Low Level Laser Therapy (Photobiomodulation) in Osteopathy

Low level laser therapy — also known as photobiomodulation or LLLT — is a non-invasive treatment that uses specific wavelengths of light to stimulate healing in damaged and inflamed tissue. Unlike surgical or aesthetic lasers, which work by generating heat, low level lasers deliver light energy at an intensity that penetrates tissue without causing thermal damage. The light is absorbed at a cellular level, triggering a cascade of biological responses that can reduce pain and inflammation and accelerate tissue repair. It is commonly used in osteopathy, physiotherapy, and sports medicine to treat a broad range of musculoskeletal pain conditions, from acute injuries to stubborn chronic tendinopathies.

The therapeutic potential of light has been explored since the early twentieth century, but modern low level laser therapy has its origins in the 1960s. Following the invention of the first ruby laser in 1960, Hungarian physician Endre Mester began investigating whether laser light could influence biological tissue. His early experiments in the late 1960s showed that low-intensity laser exposure could accelerate wound healing and hair growth in mice — observations that laid the conceptual foundation for what would eventually become photobiomodulation therapy.

Throughout the 1970s and 1980s, interest in therapeutic laser grew across Europe and the Soviet Union, where it was adopted relatively early in clinical settings. As the technology matured and devices became more practical and affordable, low level laser therapy gradually became more widely used in Western sports medicine, physiotherapy, and pain management clinics. Today’s devices offer sophisticated control over wavelength, power output, and treatment parameters, and the field has attracted a substantial body of peer-reviewed research.

The primary mechanism of photobiomodulation involves light absorption by photoreceptors within the mitochondria — the energy-producing structures inside cells. The leading target is an enzyme called cytochrome c oxidase, a key component of the mitochondrial respiratory chain. When specific wavelengths of light (typically in the red spectrum around 630–700 nm, or the near-infrared spectrum around 800–1100 nm) are absorbed by this enzyme, it triggers an increase in cellular energy production (ATP), along with changes in reactive oxygen species signalling and an upregulation of various growth factors and repair proteins.

The downstream effects of this cellular activation include reduced local inflammation, modulation of pain signalling pathways, improved microcirculation, and stimulation of tissue regeneration. Near-infrared wavelengths penetrate more deeply into tissue — reaching muscles, tendons, and joints — while red wavelengths work closer to the surface, making them particularly well suited to skin, superficial tendons, and nerve tissue.

The energy is delivered via a handheld device applied directly to the skin over the affected area. Treatment sessions are brief and painless, typically lasting between a few minutes and twenty minutes depending on the condition and the device used.

Low level laser therapy has the broadest evidence base for conditions involving pain, inflammation, and impaired tissue healing. Some of the conditions it is most commonly and effectively used for include:

• Tendinopathy: Whether it’s the Achilles tendon, rotator cuff, patellar tendon, or the tendons around the elbow, tendinopathy is one of the strongest indications for photobiomodulation. LLLT can reduce pain and tenderness, support tissue remodelling, and help restore function in conditions that are notoriously slow to heal.
• Plantar fasciitis: Chronic heel pain from plantar fasciitis can respond well to laser therapy, with research showing meaningful improvements in pain scores and functional outcomes, particularly when combined with loading exercise.
• Lateral epicondylalgia (tennis elbow): One of the better-studied applications of LLLT, with multiple trials showing reductions in pain and grip-strength deficits compared to sham treatment.
• Neck and back pain: Both acute and chronic spinal pain can benefit from laser therapy, with evidence supporting its use as part of a broader management approach.
• Osteoarthritis: Particularly of the knee and hand joints, where LLLT has demonstrated reductions in pain and improvements in joint mobility in multiple systematic reviews.
• Muscle injuries and delayed onset muscle soreness: Laser therapy applied before or after intense exercise has been shown to reduce muscle damage markers — a popular application in elite sport.
• Nerve pain and neuropathy: Emerging evidence supports LLLT for conditions involving peripheral nerve irritation or injury, including carpal tunnel syndrome and post-injury neuralgia.

Laser is also used to complement treatment for conditions such as temporomandibular joint dysfunction, bursitis, and chronic myofascial pain, where its anti-inflammatory and analgesic effects can provide meaningful relief and support rehabilitation.

Yes — photobiomodulation is one of the better-researched physical therapy modalities, with hundreds of randomised controlled trials and numerous systematic reviews now published. The quality of the evidence has improved considerably over the past two decades as research has become more rigorous in standardising dosage parameters.

A widely cited systematic review published in The Lancet examined the use of low level laser therapy for neck pain, finding that it significantly reduced both acute and chronic neck pain compared to sham treatment, with effects lasting up to 22 weeks after the end of treatment. Reviews in the British Journal of Sports Medicine and European Journal of Physical and Rehabilitation Medicine have similarly supported its use for tendinopathy, with the strongest evidence for Achilles and elbow conditions.

The World Association for Laser Therapy (WALT) has published evidence-based dosage guidelines for a range of musculoskeletal conditions to help standardise treatment across clinics, reflecting the maturity of the field.

It is worth noting that photobiomodulation research has historically been complicated by significant variation in device types, wavelengths, power outputs, and dosing protocols — factors that make comparing studies difficult. The emerging consensus is that outcomes are highly dose-dependent: underdosing produces minimal effect, while appropriate dosing at the right wavelength consistently produces clinically meaningful results. This makes device quality and practitioner knowledge critical to treatment success.

Low level laser therapy has an excellent safety profile and is very well tolerated, but there are some circumstances in which it should be used with caution or avoided:

• Active malignancy: Laser therapy should not be applied directly over known or suspected cancerous tissue, as the biological stimulation it produces could theoretically promote tumour growth.
• Pregnancy: As a precaution, laser therapy is generally avoided over the abdomen and lower back during pregnancy.
• Direct eye exposure: The laser should never be directed at the eyes, and protective eyewear is worn by both patient and practitioner during treatment.
• Thyroid gland: Direct application over the thyroid is avoided due to its sensitivity to photobiomodulation effects.
• Photosensitive medications: Some medications increase sensitivity to light, and your osteopath will ask about your current medications before treatment.
• Active infections: As with other physical therapies, laser should not be applied directly over acutely infected tissue.
• Epilepsy: Pulsing light modes are used with caution in patients with a history of photosensitive epilepsy.

Outside of these contraindications, LLLT is considered very safe, with no known cumulative risks from repeated treatment courses.

The number of sessions required varies depending on the condition being treated, its duration, and the individual’s response to treatment. For acute conditions, meaningful improvement can often be seen within three to six sessions. Chronic conditions — particularly longstanding tendinopathies — typically require more treatment, commonly in the range of eight to twelve sessions, with reassessment along the way.

Sessions are generally scheduled two to three times per week in the initial phase of treatment, which aligns with the biological timelines of the cellular processes that photobiomodulation stimulates. As the condition improves, treatment frequency is typically reduced.

Laser therapy integrates well with other treatment approaches and at this practice it is commonly used alongside manual therapy, dry needling and acupuncture, shockwave therapy, and progressive rehabilitation exercise. Combining modalities often produces better outcomes than any single treatment alone, particularly for chronic or complex presentations.

No — low level laser therapy is painless. Unlike high-powered surgical or cosmetic lasers, therapeutic lasers do not generate significant heat, and patients typically feel nothing more than the gentle contact of the handheld device on their skin. Some people report a mild, subtle warmth or tingling in the treated area, but this is not universal.

The treatment is well tolerated even in highly sensitised or acutely painful conditions, making it a good option when the affected area is too tender to tolerate more hands-on treatment. There are no needles, no electrical stimulation, and no recovery time required after a session.

Multi Radiance Super Pulsed Laser Technology

Multi Radiance’s which delivers high peak power in extremely short pulses (approximately 110 ns). This creates high energy density without generating significant heat or raising skin temperature, avoiding the photothermal effects and potential cell damage associated with continuous wave or high-powered Class IV lasers. It synchronously uses multiple wavelengths for optimal photobiomodulation across the therapeutic window:
• 905 nm super pulsed laser — deeper tissue penetration and efficiently absorbed by hemoglobins to enhance microcirculation and energy delivery.
• 850 nm broadband infrared — supports deep penetration and tissue stimulation.
• 660 nm visible red light — targets superficial tissues for anti-inflammatory and cellular repair effects.
• 455 nm visible blue light — adds antimicrobial and additional biological benefits.

This multi-wavelength approach (Cascade Energy Effect™) allows photons to penetrate different tissue depths, stimulating cellular processes like ATP production, reducing inflammation, and promoting healing without thermal risk. The unique LaserStim feature integrates TARGET™ (Treatment Area Recognition and Guidance Enhanced Technology) and DOSE technology. TARGET uses interactive neuroadaptive electrical stimulation to continuously measure tissue electroconductivity, identifying pain points or dysfunctional areas via biofeedback. It prevents tissue accommodation (habituation) with changing impulses and automatically guides precise laser dosing to the optimal sites for faster, more accurate treatment.

If you’re in Sydney’s eastern suburbs and you’d like to find out whether photobiomodulation laser therapy might be appropriate for your condition, feel free to get in touch or book online.