1. High Power Laser Therapy
(HPLT)
Revolutionizing
The Non-Surgical Treatment of
Neuro-musculoskeletal Pain
and Wound Healing
PHYSICIAN SEMINAR

2. HPLT – High Power Laser Therapy
• HPLT was first introduced to the medical field in 2002 by then
CEO of Avicenna Laser Technology, Inc, Bruce R. Coren, DVM, MS.
The company invented and developed the first High Power
Therapeutic Laser to receive FDA clearance in 2003.
• TMA – Technological Medical Advancements is a spin off from
Avicenna and was founded not only to advance the field of Laser
Medicine but also to bring other innovative medical devices to the
market place.
• TMA offers the most powerful laser platforms in the world and
thus allowing physician's of all medical disciplines the capability to
heal injuries previously refractive to traditional medical care.

3. The Design of the TMA Laser
• The TMA laser was designed from the ground up to
be a therapeutic medical laser.
• It was developed using research by our own
biomedical engineers and clinicians as well as
collaboration with a major medical school and
university optics department.
• We investigated important criteria such as
wavelength, power and power density, optics and
beam delivery in order to afford the greatest
penetration and delivery of a therapeutic dose
capable of stimulating tissue healing in deep seated
pathologies.

4. LASER— an acronym for:
Light
Amplification by
Stimulated
Emission of
Radiation

5. Lasers in Medicine
Surgical Lasers:
• Are used to cut, coagulate,
and evaporate tissues.
• This type of laser replaces
the scalpel of the surgeon.

6. Lasers in Medicine
Therapeutic Lasers:
• Are used for the stimulation of cell
function.
• The biological effect is
photochemical not thermal, as is the
case with surgical lasers.

7. Who is using TMA (HPLT)
• Pain Management Specialists, Orthopedists,
• Neurologists, Interventional Pain Management
• Doctors, Physical Medicine and Rehab,
• Physiatrists and Family Practice Physicians
• Chiropractors and Physical Therapists
• Podiatrists, Naturopaths and DOM’s
• MLB, NBA, NFL and College Sports Teams
• Medical Colleges
• The United States Military and VA Hospitals
• Veterinarians –Equine and Small Animal

8. Comparison of “Class IV”
Surgical and Therapeutic Lasers
• Surgical lasers collimate high amounts of laser energy
into a beam of high intensity resulting in tissue
destruction
• High Power Therapeutic Lasers take a high amount of
laser energy but instead of beam collimation you get
beam divergence resulting in tissue stimulation

9. Properties of Infrared Laser Light
• Laser Energy is just another form of energy on the electromagnetic spectrum. Depth of
penetration is determined by wavelength and energy density. Just like with x-rays when
deeper penetration is required, more energy must be delivered to reach the target tissues.
In general the higher the wavelength the greater the depth of penetration.
The TMA high power laser delivers infrared light at an optimal wavelength of 980nm.

10. Biological Effects of Therapeutic Lasers
• Laser therapy aims to bio-stimulate injured and
dysfunctional tissues.
• Clinical studies and trials of Class III & IV laser
technology indicate the following beneficial effects
of light therapy on tissues and cells.

11. Cellular Effects of Laser Energy
• Chromophores are components of
molecules which absorb light.
• The stimulation of chromophores
on mitochondrial membranes incites
the production of ATP.
• Leading to a biological cascade of events.

12. Cellular Effects of
Laser Therapy Continued:
•Increased Growth factor response
within cells and tissue as a result of
increased ATP and protein synthesis.
•Accelerated cell reproduction and
growth leading to faster repair of
damaged tissues.
•Increased metabolic activity- via increase in enzyme
outputs, oxygen and nutrient availability.

13. Wound Healing Effects of Laser Therapy
• Faster Wound Healing- Laser significantly increases fibroblast
and collagen production which are essential for tissue repair.
•Improved Vascular Activity- Increased capillary production
leads to faster wound closure.
• Greater Tensile Strength – Surgical repaired wounds heal
with greater tensile strength, including skin, tendon, ligament
and fascia.
•Scar Tissue Reduction- Wounds heal with less scar tissue
formation.

14. Wound Healing
PRE-LASER AND AFTER TWO AFTER TWO 5 MINUTE LASER THERAPY
MONTHS OF TRADITIONAL THERAPY TREATMENTS AT 7.5 WATTS

15. Anti-inflammatory Effects of
Laser Therapy:
Anti-inflammatory via an
anti-edemic effect as it causes
vasodilatation and activation of the
lymphatic drainage system.

16. Analgesic Effects of Laser Therapy:
•Via increased endorphin release.
•Anti-inflammatory via less edema as a
result of lymphatic system activation and
less swelling.
•Via Suppression of nociceptors.

17. Immune System Effects of Laser Therapy
• Strengthening the immune system
response via increasing levels of
lymphocyte activity and through a
newly researched mechanism termed
photo-modulation of blood.
• Documented evidence of Tumor size
reduction in animals. Mechanism
of action unknown.

18. Miscellaneous Effects of Laser Therapy
• Improved Nerve Function via increased nerve cell
reconnections
• Trigger Point Resolution
• Acupuncture Point Stimulation
•Dermatology, Respiratory, GI and OB-GYN cases also being
treated by numerous Avicenna clinicians in the field.
(Corporately we only make claims pertaining to treatment of
neuromusculoskeletal pain and would healing.)

19. Summary of LT Biological Effects
•Accelerated Tissue Repair and Cell Growth
•Faster wound Healing
•Reduced Fibrous (Scar) Tissue Formation
•Anti-Inflammation
•Anti-Pain (Analgesia)
•Improved Vascular Activity
•Increased Metabolic Activity
•Improved Nerve Function
•Immunoregulation
•Trigger Point Resolution and Acupuncture Pt. Stimulation

20. Laser Safety
Safety protocols must
ensure sufficient
precautions are taken to
protect the health and
safety of employees
and patients. Use of safety
goggles to prevent retinal
exposure is paramount.

21. All Lasers are Not Created Equally
• Although all therapeutic lasers bio-stimulate tissue, that
is where the similarities end.
• Laser Therapy is all about Physics!

22. Therapeutic Laser Classifications
• Therapy lasers are classified based on their power output
•Class IIIa = lasers 1 to 5mw of power (laser pointers)
• Class IIIb = lasers 6 to 500mw in power (typical cold laser you read
about)
• Class IV = lasers above 500mw of power
• TMA Laser Platforms = 1,000 – 60,000 mw maximum continuous
wave output

23. Energy Medicine and
Therapeutic Laser Physics
• The therapeutic dosage of laser energy is measured in Joules
• Dosage is a function of the lasers power output
• For every one watt of continuous laser power output, one joule of
laser energy is delivered per second of time
• For a pulsed laser the energy delivery depends on the duty
cycle. Duty cycle tells us what percentage of time the laser is on or
actively firing. If the duty cycle is 50% then the laser at 1 watt
only delivers 0.5 Joules / Second. For any given time period a
continuous wave laser delivers twice as much energy than a
pulsed laser with a 50% duty cycle

24. How Laser Light Penetrates Tissue
• As light energy hits the surface of the skin and subsequent
deeper layers, some of it is scattered and some of it is
absorbed and some is reflected
• At each tissue interface less energy is available to pass
further through to the next layer because of the effects of
absorption, reflectance and transmission

25. Laser Tissue Interactions

26. Absorption Curves
980 nm: Low melanin, low water, low hemoglobin absorption thus an optimal
wavelength to choose when designing a therapy laser for stimulating tissue at greater
depths of penetration.

27. Physiological Effects Light – Tissue Interactions
• 65% of laser energy is absorbed in the skin and
subcutaneous tissue layers with the following having a
high affinity for absorption:
• Hemoglobin in blood
• Melanin in skin, hair, moles, etc.
• Water (present in all biological tissue)
• In order to overcome those factors one most start with
large quantities of energy on the skin

28. Therapeutic Laser Penetration
• Prime Determinants of Laser Penetration and
Concomitant Tissue Stimulation are:
• Power – measured in Watts or milliwatts
• Wavelength – measured in nanometers
• Power Density – measured in mw / cm2
• Frequency – continuous wave versus pulsing

29. Importance of Power Density
• Approximately 65% of the energy delivered is lost
in the epidermis
• If you don’t start with enough energy on the skin,
there will not be enough to stimulate cell healing
in deeper tissues
• If you do not have sustained power density over a
long enough period of time treatments may be
ineffective

30. Multiple Wavelength Lasers
vs.
TMA Single Wavelength Continuous or Pulsed
Wave Laser
• A laser with two or more wavelengths only has the ability to
penetrate as deep as each individual wavelengths allows
• Most class iv lasers that pulse or have a high duty cycle coupled with
multiple wavelengths of energy emission will not penetrate as deep
as CW lasers of a single wavelength or lasers that can pulse but still
maintain a high average power output
• Continuous wave lasers = 100% duty cycle, laser is always delivering
energy which is needed to overcome absorption in the superficial
layers
• Newer generation of TMA lasers can now pulse yet still maintain a
high average power output allowing for greater tissue saturation
with less thermal effects

31. In Laser Medicine 1 + 1 Does not Equal 2
• Dual wavelength lasers only
penetrate as deep as each wavelength
individually. The penetration is not
additive, even our competitors
agree, and there is no real benefit to this
scenario. There are no scientific studies to
support the benefits of a dual wavelength laser.
• For purposes of penetration it is more advantageous to have one
wavelength of greater power. that stimulates cell metabolism and
tissue regeneration at all tissues in its pathway
• The TMA laser is also available in a 810nm wavelength

32. Sponge Theory
• In order to get penetration you must create significant energy density to
overcome absorption in the superficial layers of the skin. With low power
density and even with pulsed class iv lasers it is like pouring small amounts of
water onto a large sponge (the dermis and subcutaneous tissues) and
expecting the water to leak through. In order to do so you must saturate the
superficial layers of the sponge- with enough water-energy to soak the
sponge-superficial tissue structures, so as you pour more water-energy over
the sponge it will start to penetrate or leak through. This it what is needed
and why it is important to deliver a high amount of laser on the skin
especially if you want to reach deep seated pathologies.
• Low power or pulsed class iv lasers just cannot provide the energy necessary
to overcome the absorptive capabilities of the superficial skin layers and that
is why they fail to deliver a positive outcome when trying to reach deep
seated pathologies.

33. How Much is Enough
• 49-73 mw/cm2 for cell stimulation1
EFFECTS OF INFRARED LASER EXPOSURE IN
A CELLULAR MODEL OF WOUND HEALING
Mark D. Skopin and Scott C. Molitor, Department of
Bioengineering, University of Toledo, Toledo OH
• This study shows an optimal wavelength (980 nm) and
power density range for wound healing and tissue stimulation

34. Laser & Tissue Powers
Tissue Layer Max Power (mw/cm2)
Epidermis 206
Dermis Layer 182
Dermis Plexus Super. 135
2nd Dermis Layer 115
Dermis Plexus Prof. 93
Muscle Tissue 9.7
Power Setting 5 Watts, 3.0cm spot size, 980nm
(This is a snapshot in time. Calculated using computer models by U of Toledo).
Translation – As laser light or energy penetrates through the body more and
more energy is absorbed so by the time you start reaching deeper structures
there is not enough therapeutic energy to cause adequate tissue stimulation
and thus the reason why low power lasers as well as pulsing lasers
Cannot effectively treat deep seated pathologies.

35. Translation of Previous Two Slides
• Translation – It is important to comprehend that
as laser energy penetrates through the body, more
and more energy is absorbed at each tissue
interface, so by the time you start reaching deeper
structures there may not be enough therapeutic
energy to cause adequate tissue stimulation unless
you start with a sufficient amount of energy on the
skin. This is the reason why low power lasers as well
as pulsing lasers with low power output fail to
deliver when treating deep seated pathologies.

36. Other Factors Affecting Lasers Penetration
• Duty Cycle – 100%
• Laser is firing continuously
• Duty Cycle – 50%
• Laser is firing 50% of the time. This will not only cut
energy delivery but it will also affect ability to penetrate.
• Pulsing – Lasers that pulse also do not emit continuous
energy
• TMA can operate at 100% continuous wave output or
pulse the laser energy while still maintaining a high average
power output. Maintaining a high power output is key to
treating deep seated pathologies.

37. Class III vs. “Class IV” Laser Beams
With a high power output the laser beam can easily penetrate deeper joints
especially when compared to a class iii laser which at best only offers
Superficial penetration.

38. Laser Physics
With a high power output the laser beam can easily penetrate deeper joints

39. Why Therapeutic Lasers Fail
• Under penetration - The typical low level or cold laser or weak
or pulsed class iv laser does not concentrate the laser energy
sufficiently to allow for adequate penetration
• Under-dosage – The typical low level or cold laser or weak or
pulsed class iv laser does not deliver enough energy to
adequately stimulate deep seated inflammatory conditions
• TMA protocols are successful because they call for delivery of
significantly larger amounts of therapeutic energy than
industry standard protocols.

40. TMA Philosophy
• TMA’s goal has always been to build the most efficacious laser
available to deliver the best outcomes.
• Our lasers are built from the ground up and are designed to get
patients who have failed traditional therapy better
• Our competitors lasers are built based on economic factors
• There is a hugh difference between making a patient feel better
vs. actually getting them better.
• There are no shortcuts to treating deep seated pathologies and
one must deliver the correct dosage of laser energy in order to
get the best outcomes.

41. “The Key to Better Outcomes”
• Higher the power output of laser energy
•The Greater The Penetration
•The Faster the Therapeutic Outcome
•The Quicker the Patient Returns to Normal
•This is the main reasons we keep advancing our
technology and developing more powerful lasers.

42. Why More Power is Better
• More power equates to deeper
penetration, faster delivery of the proper
therapeutic dosage, and ultimately better
outcomes
• A 30 watt laser will not only penetrate
deeper, it will put more therapeutic energy
to the target pathology
• It will do this 3X faster than a 10 watt laser
and 5X faster than a 12 watt laser with a
duty cycle of 50%

43. Evidence Based Medicine
•The effects of HPLT can easily be documented
•Clinician’s can measure results using outcome assessment tools:
• Pressure Algometer
• Inclinometer , Goniometer
• Thermal Imaging and Doppler Studies
• VAS, PDQ – Pain Disability Questionnaire
•These tools are vital to document outcomes which ultimately
lead to adequate reimbursement

44. Lasers vs. Standard Modalities Currently Used
to Treat Neuromusculoskeletal Pathologies

45. —HPLT —
A New Trend in Pain Management
• Profound anti-inflammatory and analgesic effects
• Pain relief typically immediate
• Non-invasive and no side effects
• Profound tissue regeneration of all tissue types
• Overall contraindications minimal

46. Clinical Translation of the Previous Slide
as it Pertains to the Spine
• Decreased inflammation of disc, nerve roots and the
cauda equine
• Increase microcirculation of spinal structures
• Accelerate healing of annular defects
• Decreased formation of abnormal/non functional scar
tissue
• Decreased scar tissue and non-osseous hypertrophic
changes
• Reduce pain associated with prolotherapy injection
• Decrease or even eliminate need for epidurals

47. Clinical Translation of the Previous Slide
as it Pertains to the Lower Extremities
• Decreased inflammation of nerve tissue
• Accelerated Reinervation of nerve fibers
• Increase blood flow and microcirculation of tissue structures
• Accelerate healing of open wounds
• Decreased formation of abnormal/non-functional scar tissue

48. Clinical Translation as it Pertains to
the Lower Extremities Continued…
• Increase synovial fluid and cartilage production
• Increase collagen and fibroblast production
• Increase osteoblastic activity and fracture healing
• Decreased bony edema – osteochondral bone bruise
• Decrease in pain associated with epidural, prolotherapy
or other invasive injections

49. Applications of Laser Therapy
•Disc Pathologies, Spinal Stenosis, Radicular Pain,
spondylolesthesis, and sacroiliac dysfunction
•Peripheral Neuropathy and other Nerve Entrapment Syndromes
•Failed surgical back syndrome
• Accelerated Post Surgical, Soft and hard Tissue healing
•Arthritis (Degenerative Joint Disease)
•Foot and Ankle Pain
•Muscle, Ligament and Tendon Injuries
•Ulcerations and Open Wounds

50. Introducing the 2012 TMA
Suite of Laser Platforms
• A technological advancement in energy output and delivery
• The TMA suite of laser platforms offer the world’s most
powerful and advanced therapeutic laser system ranging in
power output from 10 – 60 watts or 10,000mw -60,000mw.
• As a physician based company we have treated or will know
how to treat any condition you are confronted with, the
ultimate result being a better outcome
• With the superior training and clinical support we provide
physicians, the above goal will readily be achieved

51. Introducing the 2012 TMA
Diowave Laser Platforms
10 -15 Watt Laser Platform 20 - 30 and 60 Watt Laser Platform

52. Changing the Way
Physician’s Manage Pain
www.tmainternational.com
1-(866)-862-6606