8 Whys, Whens, and Hows for Deep Tissue Applicator (On Contact) Laser Therapy
Guest Blog by Jeff Smith, DVM, CCRP, Middletown Animal Hospital, Middletown, CA
1. HOW: The Deep Tissue Applicator (on contact) lenses are applied directly to the skin. As such, the tissue is compressed (less distance), and blanched (fluid displaced—especially blood with hemoglobin). Moreover, the hair coat is “parted” and displaced (diminishing unintended absorption at the surface). Last, much less light is reflected from the skin when the lens is directly introducing the light into the tissue. Altogether, a measurable 90% more photons reach deep tissues than when applied with a non-contact handpiece.
2. HOW: Apply with moderate pressure, move the probe 1-3 inches per second, keep the probe perpendicular, move in a grid-like pattern, take the area through a range of motion, and treat the area from 360 degrees when possible.
3. HOW: 3 Levels of Expertise:
One: Deliver the therapeutic dose as described above.
Two: Elicit a myofascial trigger point release with a pleasant massaging technique .
Three: Determine diagnostic information based on the pets response (moving away from or into the pressure) to the application—use this to gauge the patient’s progress or determine areas of sensitivity.
4. HOW: Keep the heads clean and scratch free. The heads can be cleaned inside an out with alcohol and a 3X3. Keep the red lens caps in place when the heads are not in use and keep one head on the handpiece at all times.
5. WHY: Dosing the tissue consistently and effectively is the key to maximum tissue response. If 90% less of the intended dose is reaching the deeper target tissues, then one should expect much less effective response from those target tissues when using a non-contact head.
6. WHEN: Deep Tissue Applicators should be used whenever the target pathology is not visible to the eye. In other words, any pathology that requires penetration of the energy through more that 5-10 mm of tissue: Arthritis, IVDD, fractures, osteotomies, internal organs, deep tissue around the ear, deep tissue around the month, tendons, ligaments, and so on. Occasionally animals may be uncomfortable enough that the initial treatment(s) need to be accomplished with a non-contact head until enough pain relief allows the use of the contact head. Use the contact head(s) at 7-30 J/cm2.
7. WHEN: Non-contact heads can be used if you can see the damaged tissue: Hot spots, superficial wounds, burns, minor incisions, external ear canal/pinna, exposed intraoperative organs, and so forth. Use the non-contact head(s) at 3-4 J/cm2.
8. WHEN: Some protocols require both Contact and Non-contact heads (ears and mouth in particular). This type of treatment effectively allows a much more thorough treatment from both the “inside” and the “outside” of the tissue. A similar approach can be used with cases like a post-op TPLO: Treat over the incision with a non-contact head/dose, then treat 270 degrees around the incision with the contact head/dose.