr. Randy Merrick, a renowned family physician based in Orange, Virginia, received the 2011 Award for “Excellence in Clinical Practice.” Dr. Merrick is active in his community at many levels and combines sports medicine with an active general practice. In addition, he is involved in educating his fellow physicians on the benefits of Laser �erapy and his leadership qualities are the distinguishing feature of his myriad range of activities.

We extend our congratulations to all these recipients and thank them for their service to science, to their patients and their community. �e recognition bestowed in all instances is richly deserved.

Fred Kahn (centre) with the Award Winners (left to right) Bryan Milley, Joanna Malinowska, Leonard Rudnick, Mary Dyson, Benjamin Yuen, Randy Merrick.


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I just wanted to congratulate the Meditech team on running such a terrific conference. I can’t remember when I have attended a 3-day event that has run so smoothly and I have been to numerous conventions and conferences! I felt that all your staff were so welcoming, organized and helpful. I just had to send along my kudos to you all for a job well done.

My one regret is that I didn’t bring my staff along too. I am looking forward to the next Meditech sponsored Laser conference and will be sure to bring all my staff along with me. I have previously commented on the calibre of the presenters, which I thought was superb, but I know that could all have been negated if it weren’t for everyone’s efforts behind the scenes to make it come together so efficiently. I thoroughly enjoyed all my interactions with your team.

All my best.

Pam Bennett DC, Coquitlam BC


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“All our science, measured against reality, is primitive and childlike—and yet is the most precious thing we have.”

�ese are the words of Albert Einstein and should be kept in mind within the context of medical innovation.

Mainstream medicine is bound by tradition and change is therefore problematic. Physicians and their patients are conditioned to adhere to a standard therapeutic approach and change invariably results in criticism and resistance. In order to guide progress in the future, one must learn from the lessons of the past.

Over the nineteenth and even the twentieth century, appendectomies were often recommended for preventative purposes and tonsillectomies were almost considered routine, as a treatment for the prevention of colds. Failure of these therapies are realities that should provide cause to challenge the efficacy of the “flu shots,” so widely recommended today.

On the same note, gastric and duodenal ulcers were previously considered to be caused by the excessive production of acid secondary to stress, dietary intake and other etiological factors. It has taken over 20 years to convince practitioners that ulcers are more frequently caused by an organism, H. pylori bacterium, an infection that can be effectively treated with a combination antibiotic therapy. Sometimes proton pump inhibitors and H2 blockers may also be required. �e simple elimination of this bacterium will permit the ulcers to heal, at least temporarily and also decrease the risk of developing gastric cancer in the future. �ere is no conclusive evidence today that dietary restrictions play a role in ulcer healing. With the current drug

therapy, the number of patients requiring surgery has declined dramatically, along with the incidence of gastric cancer. To reiterate, history dictates the basis for the future, particularly in medicine.

Phillipe Pinel (1745-1826) in the 18th century first recognized that people who had been labelled ‘insane’ were suffering from mental illness. He took off the shackles and chains and developed the process of analytic psychotherapy — simply communicating verbally with patients about their problems. Utilizing these techniques, he restored many to normal health without the use of chains or drugs. Essentially, this is no longer an option. Pharmaceuticals are currently in vogue, consistent with the purported advent of better solutions; in essence however, the psychomimetic era has caused the treatment of mental illness to regress.

Ignaz Semmelweis (1818-1865) was a physician and gynecologist practising in the 19th century and without the benefit of microscopes recognized that some microcosm is passed by the physician through patient contact. Combined infant and maternal morbidity and mortality rates in that era, in some instances, were as high as 40%. He realized that by re-garbing before he saw the next patient and vigorously scrubbing his hands with soap, he was able to reduce these rates to less than 3% without the use of drugs or magic - just the simple understanding of the transmission of disease and the need for a more sterile environment. �e road to sepsis was breached. His colleagues as in the case of Pinel ridiculed him and haunted him into an early grave.

Moving into the more current state of medical practice, coronary artery disease is generally treated with numerous

medications including statins, dietary measures and where indicated surgical procedures such as coronary bypass, angioplasty, etc. Recently, I found an article written by Dr. Dwight Lundell,¹ a surgeon who has performed more than 5000 bypass procedures and slowly came to the realization that he was merely treating the symptoms – not curing the problem. Today he has refocused his career and passion on the prevention, cure and elimination of heart disease. At some point, he realized that heart disease does not result from the simple presence of elevated blood cholesterol but is the result of inflammation of the arterial wall, to which certain components in cholesterol adhere. He further concluded that long established dietary recommendations in North America have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and economic upheaval.

Despite the fact that up to 25% of populations today ingest expensive statin medications daily, accompanied by the induction of a false degree of complacency and despite the reduction of fat content in our diet, more Americans will die of heart disease this year than ever before. Indeed, these disorders are affecting younger people in alarming numbers.

Without inflammation being present, cholesterol would not accumulate in the walls of arteries and cause myocardial infarction, strokes, etc; without inflammation, cholesterol would move freely through the body as nature intended. It is the inflammation that results in cholesterol becoming trapped, inflammation that quite simply seeks to stimulate the body’s natural defences to foreign invaders such as bacteria, viruses and toxins. �e cycle of inflammation

A Historical Perspective of Medicine and Laser TherapyFred Kahn, MD, FRCS(C)


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protects the body from bacterial and viral invaders, however if we chronically expose the body to injury by toxins or foods not naturally intended for consumption by the human organism, a condition develops called chronic inflammation, which is just as harmful as acute inflammation is beneficial.

What thoughtful person would wilfully expose themselves repeatedly to foods or other substances that are known to cause injury to the body? Well, smokers perhaps but at least they make that choice voluntarily. �e rest of us simply follow the recommended mainstream diet that is low in fat and high in polyunsaturated fats and carbohydrates, not being aware that we are causing repeated injuries to our arterial channels. I repeat, the injury and inflammation of our blood vessels, followed by the deposit of cholesterol is caused by the low fat diet recommended by practitioners today.

What are the biggest culprits responsible for chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (refined sugar, flour and all derivative products) and the excess consumption of omega-6 vegetable oils such as soybean, corn and sunflower that are found in many processed foods. Ingestion of these items is like a brush continually irritating the walls of the arteries. Foods loaded with sugars and simple carbohydrates, then processed with omega-6 oils for prolonged shelf life, have been the mainstay of the American diet in excess of five decades. �ese foods have been slowly poisoning everyone. �e entire process leads to heart disease, high blood pressure, diabetes, obesity and possibly Alzheimer’s disease, as the inflammatory process continues unabated.

�ere is no escaping the fact that the more we consume prepared, processed foods, the more we trigger the inflammatory switch several times daily. �e human body cannot process, nor

was it designed to consume foods packed with sugar and soaked in omega-6 oils.

�e answer— return to the ingestion of foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are complex such as colourful fruits and vegetables. Most important, avoid all polyunsaturated oils. �e science that states that saturated fats alone cause heart disease does not exist, the science that saturated fats raise blood cholesterol is unproven. Cholesterol is not the cause of heart disease, it is the result of our dietary habits as denoted by the epidemic of arterial inflammation leading to occlusion, the cause of so many silent but active killers.

Laser �erapy over the past 60 years has undergone similar transformations. �e diversity of devices previously produced lacked standardization and therefore impeded wide acceptance of the technology. Until the past decade or two, minimal effort was made to improve the systems utilized in clinical practice. When Meditech was founded in 1989, we recognized these problems and began the task of engineering devices along with the development of effective clinical protocols. �ese efforts are now stimulating the integration of Laser �erapy into mainstream medicine at an accelerating rate. �e synergy combining basic research, engineering disciplines and clinicians has resulted in the production of the BioFlex Series of Laser �erapy Systems that we feel, from a therapeutic perspective, are the most advanced available on a global basis.

With the manufacture of more sophisticated and accurate instruments, reliable, scientifically based protocols have been developed, that in many instances are designed to be disease specific. Laser Therapy has definitely come of age. Parameters covering an almost infinite range of settings including wavelength, wave form, duty cycle, frequency and duration of application.

�ese are easily adjusted to treat an extensive number of disease entities. Additionally, we are able to customize protocols for the individual patient and unique problems.

As more advanced devices are developed there is an increasing need to educate therapists on the adaptation of this technology into their specialized practices. Programmes that we have generated at Meditech include the Basic Laser Certification Course, a 3 day event that teaches practitioners to become students of Laser Therapy and understand the mechanisms of action; the Laser Report published 3 times per annum, providing up to date information and new developments; periodic Advanced �erapeutic Seminars and the International Conference that we host on a bi-annual basis.

In essence, our goal remains to continually improve existing devices, promote wider application and advance educational programmes. Laser �erapy should be considered the “New Dimension in Medical Practice” and in the 20 years that I have been involved in this endevour I am gratified by our achievements, compared to the rather primitive state of the technology that existed in 1989. At the same time, the process of evolution must continue.

Whereas I am not opposed to the pharmaceutical industry, it is my distinct impression that this sector has lost its sense of objectivity in the pursuit of healthcare dollars. �e emphasis over the past 50 years on pain management should be largely disregarded. To manage pain by reducing its cerebral impact through the suppression of the pain impulse travelling along the afferent nerve pathways is outmoded, along with the application of counterirritants and a variety of modalities that do not produce a curative effect. �ese include interferential current, ultrasound and sometimes even surgery, an act of


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desperation when all else has failed. Clearly surgical intervention for pain is illogical, a process similar to setting out on a voyage without a map.

To illustrate this point, I recently reviewed a study on the efficacy of spinal fusion published by Bloomberg² and authored by Peter Waldman and David Armstrong. �is paper describes a series of studies collated in the U.S., the UK, Sweden and Norway, evaluating the results of spinal fusion in comparison to physiotherapy. �ey concluded that clinical outcomes were relatively similar. �e differences were that physiotherapy had no adverse effects and is relatively inexpensive to administer. In one group consisting of 80 patients, 27 required a second surgical intervention and almost 40% of the patients developed complications. Moreover, a large percentage of these patients became permanently addicted to Oxycontin, Hydrocodone and other analgesics. �ere were a number of instances where up to 4 surgical procedures were performed, with collective costs totalling over $500,000 in some cases.

In contrast, Laser �erapy acts at the cellular-molecular level. Symptoms, which are basically manifestations of the disease process, disappear with the application of the technology and pain management ceases to be an issue. Physicians have not yet recognized that aspect of therapy, adhering to the traditional time honoured approach of modulating or masking symptoms. It should be clear to anyone that the latter course has minimal benefit and even less merit. It is important to understand this phenomenon when utilizing Laser �erapy which, simply put, is light speaking to the cells, with the clinical response representing the language of the cells. For the practitioner this guides protocol adjustments and when this approach is properly used, the miracle of accelerated healing can occur.

In essence, the technology utilizes superluminous and laser diodes to irradiate diseased or traumatized tissue with photons. �ese particles of energy are selectively absorbed by the cell membrane and certain intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell morphology and function. �e process is intended to be curative and consequently results in the elimination of symptoms, including pain. In addition, it enhances the body’s immune response and facilitates natural healing.

When discussing Laser �erapy, one has to understand that the body consists of 10 trillion cells generated by 43 successive rounds of cell replication. Only after this impressive process of regeneration will a human organism achieve adult status. Simultaneously there is a constant turnover of cells replicating. In every individual, every second approximately 10 million cells die and must be replaced in a short period of time in order to prevent decay. If the replacement rate were only moderately reduced, the systems would break down and the body would disintegrate.

�e biophysicist Fritz-Popp³ has pointed to a condition which must be fulfilled in order that this complex evolution occurs in a controlled manner. �ere must be an intermittent coupling of cell to cell communication, which according to his calculations can only be possible when the key factors controlling these changes occur at the speed of light. It therefore follows that light or some electromagnetic action, operating at light speed must be involved in the organization of the living process.

�e many effects of Laser or Light �erapy include an analgesic component, the anti -inflammatory effect and the replacement of non-functioning or impaired cells; the latter process is facilitated by the replication of normal cells.

As a consequence, keloids have been observed to disappear, along with osteophytes, scar tissue, etc. and wounds often heal in dramatic fashion. In some instances ulcers heal after 5 to 10 treatments however in more chronic situations, as may be anticipated, longer treatment courses are required.

Laser �erapy is a technology utilized as the basic platform in the treatment of a wide variety of medical conditions. Prerequisites for effective treatment are the establishment of the correct diagnosis whenever possible and the proper application of therapy.

Applied immediately to patients injured in the workplace, the result of sports injuries and even in chronic situations, patients often begin to improve after the initial treatment and generally after 3 to 4 therapeutic sessions. �is factor alone may obviate the need for extensive diagnostic studies, consultations and other unnecessary delays. Waiting lists can be eliminated and patients can often continue to work and engage in normal activities, without any downtime.

At our clinics we continue to achieve consistent, optimal results in treating a wide spectrum of disease entities. We also explore therapies for a more comprehensive number of pathologies, particularly in cases where results from conventional treatments are ineffective. In these types of cases when all hope has been lost, Laser �erapy often achieves dramatic results. As we all know, double -blind, randomised, controlled studies are important in confirming a technology’s efficacy, however to institute such studies outside a university setting, can be extremely expensive and problematic from the standpoint of cohort selection. However, inasmuch as a link has already been established between synovial inflammatory activity and the deterioration of cartilage in osteoarthritis (Chikanza and Fernandes 2000), and controlled laboratory trials have


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discovered that LILT can reduce inflammation through the reduction of PGE2-levels and the inhibition of cyclooxygenase-2 (COX-2) in cell cultures (Campaña et al 1993, Honmura et al 1993, Sakurai et al 2000, Shimizu et al 1995); by extrapolation, the application of Laser �erapy has proven to be effective in many disease entities where inflammation is the fundamental precursor.

Frequently in medical practice problems present that do not respond to approved or traditional therapies. In many of these conditions, utilizing Laser �erapy has achieved what may sometimes be termed a dramatic level of success; this should encourage further research and application.

A list of some of the problems treated in this category include the following:

Abdominal

• Chronic/acute pain secondary to adhesions

• Regional ileitis • Ulcerative colitis• Endometriosis• Non-specific gastro-intestinal irritability

(I.B.S.)

Genito-Urinary

• Chronic interstitial cystitis• Prostatic Hypertrophy (benign)• Chronic urethritis (bacterial and

non-bacterial)• Post surgical complications (i.e. stric-

tures, bladder neck obstruction, etc.)• Peyronie’s disease

Neurological

• Dementias• Post Concussion Syndrome• Headaches (tension, migraine etc.)• Peripheral nerve regeneration• Demyelinating conditions• Spinal Cord Injury• Multiple Sclerosis

When patients have exhausted other therapies that have not been productive, there does not appear to be any contraindication to the prompt utilization of Laser �erapy. �is would be subject to the full knowledge and consent of the patient. Understandably, unless one is able to be intelligently aggressive in initiating treatment, clinical improvement cannot occur.

Another notable trend in the current environment, aside from the prolonged wait times, at least in Canada, is the comprehensive number of patient assessments and studies frequently performed. �is may indeed be detrimental to the patient’s overall physical status and appears to have no objective other than to assign responsibility for economic coverage on the part of the insurance company or the numerous facets of overly managed healthcare systems. �is process is at best irrational. No patient has ever been improved by the performance of an MRI or any other test. In medicine today, excessive focus is placed on diagnostics often including invasive procedures, when there should be a greater emphasis on the initiation of therapy. Only when the latter is instituted, can the patient’s condition begin to improve.

�e utilization of Laser �erapy in the treatment of malignancies often accompanied by metastatic lesions and fluid collections in the pleural and/or peritoneal cavities should be more widely explored. �is may be potentiated with the use of photodynamic therapy. As more cell-specific photosensitive drugs become available, this area could be the treatment of choice for many tumours. In our limited experience, we have treated a number of metastatic lesions originating in the prostate or breast with regression of pain, reduction in size and occasionally even the disappearance of metastases, along with dramatic reduction in the volumes of fluid produced.

CONCLUSIONS• Medical practice today is focused

to a greater degree on diagnostics with concomitant neglect of the therapeutic aspect of delivery systems.

• More emphasis should be placed on the application of effective treatment solutions.

• �ere appears to be an almost obsessive concern with “pain management”, rather than treating the cause of the pathology involved.

• Prompt medical care is frequently not available, particularly on nights and weekends, when it may be most urgently required. �is creates a delay in the institution of therapy, produces unnecessary wait times and frequently converts easily treated acute situations into chronic problems.

• Laser �erapy is a technology that has the potential to correct the deficiencies inherent to healthcare systems, with only minimal investment.

• �e training of large numbers of Laser �erapists in diverse locations can reverse the negative aspects of current healthcare and eliminate the resistance imposed by gatekeepers, determined to maintain the status quo.

• �e ability to think independently and assess the factors involved realistically, should stimulate all healthcare professionals to adopt solutions that are simple, effective and easily applied.

• �ese issues should be stressed in the educational process at all medical institutions.

• Finally, one should always act in the best interests of the patient.

1. “�e Great Cholesterol Lie: Why Inflammation Kills And �e Real Cure For Heart Disease” by Dwight Lundell, MD, 2009.

2. “Highest-Paid U.S. Doctors Get Rich With Fusion Surgery Debunked by Studies” by Peter Waldman and David Armstrong, www.bloomberg.com, Dec. 30, 2010.

3. “Vernadsky’s Method, Biophysics And the Life Process” by Wolfgang Lillge, MD, �e 21st Century Science and Technology Magazine, Summer 2001 Edition.


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�e Achilles tendon and connecting triceps surae musculature (medial and lateral heads of gastrocnemius and soleus) are anatomical structures frequently injured as a result of stressful, high level physical activities. �e injuries sustained often require medical intervention and when they become chronic, can lead to considerable economic loss.

Injuries of the Achilles tendon may occur at any age, however, most commonly present in the 20 to 50 age group.

Anatomy

�e Achilles tendon is the largest tendon in the body and is formed by the aponeurosis of the heads of the medial and lateral gastrocnemius and the soleus muscle. The tendon inserts into the postero-superior aspect of the calcaneal tuberosity with the retrocalcaneal bursa lying anteriorly. �e plantaris tendon also travels medial to the Achilles tendon and inserts into the calcaneus.

�e Achilles tendon is covered by a double-layered sheath of synovial cells termed the paratenon or peritenon. �e inner layer of the paratenon lies adjacent to the tendon itself and the outer layer is confluent with the subcutaneous tissue and the mesotendon. �e blood supply to the Achilles tendon is derived mainly from the mesotendon and to a lesser degree from the muscle mass and from the bony insertion. Overall, blood flow is distributed evenly throughout the tendon with the exception of decreased flow at the calcaneal insertion. While there is a relative reduction both in blood flow frequency and total area of blood in the mid-tendon region, recent dynamic studies conclude that this hypovascular zone (often referred to as the watershed area) is not the main cause of tendon pathologies;

nevertheless, the evidence may be conflicted.

Etiology

Achilles tendon and related injuries include tendonitis, tendinosis, tenosynovitis, partial and complete ruptures and tennis leg (musculotendinous rupture). Achilles tendinopathies are typically the direct result of excessive repetitive tendon strain. During strenuous exercise, the tendon is loaded up to 10 times the person’s weight. Certain systemic factors may also contribute to Achilles tendonopathies including: steroids (local injection and systemic use), quinolones, chronic renal

failure, rheumatoid arthritis, systemic lupus erythematosus, collagen deficiencies, diabetes mellitus and blood group O patients.

Achilles tendonitis is an acute tendon inflammation that develops insidiously after changes in activity, the utilization of inappropriate footwear and poor running/ training surfaces with an incidence in runners and joggers of up to 18%. It occurs more frequently in association with certain deformities including pes cavus, tibia vara and heel and forefoot varus. �e recovery time is generally 2-6 weeks.

Achilles tendinosis is the most frequent pathology and is generally considered an overuse condition. Episodes of multiple microtrauma result in the tendon no longer having the ability to heal and a mechanical breakdown of the tendon without the presence of acute inflammation results. Histological alterations include fibre disorientation, mucoid replacement of fibres, increased weaker type III collagen, collagen degeneration, increased cellularity and neovascularization. �e increase in type III collagen and decrease in normal type I collagen results in an increased susceptibility of tendon rupture.

Achilles tenosynovitis occurs in the peritenon of the tendon with an etiolology and pathophysiology similar to that of tendinosis. �e end result is fibrosis and scarring that restricts movement of the tendon within the pseudo-sheath. It occurs with greater incidence near the tendon insertion and may occur concomitantly or directly as the result of tendinosis.

Achilles tendon rupture occurs most frequently in middle age during the performance of recreational sports

Achilles Tendon Pathologies & Treatment with BioFlex Laser Therapy SystemDavid Kunashko, DC


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involving forced dorsiflexion or during active plantar-flexion as in basketball, tennis, racquet ball and squash. Partial tears present more frequently than complete rupture and have been associated with the following risk factors: history of tendinosis, steroid use, ciprofloxacin/fluoroquinolone use, type O blood, male gender, gout, hyperthyroidism, renal insufficiency and arteriosclerosis. Typically, a tendon rupture is associated with an audible “pop” or “snap” with resulting acute pain and dysfunction.

Tennis leg involves a musculotendinous junction disruption of the medial head of the gastrocnemius due to a forceful push-off of the foot, occurring most commonly in middle aged recreational athletes, during activities such as hill running, jumping, tennis, basketball and volleyball. �is injury is more prevalent in athletes with a history of recurrent calf strain and is associated with an audible “pop” and the feeling of being kicked or struck from behind.

Physical Examination

Achilles tendon rupture is associated with a palpable defect in the tendon 2-4 cm superior to the calcaneal insertion with the affected foot resting in slight dorsiflexion. If the tendon is completely ruptured, the �ompson sign may be present, such that squeezing the calf in a patient lying prone with passive knee flexion results in the absence of foot movement. A partial tear is often misdiagnosed as a strain or minor tendon injury and a diagnostic ultrasound or MRI should be considered in order to establish a definitive diagnosis.

Achilles tendinosis presents with an edematous and thickened tendon that is painful on palpation. �e patient typically describes constant pain or discomfort and crepitus during plantar and dorsiflexion. Due to the chronic nature of this disorder, an MRI is useful to visualize the degenerative changes present in the tendon.

Achilles tendonitis may also be associated with edema, however, the patient typically complains of sharp or stabbing pain most noticeable after arising from bed or after periods of inactivity. Tenderness on palpation and during forced plantar-flexion are common diagnostic signs of this condition. Imaging tests are usually negative as a result of the absence of degenerative changes within the tendon.

Tennis leg presents with acute tenderness at the medial musculotendinous junction of the gastrocnemius, accompanied by local edema that may spread to the ankle and foot. A visible and palpable muscle defect is noticeable as the edema decreases. �e Achilles tendon should be intact and pain is generated with passive dorsiflexion and resisted plantar-flexion. An MRI or diagnostic ultrasound is useful to determine the degree of injury.

Laser Therapy Treatemnt

Achilles tendon pathologies respond dramatically to low intensity laser therapy (LILT) for a number of reasons. Acute inflammation associated with tendonitis, rupture and musculotendinous disruption has been observed to be rapidly modulated with the use of LILT. Bjordal et al. concluded the inflammatory marker PGE-2 levels were significantly decreased as was pressure pain threshold after the application of LILT (i.e. the analgesic effect).

Numerous scientific research papers have also concluded that LILT produces significant clinical benefit for chronic tendon pathologies, including tendinosis and tenosynovitis. Oliverira et al. concluded that LILT improves collagen fibre organization within the Achilles tendon while Lidiane et al. deduced that LILT reduces histological abnormalities, collagen concentration and oxidative stress. Furthermore, Stergioulas et al. observed that LILT in conjunction with eccentric exercise, accelerates the clinical recovery of chronic Achilles tendinopathy.

Case Profile 1

Diagnosis: 70% partial rupture of the right medial musculotendinous junction of the gastrocnemius with tendinosis.

History:• 46-year old male• Acute forced dorsiflexion injury

while playing basketball• Duration of symptoms – 4 months• Diagnostic ultrasound was positive

for 70% rupture and considered to be inoperable

• Slight antalgia during gait with moderate decreased muscle function

Physical Examination:• Moderate edema along length of tendon• Palpable muscle defect of the medial

gastrocnemius• 5cm by 3cm area of scar tissue

formation at the musculotendinous junction

• Moderate pain on palpation of proximal muscle and musculotendinous junction of medial gastrocnemius

• Negative Thompson test with decreased foot movement compared to unaffected leg

• Positive heel lift test

Status On Completion of Treatment:• 90% reduction of tendon edema

and scar tissue formation • Negative heel lift test• Normal gait pattern re-established• Improvement of motor strength by 75%

Treatment:• Application of arrays and probes to

medial gastrocnemius, musculoten-dinous junction and Achilles tendon

• 14 treatments at the Meditech Clinic, 12 with home unit, massage treatments and eccentric exercises over a period of 10 weeks


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Discussion:�is patient presented at Meditech with a chronic musculotendinous tear resulting in accompanying tendinosis. Previous reported therapeutic intervention included physiotherapy and bracing; these aggravated symptoms with minimal positive change. Chief complaint initially consisted of stiffness, pain and edema with significant loss of function. Laser Therapy was provided at the Meditech Clinic and with a home unit concurrent with massage therapy and eccentric strengthening exercises. �e patient also initiated low weight-bearing exercise with significant improvement of motor strength. It was noted that the late intervention resulted in associated tendinosis; earlier intervention using LILT would have promoted collagen synthesis and alignment, reduced fibrosis and scar tissue formation and earlier resolution.

Case Profile 2Diagnosis: Bilateral Achilles tendonitis

History:• 53-year old female• Presented with pain in both heels

and difficulty walking• 9/10 on VAS• Duration of symptoms – periodic

recurrence over 4 years• Several ankle sprains in the past• Utilized analgesics, massage,

physiotherapy, chiropractic and cortisone injections without significant benefit

Physical Examination:• Marked thickening and tenderness of

Achilles tendons, more pronounced on the right

• Difficulty standing on toes

Progress:• Symptoms substantially diminished

after initial treatment • Able to stand on toes without difficulty• Tendon thickness and pain reduced

substantially after 4 treatments• Able to walk with normal gait

pattern after 12 treatments

Treatment:• Application of arrays and probes

to calcaneal region and Achilles tendons

• Laser Therapy treatments were initiated on 3 consecutive days and then to 2-3 sessions per week

• Weekly treatments were continued subsequently until remodeling and strengthening of the tendon was complete

Discussion:�is patient presented at Meditech with bilateral Achilles tendonitis. Previous therapeutic interventions had provided minimal positive effect with regard to function and symptom relief. The original complaint was stiffness and pain with significant loss of function. Laser Therapy was initiated at the Meditech Clinic along with eccentric strengthening exercises. �e patient completed a course of treatment with complete resolution

of all symptoms and functional levels totally retsored.

CONCLUSIONSAchilles tendon pathologies are debilitating musculoskeletal disorders that are often misdiagnosed and treated inproperly. Acute inflammatory tendonitis and traumatic injuries along with chronic tendinosis, require a correct diagnosis and early appropriate therapeutic intervention. Unlike traditional therapeutic treatments, Laser Therapy produces immediate clinical benefits with regard to the pathologies encountered, including reduction of the degree of inflammation along with PGE-2 levels and progressive collagen fibre organization.

It should be noted that calcification of the Achilles tendon is a frequent complication; in our experience, the application of Laser �erapy invariably results in complete dissolution of the calcium deposits.

Clearly Laser �erapy should be the preferred therapeutic approach, in dealing with the multiple Achilles Tendon pathologies that occur.

References Available Upon Request

Submit an ArticleWould you be interested in writing an article on your experience with Laser �erapy? Short articles (1-2 pages) can include:

• Interesting case profiles• Challenges and solutions for treating particular conditions• Strategies to increase referrals

We can help you through the process of writing and submitting an aticle to a healthcare magazine, local newspaper or a future Laser Report. Published articles can increase awareness of your clinic to patients and other healthcare practitioners. It is also an opportunity to share your expertise and expand the knowledge-base of Laser �erapy.

If interested, please contact us at [email protected].


11

Dear Dr. Kahn; June 7, 2011

My journey to better health began in November 2008. At the time of my fi rst visit to Meditech I was under the care of rheumatologists for RA and OA for about 10 years. My treatment consisted of 7 prescription drugs, weekly injections of methotrexate and occasional cortisone injections into fi nger joints and muscle. I was constantly in a drug haze and experienced considerable pain and lack of mobility.

I began intensive laser treatments that continued for 2 ½ months. Under Dr. Kahn’s care I slowly stopped ALL my medications and continued to improve.

� e decision to purchase a Home System was a good one. � ree years later, I can report that the arthritis is managed entirely with my BioFlex system.

Although my rheumatologist did not agree with my decision to stop the medications and issued dire warnings of irreparable harm by my choice, the proof that BIOFLEX works is evident and clear.

As of May 2011, I still do not need any medications. � e ability to walk several miles at a time, do yard work, and most importantly for me, play piano, make me forever grateful that I discovered Meditech and the BioFlex system. � e high level of professionalism mixed with genuine care is evident from the moment you walk into their facility.

My experience with the BIOFLEX laser system is that it works – IT WORKS!

� ank you Dr. Kahn and Team.

Sincerely,

Ruth Muxworthy

facebook

Meditech International is now on Facebook! Here you’ll be able to chat with other laser users, learn about upcoming events, interesting research, unique case studies and special off ers.

Become a fan by visiting https://www.facebook.com/pages/BioFlex-Laser-� erapy


12

Veterinary Manual

Meditech values both its clients and the customer service we are able to provide. We are pleased to bring you a Veterinary Clinical Manual based on our 20 years of experience in treating animals and humans. Historically we collaborate with Veterinarians and animal trainers who have utilized the BioFlex System and have assisted in the development of protocols for a wide range of medical conditions.

� e manual consists of over 40 preset protocols for companion animal and equine therapy. � e fl exibility of the BioFlex Systems allows healthcare professionals to safely explore the use of multiple frequencies, waveforms and energy densities with all of the treatment arrays and probes available. Indeed, it is an open system with therapeutic innovation as the norm.

BioFlex Vet Laser Therapy System

Vet Laser Therapy System Includes:

• Controller Unit• 2 Treatment Arrays

(Red & Infrared, 120 Superluminous Diodes each) • Infrared Laser Probe• Practitioner Software• Safety Kit (including safety goggles) • Carrying Case• Clinical & Operational Manuals• DVD Tutor• Power Adapter• USB Cable• Certifi cation Training• 12 month Warranty• Training Disc - Clinic Operation and Promotional Material - Clinic Forms and Templates - Videos - Power Point Presentations - Research Abstracts

Initial post surgical wound After 4 Treatments After 8 Treatments


13

Vet Laser Therapy System Includes:

• Controller Unit• 2 Treatment Arrays

(Red & Infrared, 120 Superluminous Diodes each) • Infrared Laser Probe• Practitioner Software• Safety Kit (including safety goggles) • Carrying Case• Clinical & Operational Manuals• DVD Tutor• Power Adapter• USB Cable• Certifi cation Training• 12 month Warranty• Training Disc - Clinic Operation and Promotional Material - Clinic Forms and Templates - Videos - Power Point Presentations - Research Abstracts

Meditech International Inc. is dedicated to the education of all healthcare practitioners in the fi eld of Laser � erapy, which ensures that the systems will be used properly and that optimal clinical outcomes result.

Certifi cation consists of:

1. Hands-on Training

Treatment techniques and appropriate array placement will be discussed for a wide range of clinical applications, including soft tissue injuries, wound healing, dermatological conditions and a variety of musculoskeletal problems. In addition, participants will learn to navigate the BioFlex Vet Laser � erapy System, including protocol utilization and customization.

2. Lectures

Key Laser Parameters – Class IIIb vs. Class IV lasers – Power – Frequency – Skin contact, etc. History and Physics of Laser � erapy Mechanisms of Action Laser � erapy Safety Case Profi les Marketing Laser � erapy in your clinic

3. Clinical Case Simulations

All participants will be involved in clinical case simulations, during which they will determine a diagnosis, treatment plan and customize treatment protocols for a variety of hypothetical cases. Advice and instruction from experienced Laser � erapists will help ensure everyone is comfortable prescribing and customizing Laser � erapy.

Registration$295* – Includes course materials, structured classroom presentations & hands-on clinical exposure.

All participants will receive a detailed course manual, which includes presentation slides, laser parameters for a number of clinical applications, reference materials, training CD and examples of clinical documentation.

A certifi cate is presented to all healthcare professionals upon satisfactory completion of this course. Lunch and refreshments are provided.

For more information or to register for one of our courses please contact Melissa at 1-888-557-4004 or by email at training@biofl exlaser.com.

Veterinarian Laser Certifi cation TrainingSaturday October 22 8.30am - 5pm

*Registration fee is waived for one person on purchase of a BioFlex Vet System.


14

Abstracts of Interest

Inhibitory Effects of Laser Irradiation on Peripheral Mammalian Nerves and Relevance to Analgesic Effects: A Systematic Review

Roberta Chow, M.B., BS(Hons), FRACGP, MApplSci, (Med Acu), Ph.D.,1 Patricia Armati, B.Sc., M.Sc., Ph.D.,1 E-Liisa Laakso, B Phty(Hons1), Ph.D., GCMgmt(QH),2

Jan M. Bjordal, B.Sc., Physiotherapy, M.Sc., DPhil,3 and G. David Baxter, TD BSc(Hons), DPhil, M.B.A.4Photomedicine and Laser Surgery - Volume 29, Number 6, 2011 - Pp. 365–381

Implantation of Low-Level Laser Irradiated Mesenchymal Stem Cells into the Infarcted Rat Heart Is Associated with Reduction In Infarct Size and Enhanced Angiogenesis

Hana Tuby, M.Sc., Lidya Maltz, M.Sc., and Uri Oron, Ph.D. Photomedicine and Laser Surgery - Volume 27, Number 2, 2008 - Pp. 227–234

Objective: The objective of this review was to systematically identify experimental studies of non-ablative laser irradiation (LI) on peripheral nerve morphology, physiology, and function. The findings were then evaluated with special reference to the neurophysiology of pain and implications for the analgesic effects of low-level laser therapy (LLLT).

Background: LLLT is used in the treatment of pain, and laser-induced neural inhibition has been proposed as a mechanism. To date, no study has systematically evaluated the effects of LI on peripheral nerve, other than those related to nerve repair, despite the fact that experimental studies of LI on nerves have been conducted over the past 25 years.

Methods: We searched computerized databases and reference lists for studies of LI effects on animal and human nerves using a priori inclusion and exclusion criteria.

Results: We identified 44 studies suitable for inclusion. In 13 of 18 human studies, pulsed or continuous wave visible and continuous wave infrared (IR) LI slowed conduction velocity (CV) and/or reduced the amplitude of compound action potentials (CAPs). In 26 animal experiments, IR LI suppressed electrically and noxiously evoked action potentials including pro-inflammatory mediators. Disruption of microtubule arrays and fast axonal flow may underpin neural inhibition.

Conclusions: This review has identified a range of laser-induced inhibitory effects in diverse peripheral nerve models, which may reduce acute pain by direct inhibition of peripheral nociceptors. In chronic pain, spinal cord changes induced by LI may result in long-term depression of pain. Incomplete reporting of parameters limited aggregation of data.

Objective: The aim of the present study was to evaluate the possible beneficial effects of implantation of laser irradiated mesenchymal stem cells (MSCs) into the infarcted rat heart.

Background Data: It was demonstrated that low-level laser therapy (LLLT) upregulates cytoprotective factors in ischemic tissues.

Materials and Methods: MSCs were isolated from rat bone marrow and grown in culture. The cells were laser irradiated with a Ga-Al-As laser (810 nm wavelength), labeled with 5-bromo-2_deoxyuridine (BrdU), and then implanted into infarcted rat hearts. Non-irradiated cells were similarly labeled and acted as controls. Hearts were excised 3 wk later and cells were stained for BrdU and c-kit immunoreactivity.

Results: Infarcted hearts that were implanted with laser-treated cells showed a significant reduction of 53% in infarct size compared to hearts that were implanted with non-laser-treated cells. The hearts implanted with laser-treated cells prior to implantation demonstrated a 5- and 6.3-fold significant increase in cell density that positively immunoreacted to BrdU and c-kit, respectively, as compared to hearts implanted with non-laser treated cells. A significantly 1.4- and 2-fold higher level of angiogenesis and vascular endothelial growth factor, respectively, were observed in infarcted hearts that were implanted with laser-treated cells compared to non-laser-treated implanted cells.

Conclusion: The findings of the present study provide the first evidence that LLLT can significantly increase survival and/or proliferation of MSCs post-implantation into the ischemic/infarcted heart, followed by a marked reduction of scarring and enhanced angiogenesis. The mechanisms associated with this phenomenon remain to be elucidated in further studies.


15

Marketing SupportEverything you need to Promote and Grow your Practice

For more information on any of these products and services, please contact Melissa at [email protected]

NEW! Posters• 3 designs available

PROFESSION OR PASSION... PAIN HAS NO PLACE

for fast, e�ective pain relief.

Ask For

BIOFLEX LASER THERAPYPYP

Copyright © 2011 Meditech International Incorporated. ALL RIGHTS RESERVED.

Posters3 designs available

PROFESSIPROFESSIPROFESSIOOONNN OOOR R R PASSION... PASSION... PASSION... PAIN HASPAIN HASPAIN HAS NO NO NO PLACEPLACEPLACE

for fast, e�ective pain relief. for fast, e�ective pain relief. for fast, e�ective pain relief.

AAAsk Forsk Forsk For

BBBIOFLEX IOFLEX IOFLEX LLLAAASSSEEERRR TTTHHHEEERRRAAAPPPYYYPYPPPYPYPYPPPYP

Copyright © 2011 Meditech International Incorporated. ALL RIGHTS RESERVED.Copyright © 2011 Meditech International Incorporated. ALL RIGHTS RESERVED.Copyright © 2011 Meditech International Incorporated. ALL RIGHTS RESERVED.

Referral Kit• Resource for generating business and increasing

patient referrals

• Includes a Webinar, customized brochures for the physician and patients, referral pads and supporting scientifi c research

Customized Patient Brochures• Individualized for each clinic including clinic name,

location map and contact information

• 3 designs from which to choose

Customized Clinic Websites• BioFlex Online will create, host and maintain a website

for your clinic

• 9 templates to choose from

Laser Reports• Includes informative articles and upcoming educational

events

• Send to your colleagues and patients

Clinic Listings• Update your clinic contact information for our new

website so patients can easily fi nd you

Registration includes course materials, structured classroom presentations and hands-on clinical exposure.

A certificate is presented to all healthcare professionals on satisfactory completion of this course.

For more information or to register for one of our courses please contact Melissa at 1-888-557-4004 or by email at [email protected]

415 Horner Avenue, Unit 1Toronto, Ontario, M8W 4W3Telephone: (416) 251-1055Fax: (416) 251-2116Toll Free: (888) [email protected]

Meditech International Inc. believes in the dictum of “Progress through Education.” As manufacturer of the BioFlex Laser Therapy Systems, the company is dedicated to the education of participants with regard to all aspects of Laser Therapy. This ensures that systems will be used appropriately, leading to optimal clinical outcomes.

Formal lectures are followed by hands-on training in the application of Laser Therapy for the treatment of soft tissue and sports injuries, wound healing, dermatological conditions and a wide variety of musculoskeletal problems.

Continuing Education (CE) credits are available depending on healthcare professional and provincial regulatory bodies.

Please visit our website, www.bioflexlaser.com for details.

Copyright © 2010 Meditech International Incorporated. ALL RIGHTS RESERVED.

LASER THERAPY 2011 Certification Training

Medical Device License

HealthCanada

A12233 ISO 13485

Meditech International Inc.

January

February

March

April

May

June

July

August

September

October

November

December

21-23

25-27

18-20

15-17

13-15

7-8

15-17

19-21

16-18

14-16

18-20

9-11

Toronto Dates

Remote Dates

Vancouver, BCMarch

Red Deer, ABMay

Vancouver, BCOctober

Calgary, ABNovember

12-13

28-29

22-23

12-13

Certification Training Content:

Principles of Laser TherapyThe Science and Research

Practical ApplicationSystem Operation

Development of a Laser Therapy Practice

Laser Report Summer 2011

Documents

Transcript of Laser Report Summer 2011