Can you apply too large a dose of laser therapy?
Laser therapy is added energy to the cells. The biologic effect related to the amount of added energy is described by the so-called Arndt-Shulz law, shown in the picture.
The curve shows that adding a small amount of energy yields a small amount of power, a broad-range medium amount of energy results in a positive, biologic effect, while adding a very large amount of energy provides a biologic inhibition.
This has been well-known for years, but in practice it has been almost impossible to reach the inhibitory part of the curve, simply because the laser devices available were not powerful enough.
For a long time, the general consensus has therefore been “the more, the better”. However, with more powerful lasers now being available, there is a much larger risk of applying too large a dose, i.e. an inhibitory dose. As mentioned, laser therapy is added energy to the cells, and the amount of energy that is needed is directly proportional with the number of cells that need stimulated, or in other words: the volume (area x depth) of the tissue in question. As a result, very superficial areas, such as an elbow where there is very little soft tissue, need a very small dose. Larger muscles need a significantly larger dose, and deeper areas need an even larger dose.
Energy = power x time
Energy is measured in Joules, which is measured as Watt x seconds. Consequently, the energy dose can be adjusted either by varying the power (Watt) or the time (seconds) – or a combination of both.
Not enough to reduce the time
For very superficial areas, however, it is not enough to reduce the time if the dose is too large. Here, another factor to consider is the power density, measured in Watt/cm2. If the power density or the intensity of the laser is too large, the cells will be overstimulated/inhibited, no matter how long the treatment time is. WALT* has looked into a number of common ailments and has compiled a list of recommended doses, both in terms of Joules and milliwatt (mW). The following is an extract of their list:
| Tendinopathies | Points or cm2 | Joules 780 – 820nm | Notes |
| Carpal-tunnel | 2-3 | 8 | Minimum 4 Joules per point |
| Lateral epicondylitis | 1-2 | 4 | Maximum 100 mW/cm2 |
| Biceps humeri c.l. | 1-2 | 6 | |
| Supraspinatus | 2-3 | 8 | Minimum 4 Joules per point |
| Infraspinatus | 2-3 | 8 | Minimum 4 Joules per point |
| Trochanter major | 2-4 | 8 | |
| Patellartendon | 2-3 | 8 | |
| Tract. Iliotibialis | 1-2 | 4 | Maximum 100mW/cm2 |
| Achilles tendon | 2-3 | 8 | Maximum 100mW/cm2 |
| Plantar fasciitis | 2-3 | 8 | Minimum 4 Joules per point |
| Arthritis | Points or cm2 | Joules | Notes |
| Finger PIP or MCP | 1-2 | 4 | |
| Wrist | 2-4 | 8 | |
| Humeroradial joint | 1-2 | 4 | |
| Elbow | 2-4 | 8 | |
| Glenohumeral joint | 2-4 | 8 | Minimum 4 Joules per point |
| Acromioclavicular | 1-2 | 4 | |
| Temporomandibular | 1-2 | 4 | |
| Cervical spine | 4-12 | 16 | Minimum 4 Joules per point |
| Lumbar spine | 4-8 | 16 | Minimum 4 Joules per point |
| Hip | 2-4 | 12 | Minimum 6 Joules per point |
| Knee medial | 3-6 | 12 | Minimum 4 Joules per point |
| Ankle | 2-4 | 8 |
Max 100 mW!
For very sensitive areas, it is important not to exceed 100 mW/cm2. If the power density and/or the dose is exceeded, the laser loses its otherwise positive effect and may make the tissue more irritated than it already was, with unnecessary pain as a result.
*) WALT
WALT, the World Association for Laser Therapy, is an international organization that focuses on promoting the awareness of biostimulating laser therapy. See Walt.