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The prevalence of patients being treated for chronic oedema in private practice appears to be increasing. Green (2007) identified the occurrence as being between 1.33 per 100 000 in the general population to more specifically one in 200 in the over 65s (Moffett 2003). This may seem unremarkable if it were not for Morgan's 2005 study which identified community nurses knowledge and skills for the treatment as being adequate or poor, in that there was a level of uncertainty in whose responsibility it was to treat the condition. Although it is recognised that chronic oedema is not directly for ulcer development there is an effect on wound healing (Mortimer 2003) which may be due to reduced oxygenation of the tissues (Casley-Smith 1997) by reduced micro circulation. The Current National Health Service Patient information for the treatment of Oedema, focuses on treating the underlying cause (if possible), the prescription of diuretics when suitable as with supportive stockings, with the self help advice of losing weight (if applicable), taking regular exercise, raising legs 3-4 times a day to help circulation and avoid standing for long periods. Green (2007) suggests the four stage approach of would be Skin care, Exercise, Compression therapy and Lymphatic drainage. This would appear good news for manual therapy specialists other than that with the age consideration of the patient hip and lumbar spine degenerative conditions may limit the use of some techniques, not to mention the lack of mobility would also affect the ability to exercise and thus lose weight not to mention as the condition further develops the occurrence of ulcers and wounds makes self help even more problematic. The Author noted Thelande's (2008) reported success in the majority of 700 patients using 832.8 nm and a 904nm laser showing reduced tissue pressure, circumference and patient comfort reports. The author initially used a Thor system utilising a 1w 810nm probe and mixed Led probe of 660nm and 850nm, the biphasic protocol as discussed by Huang (2009) with the dramatic results of reduced circumference of mid calf and ankle, reduced reported pain and wound healing of the broken skin and ulcers, the only drawback to the system being the small area that could be treated in the appointment time. With the development of the Lumi med 900 the author has been able to treat much more of the leg in a set treatment time by utilising the 1 w per paddle output distributed between 6x650nm 87mw laser diodes, the 2x810nm 200mw and 2x 915nm 200mw laser diodes in a 8 paddle format. The Author found wound healing has significantly improved again as swelling and pressure reduced. This configuration with a high amount of 650nm components has the advantage of increasing micro circulation, RNA synthesis and mitochondrial stimulation (Huang 2009) whilst the 810nm aids with analgesic properties through temporary nerve depolarisation. The inclusion of LLLT treatment in both allopathic settings would seem to compliment Greens best practice principles as well as any manual therapy approach as it appears to align with the principles of improving both general and micro circulation as well as the bio stimulation of tissues from a distressed state to a better functioning state with only light to aid the body in its return to a more harmonious state. Elliott Hayes is a techniology evangelist in the field of lasers and LLLT, or Low Level laser Therapy. Matt Walster M.A.O B.Ed(Hons) B.Sc(Hons) B.Sc(Hons) LLLT Laser products Elliott promotes the use of lasers and LLLT devices in medicine and Aesthetics and provides research based analysis on the latest products and treatment protocols.
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