Ενα διευκρινιστικο site σχετικα με τα lazer και την αναλυση των τεχνικων χαρακτηριστικων τους

At ColdLasers.Org we present information and specifications of many different professional grade lasers even if we do not sell these products (including Thor™, Medx™, Erchonia™, VetroLaser™, K-Laser™, and LiteCure™). Unlike exclusive sales people who must sell you their product even if it is not a good fit, we feel than an educated consumer is a happier customer and we want buyers to understand all their options and their regional regulationsand help them get the best equipment for their needs even if they buy a product we don't sell.

All these products have a good reputation with professionals and practitioners so they are all worth investigating. ColdLasers.Org does not promote products that have extraordinary or magical claims that are not based on traditional photobiomodulation. We avoid products marketed based on pseudoscience like scalar waves, quantum waves, soliton waves and zero point energy (1). We like to stick to science based products and we don't see any reason to make mystical claims when the science is so solid. We like to stick to the facts and specs. There are some people selling very questionable products including stickers that magically boost the power output of a lasers so buyers must beware.

There is also a lot of misinformation about cold lasers on the web. Low power laser manufacturers publish studies and articles trashing higher power laser manufacturer and vise versa. When we first started doing research, it was so confusing that we built this site to help people clear through the fog of conflicting claims. We are independent so we do not bash any science-based systems because we know each system has a niche but our general rules are "if it looks like a laser pointer, it probably is a laser pointer" and always check the specs. 

FDA Clearance of Cold Lasers for Therapy

Over the years, we have tried to summarize a lot of information about different cold laser technologies and styles of cold laser therapy. The FDA cleared applications for cold lasers (sometimes called low level lasers, soft lasers or therapy lasers) are pain control, inflammation reduction and increased blood circulation. Some manufacturers have extended these claims to include accelerated healing but that is not an FDA cleared claim. There are over 4000 positive published studies, dozens of books and hundreds of videos showing the efficacy of cold lasers to treat a variety of applications. We have sold systems to several branches of the U.S military, the Veterans Administration, the US Indian Health Services and many medical doctors (MDs) but acceptance of the technology is still held back by insurance companies who falsely think they are saving money paying for lifetime prescriptions for drug when a one-time laser purchase is cheaper. Even with over one million lasers current in the hands of professionals and home users, many people still question the efficacy of cold lasers and we are still limited to only making sales claims that can be traced back to the 3 main cleared applications.

Unlike hot medical lasers, which are widely used to cut and cauterize tissue, Low Level Lasers (LLLs) or cold lasers penetrates the surface of the skin with minimal heating effect. We sell several different class 4 lasers that will warm the treatment area but these are still in the same category as cold lasers because they are not hot lasers.

In most cases, cold laser therapy is considered an alternative therapy like acupuncture, message therapy, chiropractic, herbal medicine, message, and physical therapy because it does not require surgery or a life-long prescription to drugs. Practitioners have supported treatment options like Ultrasound and electrical stimulation for years and now there is a lot of interest in cold lasers as a supplement to their practice. Therapy lasers have provided relief for millions of patients over the years and they work perfectly in combination with many other traditional and alternative modalities. 

Currently, there are over 40 different cold laser manufacturers that have products that have been cleared by the FDA for various types of treatments. Cold lasers have been used around the world for over 30 years and have been in use in the US since 2001 when Microlight got the first FDA clearance. Low level laser therapy or soft laser therapy has been proven completely safe and effective in over 400 worldwide studies and there are lots of great books to help users get the most out of their laser.

The power level of therapeutic cold lasers ranges from 5 milliwatts (0.005 watts) to 60,000 milliwatts (60W). This energy can be created using one laser diode or an array of laser diode. In low-end therapy devices, it is generated using LEDs or SLDs. In many systems, an array of laser beams can increase the total power output with less risk of heating since the energy is evenly distributed over a large area. Since finding the optimum treatment spot deep inside the tissue is somewhat of an "educated guess", it can be very useful to have a larger aperture on the treatment probe. This increases the probability of getting the photons to the problem area and larger emitters also also help increase the energy in the area surrounding the main target area. Emitters that use a combination of different wavelengths also have a better chance of treating tissue at different depths since different wavelength have different absorption rates and can interact with the cells in different ways.

The average cold laser therapy session cost from $30 to $200. The average cold laser costs from $2000 - $15,000 so the return on investment (ROI) on purchasing a cold laser can be as little as 4 months.

Because cold lasers help activate human and animal tissue at a cellular level, cold lasers can be used for cervical (neck) pain, lumbar (low back) pain, wrist pain and injuries (carpal tunnel), elbow and joint pain and injuries, lower extremities pain, foot and ankle pain, joint pain and knee injuries, neuropathy, accelerating recovery after surgery and hundreds of other applications. You can use the research tool at laser-therapy.us to search for published scientific studies, books, videos and other resources. Some products are used for smoking cessationusing TCM acupuncture points. No laser is FDA cleared for smoking cessation so you must form or be a member of an IRB (Investigation Research Board) to legally advertise that you can treat patients for smoking or drug rehab therapy.

There are 2 basic styles for treatment using cold lasers, pinpoint treatments (acupuncture, laserpuncture or trigger point) and broad therapy. Each treatment style has a different goal and different equipment requirements. In many cases, the same condition can be treated with 2 totally different strategies of cold laser therapy. 

	Pinpoint	Broad Coverage
Strategy	Treatment of meridians, trigger points, acupoints or lymph system that controls the problem area.	Direct treatment of the tissue in the problem area.
Treatment Area	2 mm2 to 6 mm2.	60 mm2 to 6000 mm2

Laser Trigger Point And Acupuncture Therapy

In  laser trigger point therapy, the cold laser is used similar to acupuncture or acupressure to trigger a reaction from the body by stimulating an acupoint. In this case, a focused low level laser beam is used to concentrate all the energy from the cold laser into a very small area. Cold lasers are often compared to "acupuncture with a laser beams". In LLL laser puncture treatments, the laser beam is use to trigger the body's acupoints without the fear or pain of needles. The maximum safe power for these concentrated energy systems is 500mW. If you read our analysis of the dosage numbers, you will see that 5mW laser pointers will never achieve a adequate dosage in a reasonable time. 

Broad Treatment Therapy

In many cases, a practitioner may not be targeting a trigger point, they will choose to use a cold laser to energize a larger area of damaged tissue in the body. In this case, a cold laser with a broad focus (larger than the size of a dime) and the correct wavelength are used to penetrate the deep tissue with photons direct energize the area. These large emitters can cover areas up to 4.6 inches square. The larger treatment area increase the chances of stimulating any damaged "hot spots". Larger emitters also can reduce the treatment time and provide a more even energy distribution over a larger treatment area. The size of the treatment area and the depth of the treatment area often dictates a minimum power requirement. The following table shows sample dosages for a small/shallow and large/deep injury and calculates the treatment times to get the same energy concentration evenly distributed over the treatment area at the desired depth. This table illustrates how treatment area and depth can determine the dosage and then power determines the treatment time for that condition.

	Treatment Area (cm2)	Depth (cm)	Treatment Dosage (J)	Time (mins) 100 milliwatt system	Time (mins) 1 watt system	Time (mins) 10 watt system
Arthritic Thumb	6	0 - 1	10 - 300	10 - 50	1 - 5	<1
LB Pain	300	2 - 6	300 - 10,000	50 - 1660	5 - 166	1 - 16
Diabetic Neuropathy	2400	0 - 1	1000 - 26,000	160 - 4330	16 - 433	1 - 43

This table illustrated why larger, deeper and more complex (treating multiple areas) conditions require more powerful lasers to treat the condition in a reasonable amount of time.

Cold Laser Comparisons

There are several key factor to evaluate when choosing a cold laser. These include:

• Wavelength- In general, each wavelength interacts with cells in a unique way. 
  980nm: Best for increasing circulation and often recommended for pain control and inflammation control
  905nm: Best for increasing oxygenation from the iron in hemoglobin
  800-860nm: Best for increasing cytochrome C oxidase and adenosine tri-Phosphate (ATP)
  600-660nm: Best for interaction with melanin
  About 70% of therapy lasers operate in the 800nm to 860nm range and there is some research that shows it might have the best balance of properties for a single wavelength laser. 600 to 660nm is best for burns, lymph system treatments, acupuncture, superficial and complex issues where there is not a defined treatment area. 980nm is the most popular for higher levels of pain control and 905nm is best for home system because they are a good balance of safety and efficacy.
• Power - Since the power of a laser usually remains constant during a treatment, the energy of the light is equal to the power in watts multiplied by the time in seconds during which the light is emitted. For a continuous laser, this is simply watts times treatment duration. For a pulsed laser, the calculation is watts x duty cycle x treatment time. A laser with more power (measured in watts) or a higher duty cycle can deliver more energy (measured in joules) in less time. Delivering joules is where the bulk of the work is done when treating patients. The class of the laser (1 through 4) is largely controlled by the power level from each output beam because they are somewhat proportional to the potential for damage. 

How Much Power is Enough?

Too Little: In our summary of laser power requirements, you can that there are many inexpensive over-the-counter lasers that might help sometimes but they are drastically underpowered for many cases. According to the FDA limitations, OTC lasers are limited to 1 milliwatt (mW). If we look at the theoretical treatment times based on the power of the laser, it is easy to see that these products will never reach the typical dosages that you would get in a doctor's office or clinic in a reasonable time (FYI, one of the largest back pain clinic in the Colorado uses 7000 joules per patient minimum). With a 1mW system, it takes 5.7 days to achieve 500 joules at the surface of the skin and 500 joules over a large area (like a back) or into a deep area (like a hip) is not delivering very much energy to the damaged area. These low powered lasers are still more powerful than LED therapy systems but they are massively underpowered when compared to professional systems. 

Target Energy @ Surface		5 J	50 J	500 J	1500 J	5000 J
Laser Power	Rate (J/min)	Treatment Time
1 mw	0.06	83 minutes	13 hours	5.7 days	17 days	57 days
5 mw	0.3	17 minutes	2.7 hours	1.1 days	3.4 days	11 days
100 mw	6	1 minute	8 minutes	83 minutes	4.2 hours	13 hours
1,000 mw	60	5 seconds	50 seconds	8.3 minutes	25 minutes	83 minutes
5,000 mw	240	1 second	10 seconds	1.6 minutes	1.5 minutes	4 minutes
10,000 mw	600	.5 seconds	5 seconds	50 seconds	3 minutes	8 minutes

Blue is unreasonably short, red is unreasonable long.

Too Much: Many of the lower power laser manufacturers claim that you can put too many joules into the tissue and get "bad" results. Based on the famous Arndt-Shultz diagram (which has no real numbers associated with it), they claim that is easy to overdose a patient. There must be some point of diminishing return but no one know if we are even close to reaching that point with higher power systems. It is true that higher dosages are better at inhibiting pain. This is why some pain clinics who treat the worst pain are calling for dosages as high as 30,000 joules (J) in a single treatment and getting very happy customers. Class 4 lasers are very common in clinics that treat tens of thousands of patients with some of the most severe conditions every year and there is no evidence that they are getting "bad" results treating this huge base of patients. Keep in mind that these are doctors (who don't want to take a chance hurting someone) and they choose higher dosage because they get the best results in their experience. 

What we do see with higher power lasers is superior pain inhibition. They might not getting as much cellular stimulation as they would get with many smaller doses but they are still getting some effect of stimulating the cells at the same time they are getting superior pain inhibition. Many patients will not stick with cold laser therapy if they don't get noticeable results in a hurry. Higher power systems produce more noticeable results so they are often the best option for professionals. For home user who have the patience to stick with a therapy even if they don't get such a big change in the way they feel, a lower power system that can deliver many smaller doses is the best option. 

Another nonsensical "too much power" claim of low power laser manufacturers is that the slight heating from the laser causes damage to the tissue. When properly used, a class 4 system raises the temperature of the skin less than 5 degrees and causes less tissue heating than a heating pads, hot tub, camp fires or infrared heat lamps. If hot tubs, heat lamps and heating pads damage tissue, we are all in a lot of trouble.

It is possible to buy "too much" power. We sell 60 watt continuous output lasers that can deliver 3600 joules per minute. For a high patient-volume clinics that target higher dosages for better pain control, the extra power will shorten the treatment time and allow for higher patient volume. For this type of business, a 60 watt laser has the best Return-On-Investment because of the labor savings. It just does not make ROI sense for a practitioner who is treating a lower volume of patients.

• Pulsing Versus Continuous - Lasers can be either continuous wave or pulsing output . Continuous wave means that the laser is turned on 100% of the time during the treatment and a pulsing laser is turned on and off very quickly during the treatment. Pulsing is defined by 2 variables: 

1. Pulsing frequency measured in Hz (how many times it turns on in one second) 
2. Duty cycle (measured as a percentage of ON time to total time). 

The average pulsing setup is around 5000Hz and a 50% duty cycle but some laser go much higher or lower in the pulsing frequency and the duty cycle. Super-pulsing lasers are much lower duty cycle.

The core of photobiomodulation is based on delivering a specific dosage that historically was done using continuous wave (CW) laser and CW produces the shorter treatment times. Then the concept of pulsing the laser was developed because it allowed the laser to stay cooler (because the laser is off part of the time) and the treatment is safer because there is less potential for eye damage. As research was done, we have learned that pulsing has other advantages. Some pulsing frequencies stimulate other systems in the body. Dr. Hamblin found that 10Hz is the best pulsing frequency for stimulating the brain. Also, the human body is adaptive. If you push on one spot long enough, eventually the body adapts and you don't react to that pressure (like wearing clothes). A similar thing can happen with a continuous wave lasers and long term therapies. By pulsing the laser, it is harder for the body to adapt and stop reacting so pulsing can be the superior options in many long term treatment plans. This is less of an issue for acute problems that will be resolved in just a few treatments and for many practitioners, it is just faster and simpler to use a CW laser. If it is within your budget, the best option is to have both pulsing and continuous wave. This gives you maximum flexibility.

Depth of Penetration and Power

It seems like everything associated with cold lasers has some kind of controversy and that includes depth of penetration and its relationship with laser power. Some say that higher power lasers push the energy deeper but this is not technically correct. All laser of a similar wavelength are losing energy at the same rate as it travels through the tissue. That means that for any treatment depth, they all lose the same percentage of energy but the power level controls how fast the energy builds up at that depth. To illustrate, let's compare a 1mW laser (like the ones you can buy on Amazon) and professional 10,000mW laser in treating a small deep tissue problem like a torn meniscus. At a depth of 2 cm, 84% of the energy is gone for both systems. Even with 84% of the energy gone, a 10,000mW system is putting in 2 joules/second into the tissue at depth so the system can reach the WALT (World Association of Laser Therapy) recommended dosage of 4 to 12 joules/cm² in 2 to 6 seconds (for 1 cm²). The LED or 1mW laser system is pushing .00016 joules/second so it will take over 2 hours to a single point (1 cm²). Treating a large area can take days. Not everyone will agree with us but it is more technically correct to say that higher power systems push faster not deeper.

Emitter Coverage Area - The larger the emitter coverage area, the more consistent the energy distribution and the cooler the tissue will stay while putting out higher power levels. A larger emitter will is more likely to hit a hot spot or damaged area and since many treatments require moving the probe around a damaged area, a larger emitter can significantly reduce the therapy time. Many protocols use a combination of static treatments on the area of maximum pain, surrounded by a sweeping treatment around the entire problem area. Products with larger treatment areas are safer AND easier use. If you have a large bruise (damaged tissue) the size of your hip and you needed to "color in" the area with ink, you would want to use a big fat marker and not a ball point pen. When you are treating damaged tissue, you are essentially "painting" the tissue with light. In many cases, you might not even know the exact area that needs treatment the most. By using a larger emitter, you increase the odds that you will illuminate the critical spot. With the exception of trigger point and acupoint therapy, which is typically done by a highly trained professionals, the larger the emitter the better. Pinpoint emitters like the ones listed on our acupuncture page are not optimized for treating broad tissue damage and should only be used if there is no other options.

Treatment Time - Treatment times typically range from 7 seconds to 40 minutes. Most therapies require 1 to 6 treatment locations and an average course is 12 treatments. For those with 2 bad knees or wide spread arthritis, the total treatment time can really add up. For home use, treatment times are typically not an issue since users can often perform the therapy while relaxing or watching TV. In a doctor's office, treatment times can be the biggest issue with cold lasers. It is a common practice in the cold laser market for low-power laser manufactures to specify shorter-than-optimum treatment times because they know that no one would buy a product if they knew it would take 24 hours a day of therapy to reach a reasonable energy level in the deep tissue. The result is that patients never get even close to the optimum energy for photobiomodulation. This is why we like to talk about the key specifications of lasers like wavelengths and power levels. We try to stay away from the marketing hype. 

Protocols & Training - A complete protocol (treatment plan) library is key for new cold lasers owners to get the optimum energy into the treatment area without guesswork. Some manufacturers have created "cookbook" style protocol manuals or internal libraries. Others give general guidelines and allow professionals to develop their own optimum treatment plans based on experience. This is a simple task for some hands-on practitioners like, energy healers, chiropractors and acupuncturists. To make sure that everyone who purchases a laser from ColdLasers.Org is successful, we include a free membership in Laser-Therapy.US. With over 150 dynamically-created pictorial protocols (for humans, horses and dogs) and a therapy timer for effortless therapy sessions, it is one of the best sources for learning more about how to use a laser on a wide variety of problems.

The goal of cold laser therapy is to deliver light energy units (in joules) to cells that need energy. Photons are absorbed by the cells, stimulating the mitochondria to accelerate production of ATP.

There is some confusion about what to call the equipment that is described on this site. Probably the most accurate is photobiomodulation (or PBM) equipment but this name doesn't seem to stick with the average person. Some prefer to call the products low-level lasers or soft lasers. The goal of these names is to distinguish these lasers from the medical lasers that are used to cut and burn tissue. In some publications, you may see the abbreviation LLLT for Low Level Laser Therapy. Many of the class 4 and some of the class 3b lasers actually warm the skin during therapy so the name cold laser is not a totally accurate description either. Many low level lasers are not low level, they can go up to 60,000 mW in power. There is really no perfect description for the wide range to therapeutic, veterinary and equine lasers so we just call them cold lasers. 

Professional And Home Use

Cold laser are typically sold to practitioners but in most states there are no legal limitations for the use of cold lasers in the home. Home owners can buy a class 1 laser without any restrictions and they can purchase a class 2, 3 or 4 laser with a health care provider's recommendation. Some manufacturers now have a doctor on staff that will write the letter and this is included in the price. Some international laser companies do not require a letter. It can get complicated so if you purchase any system from ColdLasers.Org, we will make sure that we are both in compliant with the regulations. 

Classes of Cold Lasers

All lasers, hot and cold, are given a classification according to the international specification; IEC 60825. The more dangerous the laser, the higher the classification. The most dangerous cold lasers are class 4 lasers (over 500mW CW per beam) and the safest are class 1. Power level is a key factor in the application of cold laser therapy to deep tissue but this does not mean that higher class lasers are always better, it does typically mean that they are:

• More expensive
• Able to get the target dosage in less time
• Able to deliver high dosages for maximum wow factor
• More dangerous

Many higher power lasers use optics to de-focused the beam (typically around 30 degrees of divergence). This creates a larger treatment area. By spreading the energy over a larger area, the product becomes easier to use, provides for more even energy distribution and the product is safer. 

Manufacturers can use multiple laser beams in an array to get to higher total power levels while still being very safe. Using this technique, it is possible to build a 18-watt class 3b laser that would deliver energy very quickly but have very little risk of tissue damage. 

We can help you find a balance between power, treatment time, cost and safety.

Pain Control versus Healing

If we look at all the claims made made by all the manufacturers, the general consensus is that many lower energy doses are the best for cellular excitation than fewer higher dosages. For this reason, every treatment plan is unique. Since many patients will give up on the therapy if they do not feel a noticeable improvement in the first few sessions, it is a good general rule to start out treating with high enough doses to make sure they notice a change. Some patients may prefer immediate pain relief as the highest priority and others may be patient enough to stick with the plan long enough to get a permanent long-term improvement. Since long-term results can takes weeks or months of therapy, it is best to develop a reasonable expectation at the beginning of the therapy.

Potential for Heating and Tissue Damage

There is a lot of confusion about tissue heating and the potential of therapeutic lasers to do tissue damage from excessive heating. It can and does happen but much of the risk is fear-based marketing generated by lower power laser manufacturers as a reason to buy their product. The risk of tissue heating with a class 1, 2 or 3 FDA cleared therapeutic laser is extremely low. You also don't need to worry about significant heating with a class 4 if it is used according to the laser manufacturer's recommendations. For divergent (energy is coming out of the emitter in the shape of a cone) lasers below about 4,000mW (4W), there is an extremely low chance of significant heating for most skin types. It is unclear if this true for some of the non-FDA-cleared cheap foreign built lasers on Ebay and other discount sites. Most class 4 laser with a power of 10 watts or more require that the emitter is moving when the system is on. 

Heating potential is increased if :

1. The laser is collimated (not divergent)
2. And the laser is set to continuous wave (not pulsed)
3. And the power level is set to more than 4 watts CW (not pulsed)
4. And the laser is not moving
5. And the wavelength of the system is 980nm or higher
6. Or the patient has very darker skin, birth marks or tatoos

It is very rare that anyone will do enough things wrong (static, CW max-power collimated treatment) to have a problem. For most therapies, you want to cover an area of 4 to 40 times the diameter of the emitter so you need to move the laser anyway. With higher power class 4 lasers, you simply have 2 reasons to move the laser; better efficacy and safety. Many practitioners use heat lamps with power levels up to 250 watts in their practice. If used improperly, heat lamps have more potential for burning. Just like with a heat lamp, you must check with the patient and make sure they are comfortable with their level of warming.

In exchange for this potential risk, you get the opportunity to blow patients away with almost instantaneous results. Since a 10-watt system is delivering 600 joules per minute, you simply keep it moving for about 4 minutes and you have 2400 joules into the total treatment area. That level of energy will typically produce much stronger response that you get with a lower power laser. 

For many practitioners and users with serious problems, it's hard to deny that the option to deliver high dosages when appropriate is worth the slight risk of heating the tissue. If you want instantaneous pain relief, there is no substitute for power. If you really want the maximum wow factor (where patients walk away feeling totally different), a collimated class 4 laser is like no other. The real problem is that most class 4 systems are 980nm. 980nm is the best wavelength for heating the water in tissue. That is why they make great hot surgical lasers (just search for 980nm surgical lasers) and bad therapy lasers (much of the energy is lost in heating and not cellular interaction).

The Main 3 Theories of Cold Laser Effectiveness

If you analyze the entire cold laser market, you will find that there are basically 3 different philosophies of what makes a laser great. 

1. Put the optimum energy (joules) into the tissue. This is the core technology of photobiostimulation. 
2. Pulse the laser to get an additional reaction from tissue. Pulsing adds an extra dimension to lasers and allows lasers to deliver higher peak energy levels while still being safe. In some applications, the pulsing frequency is a big deal. Pulsing can also make it harder for the body to adapt to the therapy so it is more important for longer term treatment plans.
3. Use different wavelengths to simulate different reactions. Wavelengths below 800nm interact with the body in a different way than those above 800nm. Every manufacturers says they have the best wavelength but they range from 1350nm down into the 400 nm (blue spectrum). 95% of professional therapy lasers operate in the 620nm to 980nm range. The wild wavelengths are main offered in the hyper-marketed consumer market and there is very little science to justify the fringes of the market that make unbelievable claims about magic wavelengths in the blue, purple, green and yellow spectrum. For any condition that requires deep penetration, our opinion is that 800 to 860nm is the best wavelength and for many special cases 600 to 660nm is the best option. If you have time to do research, there is lots of publication to show what is the best wavelength for laser therapy. 

After years of working with tens of thousands of people, it is obvious that all these theories are part of the equation but it is up to each buyer to determine which theories they believe in and which laser is appropriate. 

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