#74 - Therapeutic Laser for Treating Pain, Part 2

Hi guys. Welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thank you for listening. When you're faced with a decision to add a new therapeutic device or piece of equipment to your practice, It's easy to get overwhelmed with the variety of options currently on the market. Whatever choice you make must have a positive impact on patient outcomes and provide a great return on your investment. But much like a hammer or a screwdriver in your garage toolbox, any device you implement into practice is only useful if you know how to leverage it to achieve your goals. In part 1 of this 2-part training, Our guest presenter, Dr. Mike Callanan, gave an overview of the evidence that supports laser therapy's impacts on everything from nerve function and tissue repair to collagen formation and even the perception of pain. In today's episode, we cover laser therapy dosing protocols and talk a little bit more about how to target varying tissue depths for specific conditions. And if you're a healthcare provider with doubts about wearable laser technology, Stay tuned. We'll give you the lowdown on red flags to watch out for and how to assess the veracity of the technology you might be considering. So whether you currently use laser therapy in practice or, or just kind of intrigued enough to want to learn more, this episode will certainly give you a better understanding of this powerful therapeutic intervention. Let's cue the intro music and get started.

So when you think about light going into tissue, the topic or the term that we like to use is therapeutic depth. And think about that as a higher power light is like a brighter light. So if you have a 20-watt laser versus a 10-watt laser, it's the same impact as if you were in a dark room and you had a 20-watt light bulb versus a 10-watt light bulb. So the brighter the light, the more photons you're going to put into the tissue per second. And that's basically going to help get light through all the tissue that you're trying to reach. So that's why having more power makes it easier to treat things in depth. So this slide just shows the difference of an infrared camera here. You wouldn't be able to see this with your naked eye, but basically they put the laser on the palm of that person and then they put 1, 5, and 10 watts of power on the palm. And you can see how that changes the amount of light that goes through. So having more power will help improve your ability to get to depth. So when you're talking about area, you need to have an estimate of how much tissue you're going to treat so that you can put in the right amount of energy. If you put in 1,000 joules of energy into, say, a low back versus 1,000 joules of energy in the back of somebody's hand, the density or the energy density of that's going to be very different. So when you're doing this, what we recommend generally is the Palm of your hand or a 3 by 5 card is about 100 centimeters squared. You estimate how much area you're going to treat. So if you're going to treat somebody's forearm, the volar part of their forearm would be about 3 palms of your hand worth of area. You would say, okay, my area I'm going to treat is 300 centimeters squared. And then if you knew that you had a dose that you were shooting for of, say, 10 joules per centimeter squared, you would have to deliver 3,000 joules of energy. So most companies sell devices that have software that helps you with this math. LightForce does because it can be sort of tedious. So we've come up with some clever ways to help with that. So don't get freaked out if that doesn't all add up right out of the gate. So this is designed to just show you also how power impacts time. Joules are energy, and that is watts times time in seconds. So basically, the more power you have, the more watts, the less time you need to deliver the same amount of energy. So it just goes to show, if you had a 1-watt laser and you wanted to dose that forearm, that 300 centimeters squared, at 10 joules per centimeter squared, it would would take 50 minutes of treatment versus if you had a 10-watt laser, you could cut that treatment time down to 5 minutes. So that's a real important concept to understand when you're shopping around and looking for things because time is money. So being able to get effective treatments in is important. And the corner you don't want to cut, which a lot of people do, is they say, oh, well, what if I took a 1-watt laser or a lower power laser and I just sort of applied it for 5 minutes and hope for the best? You'll probably be underdosing that condition by quite a bit. And you will not get very good outcomes. So that is not a good strategy if you're thinking about trying to go down the road of a low-power device and then treat the same amount of time you would on a high-power device. It's not an apples-to-apples comparison. So from a, just a general dosing perspective, these are from the basis of the protocols that LightForce is using. For superficial tissues, you'd want to use around 6 joules per centimeter squared. For intermediate tissue, like a muscle belly of an arm or a leg, you could use 10.

Okay.

And then for deeper tissues in, say, the spine or the hip, you'd want to be more around 15 joules per centimeter squared. You can increase or decrease that a little bit based on if there's inflammation present, is acute or chronic. You generally want it— you need less energy for acute problems and you need more for chronic ones. And then for high, if you want to try to impact pain as significantly as you can, you want to use higher power when you're treating that person. So just remember, power is watts. And energy is joules. So dose and power are, are slightly different, but they are interrelated. So next phase of this is to kind of get a, a sense of some, some of the recent endorsements that are based on literature that's out there for laser. So when you take a look at basically what's out there, you'll see that JOSPT has started to endorse in their different clinical pathways on a number of fronts, including 2 for the neck, Just last year in 2021, because that's 2 years ago now, they endorsed laser for use on addressing pain for acute ankle sprains, which is pretty exciting. American College of Physicians, they endorsed the use of laser. It was the only modality they endorsed for use on chronic low back pain, and we'll talk about that more in depth here in a second. And then some of the different review databases, Pedro and the Cochrane Reviews, they're very stingy as far as what they endorse as far as good science and saying, hey, this is a good paper and you should do that. But there's been some that have come out recently. We're going to talk about one of those here in a second. But exciting to see that the literature is really starting to support the use of laser for a number of different things. So last year, the CDC put out a draft report on opioid reduction. And what was interesting is that they recommended the use of laser, LLLT, among several other therapies, to help reduce the need for opioids. And the thing that was pointed out, which I think was an excellent point they made, is that there's synergistic benefit when you use laser and other things as a treatment approach. Because a lot of people, when they start talking about modalities, they think of it as a passive treatment, and they throw a lot of shade on it to say, hey, passive treatment's no good. But they point out here very wisely that when you use laser Or another modality to help passively impact pain, it opens the door for more active treatments. Because if somebody's hurting too much, they can't put weight on their leg. But if you can treat it, whether it's with a laser or with shockwave or with an e-stim unit or something to help impact pain, all of which they can, and then you were going to then do some more active work with that person, you're going to get better outcomes. And that's what they're supporting here. So. Those people that are sort of naysayers about modalities, that's definitely a point you want to keep in mind is that it's not that you just want to do passive stuff with folks. It's just helping maybe gate the ability to do more active things to create a better outcome. The other thing they point out is just that there's not enough access to these tools in our health system. So they really were trying to support health insurers and health providers and systems to try to get these modalities so that they can apply them to patients because they are successful and they work fairly well and there's very low risk. But because of the reimbursement problems, that they're generally not reimbursed. There's a paucity of it when you look at it across the entire landscape of our healthcare system. And access was mirrored in a 2021 recommendation from the American Academy of Orthopedic Surgeons for using laser for knee OA. They like the idea of laser for decreasing pain and increasing function, but they, they said they downgraded it 2 levels because of access and inconsistent Findings in their, in their lit search. But when you look at their recommendations from 2013, their recommendations were inconclusive. So it didn't really match. They had done that to several of the different modalities that they listed. I think it was more of a sort of a copy and paste thing, 'cause it didn't really make sense when I, when I dug that up. But nonetheless, in their most recent recommendations, they're supporting the use of laser for knee OA to help with pain and function. So this is a study that was done with PEDro, which is the database out of Australia that looks at rehab papers. And they looked at carpal tunnel treatments with both high-power and low-power lasers. And what was great about this paper is they were starting— you're starting to get a sense that people are really getting how this works. So they basically treated— they had 4 different categories in addition to control group where they said, hey, let's do a high-power laser, With low dose and a high-power laser with high dose. And then they said, let's use a low-power laser with low dose and a low-power laser with high dose, and then a control group that just did exercises. And what they concluded was that the high-power group with the low dose got the best outcomes. They all were improved, but that's the one that improved the most. So it gives you a nod that using high power is different than using low power with how it impacts tissue. So those folks that like to just sort of paint a very broad brush and say, they're all the same, doesn't matter, that just isn't the case. So what I wanted to go over next was just the recommendations from the American College of Physicians, because this is a pretty powerful paper, and they were trying to give their 2 cents on how to address back pain, low back pain to be specific. And so they had recommendations for acute, subacute, chronic, and low back pain with radicular complaints. So for the acute and subacute, they basically were stating on a strong recommendation not to use opioids upfront. They state that most of these patients are gonna get better on their own regardless of what intervention is, but they like the idea of using heat. And the Class IV laser does create some superficial heat. That would seem to be a good choice as well, in addition to the thought of what we were talking about earlier about how it impacts pain with the C fibers for chronic pain as well as the A delta fibers for acute pain. It would also sort of lend to think that it might have a good space here, but they didn't list laser specifically. If they do need meds out of the gate, they recommend just some NSAIDs. For chronic low back pain, another strong recommendation was multidisciplinary approach. They listed lots of different active type things and different interventions that you might be using in your clinic. But the only modality that they stated on there was the low-level laser. And I guess if you consider biofeedback a modality, that was listed as well. But there wasn't any other modalities that they listed on here, which I thought was very interesting. As far as if they're not responding to any of those things, they recommended going back to NSAIDs and these meds to help and only to go down the road of opioids if the risk reward factor is there and everything else has basically failed. So at this point, this isn't a huge, huge newsflash, but the real takeaway from here is some of the options that they're recommending as far as intervention, which include laser. They went on to sort of do a review on a handful of different modalities too. So these are their conclusions. But they did not recommend ultrasound for low back pain in any of the phases. They didn't feel that there was enough research to support that. So it's just something to think about if you're using ultrasound on a regular basis for low back pain. Not a ton of support for that use. As far as cold goes, similar findings. They didn't recommend it for any category of low back pain. So whether it was acute, subacute, or chronic. Remember that they did endorse heat for use of acute low back pain. When it comes to electrical stim, TENS, NMES, interferential for low back pain, again, didn't really find enough research there to really support it. So they weren't, they weren't too high on that either. There's obviously studies out there to support use of TENS for chronic pain and such. So don't take away that there's no support for it. It's just that this group didn't come across enough. Evidence to support it. So switching gears to JOSPT in 2017, their clinical guidelines for neck pain with— they had 2 different categories that they endorsed laser for. Chronic pain with mobility deficits. So essentially that's your OA type of neck, the wear and tear folks. You can see there what they did recommend as far as laser, dry needling, pulsed ultrasound, intermittent traction, TENS, and EMS. Those all had a place for it. But they, they didn't recommend use of continuous traction, static magnetic necklaces, or dry needling did not outweigh wet needling. So when they were using lidocaine to inject, it didn't create the same amount of relief. As far as neck pain with radiating pain, they also recommend a laser for that person, so your radicular patients, as well as intermittent traction for your chronic patients. What they didn't support was use of a semi-rigid collar. Again, continuous traction with the thought that it could put too much stretch on the nerve and irritate it. And then for chronic folks, they also did not support continuous traction or electric muscular stim or modified galvanic current. So, so for conclusions from these different groups, you could take away this: they're supporting laser for the use of chronic low back pain, neck pain— that's basically your OA necks— as well as radicular complaints. Heel pain and plantar fasciitis, that's been supported by JOSPT. Acute lateral ankle pain, you can use the laser to help with that. And then knee OA was endorsed by the American Academy of Orthopedic Surgeons for pain and function on that front. What's not supported for laser is lumbar pain with radicular complaints, and that's probably most likely due to— it's just difficult to get light down to the level of the nerve root. It can be done if you really know what you're doing and you have the right equipment, But especially with lower power devices, they just have a tough time getting enough light down to that 3 or 4 centimeters of depth at the nerve roots. And then neck pain with movement coordination, that was not supported in JOSPT. But those are people that are more like fearful of motion. They're people that need more pain counseling and muscular reeducation as far as how to reintroduce normal patterning. So it didn't surprise me that that was not a category. That was supported. So how do you fold this into a normal plan of care? There's no perfect answer to it, but just put a couple pearls here for you guys to take home. So with superficial heat, that was shown to help with acute low back pain. And so a lot of people ask me, hey, should I use it? Should I use heat first or after I use my laser? And generally, we recommend not doing anything that's going to impact the skin. So you don't want to do anything that's going to lower sensation or numb it. You don't want it to be wet. You want generally dry, cool, clean skin that you're going to treat when you have a laser because it can get warm and you want to make sure that that sensory feedback's intact. The other thing I'd point out is that if you do use the laser first, you might find that because of all the different mechanisms that it helps with pain, that you get done with the laser treatment and the patient gets up and goes, hey, I feel a lot better, and they're moving differently and they have different subjective complaints. At that point, and you might be able to, to not do the heat if you, if you choose to do so. But if you were, I would recommend doing it after. So after you treat with the laser, if you wanted to follow up with some heat, I would do it as the second treatment option. Yeah, I would pretty much leave it at that as far as that slide goes. As far as like incorporating the manual therapy, there's benefits to use the laser before you do manual therapy just because it can help basically quiet down muscle guarding and splinting and spasms. So if you have less of that, it's going to be a lot easier to mobilize the joint and get tissue stretch on things. There's going to be just less fighting that you're going to have to do or prep work you're going to have to do to get that muscle to relax. So generally, if you do the laser first, that would be great. If you use it afterwards to help improve circulation of the tissue and do things to help with tissue repair if they're stiff and things of that nature, it's not going to be a bad thing to treat them after the treatment. Might actually help with some of the soreness and perfusion issues that might be present after the manipulation so that they have less pain. But it's not going to help you with that work you're going to have to do on the front end to get that tissue to relax so that you can get to the joint that you're looking for. Same thing if you're dealing with a stiff joint, you might treat that with the laser first, just going to help take the pain down. As you remember, the pain blocking mechanisms it has just might make it a lot easier to pick up range of motion with that patient and not have to fight quite as much. And so generally, how do you combine the laser? You just need to think about what you're trying to address. So are you trying to address pain? Are you gonna be trying to focus on a specific nerve path? If they have a radicular complaint or for other factors that might be involved, and you're targeting the nerve, make sure you're just dosing that nerve properly and that you're traveling the path of that nerve. The more of it you innervate or excite with the light, probably the better result you're gonna get. If you wanna address the capsule and the synovium, 'cause you're trying to address the pain or tightness around a joint, make sure you're trying to address the entire synovium. So treat all the way around that joint on the top, bottom, and sides. Same thing with muscle tissue. Try to incorporate as much of this, of the muscle as you can. So when you're figuring out your area, if you're treating a quadricep, try to make sure that you're calculating the majority of that muscle belly. It'll help impact more of those cells that are in the muscle, which will have a lot of benefit as far as pain and potentially decreasing DOMS and things of that nature after an exercise session. Tendons, same way. You want to make sure that you're treating those with high energy level. Tendons generally have lower mitochondrial density than, say, nerves or muscles, so they have less sponges to absorb the light. So they often require a little bit more dose. You want to make sure that you're definitely treating the muscle at least a third of the way up that's attaching to that tendon, just because that's all one big system, and you'll probably get better outcomes if you do that. What's the treatment goal? Say you had somebody that had a chronic stiff joint and you wanted to do your best to get pain relief, you'd probably want to treat with higher power. If you had a really acute, like a post-op patient, and you're trying to just help overall address some of the acute circulatory issues that are present, in those cases, you might want to use lower power and lower dose because you want to reduce the chance of maybe some rebound pain or something that can happen sometimes when you treat with higher dose and higher power for an acute condition. So you just have to have your thinking cap on. You got to understand what you're doing. And if you do that, you're going to generally get better outcomes. And get better results. So if you wanted any more information on lasers, we know we kind of did a sort of a big broad overview of this science. There's a lot more information that's out there, obviously. You can connect with us by just scanning this QR code, and I'll be happy to answer any other questions you might have, or if something pops into your mind later so that we can answer that, that'd be great. But otherwise, just want to thank you for your attention. The last couple slides are the references, so if you wanted to— Get a sense of some of these papers you can look at. You can just take a screenshot, that guy or this guy. And that is all I have, Jessica.

How would you like to get even more great content from Factor in your inbox each week? Things like early access to exclusive free trainings, coupons and promotional offers from our online store, and timely updates on research and news you can use to grow your practice and improve your patient care. If I've piqued your interest, you should be sure to click on the Factor 5 Things Friday link in our show notes. Simply give us your contact details and start getting our weekly Factor 5 Things Friday email in your inbox. It's a simple bullet point style format with no fluff, just tons of great content and resources you can use for continual professional growth. So be sure to visit the show notes, click that link, and keep an eye on your inbox each Friday. Now, back to the show. So that being said, let's begin our Q&A segment. We've had a few questions that have come in here about incorporating laser therapy into practice because we do have a few on our webinar today that are novices that have not used the laser before. Dr. Mark, how do you guys recommend your practitioners after they purchase a laser How do they go about getting started with introducing this to patients? What type of support or marketing materials do they receive when they purchase a device like this? And really, how do they get going?

There's sort of 2 families to that question is how do you get the word out to the general public that you have this great technology? And then how do you execute once they get in your front door? So for LightForce, we have a lot of different materials to help with that as far as outreach goes, digital and printed assets that you can use to get the word out. And then as far as coaching up your therapists or your clinicians on how to have these discussions with the patient and how to set up an introductory session with somebody so they can experience it and how you can maximize revenue. Generally, it's a cash transaction with those patients. So it is a special type of conversation. I noticed in the chiropractic space, you guys are excellent at talking to patients about cash and your services. And you're not, you don't generally shy away from that. So it's usually a very easy conversation for you folks to pick up. Physical therapy side, that's very much the opposite. They are very bad at asking for copays and dollars for their services. And so it's usually a little bit tougher on that front. But either way, whether you've got a skilled group on that or not, we have great resources to help with those discussions so that you can have that formula from the time they walk in the front door. to the treatment to when they're walking out on how to capitalize on, on a package of purchases. I mean, the nice thing about laser is that it generally requires a couple treatments. So usually somewhere around the mean is about 6 visits. So it's a very nice add-on to a plan of care for a package price. Say, hey, it's normally this much for a single visit, but with your problem, I'm recommending 6. So if you were to purchase the whole package today, We could discount that by 10% or 15%, but that usually works out great.

Wonderful. And I think I'd imagine you would echo the sentiment that once a patient has the treatment, they see the benefits of it, they see that pain relief, it's a lot easier for them to kind of realize that even though this may not be covered by my insurance, if it's effective, it's worth doing and investing in. Yeah.

And there, there are clinics that do sort of demonstrations. They don't charge for the first session. Or they, they wait and see how they respond to it and then come back and say, hey, if you liked that, then that would be your first session from your package. Or if they're really confident with it and they can treat and get pain to change, they just charge for the service right out of the gate. There's, there's benefits and pluses and minuses with any of those approaches, and we're very skilled in those conversations. So however you want to set up your own practice, we can help you with that.

Wonderful. Now, when it comes to laser therapy and those first encounters with a patient, when you're first kind of introducing them to what this is, could you talk a little bit about the type of language that you use with a patient? Someone who may be in acute pain might be a little hesitant to try something that they think may flare things up or cause more pain. What are some talking points that practitioners could use for having those conversations?

Yeah, the important thing for that person right out of the gate is to be well-versed enough on the mechanisms of laser. And like, we provide a cheat sheet for our clinicians. It's a 2-page document which just talks about generally how it impacts a variety of different things. And you don't have to know all of them, and you don't have to be able to give a 2-hour talk on it, but you need to have at least enough information to talk about how it impacts pain and circulation and tissue repair. And by doing so, you put it into the patient's perspective, say, hey, You're here because you strained your back and you picked up that 50-pound box, strained some of the soft tissue in your lower back. It's going to take a few weeks for that to fully heal. While we're doing that, these devices we have are excellent at helping you get out of the pain you're in right now and moving forward so you can move better and get back to sitting at your desk and doing all the things you want to do that you're in here for. The thing that we really remind clinicians of is that those people are in your waiting rooms because they're in pain. So if you have solutions, whether it's a great manual technique or a laser or a traction table or whatever it might be, that's going to get them to feel better when they walk out the door. That's the secret to get people to want to come back. So the nice thing about the laser is that it doesn't require years and years of training like your, your manual skills are to manipulate joints and to do those higher-level functions. You can have extenders in most cases provide this treatment and get people feeling a lot better. So it's, it's a really nice add to a lot of clinics where you might, as the clinician, the lead doc, do the initial treatment just to make sure you get the outcome you want, to be able to explain it, answer the questions. And we generally recommend that because it's important for them to get the buy-in and have all those boxes checked. But then once you set up the protocol or the treatment parameters, you can usually hand that off to one of your extenders in the office. For the subsequent treatments. But that's the key, is that you can explain it without— because they might, like that first slide I put up, they might be thinking of Luke Skywalker with his lightsaber when you mentioned laser. You have to be able to get them off of that cliff and say, no, no, no, this isn't that at all. This is what it's going to do. And then knowing how to apply it, dose it right, and get the outcome, that's when it all comes together. You can be great at explaining it but not understand how to treat, and you're going to probably have lukewarm results. Or if you don't know how to explain it, but you know how to treat with people, same thing. But we can put those together and basically check the boxes of having that patient understand what it's doing and how it's going to help them, and then actually follow through and let that happen. Then usually it's a, it's a pretty easy process.

Absolutely. And that, that kind of flows into another question. What type of training do you recommend for practitioners that want to have their office staff assist them with utilizing laser in practice?

So different companies have different levels of training, anywhere from here's your box, good luck with a, with an instructional manual, to like what we do, which is more white glove, full service. So we understand it's complicated. A lot of companies have sales forces that maybe sell a lot of different products and they're not experts in this space. And it's, it's quite technical when it comes down to getting good outcomes for all the different conditions that you treat. So we have a series of Asynchronous, like videos you can watch and get certified from that. So that gives you sort of a lot of just the general background and how the machine works. And then if that's not enough to cover it, we come in and do a training live on the first day that is set up. So you're going to have a live person helping answer questions and show you how to treat, and then they're going to sit there and treat some patients with you to make sure that you understand it, your staff understands it. And then on the back end, there's still questions a month or two down the road. And if you feel like you need more help, then there's, that's where my team comes in. We can get on a screen like this and help talk through some of those questions and get you up to where you need to be. But our goal is to just make sure that there isn't any questions and there's no stones unturned so that whether it's on the marketing front or it's on the treatment front, we answer those questions so you can be successful. Because if you're not successful, we're not going to be successful.

Absolutely. And I love that. I think it's really important, especially when you're making this type of investment in a modality to incorporate into practice, that you have that support and you have that team that can kind of help answer those questions as they inevitably will come up. When it comes to the conditions that are really effective and can have really great results when treating with laser therapy, if you had to kind of name the top 3 after pouring through all of the research that you have over the years, what would you say are kind of the 3 main conditions that laser is showing very quick and effective results with?

So as, as a big picture, the deeper the tissues you're trying to address, the harder it is. So it's, if you think about your deepest tissues, like, hey, I want to try to treat nerve roots in the low back, or I want to try to treat glute med tendons in the hip that are many, many centimeters deep in larger patients, those are going to be the ones that are going to be harder to get results with. But the more superficial the target tissue is, the easier it is. So when you start talking about like a knee, an arthritic knee that has a capsule that's providing pain, that's only a couple millimeters below the surface of the skin, very easy to address that with a laser to make changes in that tissue as well as the pain from a single treatment. So I would say pretty much any appendicular joint, elbows, wrists, knees, ankles, and they're getting support from these different groups like the APTA. They support it for plantar fasciitis, heel pain, Achilles tendinopathy, ankle sprains. Shoulder is one of those ones that's sort of a tweener. Like if you are using the right equipment, and you know what you're doing, and it's for a pathology that isn't something that requires surgery, or isn't something like a frozen shoulder that is going to just require time because of the nature of the pathology, You can move the needle on those pretty well. So like if you have general stiffness or guarding in a muscle because they say it's more of an acute impingement, and you're going to treat some of those muscles that are in the front of the shoulder that could be guarding that aren't allowing normal mechanics, you can see range improve dramatically with those people because of just the mechanism of that problem. So I know it's kind of a long answer. But when, when you look at research, the superficial things You have a lot of support. So like TMJ is one, need a lot of power or energy to reach the muscles of mastication or impacts the facial nerves that are involved with that. So those people tend to do really well with laser. There's lots of research in the dental space that talks about how effective it is to help with the, they're doing dental implants or healing after dental procedures. That's a whole sort of separate market. Our devices aren't really set up to do that, but find that when you're thumbing through the journals, there's a lot of that. But the backs, the necks, because it's, it's not as deep, that's where the, the JOSPT endorsement comes for treating neck problems, because you're dealing with tissues that are maybe 2 centimeters deep, as opposed to 2 to 3 fold when you get in the lower back. So I would say for the average outpatient person, if you're using it to help with neck pain patients, anything in the periphery, And if you had a specialty interest in possibly like TMJ or something like that, you're probably going to love, love the laser.

Absolutely. Now, I remember a few years ago, LightForce came out with one of the first lasers that had a wand that could kind of help you sense depth of penetration. Tell me a little bit about how that technology has evolved over the past few years and what are some exciting things on the horizon? What's ahead?

Yeah, that's a good question. So the smart handpiece, which I think you're referring to, that was designed when we launched our 40-watt laser a couple years ago. And with 40 watts of power, it creates more heat on the surface of the skin. So we wanted to make sure that we had a way to help make it easy to apply in a safe way for the clinician and the patient. So our smart handpiece has an accelerometer in it. So it judges the speed that you're moving that. And if you're too slow, it will basically— the light on the handpiece will turn red. Which will alert you to, hey, you're going too slow. It'll also vibrate too. It's got haptic feedback. So it helps the clinician know, hey, I got to speed up or slow down, basically, because you don't want it to be so fast that you're not getting enough light to penetrate, and you don't want to be too slow because it gets too hot. So that was from feedback we got from users over the years. They were always like, how fast should we do it? This sort of helps take care of that question. The other thing it does on the heat front is that it is connected It's a smart handpiece in that it knows, it tells the laser what head you have on there. Our devices have 5 to 6 heads when you purchase the unit of different sizes. Some are on contact, some are off. And when you're using our protocols on our newer machines, it'll actually tell you, hey, you're supposed to use either that head or that head. Won't let you do the protocol unless you have the right head attached. And part of that is so that you'll get the best treatment for that problem, but it also makes sure that the power settings are appropriate for the head that you use. So we try to make it as idiot-proof as possible. So these things make it much easier to, if you are going to use high power, you have the right head attached so that it doesn't get too uncomfortable for the patient and that you're going to get the best results essentially. As far as future, can't get into that too specifically, but we're definitely looking at a handful of different things that could possibly treat some different populations, possibly help some folks at home, but we haven't launched any new product announcements just yet. So you'll have to stay tuned for that.

That was actually my next question. You've, or we've heard a lot in the healthcare industry about wearable laser technology, about treat-at-home laser technology. You'll go to any healthcare trade show and see tons of vendors out there selling different patches or booties you can wear or things of that nature. What are some things to look for when you see something like that, that kind of would be a red flag to say, Okay, this isn't quite what they're saying it is. Like, what should we as consumers and as practitioners look out for to make sure that the technology, if it's really not there yet, that we're not buying into something that's not able to deliver?

Yeah, yeah, it's definitely a buyer beware category for sure. I would point out the discussion we had, I pointed out here on LEDs, there's certain things that they can do quite well, but there's other things they can't do so well. So I would take a look at what they're purporting If you have an LED red device that you're going to strap onto your thigh or something and your intent is to try to increase blood flow at the very superficial levels of the skin and that muscle, okay, you could probably make that argument. You definitely want to know what wavelengths they're using though. If they're solely using red and that's it, or they're using things that are shorter, like I've seen these patches that have blue or yellow wavelengths. And purporting the greatness of that. Like, for example, like in the, in the 430 range, which is in the blue range, there's been some studies that have shown that that helps with bacterial infection. It can help with bacteria. So everybody goes, oh gosh, that'll be great, put that all over everything. But the downside of that is that that blue range gets absorbed almost completely at the skin. So if you were buying devices to help with, say, wound treatments and you got something that was in that 400 range, Okay. There might be something to be said for that. But if you are sold a blue patch, which I saw one that was made that was designed to go on backs and things of that nature, it's probably going to do very little to help out anything that's going on at depth as far as a muscle strain or problem at a facet joint or things of that nature. It just doesn't have the ability with those wavelength ranges to get there. So I would check the wavelength. Ideally, if it's in between the 800-900 range, that's giving it some credence, like, okay, they're in the right ballpark. The next piece is how intense that light is. So, the irradiance, you'd probably want to take a look at a few studies that have shown that an LED works. You'd want to see what the intensity of that light was, or basically the brightness or the milliwatts per centimeter squared. There are certain thresholds that need to be reached for those to be effective. And, the analogy you can think of is that if you sit out on the beach Getting a suntan for several hours, you're getting thousands of joules of energy put onto your skin. But, because the intensity of that light is low and you're getting barraged with all sorts of wavelengths in the visible spectrum, it's not just, say, 810 or 980. Generally, you're not creating any photobiomodulation below the skin. It might create some issues at the skin. That's how you can get a sunburn if you're out there too long. But as far as changing things, say, at your knee joint by sitting out in the sun, from a true sort of photobiomodulation standpoint, that's probably not going to happen. So intensity of the light and the wavelength of the light are 2 keys that you'd want to know what that device has before you plunk down your hard-earned money, because if they're off on either one of those, probably not going to be super effective.

Again, thank you, Dr. Callanan, and thank you to Inovis for participating in our webinar today. And we'll see all of our attendees next month. Thanks, guys.

Thanks, Jessica.

That's it for today's episode. Be sure to tune in next time where we feature a new training on integrating master acupuncture points with Dr. Jeanette Kerban. You won't want to miss it. Episode 75 drops in 2 weeks. If you enjoy listening to The Factor Podcast, be sure to like, download, and rate our show, then share it with a friend. Every share allows us to continue on our mission to deliver the best cutting-edge education to healthcare providers. And of course, be sure to check out the show notes for a link to the full webinar training featured in today's episode, along with a few other links, free sources, and special offers from our sponsors. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.