Abstract
This article explores the transformative potential of Photobiomodulation Therapy (PBMT), often referred to as laser therapy, in modern healthcare, particularly when integrated with orthobiologics and comprehensive chiropractic care. From my perspective as an integrative practitioner, I will guide you through the scientific principles of how light energy can stimulate cellular healing, reduce inflammation, and accelerate recovery. We will delve into the cellular-level physiological mechanisms, including mitochondrial activation and cytokine modulation, drawing on the latest evidence-based research. I will also discuss the collaborative, multidisciplinary model at our clinic, where I work alongside our Medical Director, Dr. Maria Guadalupe Cardenas, MD, to provide a seamless blend of medical oversight, chiropractic adjustments, functional medicine, and advanced therapies like PBMT. This post aims to illuminate how this synergistic approach is not just treating symptoms but fundamentally altering the course of both acute and chronic conditions, paving the way for true disease modification and improved patient outcomes.
A New Dawn in Healing: My Journey with Photobiomodulation
I feel like I've found my community. For nearly a decade, I have been a passionate advocate for using light as a healing modality, and I've never heard the word "laser" used so frequently and with such enthusiasm as I do now at conferences among my peers. It is genuinely thrilling to have this opportunity to share my experience with you.
I can tell you the journey has not been easy, especially when it comes to discussing laser therapy. For the first five years, it felt like I was dodging rotten tomatoes and broken beer bottles. I am sure many of you in the regenerative and biologic medicine space can relate to the resistance you feel when introducing groundbreaking yet unfamiliar concepts. The rollout of orthobiologics faced similar skepticism. So, it is with great pleasure that I can now stand before a receptive audience and share the incredible science and clinical success of photobiomodulation.
Let's begin with a fundamental concept we all accept: photosynthesis. The sun shines; plants absorb this light energy, convert carbon dioxide into the oxygen we breathe, and provide sustenance for virtually all life on Earth. As a species, we have evolved over hundreds of thousands of years on the surface of this planet, bathed in sunlight. Our cells, down to their deepest genetic components, have been adapting under this light. It should, therefore, come as no surprise that our bodies are exquisitely sensitive to light.
Think about this: in medical school, we were all taught that sunlight is essential for vitamin D synthesis. We accept this without question. Yet there is a significant gap—a chasm, really—in modern medical education regarding Photobiomodulation Therapy (PBMT). The idea that light can be harnessed for therapeutic purposes beyond vitamin D is rarely, if ever, discussed. Today, I want to bridge that gap and show you how the themes of cellular therapy, which are so familiar in the world of biologics, are remarkably consistent with the principles of PBMT.
The Science of Light and Life: What is Photobiomodulation?
The term "photobiomodulation" breaks down quite simply:
Photo: Light
Bio: Life
Modulation: To affect or change
At its core, PBMT is the use of light to create a biological effect. We know that light is a form of energy, composed of particles called photons. Think of photons as the currency of light energy. When these photons penetrate the body's tissues, they transfer their energy to our cells, initiating a cascade of beneficial biological responses.
For the first twenty years of my clinical practice, I operated like a mechanic, using a set of tools to "fix" specific conditions. The last ten years, however, have transformed me into more of a biologist. The central question has become: How can we empower the body's own cells to orchestrate a healing response? This is where the concept of cellular recovery becomes paramount, and it’s why I feel so connected to those in the regenerative medicine field. This is what you do and what you get excited about.
Deep Dive into the Cellular Mechanisms of PBMT
Everyone in functional and regenerative medicine is talking about mitochondrial health and ATP (adenosine triphosphate) production, and for good reason. It’s the energy engine of our cells. But the effects of PBMT go much deeper. Let's explore the cell-mediated reactions well documented in the basic science literature.
Mitochondrial Activation: The primary target of PBMT within our cells is an enzyme in the mitochondria called cytochrome c oxidase. This enzyme is a photoacceptor, meaning it is specifically designed to absorb photons. When it absorbs this light energy, the enzyme becomes more active. This supercharges the Krebs cycle, leading to a cascade of events.
Signaling and Gene Transcription: The activation of cytochrome c oxidase leads to a transient increase in reactive oxygen species (ROS), the release of nitric oxide (NO), and ultimately, increased ATP production. These molecules act as powerful downstream messengers. This signaling cascade travels from the mitochondria to the cell's nucleus, where it influences gene transcription. This means the light is literally turning on the genetic switches responsible for healing and repair.
Immune and Inflammatory Modulation: Gene transcription produces proteins, including cytokines. Cytokines are the master communicators of the immune system. When you have an injury, a flood of pro-inflammatory cytokines is released, bringing in platelets and white blood cells to clean up the damage. Research has clearly demonstrated that PBMT, when used at the correct wavelengths and dosage, can shift this balance. We can measure an increase in anti-inflammatory cytokines, like interleukin-10 (IL-10), and a simultaneous decrease in pro-inflammatory cytokines, such as interleukin-6 (IL-6). This effectively moves the tissue out of a destructive, chronic inflammatory state and into a reparative, healing phase.
Angiogenesis and Neurogenesis: PBMT also stimulates the creation of new blood vessels, a process known as angiogenesis. This is partly driven by cytokines such as galectin and results in improved microcirculation, thereby delivering more oxygen and nutrients to the damaged area. Furthermore, we see evidence of neurogenesis, or nerve repair. Specific proteins, such as HNRP-K, can be assayed to assess enhanced axonal growth, demonstrating that PBMT can help repair damaged nerves.
Muscle and Tissue Repair: The benefits extend to muscle tissue as well. Electron microscopy studies have shown that PBMT can improve muscle cell development and increase myoglobin production, which enhances oxygenation. Finally, PBMT activates fibroblasts, the cells responsible for producing collagen and building the structural framework for new tissue. These are the very same cells that orthobiologic treatments aim to stimulate.
In essence, PBMT orchestrates a symphony of healing at the cellular level. It modulates the immune response, increases blood flow, repairs nerves, and rebuilds muscle and connective tissue. It provides the energy needed to transition from an acute or stalled chronic inflammatory state to a proactive recovery phase.
Our Integrative Clinical Model: Chiropractic, Medical, and Functional Care
At Injury Medical Clinic, we have built a practice around this integrative philosophy. Our model is designed to treat the whole person, not just an isolated injury. As a doctor of chiropractic with extensive training in functional and integrative medicine, my focus is on restoring structural integrity and optimizing physiological function. Chiropractic care is foundational; by ensuring proper spinal alignment and nervous system function, we create an optimal environment for the body to heal itself.
This approach is powerfully complemented by our collaboration with Dr. Maria Guadalupe Cardenas, MD. With over 40 years of experience as a board-certified internist, Dr. Cardenas serves as our medical director and collaborative physician. This multidisciplinary structure, common in leading injury and integrative clinics, allows us to offer a comprehensive spectrum of care under one roof. Dr. Cardenas provides essential medical oversight, diagnosis, and management, ensuring that all treatments are safe, appropriate, and medically sound.
Together, our team integrates the following:
Chiropractic Adjustments: To correct biomechanical faults and improve nerve function.
Medical Oversight (Dr. Cardenas): For accurate diagnosis, management of underlying medical conditions, and collaborative treatment planning.
Functional Medicine: To identify and address root causes of dysfunction through advanced lab testing and personalized nutrition and lifestyle protocols.
Photobiomodulation Therapy (PBMT): To provide the cellular energy needed to fuel the healing processes.
Rehabilitation and Personal Injury Care: To restore strength, mobility, and function following an injury.
This integrated system ensures that when we apply a therapy like PBMT, the patient's entire system is primed for success. The chiropractic adjustment has already improved nerve flow, the functional medicine protocol has reduced systemic inflammation, and the medical oversight has ruled out any contraindications. It is a truly synergistic model.
Understanding the "How": The Physics of Laser Therapy
So, why does PBMT work for so many different conditions, from tendonitis to arthritis? When I first started, I was labeled a "snake oil salesman" for suggesting that one modality could treat everything from neck pain to carpal tunnel. But the truth is, we are not treating conditions; we are treating dysfunctional cells. By altering the cellular environment and supplying energy for repair, we can influence any pathological process rooted in inflammation and cellular dysfunction. This is why PBMT is effective for most things that end in "-itis."
To understand how it works, we need to look at the electromagnetic spectrum. Visible light is just a tiny sliver of this spectrum. On one end, you have high-energy, short-wavelength rays like gamma rays, which are destructive. On the other end are low-energy, long-wavelength radio waves, which pass right through us.
There exists a "therapeutic window" within this spectrum, roughly from red light (around 600 nanometers) to near-infrared light (up to about 1200 nanometers). Light within this window has the perfect balance of energy and wavelength to penetrate tissue and be absorbed by our cells without causing damage.
The key challenge is getting the photons to the target tissue where the pathology lies. Three main barriers absorb or scatter light:
Skin (Melanin)
Blood (Hemoglobin)
Water
Effective PBMT devices must use wavelengths that can bypass these absorbers to penetrate deeply. Red light, for example, is great for skin conditions because it only penetrates 3-4 millimeters. But for a deeper joint or muscle injury, you need near-infrared wavelengths that can reach the target.
MLS Laser Technology: A Synchronized Approach to Healing
In my practice, I am a huge proponent of MLS (Multiwave Locked System) laser technology. I have spent a great deal of time researching different devices, even visiting the manufacturers in Italy. Not all lasers are created equal, and the MLS system has a unique mechanism that I believe makes it particularly effective and safe.
The MLS laser uses two different wavelengths simultaneously:
A continuous wave (808 nm) that provides a powerful anti-inflammatory and anti-edema effect.
A pulsed wave (905 nm) that delivers a strong analgesic (pain-relieving) effect.
These two wavelengths are synchronized and pulsed on and off thousands of times per second. This pulsing action allows the tissue to absorb the photons and initiate the biological cascade without accumulating thermal energy (heat). This is a critical safety feature. It means we can deliver a powerful therapeutic dose of energy safely and efficiently. I can literally turn the laser on, position it over the treatment area, and attend to another patient in the next room without worrying about thermal damage. The safety profile and efficacy are simply incredible.
The Ultimate Synergy: Combining PBMT with Orthobiologics
Now we arrive at the most exciting frontier: combining PBMT with orthobiologics like Platelet-Rich Plasma (PRP). We know that PRP contains a powerful cocktail of growth factors and anti-inflammatory proteins. It delivers a message to the local cellular environment, telling the cells to begin a healing and regeneration process.
Now, think about what happens when you combine that powerful message with the fuel required to carry it out. PBMT provides that fuel. By activating the mitochondria and ramping up ATP production, we are revving the cell's engine, making it more responsive to signals from the PRP. We are fueling the very cellular activity that the biologic message is intended to create.
Are others talking about this? Absolutely. While much of the initial evidence was anecdotal, the hard science is catching up. And when I'm not sure about a new frontier in human medicine, I often look to our colleagues in veterinary medicine, who are frequently a few steps ahead.
A landmark study on canine knee osteoarthritis provides compelling evidence. This was a brilliantly designed randomized controlled trial where each dog served as its own control. The researchers treated the dogs' arthritic knees with:
PBMT alone.
PRP injection alone (after a washout period).
A combination of PBMT and PRP.
The results were clear: the combination of PBMT and PRP produced significantly better outcomes. And yes, there are patient-reported outcomes in the veterinary world! Owners documented improvements in their dogs' ability to get into cars and go up and down stairs. Dogs don't have secondary gain or a placebo effect; when they stop limping, you know the treatment worked.
The Future is Biology: From Symptom Management to Disease Modification
For too long, medicine has been focused on treating symptoms. Our goal should be to get ahead of the disease process and intervene earlier to prevent progression to end-stage conditions that require metal implants and joint replacements. The future of orthopedics is biology.
I am especially proud to share some recent research that underscores this point. My son, Zachary, recently completed a study at the Mass General Brigham Enable BioSkills Lab. We took human tenocytes (tendon cells) and treated them with our laser. The results were astounding: we demonstrated a 20% dose-dependent increase in tenocyte proliferation with PBMT alone. We are literally growing new tendon cells with light. Our next steps involve qPCR testing to map the genetic messaging and ELISA testing to measure the protein production, which will further elucidate the specific pathways being activated.
This is a proud dad moment, but more importantly, it is a powerful validation of what we have been observing clinically for years. Photobiomodulation works. Laser therapy works. It has been a pleasure to share this information with you, and I am more confident than ever that by integrating these advanced biological approaches, we can truly change the future of healthcare.
Thank you.
References
Anders, J. J., Lanzafame, R. J., & Arany, P. R. (2015). Low-level light/laser therapy versus photobiomodulation therapy. Photomedicine and Laser Surgery, 33(4), 183–184. https://doi.org/10.1089/pho.2015.9848
Bagnato, G. L., Miceli, G., Marino, N., Sciortino, D., & Bagnato, G. F. (2016). Photobiomodulation and complementary and alternative medicine in osteoarthritis: a narrative review. Clinical Rheumatology, 35(6), 1461–1468. https://doi.org/10.1007/s10067-016-3242-7
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). https://doi.org/10.15406/mojor.2015.02.00068
de Freitas, L. F., & Hamblin, M. R. (2016). Proposed mechanisms of photobiomodulation or low-level light therapy. IEEE Journal of Selected Topics in Quantum Electronics, 22(3), 348-364. https://doi.org/10.1109/JSTQE.2016.2561201
Dowd, S. E., & Pautler, R. G. (2022). A review of the evidence for the use of photobiomodulation in the management of pain. Journal of Pain Research, 15, 2187–2200. https://doi.org/10.2147/JPR.S361958
Zein, R., Selting, W., & Hamblin, M. R. (2018). Review of light parameters and clinical efficacy of photobiomodulation for osteoarthritis. Photomedicine and Laser Surgery, 36(8), 404–412. https://doi.org/10.1089/pho.2017.4410
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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