Photobiomodulation and Red Light Therapy (Low Level Laser Therapy)
Photobiomodulation and low level laser therapy stimulate circulation, improve tissue repair, reduce pain and inflammation by the application of red and near infra-red light over injuries or lesions. First developed in 1967, it is now commonly referred to as photobiomodulation or red light therapy (previously called laser therapy)
Photobiomodulation / red light therapy has been used for many years on sports injuries, arthritic joints, neuropathic pain syndromes, back and neck pain. PBMT is 54 years old in 2021. Over 1000 randomised, controlled clinical trials have been published with no significant adverse effects reported. Many systematic reviews and professional guidelines now recommend PBMT
Treatments with Photobiomodulation / red light therapy take up to 10 minutes typically and may be applied two or more times a week in acute situations or weekly in less acute conditions alongside conventional osteopathic treatment in strains, sprains, inflammation and chronic pain. At Amersham Osteopathic Clinic, photobiomodulation / red light therapy is used to help speed up healing / repair and reduce the need for anti-inflammatories which slow down the tissue repair process.
PBM / red light therapy is used by the NHS, British and US military, Premier Division soccer teams, Olympic teams, Formula 1, rugby and cricket team therapists, specialist pain clinics, physicians, physiotherapists, osteopaths and chiropractors in the UK and USA and around the world.
The effects of PBM / red light are photochemical (like photosynthesis in plants). When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases ATP. This improves cell metabolism and reduces inflammation. When pain relief / analgesia is required, there is a different type of treatment with a different mechanism of action used. PBM works predominately on a protein in mitochondria (cytochrome c oxidase) to increase ATP and reduce oxidative stress. A cascade of mitochondrial and intracellular downstream effects lead to improved tissue repair and reduced inflammation
PBM and red light therapy is popularly used for soft tissue injuries, joint conditions, neuropathic pain, fibromyalgia and TMD. The intensity of lasers and LED’s is not high, like a surgical laser. There is no direct heating effect.
In the last 15 years, many systematic reviews have found in favour of red light / PBM Therapy:
A BMJ Open (2019) systematic review and meta-analysis found PBM / red light was effective for knee arthritis with overall, pain and disability were significantly reduced by PBM / red light therapy compared with placebo at the end of therapy click here as did a TMJ systematic review here
BMJ PBM for chronic non-specific low back pain: a systematic review and meta-analysis of randomised controlled trials found “moderate quality of evidence” and “clinically important benefits” in the short term. (2016) Click here
BMJ Sports Medicine Journal, a systematic review of surgical and conservative interventions for frozen shoulder found “strong evidence” for PBM. (2010) Click here
The International Association for the Study of Pain (Global Task force on musculoskeletal pain) found “strong evidence” for PBM /l Laser Therapy on myofascial pain syndrome. (2010) Click here and to be of benefit for temporomandibular myofascial pain (2018) (click here)
PBM has been found to be “an effective, safe, and well-tolerated treatment for fibromyalgia” in a 2019 systematic review and meta-analysis (here)
A 2015 systematic review found for PBM in shoulder tendinopathy (here) and in 2020, evidence for various tendinopathies (here). American Physical Therapy Association guidelines recommend PBM for Achilles tendonitis (2010). Click here
The Lancet systematic review found it “reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain”. (2009) Click here
World Health Organisation (Bone and Joint Task Force) for neck pain noted it was “more effective than no treatment, sham, or alternative interventions” (2008) Click here
In August 2010 The Lancet reported that the systematic review of laser therapy for neck pain was in their top 20 most downloaded papers for 2010.
There is also evidence to support the use of PBM in aiding fracture / bone healing click here, here and here for some research on this.
NICE (National Institute of Clinical Excellence recommends Photobiomodulation therapy for oral mucositis (an extremely common side effect of cancer therapy) click here: NICE , and a recent systematic review (2020) of Safety and Efficacy of Photobiomodulation therapy in Oncology found significant and growing literature indicates that PBMT is safe and effective, and may even offer a benefit in patient overall survival (Cancer / Oncology)
There is exciting emerging evidence for PBM / red light therapy effects on traumatic brain injury (TBI) click here . A 2020 RCT on TBI stated “Transcranial near-infrared low-level light therapy administered after traumatic brain injury (TBI) confers a neuroprotective response” and found PBM had a demonstrable effect on the brain, “trans-cranial LLLT targets and engages neural substrates that play an integral role in the pathophysiologic effects of moderate TBI” and may affect myelin repair pathways (TBI RCT ); a 2019 systematic review showed benefit of PBMT for depression and stress (here).
In 2025, the US FDA authorised PBM for Dry age-related related macular degeneration.
