*Published in The Australian By SUVI MAHONEN - 5th June 2021

Ron Till, 69, was exhausted. For two years he had lost the ability to have a good night’s
sleep. He would go to bed early, only to be woken by his body jerking violently, one of his
many symptoms of Parkinson’s disease.

But things changed for the better when he signed up for a clinical trial assessing the
effectiveness of infra-red light therapy for Parkinson’s sufferers.

“It improved my sleep so much,” Till, who lives in Mannum, South Australia, says.
Within weeks of starting the trial, which involved applying infra-red light therapy to his head
and abdomen, three times a week for 12 weeks, he stopped jerking awake. “I got back my
two blocks of four-hour sleep, which is like gold to me,” Till says.

He was so pleased with his improvement that once the study ended Till purchased a light
helmet device used in the trial, and continues to use it for 20 minutes every second day.
“Sometimes I forget to bring it when I go to visit my brother in Robe,” Till says, “and my
sleep goes downhill fast.”

Till credits his ongoing use of light therapy for preventing his Parkinson’s symptoms from
getting worse. “Since I started the light treatment I’ve plateaued so nicely that my neurologist
has reduced my three monthly visits to yearly.”

The results of the peer-reviewed trial that involved 19 participants in NSW and SA, showed
that Till was not an isolated case – most demonstrating improvements in Parkinson’s
symptoms including gait, balance, cognition and fine motor skills after receiving infra-red
light therapy.

In addition, the trial examined for, and found, changes in the vast numbers of bacteria,
protozoa and fungi that are normally present in the gastrointestinal tract – known as the gut
microbiome. That changes were found in the participants’ gut microbiome meant that this
was the first known trial worldwide to demonstrate changes in the human gut microbiome
following infra-red light therapy.

Brian Bicknell, microbiologist and lecturer at the Australian Catholic University, says he
came up with the idea during a discussion in 2016 with colleagues about why a monkey
previously involved in an experiment on Parkinson’s disease, would show improvement in
symptoms after receiving infra-red light therapy only to its abdomen.
“I suggested it was probably the microbiome,” Dr Bicknell says. “The gut microbiome seems
to be incredibly important to our own overall health.”

Breakthrough Hope

The Australian study’s microbiome findings, which are being published in The Journal of
Photochemistry & Photobiology, B: Biology, offer a potential ray of hope for about 80,000
Australians and 10 million people worldwide who are facing a long, slow decline from a
progressive neurodegenerative disease for which treatment options are limited.

The number of cells in the gut microbiome is estimated to be more than 100 trillion, which is
as many as the number of cells in the rest of our entire body.
​
There has been increased interest in the gut microbiome over recent years, with an
unbalanced microbiome linked to a number of medical disorders, including
neurodegenerative disease, cardiovascular disease, asthma, diabetes, irritable bowel
syndrome, inflammatory bowel disease, colorectal cancer and obesity.

There has long been a postulated link between Parkinson’s disease, the gastrointestinal tract
and the gut microbiome. The gut microbiome in Parkinson’s patients has been shown to be
altered compared to those of the general population.

Constipation affects 90 per cent of Parkinson’s sufferers, often preceding the initial diagnosis
by many years, and there is an increased risk of Parkinson’s disease in those who already
have IBS or IBD.

The reason for this link is undetermined, however the prime suspect is a protein known as
alpha-synuclein. Abnormal accumulations of this protein in nerve cells form microscopically
visible lesions known as Lewy bodies, which are associated with a decreased ability to repair
the DNA damage and increased cell death.

Lewy bodies have been detected in the gastrointestinal tract up to 20 years before the
diagnosis of Parkinson’s disease. They are also present in high numbers in the brain of
Parkinson’s patients.

It is thought that inflammation leads to increased alpha synuclein accumulation in the
gastrointestinal tract, with some of this excess being transported to the brain via the vagus
nerve.

This hypothesis is supported by the fact that those who have undergone a surgical transection
of the vagus nerve — that starts at the brain stem and travels down the body to supply the
stomach, small and large intestine — are less likely to develop Parkinson’s disease.
​
Improvements in the gut microbiome may reduce gastrointestinal tract inflammation and
permeability, which would reduce alpha-synuclein transportation to the brain, as well as
increase the beneficial microbial metabolic by-products, such as serotonin, GABA and
dopamine, thereby reducing the risk of Parkinson’s and improving symptoms in those who
already have the disease.

From Mice to Humans

Australasian Research Institute’s Ann Liebert and her colleagues had already found through
earlier research that the gut microbiome of mice could be altered through administration of
infra-red light therapy. They wished to see if this finding could be replicated in humans.
Nineteen volunteers with Parkinson’s disease from NSW and SA were recruited. All
participants were aged between 60–80 and had mild to moderate symptoms and signs of
Parkinson’s.

The participants gave a faecal sample to researchers before the trial began and were asked not
to alter their dietary habits or day-to-day activities during the duration of the study.

The participants were then given infra-red light therapy via laser devices to their abdomen at
a wavelength of 904-nanometres, and to their head at a wavelength of 810-nanometres and/or
their neck at a wavelength of 904-nanometres, three times a week for 12 weeks. At the end of
the 12 weeks a further faecal sample was collected from each participant and the microbiome
from each of these faecal samples were analysed via DNA extraction and testing.

​Eureka Moment

“It was incredibly exciting to see changes in the microbiome and improvements in symptoms
happening at the same time,” Dr Liebert says.

“Even more exciting when we saw the same kind of changes in the Sydney trial where we
treated the abdomen only.”

The majority of participants showed a significant increase in 10 different genera of
microorganisms including bacteroids, alistipes and prevotella and a significant decrease in 17
different genera including bifidobacterium, streptococcus and various clostridium and
enterococcaceae genera.

Interestingly two of the bacterium that showed an increase – bacteroids and prevotella – have
been shown in multiple studies to be reduced in the gut microbiome of Parkinson’s sufferers.
In fact low levels of prevotella are so strongly associated with a more rapid progression and
greater severity of Parkinson’s that it has been proposed as a biomarker for the disease, while
bacteroids are considered beneficial to the microbiome through their anti-inflammatory
properties and production of healthy short chain fatty acids.

Five of the bacteria that showed a decrease post light therapy – bifidobacterium,
streptococcus, lactobacillus, christensenella and enterococcaceae – have been shown in
multiple studies to be increased in the microbiome of Parkinson’s sufferers.
Several of the bacteria are generally considered detrimental to the microbiome.
Enterobacteriaceae is thought to decrease gut integrity and produce pro-inflammatory
metabolites; Clostridium genera are associated with high fat diets and Type 2 diabetes; and
streptococcus is considered to be potentially pathogenic.

“It is quite possible that laser will provide a synergistic effect to the currently available
therapeutic manoeuvres (to the gut microbiome),” Professor of Cardiology at Macquarie
University Hosen Kiat says. “It is a no-brainer if it is useful because it is relatively cheap, it is
non-invasive and it has zero side effects.”

Surprise Discoveries

Not all the microbiome findings were as expected. Both lactobacillus and bifidobacterium are
considered to be beneficial to the microbiome, yet both bacteria showed a significant
decrease in the majority of participants following light therapy.

“We know that very few diseases have a magic bullet treatment,” Professor Kiat says. “I
don’t want to overall any technology in its infancy. But if I were a Parkinson’s patient I
would seek out the laser and I would use the same protocol as we described.”

Despite these uncertainties, one of the trial’s participants, Margaret Jarrett, 75, is convinced
of light therapy’s benefits. As an avid flower gardener at her Adelaide home, she was
dismayed when she developed anosmia (loss of smell) as a result of her Parkinson’s.
After several weeks of therapy, she regained her sense of smell. “It’s amazing, you go outside
and I suddenly smell the perfume of murraya in full bloom,” she says.

Jarrett noted another improvement post therapy. For years she had been plagued with
debilitating irritable bowel syndrome. “I never knew what the morning would be like,” Jarrett
says. “I like to get up early and go for a walk and sometimes I would get caught short.”
Interestingly, two bacteria that have been found to be elevated in IBS, dorea and
enterococcaceae, decreased post light therapy in Liebert’s trial. “The laser has really helped
me not to have diarrhoea,” Jarrett, who continues to administer light therapy via a handheld
device to her abdomen three times a week, says.

David Harrison, 62, from Sydney, is another trial participant. Diagnosed with Parkinson’s
disease in his mid-50s, Harrison’s symptoms had become so severe that he was having to use
his left hand for most tasks.

“Eight weeks after starting laser therapy I was driving myself home and I suddenly realised I
was right-handed again,” Harrison says.

Post-trial Harrison purchased a handheld laser device and also continues to use it three times
a week. “I still take my medications for Parkinson’s, I think it’s prudent to do that,” he said.
“But I use the light therapy as well. I’m doing everything I can to beat Parkinson’s.”

It is impossible at this stage to know whether the improvements in the Parkinson’s symptoms
of the trial participants were due to the effect of infra-red light therapy to the brain, or due to
changes in the gut microbiome, or partially due to a placebo effect, or, most likely, a
combination of the above.

What is unquestioned is that exposure to light therapy did alter the gut microbiome,
seemingly for the better, and that further research in this area is urgently needed.
With his Parkinson’s symptoms in check, Till plans to do more travelling. “I have family up
on the Gold Coast, and I think to myself, ‘Can I drive that far?’ Before it was impossible but
now I think, ‘Perhaps I can’.”

As for Jarrett, she has some important advice for others who may have Parkinson’s disease
diagnosed.

“Don’t despair and don’t panic,” she says. “Be open-minded about adjunctive therapies and
get a good team to support you. When I was first diagnosed with Parkinson’s I said to my
doctor, ‘It’s not going to get me. I’m going out to meet it’.”

​​Who would have thought that a beam of light could reduce pain and promote healing on almost every part of the body without any side effects? It sounds like science fiction! Cold laser therapy, or photobiomodulation (PBM) is a cutting edge, scientifically proven option for treating a range of conditions.
​

• An Introduction to Cold Laser therapy (PBM)
• How Does Cold Laser (PBM) compare to other treatments?
• ​How does Cold Laser therapy work (PBM) and how long does it last?
• What conditions can Cold Laser therapy (PBM) be used to treat?
• Is Cold Laser therapy scientifically proven to be effective? 
• How safe is Cold Laser therapy (PBM)? 
• Further Reading 

Cold laser therapy is also known as:

• low-level laser therapy (LLLT)
• low-power laser therapy (LPLT)
• soft laser biostimulation
• photobiomodulation therapy (PBMt).

 
Cold laser therapy or photobiomodulation (PBM) can provide relief in just minutes to a wide spectrum of conditions, from sprains, tennis elbow and bruising to carpal tunnel, chronic back, neck and shoulder pains and even conditions such as arthritis and fibromyalgia. Increased blood flow, decreased scar tissue, decreased inflammation and increased cellular growth.
 
Cold laser therapy is simply a beam of light that stimulates the powerhouse of your cells at the site of injury, it provides energy to the cells to speed up healing.
 
Treatment times are usually short, about 10-20 minutes and because it just uses light, treatment doesn’t hurt at all, there are no side effects and often provides relief in the first session and underlying issues effectively treated with 3 to 6 sessions.
 
For chronic conditions, these effects can be long-lasting for sometimes months and even years as a result of improved tissue healing.

​Effective pain management is critical for quality of life for sufferers of both acute and chronic pain and inflammation.
 
Day-to-day life can be a battle when you’ve got pain or inflammation, which can affect all aspects of your life including sleep, mental wellbeing, work and relationships in addition to restricting the ability to undertake physical activities which are so important for maintaining emotional and physical well-being.
 
However many of the treatment options for pain management can be ineffective, invasive or have significant side effects.
 
Low level laser therapy (PBM) has been scientifically proven to significantly reduce inflammation and promote tissue repair and has been used in pain management for years. This painless and non-invasive therapy works at a cellular level to relieve pain. The significant advantages of PBM over other pain management options are that it is non-invasive, may provide long-lasting relief and importantly has no known side effects.

Cold laser therapy (PBM) uses a red or infrared continuous laser (typically 600 to 1000 nm wavelength) for pain reduction and healing stimulation. Light is applied to an injury or a painful site for 30–60 seconds a few times a week for several weeks. Approximately 3-6 treatments are required to reduce inflammation and promote blood circulation which assists revitalisation of cells and promotes healing. The result is a reduction of inflammation, pain relief and accelerated tissue regeneration.
 
With over thirty years of research in this field we can safely say that cold laser therapy (PBM) has no bad side effects. Dr Ann Liebert at Artarmon Physiotherapy has studied the positive effects of laser on musculoskeletal conditions, headache and Parkinson’s disease (refer below). 
 
Cold laser therapy is ‘cold’ because the effect is photochemical, not thermal. The use of lower doses of light is more effective than much higher doses - hence the term low level laser therapy. Cells communicate with each other using light. An easy way to think about how it works it as the effect of light in photosynthesis in plants. Photosynthesis occurs because when light is absorbed by the photoreceptors in plant cells the energy from the light triggers a biochemical reaction in the cell.
 
When cells are injured and diseased, the type of light emitted is altered. Laser therapy uses a 'healthy' light wavelength to re-program injured or diseased cells. This results in repairing the damaged cells to help fast-track recovery. These low doses of light have demonstrated the ability to heal skin, nerves, tendons, cartilage and bones.
 
Cold laser therapy acts as an anaesthetic agent and the most immediate effect is pain relief which can occur within a few minutes of application. This fast-acting pain relief occurs as a result of blocking pain nerves and a reduction of muscle spasms by causing the contracted muscle to release or relax.
 
Within hours and days of treatment, there is a reduction in inflammation and swelling and the long term effects from improved tissue healing occur within a week or two and can last for months or sometimes years.

Cold laser therapy can be used to effectively treat many types of acute and chronic pain and inflammation. Because it acts at a cellular level, the spectrum of conditions that can be treated is incredibly diverse.
 
Studies have shown that it can be effective for:

• Neck pain
• Back pain
• Lymphoedema
• Women’s health/pelvic pain
• Sports injuries
• Migraines/headaches
• Tendonitis
• Frozen shoulder
• Sciatica
• Knee pain
• Carpal tunnel
• Inflammation (e.g. from rheumatoid arthritis or autoimmune diseases)
• Fibromyalgia

 
There are currently clinical trials testing the effectiveness of photobiomodulation on diseases like Parkinson’s Disease, traumatic brain injury, spinal cord injury and Alzheimer’s disease, with patients reporting significant improvement in symptoms after treatment.

​While the list of what can be treated seems almost endless, the key is to match the correct treatment with the targeted condition. The right location-specific dosage and treatment procedure must be adhered to for it to be effective. This is why cold laser therapy should only be administered by a trained, qualified practitioner.
 
There are four main target areas for cold laser therapy:

1. On an injury site to promote healing and reduce inflammation.
2. On lymph nodes to reduce swelling and inflammation.
3. On Nerves to relieve pain.
4. On trigger points to reduce tenderness and relax contracted muscle.

 
Using different treatment times, wavelengths of light and combining laser therapy with physiotherapy for specific injuries can further improve the effectiveness of the treatment.
 
The way it works and the length of time that it remains effective also varies depending on the condition.

There have been 30 years of research into cold laser therapy and other forms of photobiomodulation, which includes many significant clinical trials and reviews of the effectiveness for a range of conditions:
 
Effectiveness and results for Osteoarthritis and rheumatoid arthritis
Cold laser therapy (photobiomodulation) is recommended for short term relief of pain and morning stiffness for arthritis. In clinical trials using cold laser therapy treating hands for rheumatoid arthritis patients reported reduced pain by 70% and reduced morning stiffness by almost 30 min and increased flexibility in the treated hand compared with the untreated hand or placebo treatment.
 
Effectiveness and results for chronic knee back and TMJ pain
Cold laser therapy (photobiomodulation) is extremely effective in reducing pain and improving the range of motion for chronic joint conditions. In a review of 10 clinical trials investigating the effectiveness of cold laser therapy in the treatment of knee, back and jaw (TMJ) pain in 90% of the trials the patients reported a significant reduction in pain this reduction remained significant for three weeks and there was in some instances up to six months following treatment.

Effectiveness and results for Fybromyalgia
In a comprehensive review of 9 clinical trials with 325 patients, patients reported significant improvement in their fibromyalgia impact questionnaire (FIQ) score, reduction in pain severity, the number of tender points, fatigue, stiffness, depression, and anxiety after cold laser therapy.
 
Effectiveness and results for tendon injuries
Chronic tendon injuries (tendinopathy) can take weeks, months or even years to recover with limited treatment options. Cold laser therapy is particularly effective in treating conditions such as Achilles tendon and “Tennis Elbow”. In a review of trials with 80 patients suffering Achilles tendonitis, researchers found cold laser therapy resulted in a significant improvement of pain, range of motion and motor function with lasting relief of symptoms (refer below). Cold laser therapy combined with exercise is even more effective than either treatment alone. A similar review of shoulder tendinopathy found that the current dosage and treatment regime was critical in providing relief and rapid improvement and could be effective alone or in conjunction with physiotherapy.
 
Effectiveness and results for Headaches/Migraines
In a recent study investigating the effectiveness of cold laser therapy for the treatment of chronic migraines, they found that patients treated with cold laser therapy over 5 weeks reported a significant reduction in headache days, reductions in medication use and decreased the intensity of pain. Sleep disturbance was also reduced.
 
Effectiveness and results for Lymphoedema
Lymphoedema (swelling due to accumulation of lymph fluids in an area of the body) has no cure and there are limited therapeutic options to treat it. Cold laser therapy is very effective in treating volume of the affected area, breaking down scar tissue, and increasing the range of motion. In some studies, improvements were reported 12 months after treatment.
 
Effectiveness and results for women’s health/pelvic pain conditions
​Menstrual cramps are caused by powerful chemicals called prostaglandins and arachidonic acid that induce uterine muscle contractions. Cold laser therapy can reduce period pain by reducing inflammation and relaxing muscle contractions, it has also been shown to decrease scar tissue and adhesions association with pelvic pain. One study examined the effects of cold laser therapy and women's health on trigger points combined with exercise on period pain found 76 % of the women receiving three treatments per month reported complete relief after three months. In another study, cold laser therapy treatment five days before the start of menstruation reduced period pain by 83% in the first month. It has also been reported to be effective in the treatment of endometriosis. 

Cold laser therapy is extremely safe when administered by a trained practitioner. All physiotherapists at Artarmon Physiotherapy are fully trained and qualified to administer laser treatment.
 
The technique is called “cold” laser therapy because the low levels of light aren’t enough to heat your body’s tissue. The level of light is low when compared to other forms of laser therapy, such as those used to destroy tumours and coagulate tissue. Surgical and aesthetic lasers heat the tissue being treated. True to its name, cold laser therapy does not.
 
There are no recorded side effects of cold laser therapy. Safety glasses should be worn by everyone present to protect the eyes from the laser’s red or infrared light, as a laser could cause damage to the eye (just like looking straight into a beam of light from the sun).
 
However, there are a number of precautions and conditions where it is recommended to speak to your practitioner about before having treatment:

• Cancer - not recommended over the site of any cancerous tissue, unless the therapy is for palliative care or to reduce chemotherapy side effects.
• Pregnancy- while there is no evidence to suggest that cold laser therapy during pregnancy is harmful, it is recommended that treatment should not be done directly over the developing fetus.
•  Epilepsy - low frequency pulsed visible light (<30Hz) might trigger a seizure in photosensitive, epileptic patients.

All physiotherapists at Artarmon Physiotherapy are trained to perform cold laser therapy - so if you're in Sydney, click the link below to book a session or call  02 9419 3404

• Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials  The Lancet (2009) 374: Chow RT, Johnson MI, Lopes-Martins RAB, Bjordal JM
• In chronic low back pain, low level laser therapy combined with exercise is more beneficial than exercise alone in the long term: a randomised trial.  Australian Journal of Physiotherapy (2007) 52: 155–160; Djavid GE, Mehrdad R, Ghasemi M, Hasan-Zadeh H, Sotoodeh-Manesh A, Pouryaghoub G.
• Low-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis. Pain Physician (2019) 22: 241-254; Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH, Kuan YC.
• A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Australian Journal of Physiotherapy (2003) 49: 107-116; Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren, EA.
• The effects of laser treatment in tendinopathy: a systematic review. Acta Ortopédica Brasileira,(2015) 23: 47-49; Cavalcanti A, Moura M.