Why Combine High Power Laser and Shock Wave Therapy?
Extracorporeal Shock Wave Therapy (ESWT) is a proven, non-invasive, and effective treatment for many musculoskeletal conditions. It works by:
- Overstimulating C-nerve fibers to reduce pain (lowering Substance P levels).
- Blocking neurogenic inflammation.
- Stimulating tissue healing with growth factors like BMPs, eNOS, VEGF, and PCNA.
However, to achieve clinically meaningful effects, ESWT often requires high energy flux densities (EFDs). This higher intensity can be very painful for patients—sometimes limiting how much energy can be applied and reducing effectiveness.
Local anesthetics can reduce pain, but unfortunately, they also block the very nerve responses that make ESWT effective. This is why local anesthesia before ESWT has been linked to poorer clinical outcomes.
How High Power Laser Improves Tolerance and Outcomes
A pulsed, high power laser with a 904 or 905 nm wavelength offers a solution. Its mode of action includes:
- Reducing nociceptor firing rates for rapid analgesia in minutes.
- Lowering Prostaglandin E2 (PGE2) concentrations, reducing acute inflammation.
- Decreasing pain transmission through inflammatory nociceptors.
While High Power Laser (HPL) therapy alone is effective (with over 23 RCTs supporting it), it typically requires many more treatment sessions compared to ESWT.
But when used before ESWT, HPL has been shown to significantly increase patients’ tolerance for ESWT’s energy:
- Up to 50% more energy can be applied just 5 minutes after laser treatment.
- Up to 100% more energy can be delivered if there's a one-hour gap.
This allows practitioners to deliver higher, more clinically effective doses of ESWT without local anesthesia—maintaining ESWT’s biological effects on pain modulation and tissue healing.
Recommended Treatment Protocol
- < 1 month (acute pain): DolorClast® High Power Laser only
- > 1 month (subacute or chronic pain): Combination of DolorClast® High Power Laser + DolorClast® Shock Wave Therapy
Clinical Advantages for Practitioners
By adopting this combination approach, healthcare providers can:
- Improve patient comfort without sacrificing treatment effectiveness.
- Deliver higher EFD safely and without anesthetic that would blunt ESWT’s benefits.
- Achieve better outcomes in fewer sessions.
- Enhance patient satisfaction and adherence to care plans.
Conclusion
High Power Laser and ESWT are both powerful on their own. Together, they provide a synergistic effect that helps practitioners achieve better, faster, and more comfortable results for patients.
FAQ:
Q: Is combination therapy painful?
A: The high power laser reduces pain before ESWT, making higher shock wave intensities tolerable without local anesthesia.
Q: How many treatments are needed?
A: It depends on the condition, but combination therapy can often reduce the total number of sessions needed for chronic cases.
Q: Is there evidence supporting this approach?
A: Yes! Both modalities have strong RCT support individually, and recent studies show their combination is even more effective.