WALT Proposed Guidelines

World Association for Laser Therapy (WALT) proposed treatment guidelines for the most common veterinary conditions

Guidelines for Common Veterinary Conditions Based on Research and Clinical Practice

In 2019, WALT convened the top minds on veterinary photobiomodulation, including veterinarians, device manufacturers and clinical researchers. The charts below are the proposed guidelines for different types of devices, designed to ensure the highest chance of positive treatment outcomes.

The guidelines have separate suggestions for stationary devices (which can be kept in place), scanning devices (which must be moved in order to avoid burning the fur) and super-pulsed devices (which offer quick bursts of very high power for very short durations).

Jump to: Stationary Devices · Scanning Devices · Super-Pulsed Devices

Stationary Devices

WALT Veterinary Dosage Recommendations Task Force — Chart Set 1: Stationary Contact Application, CW & Switched/Gated CW

Feline 10 lb: Osteoarthritis / Degenerative Joint Disease

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec) #		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²) #
Manus/PesSingle220 – 300:40 – 1:000.05 – 0.253.0 – 10.00.05 – 0.251.5 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2510.0 – 37.50.05 – 0.251.5 – 5.0
Cluster1 – 240 – 901:20 – 1:300.10 – 0.759.0 – 60.00.03 – 0.102.7 – 4.0
Carpus/TarsusSingle2 – 420 – 301:00 – 1:200.05 – 0.253.0 – 20.00.05 – 0.251.5 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2510.0 – 37.50.05 – 0.251.5 – 5.0
Cluster1 – 240 – 901:20 – 1:300.10 – 0.759.0 – 60.00.03 – 0.102.7 – 4.0
ElbowSingle2 – 420 – 301:00 – 1:200.10 – 0.256.0 – 20.00.10 – 0.253.0 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2520.0 – 37.50.10 – 0.253.0 – 5.0
Cluster2 – 340 – 902:20 – 3:000.10 – 0.7518.0 – 90.00.03 – 0.102.7 – 4.0
ShoulderSingle3 – 620 – 301:30 – 2:000.10 – 0.2512.0 – 22.50.10 – 0.253.0 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2520.0 – 37.50.10 – 0.253.0 – 5.0
Cluster2 – 440 – 902:40 – 3:000.10 – 0.7524.0 – 135.00.03 – 0.102.7 – 4.0
StifleSingle4 – 820 – 302:00 – 2:400.10 – 0.2516.0 – 30.00.10 – 0.253.0 – 5.0
Multi1 – 220 – 300:30 – 0:400.50 – 1.2520.0 – 37.50.10 – 0.253.0 – 5.0
Cluster2 – 440 – 902:40 – 3:000.10 – 0.7518.0 – 120.00.03 – 0.102.7 – 4.0
HipSingle4 – 820 – 302:00 – 2:400.20 – 0.5016.0 – 30.00.20 – 0.506.0 – 10.0
Multi1 – 220 – 300:30 – 0:401.00 – 1.2520.0 – 37.50.20 – 0.506.0 – 10.0
Cluster2 – 440 – 902:40 – 3:000.20 – 0.7536.0 – 120.00.03 – 0.252.7 – 10.0
Back – LumbarSingle8 – 1220 – 303:30 – 4:300.20 – 0.5048.0 – 120.00.20 – 0.506.0 – 10.0
Multi2 – 320 – 301:00 – 1:301.00 – 2.5060.0 – 150.00.20 – 0.506.0 – 10.0
Cluster4 – 640 – 903:20 – 6:000.10 – 0.7536.0 – 150.00.03 – 0.102.7 – 4.0
Back – ThoracicSingle8 – 1220 – 303:30 – 4:300.20 – 0.5048.0 – 120.00.20 – 0.506.0 – 10.0
Multi2 – 320 – 301:00 – 1:301.00 – 2.5060.0 – 150.00.20 – 0.506.0 – 10.0
Cluster4 – 640 – 903:20 – 6:000.10 – 0.7536.0 – 180.00.03 – 0.102.7 – 4.0
NeckSingle6 – 1020 – 303:00 – 3:200.20 – 0.2536.0 – 50.00.20 – 0.506.0 – 10.0
Multi2 – 320 – 301:00 – 1:301.00 – 1.2560.0 – 75.00.20 – 0.506.0 – 10.0
Cluster4 – 660 – 906:00 – 6:200.10 – 0.7536.0 – 270.00.03 – 0.102.7 – 6.0

Feline 10 lb: IVDD; Wounds

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec) #		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²) #
IVDDSingle16 – 3220 – 308:00 – 10:400.20 – 0.25120.0 – 128.00.20 – 0.506.0 – 10.0
Multi3 – 620 – 301:30 – 2:301.00 – 1.25150.0 – 160.00.20 – 0.506.0 – 10.0
Cluster4 – 860 – 906:00 – 8:000.10 – 0.7548.0 – 270.00.03 – 0.102.7 – 6.0
Superficial/Acute Wound
Note 5		SingleTreat intact skin around entire wound periphery.20 – 40As applicable.0.04 – 0.20As applicable.0.04 – 0.201.6 – 4.0
Multi20 – 400.20 – 1.000.04 – 0.201.6 – 4.0
Cluster30 – 600.10 – 0.750.03 – 0.101.8 – 3.0
Difficult Wound
Notes 5 & 6		SingleTreat intact skin around entire wound periphery.20 – 40As applicable.0.04 – 0.20As applicable.0.04 – 0.201.6 – 4.0
Multi20 – 400.20 – 1.000.04 – 0.201.6 – 4.0
Cluster30 – 600.10 – 0.750.03 – 0.101.8 – 3.0

Canine 50 lb: Osteoarthritis / Degenerative Joint Disease

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec) #		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²) #
Manus/PesSingle3 – 520 – 301:30 – 1:400.05 – 0.255.0 – 22.50.05 – 0.251.5 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2510.0 – 37.50.05 – 0.251.5 – 5.0
Cluster1 – 240 – 901:20 – 1:300.10 – 0.759.0 – 60.00.05 – 0.104.0 – 4.5
Carpus/TarsusSingle3 – 520 – 301:30 – 1:400.05 – 0.255.0 – 22.50.05 – 0.251.5 – 5.0
Multi1 – 220 – 300:30 – 0:400.25 – 1.2510.0 – 37.50.05 – 0.251.5 – 5.0
Cluster1 – 240 – 901:20 – 1:300.10 – 0.759.0 – 60.00.05 – 0.104.0 – 4.5
ElbowSingle8 – 1220 – 304:00 – 4:200.05 – 0.2524.0 – 60.00.10 – 0.253.0 – 5.0
Multi2 – 320 – 301:00 – 1:200.25 – 1.2530.0 – 75.00.10 – 0.253.0 – 5.0
Cluster3 – 440 – 902:40 – 4:300.10 – 0.7527.0 – 120.00.05 – 0.104.0 – 4.5
ShoulderSingle8 – 1220 – 304:00 – 4:200.05 – 0.2524.0 – 60.00.10 – 0.253.0 – 5.0
Multi2 – 320 – 301:00 – 1:200.25 – 1.2530.0 – 75.00.10 – 0.253.0 – 5.0
Cluster3 – 440 – 902:40 – 4:300.10 – 0.7527.0 – 120.00.05 – 0.104.0 – 4.5
StifleSingle12 – 1620 – 305:20 – 6:000.05 – 0.2536.0 – 80.00.10 – 0.253.0 – 5.0
Multi3 – 420 – 301:20 – 1:300.25 – 1.2545.0 – 100.00.10 – 0.253.0 – 5.0
Cluster3 – 440 – 902:40 – 4:300.10 – 0.7527.0 – 120.00.05 – 0.104.0 – 4.5
HipSingle12 – 1620 – 305:20 – 6:000.05 – 0.2536.0 – 80.00.20 – 0.506.0 – 10.0
Multi3 – 420 – 301:20 – 1:300.25 – 1.2545.0 – 100.00.20 – 0.506.0 – 10.0
Cluster3 – 440 – 902:40 – 4:300.20 – 0.7554.0 – 120.00.10 – 0.259.0 – 10.0
Back – LumbarSingle28 – 3220 – 3010:40 – 14:000.20 – 0.50168.0 – 320.00.20 – 0.506.0 – 10.0
Multi8 – 920 – 303:00 – 4:001.00 – 2.50240.0 – 450.00.20 – 0.506.0 – 10.0
Cluster8 – 940 – 906:00 – 12:000.10 – 0.7572.0 – 270.00.05 – 0.104.0 – 4.5
Back – ThoracicSingle36 – 4020 – 3013:20 – 18:000.20 – 0.50216.0 – 400.00.20 – 0.506.0 – 10.0
Multi9 – 1020 – 303:20 – 4:301.00 – 2.50270.0 – 500.00.20 – 0.506.0 – 10.0
Cluster9 – 1040 – 906:40 – 13:200.10 – 0.75200.0 – 243.00.05 – 0.104.0 – 4.5
NeckSingle18 – 2420 – 308:00 – 9:000.20 – 0.25108.0 – 120.00.20 – 0.506.0 – 10.0
Multi5 – 620 – 302:00 – 2:301.00 – 1.25150.0 – 150.00.20 – 0.506.0 – 10.0
Cluster5 – 660 – 906:00 – 7:300.10 – 0.75135.0 – 180.00.05 – 0.104.5 – 6.0

Canine 50 lb: IVDD; Wounds

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec) #		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²) #
IVDDSingle32 – 6420 – 3016:00 – 21:200.20 – 0.25240.0 – 256.00.20 – 0.506.0 – 10.0
Multi8 – 1620 – 304:00 – 5:201.00 – 1.25300.0 – 320.00.20 – 0.506.0 – 10.0
Cluster8 – 1660 – 9012:00 – 16:000.10 – 0.75288.0 – 326.00.05 – 0.104.0 – 6.0
Superficial/Acute Wound
Note 5		SingleTreat over intact skin around entire wound periphery.20 – 40As applicable.0.05 – 0.25As applicable.0.04 – 0.201.6 – 4.0
Multi20 – 400.25 – 1.250.04 – 0.201.6 – 4.0
Cluster30 – 600.10 – 0.750.03 – 0.101.8 – 3.0
Difficult Wound
Notes 5 & 6		SingleTreat over intact skin around entire wound periphery.20 – 40As applicable.0.05 – 0.25As applicable.0.04 – 0.201.6 – 4.0
Multi20 – 400.25 – 1.250.04 – 0.201.6 – 4.0
Cluster30 – 600.10 – 0.750.03 – 0.101.8 – 3.0

Notes — Stationary Devices

# The potentially-effective fluence ranges are quite broad, so to highlight the ranges that are most likely to produce good results we have multiplied the lowest recommended power by the longest per-point/site duration to define one end of the recommended fluence ranges for each indication, and the highest recommended power by the shortest per-point/site duration to define the other end of the ranges. Similarly, we have used the longest per-point/site duration multiplied by the smallest number of points/sites, and the highest number of points/sites by the shortest per-point/site duration, to define the recommended total treatment time ranges for each indication. Fluences and total treatment durations outside these narrowly-defined ranges may still be effective.

  1. For the purposes of this document, the applicator used to deliver light to the patient is called the ‘probe’, and probes are typically available in three general styles:
    a. Single: The probe contains a single (typically laser) emitter and treats one point at a time.
    b. Multi: The probe contains 4–5 (typically laser) emitters, each of which projects a distinct and separate beam spot upon the skin; from a treatment perspective, such probes can be considered as treating 4–5 distinct points concurrently, thus reducing total treatment time compared to a single-emitter probe.
    c. Cluster: The probe contains an array of closely-spaced LEDs and/or lower-power laser diodes, with little or no space between beam spots upon the skin. Typically, clusters such as this project a large and almost-homogeneous beam spot upon the skin.
  2. A ‘point’ is nominally defined as a contact region with the skin or tissue of less than or equal to 1 cm², or the beam spot size upon the skin, whichever is larger. A ‘site’ refers to a multiple of points within the region of single contact application of a Multi probe, or the overall area contacted by a Cluster probe at one time. Individual application points or sites may be immediately adjacent or spaced some appropriate distance apart; typically, they do not overlap.
  3. In this document, ‘power’ refers to the average power of the incident beam, whether from a continuous wave (CW) or switched (a.k.a. gated or chopped) CW source.
  4. Irradiance is the intensity of the beam of light upon the irradiated surface.
  5. When treating wounds, treat the entire wound periphery but avoid overlapping of placements. If direct treatment of the wound is desired, such as accelerating the development of a granulation bed, the probe should be held directly over but slightly away from the wound surface or covered with disposable clear plastic (i.e. sterile sleeve) to avoid contamination.
  6. PBM as an adjunct therapy to sound medical and surgical management of difficult wounds may involve increasing frequency of treatments and ensuring the fluence falls within the biostimulatory range of 1–4 J/cm².
  7. The ‘total emitted energy’ refers to the total amount of energy emitted from the probe during the ‘total treatment duration’, given the probe’s ‘total average power’. The total incident energy – i.e., the energy actually received at the skin – may be proportionally less than the total emitted energy, depending upon the size of the anatomical target in relation to the size of a multi-emitter probe.

User should be familiar with device specifications. Consult device documentation or manufacturer regarding any information that is unclear or absent.

Additional Considerations — Stationary Devices

  • Above protocols are for an ‘ideal’ 10-pound feline and 50-pound canine with light coat. Treatment times may need to be adjusted up or down depending on estimated target depth, size and pigmentation of patient.
  • Applicable power for each laser emitter in single-emitter and multi-emitter probes is 50–1000 mW in the wavelength range 780–860 nm.
  • Applicable total power for infrared LED &/or laser clusters is 200–1400 mW in the wavelength range 780–860 nm. The recommended minimum average irradiance of such cluster probes is 25 mW/cm², with 40–50 mW/cm² being preferred.
  • Wavelengths from 630–690 nm are typically used for superficial tendons, skin conditions and wounds. They may be used for general musculoskeletal disorders, however, the lesser penetration of these wavelengths may make them unsuitable for targets deeper than 1–2 cm.
  • Recommended technique is stationary skin contact with appropriate amount of pressure applied for target depth and moderated according to patient’s tolerance.
  • Acute conditions may respond better initially to increased frequency of treatment and/or increased treatment time.
  • Effort should be made to maximize light delivered to target tissue without interference. This may be achieved by increasing probe pressure on skin surface, using comb-like protruding lens or diode devices, manipulating fur away from target, clipping, cleaning skin and hair with alcohol, and/or wetting the hair coat.
  • Laser PBM has both local and distal/systemic effects, all of which contribute toward the desired clinical outcome. Ideally, local irradiation directly over the injured/pathologic tissue is performed, and additional sites, such as trigger points and dorsal roots, can be incorporated to maximize pain management. To maximize systemic effects, incorporate irradiation over proximal/regional lymph nodes and major arteries or veins into any treatment protocol. Irradiation over bone containing active marrow has been shown to increase the number of circulating stem cells which may be recruited by diseased tissue to replace and regenerate injured cells, stimulate angiogenesis and decrease inflammatory and fibrotic factors.
  • Switched-CW may be of benefit in treatment with PBM, but at this juncture not enough is known to make set recommendations about when to use Switched-CW versus CW, and/or which specific frequencies to use.
  • Super-Pulsed lasers are addressed separately, due to their significantly different mode of operation.

Scanning Devices (device probe must be moved)

WALT Veterinary Dosage Recommendations Task Force — Chart Set 3: Scanning Application, CW & Switched/Gated CW

Feline 10 lb: Osteoarthritis / Degenerative Joint Disease

Contact application with constant motion

10 lb Feline
Pathology / Anatomical Location		Area
(cm²)
Note 1		Dosage
(J/cm²)
Note 2		Power
(Watts)
Note 3		Time
(min:sec)
Note 3		Total Energy
(Joules)		Irradiance, 25 mm
(W/cm²)
Note 4		Irradiance, 50 mm
(W/cm²)
Note 4
Manus/Pes40312:001200.200.05
Carpus/Tarsus50421:452100.410.10
Elbow60531:453150.610.15
Shoulder90642:205600.820.20
Stifle90432:003600.610.15
Hip90642:205600.820.20
Back – Lumbar100752:207001.020.26
Back – Thoracic120752:458251.020.26
Neck80742:205600.820.20
IVDD120752:458251.020.26

Canine 50 lb: Osteoarthritis / Degenerative Joint Disease

Contact application with constant motion

50 lb Canine
Pathology / Anatomical Location		Area
(cm²)
Note 1		Dosage
(J/cm²)
Note 2		Power
(Watts)
Note 3		Time
(min:sec)
Note 3		Total Energy
(Joules)		Irradiance, 25 mm
(W/cm²)
Note 4		Irradiance, 50 mm
(W/cm²)
Note 4
Manus/Pes100542:004800.820.20
Carpus/Tarsus100652:006001.020.26
Elbow180663:0010801.220.31
Shoulder200874:0016801.430.36
Stifle180763:3012601.220.31
Hip220883:2017601.630.41
Back – Lumbar250893:4520251.840.46
Back – Thoracic275894:0021601.840.46
Neck220883:2017601.630.41
IVDD275894:0021601.840.46

Wounds – Superficial or Acute

Non-contact application with constant motion

Area
(cm²)
Note 1		Dosage
(J/cm²)
Note 2		Power
(Watts)
Note 3		Time
(min:sec)
Note 3		Total Energy
(Joules)		Irradiance, 25 mm
(W/cm²)
Note 4		Irradiance, 50 mm
(W/cm²)
Note 4
25311:15750.200.05
50321:151500.410.10
100322:303000.410.10
150332:304500.610.15
200333:206000.610.15
250334:107500.610.15
300343:459000.820.20

Wounds – Deep or Chronic

Non-contact application with constant motion

Area
(cm²)
Note 1		Dosage
(J/cm²)
Note 2		Power
(Watts)
Note 3		Time
(min:sec)
Note 3		Total Energy
(Joules)		Irradiance, 25 mm
(W/cm²)
Note 4		Irradiance, 50 mm
(W/cm²)
Note 4
25512:051250.200.05
50522:052500.410.10
100542:055000.820.20
150643:459000.820.20
200654:0012001.020.26
250664:1015001.220.31
300665:0018001.220.31

Notes — Scanning Devices

  1. The area to be treated is defined as:
    a. For joints and musculoskeletal conditions – the area of treatment includes the joint and all biomechanically associated soft tissue, treated from 360° or from as many different directions as possible.
    b. Wounds – the area of treatment includes the entire surface of the wound and a surrounding border of 2–3 cm of normal tissue. Treatment from multiple directions is recommended if possible, particularly for deeper wounds.
  2. If a response to therapy has not been noted after 2–4 treatments the dosage should be increased.
  3. Power and time adjustment – If the laser device being used is lower power than the recommended power, the time can be increased proportionally. For example, with a continuous emission, a 4 watt laser delivers total energy of 240 joules in one minute; a 2 watt laser will deliver the same total energy in 2 minutes and a 1 watt laser delivers the same total energy in 4 minutes.
  4. Irradiance is the intensity of the beam of light upon the irradiated surface.

User should be familiar with device specifications. Consult device documentation or manufacturer regarding any information that is unclear or absent.

Additional Considerations — Scanning Devices

  • These protocols are for “ideal” 10 pound feline and 50 pound canine patients with light skin and hair coats. The dosage and total energy should be adjusted up or down depending on size of patient, hair color and length, and skin color.
  • Acute conditions may better respond to increased frequency of treatment or increased total energy.
  • The recommended power and time are appropriate for CW delivery. If pulsing delivery is used, power and time must be adjusted to deliver the recommended total energy. Pulsed delivery may be of benefit in treatment with PBM but there is insufficient consensus to make recommendations in this document about when to use pulsed versus CW, or which specific frequencies to use if pulsing.
  • These recommendations do not apply to super-pulsed lasers due to their different mode of operation.

Super-Pulsed Devices

WALT Veterinary Dosage Recommendations Task Force — Chart Set 2: Stationary Contact Application, Super-Pulsed 904/905 nm

Feline 10 lb: Osteoarthritis / Degenerative Joint Disease

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec)		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²)
Manus/PesSingle1 – 230 – 901:00 – 1:300.01 – 0.060.9 – 3.60.02 – 0.061.8 – 2.0
Small-Multi1 – 230 – 901:00 – 1:300.04 – 0.123.6 – 14.40.02 – 0.061.8 – 2.0
Large-Multi1 – 230 – 901:00 – 1:300.10 – 0.729.0 – 43.20.02 – 0.061.8 – 2.0
Carpus/TarsusSingle1 – 230 – 901:00 – 1:300.01 – 0.060.9 – 3.60.02 – 0.061.8 – 2.0
Small-Multi1 – 230 – 901:00 – 1:300.04 – 0.123.6 – 14.40.02 – 0.061.8 – 2.0
Large-Multi1 – 230 – 901:00 – 1:300.10 – 0.729.0 – 43.20.02 – 0.061.8 – 2.0
ElbowSingle3 – 530 – 902:30 – 4:500.01 – 0.062.7 – 9.00.02 – 0.061.8 – 2.0
Small-Multi1 – 230 – 901:00 – 1:300.04 – 0.123.6 – 18.00.02 – 0.061.8 – 2.0
Large-Multi1 – 230 – 901:00 – 1:300.10 – 0.729.0 – 43.20.02 – 0.061.8 – 2.0
ShoulderSingle3 – 640 – 1204:00 – 6:000.01 – 0.063.6 – 14.40.02 – 0.062.4 – 2.6
Small-Multi1 – 240 – 1201:20 – 2:000.04 – 0.124.8 – 24.00.02 – 0.062.4 – 2.6
Large-Multi140 – 1200:40 – 2:000.10 – 0.7212.0 – 28.80.02 – 0.062.4 – 2.6
StifleSingle4 – 840 – 1205:20 – 8:000.01 – 0.064.8 – 19.20.02 – 0.062.4 – 2.6
Small-Multi1 – 240 – 1201:20 – 2:000.04 – 0.124.8 – 24.00.02 – 0.062.4 – 2.6
Large-Multi1 – 240 – 1201:20 – 2:000.10 – 0.7212.0 – 57.60.02 – 0.062.4 – 2.6
HipSingle4 – 840 – 1205:20 – 8:000.01 – 0.064.8 – 19.20.02 – 0.062.4 – 2.6
Small-Multi1 – 240 – 1201:20 – 2:000.04 – 0.124.8 – 24.00.02 – 0.062.4 – 2.6
Large-Multi140 – 1200:40 – 2:000.10 – 0.7212.0 – 28.80.02 – 0.062.4 – 2.6
Back – LumbarSingle8 – 1260 – 12012:00 – 16:000.01 – 0.069.6 – 43.20.02 – 0.062.4 – 3.6
Small-Multi2 – 360 – 1203:00 – 4:000.04 – 0.129.6 – 54.00.02 – 0.062.4 – 3.6
Large-Multi1 – 260 – 1202:00 – 2:000.10 – 0.7212.0 – 86.40.02 – 0.062.4 – 3.6
Back – ThoracicSingle8 – 1260 – 15012:00 – 20:000.01 – 0.0612.0 – 43.20.02 – 0.063.0 – 3.6
Small-Multi2 – 360 – 1503:00 – 4:000.04 – 0.1212.0 – 54.00.02 – 0.063.0 – 3.6
Large-Multi1 – 260 – 1502:00 – 2:300.10 – 0.7215.0 – 86.40.02 – 0.063.0 – 3.6
NeckSingle6 – 1060 – 18010:00 – 18:000.01 – 0.0612.0 – 36.00.02 – 0.063.6 – 3.8
Small-Multi2 – 360 – 1803:00 – 6:000.04 – 0.1216.0 – 54.00.02 – 0.063.6 – 3.8
Large-Multi1 – 260 – 1802:00 – 3:000.10 – 0.7220.0 – 86.40.02 – 0.063.6 – 3.8

Feline 10 lb: IVDD; Wounds

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec)		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²)
IVDDSingle16 – 3260 – 18032:00 – 48:000.01 – 0.0632.0 – 115.20.02 – 0.063.6 – 3.8
Small-Multi4 – 860 – 1808:00 – 12:000.04 – 0.1232.0 – 144.00.02 – 0.063.6 – 3.8
Large-Multi2 – 360 – 1803:00 – 6:000.10 – 0.7240.0 – 129.60.02 – 0.063.6 – 3.8
Superficial/Acute Wound
Note 5		SingleTreat intact skin around entire wound periphery.20 – 80As applicable.0.01 – 0.06As applicable.0.02 – 0.061.2 – 1.6
Small-Multi20 – 800.04 – 0.120.02 – 0.061.2 – 1.6
Large-Multi20 – 800.10 – 0.720.02 – 0.061.2 – 1.6
Difficult Wounds
Notes 5 & 6		SingleTreat intact skin around entire wound periphery.30 – 120As applicable.0.01 – 0.06As applicable.0.02 – 0.061.8 – 2.4
Small-Multi30 – 1200.04 – 0.120.02 – 0.061.8 – 2.4
Large-Multi30 – 1200.10 – 0.720.02 – 0.061.8 – 2.4

Canine 50 lb: Osteoarthritis / Degenerative Joint Disease

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec)		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²)
Manus/PesSingle3 – 530 – 902:00 – 6:000.01 – 0.063.6 – 7.20.02 – 0.061.8 – 2.0
Small-Multi1 – 230 – 901:00 – 1:300.04 – 0.123.6 – 18.00.02 – 0.061.8 – 2.0
Large-Multi1 – 230 – 901:00 – 1:300.10 – 0.726.0 – 64.80.02 – 0.061.8 – 2.0
Carpus/TarsusSingle3 – 540 – 902:40 – 6:000.01 – 0.063.6 – 9.60.02 – 0.061.8 – 2.4
Small-Multi2 – 240 – 901:20 – 3:000.04 – 0.127.2 – 24.00.02 – 0.061.8 – 2.4
Large-Multi1 – 240 – 901:20 – 1:300.10 – 0.729.0 – 57.60.02 – 0.061.8 – 2.4
ElbowSingle10 – 1440 – 1209:20 – 20:000.01 – 0.0612.0 – 33.60.02 – 0.062.4 – 2.6
Small-Multi2 – 340 – 1202:00 – 4:000.04 – 0.129.6 – 36.00.02 – 0.062.4 – 2.6
Large-Multi1 – 240 – 1201:20 – 2:000.10 – 0.7212.0 – 57.60.02 – 0.062.4 – 2.6
ShoulderSingle10 – 1460 – 15014:00 – 25:000.01 – 0.0615.0 – 50.40.02 – 0.063.0 – 3.6
Small-Multi2 – 360 – 1503:00 – 5:000.04 – 0.1212.0 – 54.00.02 – 0.063.0 – 3.6
Large-Multi1 – 260 – 1502:00 – 2:300.10 – 0.7215.0 – 86.40.02 – 0.063.0 – 3.6
StifleSingle12 – 2060 – 15020:00 – 30:000.01 – 0.0618.0 – 57.60.02 – 0.063.0 – 3.6
Small-Multi3 – 560 – 1504:00 – 7:300.04 – 0.1218.0 – 72.00.02 – 0.063.0 – 3.6
Large-Multi1 – 260 – 1502:00 – 2:300.10 – 0.7230.0 – 86.40.02 – 0.063.0 – 3.6
HipSingle16 – 2060 – 15020:00 – 40:000.01 – 0.0624.0 – 72.00.02 – 0.063.0 – 3.6
Small-Multi4 – 560 – 1505:00 – 10:000.04 – 0.1224.0 – 90.00.02 – 0.063.0 – 3.6
Large-Multi1 – 260 – 1502:00 – 2:300.10 – 0.7215.0 – 86.40.02 – 0.063.0 – 3.6
Back – LumbarSingle28 – 3280 – 15042:40 – 70:000.01 – 0.0642.0 – 153.60.02 – 0.063.0 – 4.8
Small-Multi7 – 880 – 15010:40 – 17:300.04 – 0.1242.0 – 192.00.02 – 0.063.0 – 4.8
Large-Multi2 – 380 – 1504:00 – 5:000.10 – 0.7230.0 – 172.80.02 – 0.063.0 – 4.8
Back – ThoracicSingle36 – 4080 – 18053:20 – 108:000.01 – 0.0664.8 – 192.00.02 – 0.063.6 – 4.8
Small-Multi8 – 1080 – 18013:20 – 24:000.04 – 0.1257.6 – 240.00.02 – 0.063.6 – 4.8
Large-Multi380 – 1805:20 – 9:000.10 – 0.7254.0 – 230.40.02 – 0.063.6 – 4.8
NeckSingle18 – 2480 – 18032:00 – 54:000.01 – 0.0632.4 – 115.20.02 – 0.063.6 – 4.8
Small-Multi5 – 680 – 1808:00 – 15:000.04 – 0.1236.0 – 144.00.02 – 0.063.6 – 4.8
Large-Multi2 – 380 – 1804:00 – 6:000.10 – 0.7236.0 – 172.80.02 – 0.063.6 – 4.8

Canine 50 lb: IVDD; Wounds

Pathology / Anatomical LocationProbe Type
Note 1		Number of Probe Applications
(points / sites)
Note 2		Duration per Point / Site
(seconds)		Total Treatment Duration
(min:sec)		Total Average Power
(Watts)
Note 3		Total Emitted Energy
(Joules)
Note 7		Surface Irradiance
(W/cm²)
Note 4		Fluence at Target Point/Site
(J/cm²)
IVDDSingle32 – 6480 – 18085:20 – 96:000.01 – 0.0657.6 – 307.20.02 – 0.063.6 – 4.8
Small-Multi8 – 1480 – 18018:40 – 24:000.04 – 0.1257.6 – 336.00.02 – 0.063.6 – 4.8
Large-Multi3 – 480 – 1805:20 – 9:000.10 – 0.7254.0 – 230.40.02 – 0.063.6 – 4.8
Superficial/Acute Wound
Note 5		SingleTreat intact skin around entire wound periphery.20 – 80As applicable.0.01 – 0.06As applicable.0.02 – 0.061.2 – 1.6
Small-Multi20 – 800.04 – 0.120.02 – 0.061.2 – 1.6
Large-Multi20 – 800.10 – 0.720.02 – 0.061.2 – 1.6
Difficult Wounds
Notes 5 & 6		SingleTreat intact skin around entire wound periphery.30 – 120As applicable.0.01 – 0.06As applicable.0.02 – 0.061.8 – 2.4
Small-Multi30 – 1200.04 – 0.120.02 – 0.061.8 – 2.4
Large-Multi30 – 1200.10 – 0.720.02 – 0.061.8 – 2.4

Notes — Super-Pulsed Devices

  1. For the purposes of this document, the applicator used to deliver light to the patient is called the ‘probe’, and probes are typically available in three general styles:
    a. Single: The probe contains a single GaAs super-pulsed laser emitter and treats one point at a time.
    b. Small-Multi: The probe contains 4–5 GaAs super-pulsed laser emitters, each of which projects a distinct and separate beam spot upon the skin; from a treatment perspective, such probes can be considered as treating 4–5 distinct points concurrently, thus reducing total treatment time compared to a single-emitter probe.
    c. Large-Multi: The probe contains 10–12 GaAs super-pulsed laser emitters, each of which projects a distinct and separate beam spot upon the skin; from a treatment perspective, such probes can be considered as treating 10–12 distinct points concurrently, thus reducing total treatment time compared to a single-emitter or small multi-emitter probe.
  2. A ‘point’ is nominally defined as a contact region with the skin or tissue of less than or equal to 1 cm², or the beam spot size upon the skin, whichever is larger. A ‘site’ refers to a multiple of points within the region of single contact application of a Multi probe. Individual application points or sites may be immediately adjacent or spaced some appropriate distance apart; typically, they do not overlap.
  3. In this document, ‘total average power’ refers to the combined output power of all GaAs emitters in the probe; therefore, the recommended power of each emitter can be calculated by dividing the total average power recommended in these charts by the number of emitters in the probe. The recommended minimum average output power of each GaAs super-pulsed laser emitter in a single-emitter or multi-emitter probe is 5 mW, with >10 mW being preferred.
  4. Irradiance is the intensity of the beam of light upon the irradiated surface. The recommended minimum average irradiance of GaAs super-pulsed laser probes is 5 mW/cm², with >20 mW/cm² being preferred.
  5. When treating wounds, treat the entire wound periphery but avoid overlapping of placements. If direct treatment of the wound is desired, such as accelerating the development of a granulation bed, the probe should be held directly over but slightly away from the wound surface or covered with disposable clear plastic (i.e. sterile sleeve) to avoid contamination.
  6. PBM as an adjunct therapy to sound medical and surgical management of difficult wounds may involve increasing frequency of treatments and ensuring the fluence falls within the biostimulatory range of 1–4 J/cm².
  7. The ‘total emitted energy’ refers to the total amount of energy emitted from the probe during the ‘total treatment duration’, given the probe’s ‘total average power’. The total incident energy – i.e., the energy actually received at the skin – may be proportionally less than the total emitted energy, depending upon the size of the anatomical target in relation to the size of a multi-emitter probe.

User should be familiar with device specifications. Consult device documentation or manufacturer regarding any information that is unclear or absent.

Additional Considerations — Super-Pulsed Devices

  • Above protocols are for an ‘ideal’ 10-pound feline and 50-pound canine with light coat. Treatment times may need to be adjusted up or down depending on estimated target depth, size and pigmentation of patient.
  • Where the average output power of the super-pulsed GaAs laser emitter(s) comprises only a small percentage (<25%) of the total output of a probe that also contains continuous wave (CW) and/or switched (a.k.a. gated or chopped) CW laser and/or LED emitters, please instead refer to the chart entitled ‘Stationary Contact Application: CW & Switched/Pulsed CW’.
  • For laser PBM the peak power of the laser emitter(s) is of little consequence beyond its contribution to the average power, which is used to determine treatment duration and dose. If the average power is not specified it should be calculated for each available pulse frequency setting, as follows:
    P_average (W) = P_peak (W) × Pulse Width (s) × Pulse Frequency (Hz)
  • Recommended technique is stationary skin contact with appropriate amount of pressure applied for target depth and moderated according to patient’s tolerance.
  • Acute conditions may respond better initially to increased frequency of treatment and/or increased treatment time.
  • Effort should be made to maximize light delivered to target tissue without interference. This may be achieved by increasing probe pressure on skin surface, using comb-like protruding lens or diode devices, manipulating fur away from target, clipping, cleaning skin and hair with alcohol, and/or wetting the hair coat.
  • Laser PBM has both local and distal/systemic effects, all of which contribute toward the desired clinical outcome. Ideally, local irradiation directly over the injured/pathologic tissue is performed, and additional sites, such as trigger points and dorsal roots, can be incorporated to maximize pain management. To maximize systemic effects, incorporate irradiation over proximal/regional lymph nodes and major arteries or veins into any treatment protocol. Irradiation over bone containing active marrow has been shown to increase the number of circulating stem cells which may be recruited by diseased tissue to replace and regenerate injured cells, stimulate angiogenesis and decrease inflammatory and fibrotic factors.
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