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Reports on the efficacy of low reactive level laser therapy (LLLT) cover a range from 60% to 90%, depending on the criteria set by the authors, and also cover a large range of methodologies based on anatomical considerations, Oriental Medicine acupuncture-based tenets, or a blend of the two. From his experience in having treated 48,145 patients (correct as of July 1st 2005) in over 25 years of practicing LLLT, the author presents an anatomically-based treatment method which gives consistently good results, and maximizes the efficacy of laser therapy in a large variety of conditions including pain attenuation, wound healing, scar revision or treatment of areas of abnormal skin colour. No matter what entity is being treated in what location, laser therapy is always started in the contact pressure method bilaterally on the side of the neck approximately 2 cm down from the ears, and then on the C1/C2 intervertebral points, the C1/C2 zone, working round the base of the skull at points about 1 cm apart while angling the laser probe upwards by about 45°. The system used is an 830 nm GaAlAs diode laser (60 mW, continuous wave, incident power density 3 W/cm 2 , 10 sec/point, energy density 30 J/cm 2 ). Subsequent treatment points run from proximal to distal towards the final treatment site, thence the name ‘proximal priority’. Irradiation of the sides of the neck targets increased blood supply to the brain; the C1/C2 zone targets in particular the 2nd and 3rd neurons, and the cerebellum, pons and medulla oblongata, in which lie a number of important control centres including those which control blood pressure and the descending inhibitory pathway of the reticulospinal tract. By activating these centres before moving to the site of interest, it is believed that a more efficient endorphin and enkephalin synthesis is triggered in the case of pain attenuation, via activation of the reticulospinal tract through the pyramidal and extrapyramidal fibres, and the parasympathetic system is given a ‘wake-up’ call in the case of all conditions. Laser therapy applied directly to a site of interest will still have some effect, possibly a good one, but the author suggests that adherence to the proximal priority method will make a good effect even better.

THE PROXIMAL PRIORITY TECHNIQUE: HOW TO MAXIMIZE THE EFFICACY OF LASER THERAPY