Bring out the Laser! Cold laser (Low Level Laser) …that is!

services-cold-laser

Fiona McMahon, DPT

When you think laser you may think of lasers for hair removal, tattoo removal, as surgical instruments, or if you are a child of the late 80’s early 90’s like me, you may think of Dr. Evil from the Austin Powers movies. These lasers are all examples of thermal lasers, ( ok, I didn’t check on Dr. Evil’s laser), which use heat to treat tissues. These examples may be all you think of when you think of lasers, but did you know that a different type of laser, cold laser, is a new and effective tool that the therapists at Beyond Basics are using to help treat their patients who suffer from a broad range of conditions from orthopedics injuries, pelvic pain to post operative recovery?

 

What is Cold Laser and how is it thought to work?

Cold laser or low level laser light therapy (LLLT) differs from the conventional lasers mentioned above in that they have a much lower light density than that of the lasers used in hair removal or surgery. Cold lasers do not emit heat, thus the moniker, cold laser.

Lasers were invented in the 1960’s and they were quickly used for therapeutic purposes.  1967 lasers were applied to the backs of shaved mice and the hair of the mice treated with laser grew back quicker than the mice that did not receive the laser treatment. Shortly after that study was conducted, lasers began being used to stimulate wound healing in non-healing ulcers.

Even though initial research on lasers started in the early 60’s, the mechanism by which lasers do their work is still not fully understood. There is strong evidence to suggest that laser therapy aids in ATP production ( the energy of cells), collagen production, cell turnover, and release of endorphins. The use of laser for therapeutic purposes was deemed safe by the Food and Drug Administration in 2002.

 

What can the use of cold laser help with?

Cold laser can be a brilliant adjunct to standard physical therapy treatment; however it is a component of treatment and does not correct the underlying factors that caused the original injury, therefore traditional physical therapy treatment of strengthening weak muscles and stretching and lengthening tight ones, correcting alignment, and improving overall fitness is essential to provide patients with truly long lasting results.

 

The use of laser has been found in many studies to be effective in reducing pain. In a meta-analysis conducted by Huang and colleagues, laser was shown to have a significantly  greater effect at lowering pain scores over placebo in patients with chronic low back pain.

 

In another study conducted in 2003, low level laser therapy was found to be more effective than placebo in reducing pain in patients with myofascial pain syndrome. In this study, both groups were given stretching exercises, but one group was also given  LLLT.  Immediately following the experiment and at the 3 week follow up pain levels were found to be significantly lower in the group that received LLLT.

 

Another study conducted by Foley et al, examined the “return-to-play” times for college athletes who were treated with laser versus their projected “return-to-play” times based off of historical data for the players’ given injuries. The study found that laser treatment shortened the “return-to-play” times by 9.6 days, which was statistically significant. The athletes required 4.3 laser treatments on average before they could return to their sports.

 

Laser is a great adjunct to traditional physical therapy and is a great help to patients where nothing nothing else has been effective. At Beyond Basics PT, LLLT complements our expert manual and orthopedic skills to treat pelvic pain, incontinence, post-surgical injuries, and orthopedic conditions. If you think LLLT may be right for you, make an appointment at Beyond Basics Physical Therapy today!

 

Foley J, Vasily D, Brandie J, et al. 830 nm light-emitting diode (led) phototherapy significantly reduced return-to-play in injured university athletes. Laser Ther. 2016; 25(1):35-42

 

Chung H, Dai T, Sharma S. The nuts and bolts of low level laser (light) therapy. Ann Biomed Eng. 2012; 40(2) 516-33

 

Hakgüder A, Birtane M, Gürcan S, et Al. Efficacy of low level therapy in myofascial pain syndrome: an algometric and thermographic evaluation. Lasers Surg Med. 2003;33(5): 339-43
Huang Z, Ma J, Shen Bin, et al. The effectiveness of low-level laser therapy for low-level laser therapy for nonspecific chronic low back pain: a systematic review and meta-analysis. Arthritis Res Ther. 2015; 17: 360.

 

A Fitbit for your Vagina?!

Fiona McMahon, DPT

Elvie

 

For a while you could find me strolling around the clinic with a little fitness tracker on my wrist. I used it to track my steps, sleep, and heart rate. I’m a girl who loves gadgets and apps. From Venmo to Spotify, technology enriches my life and makes it easier. So when Elvie sent their kegel trainer to Beyond Basics, I jumped at the chance to volunteer myself guinea pig, to try out this new fitness tracker.

 

Unboxing, Aesthetics, and Set Up

Man, oh man is the product design gorgeous on this one. It comes in a beautiful silver embossed box with the tagline “ your most personal trainer”  ( wink, wink, nudge, nudge). Inside there is an inch diameter cylinder “vessel” for lack of a better term, which houses the Elvie tracker. The vessel functions as both a carrying case and a charger. It’s pretty slick looking.

The Elvie itself looks like a little tadpole with a tail. It’s about an inch long and half an inch in diameter not counting its little tail. There is also an optional cover provided in the box, which may be more comfortable for some ladies.

The whole set up: The tracker had the feel of opening an iphone, in that the directions provided in the tracker were kept pretty minimal. There was a small pamphlet with cleaning instructions, on charging, how to insert, and exercise. As a pelvic floor physical therapist, I definitely felt that the instructions on how to properly kegel left a lot to be desired. The instructions were literally two bullet points instructing the user not to hold her breath or tighten her buttocks, while she lifts her “pelvic floor”. For many of my patients, I find that they come to me with little knowledge of how to properly kegel or are doing it wrong, “lift the pelvic floor” is rarely a cue that allows for a fully correct kegel.

My next step was to download the Elvie app. I have an iPhone 6. You need a smartphone to run the elvie. They recommend iPhone 5 or later or Android phones running version 4.3 or later. The app download was easy. It was time to get started.

 

Elvie: Day 1

The moment of truth had arrived. Time to insert one of the cuter inanimate objects I had come accross “up there”. “Bye, little guy. Safe travels” I thought as I bid Elvie adieu. Insertion was no problem. For me, it was pretty comfortable, the caveat being, I have a pretty healthy pelvic floor. The one thing I did not like was that Elvie’s tail kept bopping me in the clitoris, which wasn’t very comfortable. Other than that no complaints.

The first thing I did was try and trick Elvie into thinking I was kegeling when I wasn’t (I really want to ensure this thing is fool proof). Elvie is unfortunately a gullible little thing. Bulging my pelvic floor, ( mimicking the action you would do to have a bowel movement, essentially the opposite of a kegel) and thrusting my hips tricked Elvie into thinking I was doing a really good job when I wasn’t. My favorite activity to trick Elvie was to do a little dance around my bedroom, while wiggling my bottom. Thank goodness my doors lock.

But enough goofing off, it was time to give Elvie a good old honest college try. The package recommends either standing or lying to do your kegel exercises, but they say to pick a position and stick with it. I chose lying down.

The minute I got on the bed, Elvie’s connection was lost. Poor Elvie! It was deep inside a strange place with no connection to the outside world. The app instructed me to move my phone closer to my vagina, which restored the connection but was pretty awkward, kind of like my lady parts were trying to facetime someone.

Once I got through the technical difficulties, I loved the way the exercise program was set up. They have 3 different stages that work on pulsing or “quick flicks”, endurance, and pure power. I was mediocre at all three, but it gave me a good start to go with.

Screengrab
Screen grab from the Elvie App

 

Elvie Day 2:

Today was the day I decided to experiment with how distracted one can be while using Elvie. We all like to multitask, so I decided to try it out while continuing my current Netflix binge. It was a bad idea, I missed a lot of my targets and kept forgetting to keep my legs open to allow Elvie to stay connected. It was clear to me that Elvie requires your full attention to get any benefit from it. I did improve on my ability to pulse and my endurance, which was super gratifying.

After I was done with my workout I spent some time exploring the app. Nestled in the “help” section, were much more detailed and helpful directions for performing a correct pelvic floor contraction. I wish this was more easily accessible. I think the lack of concise directions was a major failing of this product.

 

Elvie Day 3:

I decided this would be my last day using Elvie. I run on the tighter side of things, and I know from my clinical experience that doing kegels on an already tight pelvic floor can cause a whole host of issues from constipation, fecal leakage, painful sex, even urgency urinary incontinence!

I decided to give my all out full attention to the vagina workout ahead of me, but first I would try and cheat again. Lying down I tried my old tricks, wiggling my butt, thrusting my hips, but Elvie was not fooled! It appears that lying on your back is a way better way to train your pelvic floor using Elvie.

My last day, I really had the hang of things. I had no connectivity issues and was able to complete the whole workout uninterrupted. The only bummer was that on two of the three measures, I regressed!

 

Thoughts on Elvie

My thoughts on this device are mixed. It is so rare that I see someone walk into the clinic only needing strengthening of the pelvic floor. Usually there is some component of tightness or boney (structural) malalignment that needs to be corrected before kegels can be done effectively or safely.

For those patients who only require strengthening, I think Elvie can make an excellent motivator to regularly do your kegel exercises. I would eliminate the pure power part of the Elvie exercise program. Doing a max contraction of the pelvic floor usually does more harm than good. In a perfect scenario, I see Elvie being used by patients under the guidance of a pelvic floor physical therapist and only doing the “pulse” and “hold” portions of the program. These are patients who have been screened for any tightness or trigger points that may need treatment before starting out with strengthening

 

Pros and Cons of Elvie

 

Cons

  • Not appropriate for everyone
  • Poor connectivity to iphone
  • Not always consistent in measuring a true kegel versus a fake one, especially in standing
  • Requires a later model smart phone
  • Only brief instructions easily accessible
  • Max contraction not very helpful

Pros

  • Charts on the App to track your progress
  • Incredibly adorable product design
  • Much more comfortable than many other biofeedback sensors
  • Structured training program to target many components of muscle function

Pro Tips for Elvie

  • Use Elvie lying down; it’s way more accurate that way
  • Use a water based lube for insertion, silicone lubricants usually don’t mix with instruments designed to go into the vagina
  • If you have pain, Elvie is definitely not for you. Even if you don’t have pain it is wise to consult with a pelvic floor physical therapist to ensure that your muscles are not in fact, too tight and that you are doing the exercise correctly.

Disclaimer: Product was provided by Elvie. No other form of compensation was provided by Elvie for this review.