Abstract
In this educational post, I will guide you through the latest advancements in photobiomodulation, with a focus on Multiwave Locked System (MLS) Laser Therapy. We will explore how this cutting-edge technology works at a cellular level to alleviate pain, reduce inflammation, and accelerate healing. Drawing upon the latest evidence-based research from leading experts, I will break down complex concepts such as optimal energy density, the Arndt-Schultz law, and the unique dual-wavelength approach of MLS lasers. We will discuss practical applications for both acute and chronic conditions, including low back pain and osteoarthritis, and the powerful synergy of these conditions with orthobiologics such as Platelet-Rich Plasma (PRP).
Furthermore, I will explain how we seamlessly integrate this technology into integrative chiropractic care to create a holistic, patient-centered treatment plan that addresses the root cause of dysfunction and optimizes your body's innate healing potential. This post aims to provide a comprehensive, easy-to-understand overview of the physiological underpinnings and clinical strategies revolutionizing non-invasive pain management and tissue regeneration.
Setting the Stage for Advanced Healing: Patient Comfort and Precision
When preparing for an advanced therapy session like Multiwave Locked System (MLS) Laser Therapy, my primary focus is always on patient comfort. This is not just a matter of courtesy; it is a clinical necessity. Especially when utilizing a robotic laser applicator, the patient must be comfortable and relaxed to remain still. Any movement could shift the targeted area, compromising the precision of the treatment.
The goal is to deliver light energy directly to the skin over the affected area. Let's take the common case of low back pain and stiffness. In my clinic, I've observed countless patients like John, who presented with joint pain and stiffness localized around the L4-L5 facet joints, with some discomfort radiating down the right side. For this, a face-down position is ideal. We ensure the patient is comfortably positioned before exposing the skin over the treatment area.
The Clinical Multimodal Approach: Treating the Source, Not Just the Symptom
Once the patient is ready, we roll the robotic laser into position. The interface is remarkably intuitive. For John’s low back stiffness, I select the "Joint Pain and Stiffness" protocol. My first step is to zero out the X and Y axes on the control panel. This temporarily fixes the laser's position, allowing me to precisely center the aiming beam over the primary site of his discomfort.
From there, I expand the treatment perimeter. This is a key part of our clinical multimodal approach. We don't just target the single spot of pain. Pain is often a symptom of a broader issue involving surrounding tissues. Therefore, I expand the robotic laser's treatment grid to cover not only the specific vertebral level but also the adjacent connective tissues, ligaments, and muscles. This global approach ensures we are treating the source of the dysfunction and its interconnected network, rather than just chasing the pain.
Why Distance Matters: The Focal Point and Collimated Beam
A crucial element of this therapy is the distance of the laser from the skin. The MLS laser's robotic head is designed with a specific focal point. We use the simple ruler that comes with the device to set the distance to exactly 6 inches.
Focal Point: The laser energy is most effective at a distance of 5 to 7 inches, with the optimal center at 6 inches.
Collimated Beam: The laser beam is collimated, meaning the light waves are parallel and do not spread out significantly over distance. This provides a small margin of error, but precision remains key for optimal energy delivery to the target tissues.
Once the height is set and the area is defined, the treatment begins. For John’s low back, it was an eight-minute session. During this time, the robot automatically moves, treating the entire programmed area without any further intervention.
The Dual-Wavelength Advantage of MLS Laser Therapy
What is happening during those eight minutes is a sophisticated delivery of light energy. The MLS system is unique because it uses two different wavelengths of light synchronized to work together: 808 nanometers (nm) and 905 nanometers (nm).
The 808 nm continuous wave is excellent for reducing inflammation and edema. It works more superficially and steadily.
The 905 nm pulsed wave has a powerful analgesic (pain-relieving) effect and can penetrate deeper into tissues.
You can actually visualize a portion of this technology. If you view the treatment area through a smartphone camera, you can see a distinct triangle of light—this is the 808 nm wavelength at work. The 905 nm wavelength pulses so rapidly, in nanoseconds, that the camera can't capture them, but they are delivered simultaneously.
This synchronized, patented pulse delivers very high peak power (up to 50 watts) in extremely short durations. This is like a powerful, yet gentle, "punch" of energy that penetrates deep into the tissue. Following each pulse, there is a period of thermal relaxation, allowing the tissue to absorb the energy without overheating. This is why patients, including John, typically feel nothing more than a gentle warmth or a slight tingling. If a patient is sensitive and feels a bit more, I often lightheartedly call them an "overachiever," reassuring them it's a perfectly normal response to the stimulation of their cells.
Energy Density vs. Total Joules: The Science of Dosing
A common question I get is about the "dose" of laser therapy. In the world of photobiomodulation, there is a lot of discussion about total joules versus energy density (joules/cm²). While related, they are not the same. The scientific literature, including guidelines from the World Association for Laser Therapy (WALT), overwhelmingly indicates that energy density is the more critical metric for achieving predictable clinical outcomes.
Our goal is to deliver a specific dose of energy to a specific volume of tissue. The therapeutic window for most conditions falls between 4 and 10 joules/cm².
Too little energy, and you won't stimulate a therapeutic response.
Too much energy, and you risk the bioinhibition paradox, where the therapeutic effect diminishes or becomes inhibitory. This concept is rooted in the Arndt-Schultz Law, which states that weak stimuli excite physiological activity, moderate stimuli favor it, and strong stimuli inhibit it.
For John's low back pain, the protocol was set to deliver 6 joules/cm². The software is incredibly advanced; if I were to change the size of the treatment area (the X and Y axes), the machine would automatically recalculate the treatment time to ensure it still delivers a precise 6 joules/cm² to that new area. This automation ensures dosing accuracy and consistency, which is a significant leap forward in laser technology.
Integrating Hands-On Care with Robotic Precision
While the robotic laser treats the broader area, I often use a handheld MLS laser applicator simultaneously. This handheld piece has one laser diode and is used in direct contact with the skin. It's perfect for targeting very specific points, such as:
Trigger points (hyperirritable knots in muscle tissue)
Specific joint spaces
Acupressure points
This allows me to perform a more dynamic treatment. For example, I can have the patient move while I apply the laser to a specific joint, combining photobiomodulation with active motion. Clinically, I often search for what a DPT once described to me as the difference between "raw meat" (soft, healthy muscle) and "cooked meat" (the dense, knotted feel of a trigger point). The goal is to use the laser to help release that knot and restore the muscle to a healthier state.
The robot and the handpiece operate on two separate channels, so I can run a general program on the back while simultaneously addressing specific trigger points in the glutes or the piriformis muscle, providing a truly comprehensive and layered treatment in a single session.
The Synergy with Integrative Chiropractic Care
This is where the principles of integrative chiropractic care come into full play. Laser therapy is not a standalone solution but a powerful tool within a broader therapeutic strategy.
Chiropractic Adjustments: Before or after the laser session, I perform specific chiropractic adjustments. If a vertebra is misaligned (subluxated), it can cause nerve irritation and muscle guarding. By restoring proper joint mechanics through an adjustment, we alleviate the root mechanical stress. The laser then works at the cellular level to reduce inflammation and pain in the surrounding soft tissues, accelerating the healing initiated by the adjustment.
Soft Tissue Mobilization: Techniques like Graston or Active Release Technique (ART) can be used alongside the handheld laser. I can use instruments to break down fascial adhesions and scar tissue, then immediately apply laser therapy to reduce post-procedural inflammation and accelerate healthy tissue regeneration.
Corrective Exercises: The reduction in pain and inflammation from laser therapy creates a crucial window of opportunity. Patients who were previously too sore to perform their rehabilitative exercises can now do so more comfortably. This allows us to strengthen weak muscles, stretch tight ones, and correct the postural and movement patterns that contributed to the injury in the first place.
This integrative model ensures we are addressing the issue from all angles: structural (chiropractic adjustments), cellular (laser therapy), and functional (rehabilitative exercise).
Applications Beyond Back Pain: Knees, Orthobiologics, and Chronic Conditions
The principles are the same for other conditions, like knee osteoarthritis. For a knee, we must be strategic. Applying the laser directly to the front of the knee means much of the energy will be reflected by the patella (kneecap). Therefore, a more effective approach is to treat the knee in a flexed position, targeting the joint from the medial and lateral sides, and often from the posterior (back) as well. This allows the light energy to penetrate the joint space more effectively.
A Powerful Alliance: MLS Laser and Orthobiologics (PRP)
One of the most exciting frontiers is combining MLS laser therapy with orthobiologics, such as Platelet-Rich Plasma (PRP) injections. PRP involves using a patient's own concentrated platelets to stimulate healing in injured tissues. The challenge with PRP is that its success depends on the health of the surrounding tissue environment.
Here is where the laser becomes a game-changer. We've developed protocols based on emerging research that show incredible promise:
Pre-Injection Priming: We recommend two to three laser sessions before the PRP injection. The goal is to "prepare the soil." The laser increases local blood circulation, reduces inflammation, and starts to optimize the cellular environment, making it more receptive to the growth factors in the PRP.
Day of Injection: A laser session on the day of the injection can further enhance the process.
Post-Injection Support: Six or more laser sessions after the PRP injection help modulate the initial pro-inflammatory phase of PRP, manage discomfort, and support the regenerative cascade initiated by the platelets.
Based on my clinical observations and data shared by leading researchers, adding MLS laser therapy to a PRP protocol can enhance efficacy by an estimated 15-20% compared with PRP alone. It augments the healing process, rather than interfering with the beneficial inflammation that PRP initiates.
Understanding the Cascade: From Acute Relief to Chronic Healing
How does this therapy work for both acute injuries and chronic conditions? The effects are layered and build over time.
Acute Phase (First 1-3 Treatments): The immediate effect is primarily analgesic and anti-inflammatory. The laser energy helps modulate nerve signals (affecting the small, C-fibers that transmit pain) and reduces the inflammatory mediators in the area. Patients often feel noticeable pain relief within 4-6 hours of their first treatment. As one colleague noted, you'll feel the effects long before the bourbon kicks in!
Sub-Acute Phase (Treatments 4-6): As inflammation and pain are controlled, the bio-stimulative effects take center stage. The light energy is absorbed by cytochrome c oxidase within the mitochondria of our cells. This supercharges the mitochondria, leading to a massive increase in ATP (adenosine triphosphate) production, the cell's primary energy currency. This extra energy fuels cellular repair and regeneration.
Chronic/Regenerative Phase (Treatments 7-12+): With continued treatment, we see significant, more lasting changes. The sustained increase in ATP production supports mitochondrial biogenesis (the creation of new mitochondria), enhances protein synthesis, and boosts collagen production. This leads to the actual repair and remodeling of damaged tissue, providing long-term resolution.
This is why we structure our treatment plans in packages. For an acute condition, 6 sessions might be sufficient. For a chronic issue that has persisted for years, 12 sessions are typically needed to push through the layers of dysfunction and achieve lasting healing. The effects are cumulative, so consistency is key. We typically recommend a schedule of three treatments per week to build momentum as quickly as possible.
In conclusion, advanced laser therapy is not magic but profound science. By delivering specific wavelengths of light in precise doses, we can stimulate the body's incredible capacity for healing at the most fundamental cellular level. When combined within a comprehensive, integrative chiropractic framework that addresses the body’s structure and function, it becomes one of the most powerful non-invasive tools we have to help patients move beyond pain and reclaim an optimized, active life.
References
Cotler, H. B., Chow, R. T., Hamblin, M. R., & Carroll, J. (2015). The use of low level laser therapy (LLLT) for musculoskeletal pain. MOJ Orthopedics & Rheumatology, 2(5), 00068. https://doi.org/10.15406/mojor.2015.02.00068
Chung, H., Dai, T., Sharma, S. K., Huang, Y. Y., Carroll, J. D., & Hamblin, M. R. (2012). The nuts and bolts of low-level laser (light) therapy. Annals of Biomedical Engineering, 40(2), 516–533. https://doi.org/10.1007/s10439-011-0454-7
World Association for Laser Therapy. (n.d.). WALT recommended treatment doses for LLLT. Retrieved May 2, 2026, from https://waltza.co.za/documentation-links/dosage-recommendations/
Ferraresi, C., Hamblin, M. R., & Parizotto, N. A. (2012). Low-level laser (light) therapy (LLLT) on muscle tissue: performance, fatigue and repair benefited by the power of light. Photonics & Lasers in Medicine, 1(4), 267–286. https://doi.org/10.1515/plm-2012-0032
Huang, Y. Y., Chen, A. C. H., Carroll, J. D., & Hamblin, M. R. (2009). Biphasic dose response in low level light therapy. Dose-Response, 7(4), 358–383. https://doi.org/10.2203/dose-response.09-027.Hamblin
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
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Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
email: coach@elpasofunctionalmedicine.com
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Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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