In today’s episode, we dig in deep on the subject of low-level laser therapy for musculoskeletal pain with Dr. Robert Silverman. Dr. Silverman shares some incredible insights for using lasers for pain and a host of other chronic conditions. As an educator, he has a knack for describing the science and physiology behind laser therapy in a way that makes sense. To learn more about Dr. Silverman or to attend one of his upcoming training you can check out more here: https://www.facebook.com/DrRobertSilverman
https://www.linkedin.com/in/drrobertsilverman/
https://www.erchonia.com/seminars/
Dr. Chad Woolner: This episode of the laser light show is brought to you by the immune reboot, a brand new book that will be out by Dr. Robert Silverman. Dr. Silverman is a chiropractic doctor, clinical nutritionist, national and international speaker, author of Amazon’s number one bestseller Inside Out health. He’s the founder and CEO of Westchester Integrative Health Center, the ACA Sports Council named Dr. Silverman sports chiropractor of the year in 2015. He is a seasoned health and wellness expert on both the speaking circuit and the media. Dr. Silverman is a thought leader in his field and practice, a frequently published author in peer reviewed journals and other mainstream publications. And Dr. Silverman’s new book, The immune reboot will be available on Amazon September 2022.
What’s going on everybody, Dr. Chad Woolner here with Dr. Andrew Wells. This is episode 15 of the laser light show and on today’s episode we have with us our good friend and special guest Dr. Rob Silverman. He is going to be talking about lasers for musculoskeletal pain.
[INTRO]
Growing up in Portland, Oregon, I used to love going to laser light shows at the Oregon Museum of Science and Industry. They would put on these amazing light shows with incredible designs synced up to some of my favorite music. From the Beatles to Pink Floyd to Jimmy Hendrix and Metallica; they were awesome. Little did I know then that lasers would have such a profound effect on my life decades later. As a chiropractic physician, I have seen first-hand just how powerful laser therapy is in helping patients struggling with a wide range of health problems. As the leader in laser therapy, Erchonia has pioneered the field in obtaining 20 of the 23 total FDA clearances for therapeutic application of lasers. On this podcast, we’ll explore the science and technology and physiology behind what makes these tools so powerful. Join me as we explore low-level laser therapy. I’m Dr. Chad Woolner along with my good friend Dr. Andrew Wells and welcome to The Laser Light Show.
Dr. Chad Woolner: All right, we are underway here with Dr. Rob Silverman. Dr. Silverman, thank you so much for being here with us. We sure appreciate you taking time out of your schedule.
Dr. Rob Silverman: Thanks for having me. I’m excited and without question truly stoked to be here to share some insights on laser therapy.
Dr. Andrew Wells: Awesome. And for our listeners, if you think this is gonna be a boring musculoskeletal, here’s why you should use lasers episode, this is not going to be that it’s going to be really exciting. If for no other reason. We have a New Yorker as a guest on our podcast. And so it’s going to be a colorful episode at least I hope it will. Expectation Dr. Silverman. So I hope you can live up to that.
Dr. Rob Silverman: I’m gonna try. I’m going to try and be rhapsodic Rob today.
Dr. Andrew Wells: There you have it. I love it. You know, not too long ago, I thought when I heard of Erchonia lasers, I just assumed I thought just because of a lack of knowledge. And just being naive. I thought that lasers were only used for musculoskeletal pain. That’s what they were designed for. And that’s all they could do. And as I learned more about laser therapy, on, you know, this, this vast amount of protocols and different conditions you can use it for, it’s pretty astounding. But today, we’re going to focus on what most Doc’s would think of as the obvious, especially if you’re a chiropractor, you just kind of associate laser therapy with musculoskeletal pain. And so we’re gonna dive into that. And I’m kind of curious about Dr. Silverman. In the chiropractic profession, especially we have lots of gadgets, we have logic, lots of gizmos, equipment, things that you go to any chiropractic conference, or we’re just bombarded by these different like, innovations in technology kind of seems like and so for musculoskeletal pain, you have anything from decompression tables to 10s units to cold therapy, hot therapy. Oh, man, and if you go to a chiropractic conference, and you’ll be kind of astounded by what the possibilities are, but kind of curious for you, how did you Why and how did you decide to use lasers in your practice?
Dr. Rob Silverman: Yeah, that’s a great starting point. Those who have seen me or know me, know that I suffer from what we call congenital torticollis. So in that, you know, like you said, I’m in New York, growing up in a tough section in New York. That wasn’t a bunch of fun. That said, about 10 years into practice. My neck really started to fuse at the osseous level. And I was looking for something to actually help myself and a friend of mine, a big sports car to come in and say, Man, you got to try this laser. So I investigated it, went to a seminar, tried it on myself, I needed something other than just obvious adjustments. And man, it lit my fire. It was an epiphany without question. So as most of us when we try something in chiropractic, we try it ourselves. Then of course we try it on our friends and our family. We put it into practice, and really that little spark was the fire to get out and really talk about and utilize lasers and make protocols. It was, you know, hopefully not selfishly views for myself, for after seeing that response. I wanted to share it with everybody else. And that’s the unique thing about chiropractic, if I may say that practice always or touched or do something, or haven’t done to themselves, to spur them on to want to share with everybody else.
Dr. Andrew Wells: Yeah, that parallel is really that Erchonia was even founded out of desperation, somebody with lower back pain that needed this solution, and, and created this solution out of a need to feel better and to and to function better. So that’s, that’s interesting that you did that you found it through your own personal health needs.
Dr. Chad Woolner: The thing too, that I think is incredible, especially going back to what you were saying, Andrew, when you’re at all these different shows, and conventions, and you see all that array, you know, you go through the gauntlet of different vendors, promoting their various tools and technology. I think there’s a certain inherent part of us that wants to feel something like immediately when it’s happening, right, we want to get zapped, we want to feel the heat coming off of some tool or something like that. And I think that’s one of the most incredible things about your Erchonia lasers. And, and I would, I would assume with you, Dr. Silberman, that must have been an epiphany for you having used these lasers, you know, especially for such a really important need, and to not necessarily feel anything during the treatment, while the treatments are actually happening. You’re like, What the heck is going on here, and then all of a sudden, to see the results that you’ve seen from it that I think almost enhances the kind of wow factor, I think, to a certain extent, because, for me, that’s kind of I’ve come to that I’ll admit it, you know, I want my patients to feel something, you know, and it needs to produce something I can’t I can’t tell a patient, hey, if you’ll just wait 20 visits, or six months, we may see something happen, you know, and they’re like, Yeah, right. I’m not going to do that, you know, so they need to, we live in a kind of an instant gratification world. And so there has to be something either that zaps you, like I said, or heats up your skin or something like that with Erchonia. You don’t get a lot of that. But what you do get is a profound, almost immediate result when people see that. And so that had to have been, I’m guessing again, you tell me if that was the case for you, but very eye opening for you to experience that.
Dr. Rob Silverman: Again, without question, what’s interesting about it is it’s non thermal. So there’s no heat involved as a matter of fact, in certain heating lasers, that can be extremely deleterious. Right. The real takeaway for me for laser therapy over the last 12 years, is its ability to attenuate or ameliorate different symptoms in outside conditions. So I believe that the economy laser is the most versatile healthcare tool of the 21st century, in that it’s versatile in the ability to work with so many different conditions. It’s versatile, and I can take it from room to room, I can take it home, I can go to the field. When I say the field, you know the playing field, I can also have a great equalizer amongst 15 different dogs who have different skill sets with adjust. But what’s most interesting to me about lasers is, you know, they think it’s the new kid on the block. It really is it in 1903 Dr. Thiessen was awarded a Nobel Prize in Physiology for treating skin tuberculosis with blue light and smallpox with red light, which truly mimics our adrl About 120 years later, wow. Now 50 years ago, a couple of doctors in Hungary were using it for wound healing. So really to speak to what Dr. Wells said, laser. What does it mean? Well, faccin acronym, light Amplification by Stimulated Emission of Radiation. It’s a focused beam of light that emits Photon energy, you want it all going in the same direction in the same beautiful wave. And we call that coherence. That’s a critical element to laser effectiveness, some synonyms of laser to really speak to the idea where you don’t feel it, but you see the results after photobiomodulation, or low intense light therapy. Here’s the skinny, here’s the secret sauce. It’s electromagnetic transfer of energy based on a photochemical effect, not a photo thermal, those chemical changes change within the cells. And what I like to correlate it to or use of metaphor, if you will, it’s photosynthesis of the body. That said, five big components for beneficial outcome of laser therapy is the wavelength and I hope we go through it in two wavelengths that according to utilizes our 635 nanometer wavelength, which is red because the red depicts the type of wavelength and a four or five violet wavelength. Some other things are dosage, one of the unique components To corneas lasers is a low dosage, low power, guys, you don’t want a lot of power, you don’t need a lot of power. Because that delivery mechanism needs to be coherent. It’s all about absorption. The body is all interconnected. It’s not about depth of penetration. And of course, we’ll talk a little bit about I’m sure in some of the succeeding topics, we’ll talk about movement. And the big idea for musculoskeletal because that’s the big overlay that we’re talking about, is that we want the light to be pulse. Interestingly enough for the photochemical idea, what are some of the molecular targets for low level laser therapies? Well, I tell a lot of my patients because they think they understand this a little better. Think of different wavelengths of light as like different nutrients, it’s important to determine which nutrient is the best for also the timing and the dosage, lasers effective with wound healing, reducing inflammation and pain. That’s the kind of practice that I want my mantra is to manage and modulate inflammation in my patients. The target of visible light, not to get too technical, is cytochrome c oxidase that resides in the mitochondria, the cytochrome c oxidase initiation signal cafe that stimulates the cellular response. Everything that the mitochondria is really what the laser is pointed to. So a brief simplification, you get a photo of photon absorption, electromagnetic transfer of energy, mitochondria activation, increase the efficient ATP production, and stable healthy cells.
Dr. Andrew Wells: Well, that’s the I think that’s the best way I’ve heard the science of lasers articulated. And yeah, so that’s, I understand now, why Erchonia wants you to do talks? Because that was great. I can’t help adding something to you.
Dr. Chad Woolner: I think I can’t help but think when you’re explaining this, Dr. Silverman, I’ve been surprised as to how many of my patients are actually listening to this podcast. I thought originally, when we started this, it was just going to be all for doctors, rightfully so. Right? Because we’re diving pretty deep. And yet, I’m finding that patients are really wanting to know this information at a really deep level. And so I’m, I’m really as you’re, as you’re explaining this, I’m like, Oh, I’m so excited for my patients, and other doctors, patients, for that matter, to to hear these explanations, because I think when they hear it, all of a sudden, it’s gonna like really resonate, especially that comparison to photosynthesis, but then really helping them understand it at a deeper level. Because I think sometimes with technology like this, rightfully so, we as doctors, want to just kind of gloss over things. And we’re in some instances, maybe we do that, because we don’t necessarily feel totally comfortable. Getting at a deep level. We’re just kind of like, Yeah, I know that when it stimulates the tissue, it speeds up healing, it reduces inflammation, and a bunch of other good stuff, you know, and they’re like, okay, but but for some patients, they’re like, Yeah, but how does it do that? You know, and so I think, again, you’re doing a great job explaining that in vivid detail. And yet, it’s fairly straightforward. You know, that makes sense. When you hear that you’re like, oh, that totally makes sense. So, yeah, that’s awesome.
Dr. Rob Silverman: You know, it’s funny, you mentioned that there was an article yesterday. And the last thing I want to do is talk about COVID. But the explanation was outstanding in that patients resonate, and rely on doctors that communicate that they trust. So when they’re able to understand what you’re doing, because you don’t feel the laser, would you see the results? If that trust is that explanation, and I start testing for treatment, and the testing after the treatment. So I always assess, treat, and reassess. Which really speaks to what you said, this way, the patient knows what’s going on. I mean, everybody in that photosynthesis way, understands what photosynthesis is. In seventh grade. Everybody knows what mitochondria and ATP are. Yeah, because we learned that in high school, do you let me give you one little tidbit, I always love to get these factoids. The number one party of the body that gets stimulated has the most mitochondria, your brain and where are you accurate, right? Yeah.
Yeah. Now, to most doctors, I think what you’re saying makes sense. And I think it’s calm is a common sense approach to helping your overall physiology and your cells work better your brain work better, your muscles, your musculoskeletal system work better, but what would you say to a doctor that says, like, you know, this, this makes sense to me, I want to try to integrate this into my practices are a model that I can follow. That was easy for me to pick up and start using this with patients and I think you’ve developed what you call like a three three phases of care model. Can you explain what that looks like?
Dr. Andrew Wells: Yeah. Now, to most doctors, I think what you’re saying makes sense. And I think it’s calm is a common sense approach to helping your overall physiology and your cells work better your brain work better, your muscles, your musculoskeletal system work better, but what would you say to a doctor that says, like, you know, this, this makes sense to me, I want to try to integrate this into my practices are a model that I can follow. That was easy for me to pick up and start using this with patients and I think you’ve developed what you call like a three three phases of care model. Can you explain what that looks like?
Dr. Rob Silverman: For sure, are the three phases of care and you know, very simplistically in a concise manner, looking at different phases of healing phase one is the acute phase. That’s obviously let’s use a strength danco Lower back that’s the initial outward hurt swelling is hot. It has all the signs of inflammation that typically runs its course in a three to five day period. But it’s critical, you want to support different things in those first three to five days, then phase two is what we call the sub acute phase where there’s repair and remodeling of an injury, current. And this is where collagen and fibroblast proliferation occur, where you’re hoping that the soft tissue structures will heal in a parallel form and not a perpendicular form, leading you down a path of scar tissue, again, for the four five up into including the gates. And of course, there’s a third phase of care, which I think we all want to live in, which is wellness, and performance. This is after an injury, not just holding where they were before pushing them to new levels, because as we know, the American population is not healthy. Everybody’s on fire. 75% of Americans are overweight or obese. 12% of Americans are metabolically healthy, and only 3% of Americans are here on what we would call a checklist of a cure for wellness. And one little thing to keep in there. There’s also the chronic and unfortunately, too many of us as practitioners deal with the chronic because the patient waits to see if the injury goes away. If you’re a patient, if you’re a consumer, don’t wait to see if it goes away musculoskeletal injuries will heal on their own with scar tissue. Go see your practitioner. And one of the beautiful things I just want to give a little background. There’s a great study in frontiers of physiology in February of 2022, which really depicted and explained in a very scholarly manner. The mechanisms of low level laser in the treatment of a tendon injury as we all know attending goes from the muscle to the bone and helps us do what we call differentiation of cells, collagen synthesis, and angiogenesis. It also allows for the remodeling which I referred to before, of extracellular matrix, everything outside the bone and here’s a real takeaway outside the bone, cartilage, ligaments, muscle fascia, so it showed that factors that were associated with the remodeling of extracellular matrix, it increased laser protein synthesis and decreased protein degeneration. And it also decreased the damaged stage of specific cytokines which are emmalin macrophages, neutrophils, TNF alpha, interleukin six, interleukin Iby, Cox two and of course, the NF kappa B inflammatory pathway, and it stimulated the repair phase, the m two macrophages and we could spend all day on this cop seven, and interleukin seven. So essentially the takeaway there was laser decrease inflammation, stimulated repair at a cellular level and the ecrl and or the FX four or five, which is mix slides, both a red and a violet light, are without question, the choice for these musculoskeletal injuries because the red light or six batteries is great for wound healing tendons, ligaments, cartilage and bone. But the violet light is great for fascia, the saran wrap of the body. And that molding of those four or five different things leads to higher level outcomes because I believe the lack of that saran wrap of the body now when I say saran wrap, what’s a good example for patients? Anybody ever pulled the skin off a chicken? Well, you got the meat, you got the skin, but that little white film, that’s your fascia, if that’s not healed, if that’s not addressed, you’re not going to have a musculoskeletal optimum. So in the violet light that synergy between them is the choice laser light to use for musculoskeletal injuries.
Dr. Chad Woolner: Yeah, I found it interesting. I was just gonna say real quick. I remember in in chiropractic college, you know, them giving us this kind of model to follow that, you know, if if there’s an injury to an area, the body is going to send all of the various repair cells and or, you know, kind of infrastructural, you know, fibroblasts to do something. But if nothing is done to, in essence, signal them to do what they need to do. Basically, the default mode is going to be scar tissue or fibrotic tissue, right? And so the reason why we would engage the patient in some type of rehab where we’re actively moving, you know, the injured area to strengthen or stabilize it, a big part of that is to, in essence, signal those repair cells to do something other than the default. Right? And that’s how we help. One of the ways in which we help, but if doctors are hearing this, the way that I’m hearing it, what we’re hearing is that one additional tool in that quote unquote, signaling And I think there’s something to it. I’m hearing this and again, maybe you can connect this better than I can Dr. Silverman, but something about this idea of the coherence of light, right? This is the light being organized or structured in such a way that it’s not scattered. It assists in creating a coherent likewise tissue structure, right? Because ultimately, that’s the one of the differentiations between say fibrotic tissue or scar tissue and let’s say healthy muscle or tendon is those parallel fibers or you could say those coherent fibers so coherent something about that is, am I am I hearing that correctly, coherent light creates coherent fibers, scattered light may not necessarily help to develop those kind of parallel or coherent fibers is that is that a correct analogy there?
Dr. Rob Silverman: That’s a great analogy, the bodies all interconnected. As we all know, from our chiropractic origins, we communicate, the body should communicate in a molecular soliloquy, if you will, not disease is like an orchestra playing without the conductor, right. So the laser right, though coherence, the ability for it to be pointed, verse scattered, allows for clinical outcome. And I think that’s beautiful. And that is one of the key components to the corneal laser because they have a special lined line dial that enhances the coherence and just think of it a sniper verse, or better yet, what I tell all my patients is take a hose and press the hose, so it goes straight out the water, put your hand on the hose, and it’s scattered all over the place, you get everybody wet, but you’re not really hitting the fire that you need. Right. So your analogy was stellar.
Dr. Andrew Wells: So I want to kind of jump in the different different body parts you’re using this for so we’re talking about musculoskeletal pain. The first one obviously, that jumps to mind is lower back pain. That’s I’m sure I don’t know the percentage but it’s a bulk of patients walking into any health care providers office with pain, good chances lower back pain without so maybe we’ll start
Dr. Rob Silverman: sorry. And 10 Americans, as we all know, at some point have lower back pain. I mean, we were having a conversation before Functional Neurology functional medicine is chiropractor, or practitioner just honed in on lower back, they would be so busy, they probably would have 10 practices and 15 different associates. Sometimes people stray from that, but that’s where we all started. That’s our home base, if you will laser shown to help with spinal cord injuries, it’s actually shown to allow neurons to survive is shown to elevate specific interleukins interleukin four interleukin 13. So the takeaway and in nature.com study was that a low level laser can be an effective candidate for the treatment of spinal cord injuries. Lasers, also shown to precipitously decrease specific objective blood markers like interleukin six and interleukin eight. And as I said before, interleukin six is the the evil sister when that’s elevated, a lot is going on as a matter of fact, lasers shown to decrease dramatically interleukin six and interleukin eight but here’s what’s most interesting 405 nanometer wavelength does a great job and interleukin six and the red light 635 does a better job on the interleukin eight really piggybacking on the theme that the mixed life is a better choice as we all know, or cornea has an FDA clearance requirements or back pain. And when you looked at the visual analogue scales, the Oswestry scales and treating low back with the 12 month follow up, you had this dramatic drop in pain, you had this tremendous increase in range of motion. But here’s the idea to speak to what Andrew spoke about before the idea of putting the body’s health signals in motion 12 months after any treatment, there was still an 80% decrease in pain with no other treatment. So one that should excite any patient number two, doctors should say well, you know what, I have to let them know that they’re going to continue to get better. And I think that’s where, unfortunately sometimes we fall short and we’re not elucidating what we need in June 2019 To really pile on a little bit akoni was the first to receive a non-invasive technology FDA clearance for overall most receptive musculoskeletal pain. So what does that mean in layman’s terms? It basically means anybody for any muscle, any joint you apply the laser, you’re gonna get a good outcome. But let’s take it one step further. Let’s really mesh that idea about using the laser in a red light and then the vital life why the violet light works so well on the lower back. Well, studies have shown that about 50% of people have a bacterial infection in a herniated or surgically repaired desk, the violet lights, special properties are that bacterial, antifungal, antiviral. So that says, when you mix reading the vital life, you’re really getting a better musculoskeletal outcome. And if I could just say for me, using what we call the FX 405, I found that laser therapy is either a standalone set it and leave it or synergistic with other treatment modalities. So the standalone home, set it and forget it, right? You can walk out of the room, or you can use it with myofascial release, electric stim, if that’s your jam, exercise, rehab, acupuncture, dry needling, decompression, taping, even adjustment, instrument assisted soft tissue mobilization, and any other modality. So again, the real takeaway is it’s great as a standalone in musculoskeletal life. But it’s great in synergy. So people also say, Hey, do I have to lose something to put the laser in? Nope.
Dr. Andrew Wells: That’s one of the big messages I’m getting for you. Dr. Silverman, is I’m thinking of all the different ways that chiropractors and other physicians practice, like, Hey, I’m, I’m a sports chiropractor, or I’m a pie doc, or I’m a wellness Doc, I’m a high volume Doc, I’m a pediatric doc. From what I’m understanding this could fit in and correct me if I’m wrong. Is there any? Is there any general chiropractic practice model where this would not complement what they’re already doing?
Dr. Rob Silverman: I’m a big believer, that low level laser corneas laser fitting any practitioners armamentarium.
Dr. Andrew Wells: Yeah, I’m just making like, I came out of school, like a very like, I call myself a right wing chiropractor, like, all we need to do is adjust the patient. And I had never heard of this study where 50% of people with lower back pain or disc issues have some sort of underlying infection, there are some infections going on that and adjustments not going to affect in a positive way, at least in the short term.
Dr. Rob Silverman: And nobody’s saying that we don’t have to adjust the patients, we’re just saying that this fits in within the adjustment. If we get a lot of things like, do I have to give up adjusted No. adjustment is an extraordinarily effective thing without question ScienceBase. But being that we’re ScienceBase, we have to look at other things. My goal isn’t to adhere to a principle, my goal is to fix the patient. So when someone comes in, it’s not that I’m married. Technique matters, America is getting better. That’s my Oh, that’s what I promised my mom.
Dr. Chad Woolner: I wanted to chime in. You know, I had a patient literally just yesterday, who was asking me about the laser. And his question to me was, he says, so if I do this laser, and I go through, you know, X number of sessions, are the results going to be permanent? Is what he asked me. I mean, talk about a loaded question there, you know, and I couldn’t help but think of this study that you just mentioned there that after a 12 month follow up, there were still positive results with these patients. And, and that was what I was trying to explain to him is that the studies that I was aware of, and this is this is a good study to reference. Whenever I get that kind of loaded question there is, and my response, obviously, is we don’t live in a vacuum. Obviously, I can’t predict the future in terms of what happens, you could slip, you could fall, any number of variables, infinite numbers of variables can come about. But that being said, Knowing and I think that the question that they’re asking isn’t necessarily is it going to be permanent? But is it going to be a band aid? Or is there going to be a longer term outcome here, and I think that’s the benefit that you’re talking about. There’s definitely longer term outcomes. So that’s exciting to hear. Patients should be really excited about that.
Dr. Rob Silverman: And it takes the patient variability out so we do everything and I know you guys do, we had a nice conversation. Everything’s personalized and individualized. There’s no, no people asked for a protocol, but we individualize and personalize our protocol for each one of our patients. But within that, some patients have difficulty following instructions. There are strains on them, the laser, even an appointment, shoot, help somebody. But the special idea is that if you can get that person moving, so I do something that I like to share with everybody, I call it Simon Says, as simple as 123. So all your laser guys, everybody calls up and wants to know how to have the eyebrow grow. And I’m just using that as a wild example. Sure. So it’s really simple. Everybody pointing shoots at the area. Passively move the area while applying a laser. Actively have the patient move the area. Use a little resistance to upregulate the brand, and you just had it out, standing tree ring, you covered it simply as 123. And you got a little proprioception in there. And guess what? That patient is going to be better. Now we can share real complex protocols with complex conditions. But everybody needs to start with that, especially in a musculoskeletal, like, keep it simple, keep it consistent, individualize and personalize it and you’re going to optimize your outcome. Without question.
Dr. Andrew Wells: I’m hearing a consistent theme with a lot of the doctors and experts we’ve interviewed on this podcast and that if you’re using a laser number one, you’re not going to hurt somebody. Number two, it’s pretty easy to help somebody by just keeping it simple. Like you said, point to the area that hurts, get some motion going and you’re gonna do a lot of good and not have to worry about injuring that person or, or worry about getting, you know, the best outcomes just start somewhere. And I think that’s a great way to start. And I was thinking about how Dr. Silverman had a really nasty car accident about four years ago and broke my neck and broke my shoulder and I was out for a while. And you know, I had a lot of good therapies at my disposal, but my shoulder wasn’t healing quickly. And I had it diagnosed as a misdiagnosis, a tear, and I had an MRI and I was pretty sure it was a frozen shoulder but it just wasn’t getting better wasn’t getting better. I went to a really nice chiropractor who’s in town here. He had PMF machine that he did some work on and some hold similar types of laser laser therapies, and I think it helped but I was desperate with a frozen shoulder for a solution. Do you see a lot of frozen shoulder issues in your office?
Dr. Rob Silverman: I do and laser data is robust on helping with frozen shoulder studies that have shown a significant decrease in overall night and activity pins at the end of different time intervals for eight and 16 weeks. There was also a significant decrease in shoulder pain and disability index in those same time frames coupled with a decrease of disability of arm, shoulder and hand. And the very basic health appraisal questionnaire really decreased precipitously in 48 weeks. There was also, believe it or not, a study on lasers for shoulder 10. The opposite was 17 randomized controlled trials. And a lot of times, they’re attended oppositely before the frozen shoulder. And the takeaway was that optimal low level laser therapy can offer clinical Revelin pain relief and initiate a more rapid course of improvement, both alone and in combination with physiotherapy interventions and other chiropractic. So for me, I believe combining low level laser with exercises over a three month period is really the type of approach that you want to have with a frozen shoulder. So exercise works, laser works, the combination works best.
Dr. Andrew Wells: I love it. I want to talk a minute about this kind of deviation a little bit from musculoskeletal conversation. But let’s talk about concussions for a minute. And your treatment protocols for concussion and how lasers are being implemented for this type of issue.
Dr. Rob Silverman: You know, I applied for laser concussion out of need about five, five and a half years ago, so many of my high school athletes were coming in with his costume and weren’t being treated and a couple of notes on concussion. Number one, you don’t actually have to have a concussion that damages the brain. It can be a cumulative self concussion, a bump on the head can do it. Women are much more apt to have a concussion than men and women are more susceptible to concussion simply because even though there is a strong pound for pound it is men below the waist. They’re a little weaker up the waist pound for pound more of a height with more of a shear more of repair. Also, they are morally different. So something called withdrawal hypotheses. Women are based on a progesterone in the last two weeks of their menstrual cycle. When progesterone elevates, it has a healing calming effect on a female’s brain. The problem is after concussion, there were strong hypotheses that the pituitary in many instances stops producing progesterone and that we’ll get to women’s microglial cells really get turned on in crime much quicker than that. So let’s dial it back down and let’s talk about a concussion approach and multi system approach number one musculoskeletal system. Everybody shouldn’t be looking at the upper cervical region. The occipital triangle especially the rectus capitis posterior minor is Dural attachments really implicated in a concussion number two balanced training if you will proprioception your balance in your nervous and your muscular system number three visual disturbances. I know you’ve had a couple of Cairo neurologists who did a great job above explaining that with gaze stabilization laser and of course, we’re going to go into laser and nutritional supplementation. I’ll try and touch upon that. But my five big nutritional supplementation suggestions are magnesium L, three and eight pro resolving mediators, omega three fatty acids, and glutathione. And good old tumeric, which decreases NF\ kappa B. But we really want to delve into lasers. So let’s get a little granular: what is the molecular cascade that occurs after a concussion? Well, concussion can damage axons, from the whipping back and forth in these, what I like to call electrical cords can tear if they tear, it’s a bad day. In addition, you have something called excitotoxicity. The NMDA our pathway opens this synaptic cleft in calcium goes from the extracellular space to the intracellular space in potassium goes from intro to extracellular. That being discussed, there’s membrane disruption and axon damage, it can lead to painful ptosis. It can also lead to mitochondrial dysfunction, which can lead to cellular damage. Concussion injury also can lead to microglial activation, what with microbials. We hear it all the time. Well, they’re actually macrophages, they eat up cellular debris, they’re very specific to the central nervous system. So in their primes over activated for the macrophages exam, one is very damaging to overall health. So the takeaway is you want active and targeted treatments that may enhance recovery after concussion. One of the big things I tell everybody I love to share with my practitioners is when you talk about laser therapy, each individual has a different tolerance threshold, and a need for variability. So protocols are not going to be 20 minutes or two minutes, it’s going to be within a specific timeframe for that individual. Having covered that low level laser therapy in multiple studies have shown to be effective for acute recovery post TBI. They improve neurological performance, they stimulate the growth of new nerve tissue. They also help regulate proinflammatory microbial cytokines. They are also shown, especially 635 nanometers, to modulate and decrease NF kappa B signaling pathways. Dr. Oran in Israel did studies and showed that the size of an injury 30 days later, after concussion was significantly smaller if you apply the laser versus placebo. And the big question is, if I can try and put in one epigrammatic paragraph, how does laser work? Low Level lasers suppress pro-inflammatory cytokine expression of interleukin one beta and interleukin six. So protective effects of low level laser may be ascribed to enhance ATP production and selective modulation of pro inflammatory mediators. So that was a little bit of a load. I’m sorry to give you so much. Oh, no, I was great.
Dr. Andrew Wells: That was great. Would this help for somebody who had a concussion, let’s say, two years ago, or five years ago, or 10 years ago? I’m thinking like, my thought is, obviously if you have a concussion or traumatic brain injury, this inflammatory cascade happens immediately. But we all are starting to learn now that having a traumatic brain injury really affects somebody decades later. So let’s say you had an injury, played sports or football or had a car accident or fell and hit your head years ago, is there an application for laser therapy for somebody years post post injury?
Dr. Rob Silverman: Absolutely. You know, people ask that, and that is probably the most frequently asked question I had six years ago, 10 years ago. Can you help me? Well, number one, we can stop generation number two. In most instances, it’s never too late. So when you really look at what laser does, and this comes from November 2017, neuroscience research and I love to quote non chiropractic journals when it comes to laser and concussion, really to speak to what you said, applying laser or 635. anatomy to red light, actually increased angiogenesis, blood vessels, decreases brain edema, lymphatic drainage, increase, increased blood flow, so you had cerebral oxygenation allow for neuronal progenitor cells synaptogenesis, basically and stimulated something called BDNF brain derived neurotrophic factors. And this is the key component by stimulating BDNF. You’re allowed to have brain neurogenesis, ultimately having positive neuroplasticity over a duration of time and decreasing the excitotoxicity. So to answer your Last June, yes, it’s typically never too late, but it’s always better sooner.
Dr. Chad Woolner: So selfishly, I’m going to ask you, Dr. Silverman in this context, I have a patient right now literally coming in. We just got the lasers into our practice about almost four weeks ago. And we’ve been getting so many patients who have just been coming in from referral already, it’s been actually pretty shocking to us to see that. We have a gentleman who was in a really traumatic car accident racing accident, he was a racecar driver, and had a really bad brain injury 12 years ago, and he still to this day is having difficulty with speech, difficulty in terms of speaking and then also cognitively making that connection in terms of being able to articulate the words he and you can tell, he understands, cognitively, everything’s fine, and everything’s there, but just having a difficult time getting the words out. And so were and when they asked me, you know, can this help him? You know, my response was lasers, you know, can help just about anybody. But I was obviously, as you could imagine, probably a little apprehensive just because of the fact that I’m, I’m not a neurologist. You know, I’m familiar to a degree with, you know, some of these protocols you’re talking about in terms of, you know, recovering, but in that instance, anything particular that you would recommend in that situation, in terms of protocols, specifically with the laser, specifically with speech, and things like that. Yeah,
Dr. Rob Silverman: Absolutely. So the concussion protocol that I would give you, obviously, again, I think you guys have to be one, the 635 or the four or 5am? Am I correct?
Yeah, we have the 405.
Okay, great. Apply the 405 for, you know, two to 10 minutes. Again, you want to see how they respond to win you imbue the mitochondria. With all that energy. You’ll have them speak during the process, have them read, have them do a crossword puzzle. And also, I know we’re going to cover this and maybe some of the upcoming podcasts, vagus nerve stimulation, especially in VR, a regular portion of the body that is now without question, the hidden job. It’s a true clinical nugget to get that regular portion. And are you guys ready for this? I know I don’t want to give away everything. I know. We’re going to talk about it later. But you know, not everybody listens to every podcast, if you want to decrease the sympathetic activity, activation of the vagus nerve, laser, the trigeminal nerve. Okay, so doing all that, getting a little proprioception, doing some crossword puzzles, having them read, having them speak. So a little personal note, my mom had some trouble speaking with my mom, 93 and 91 and a half, she was starting to lose some of our cognitive ability, Nothing extravagant. Unfortunately, she got COVID COVID affected her brain cognition most. And it was pretty bad. You know, I’m a Jewish guy. As you guys said, from New York, my mom has never called me by my Hebrew name in my whole life, my Bar Mitzvah. And my mom was starting to call me by my Hebrew name when I walked in the house, which is, which will be out if I can use a particular type of binoculars? Yeah, so I’ve been doing exactly what we said. And you know, the only people in the world to call me Bob, so please don’t call me Bob, or my parents. She’s not referring to me, as Bob and cognitively is coming back. So that protocol was not mainly just for patients. That protocol was made to help my Jewish mom. So there was a lot of pressure there.
Dr. Andrew Wells: Thank you for sharing that story. You know, it’s interesting how some of these protocols come about. And again, we talked about at the beginning of the podcast, just out of sheer necessity to help people and help the people that are closest to us. So appreciate you sharing that story with us. I know Dr. Silverman, you do a lot of work with athletes and sports performance. How have you been using lasers for those types of patients?
Dr. Rob Silverman: I’ve been using them in a two fold manner using for protective and energetic so number one protective you know, I’m trying to decrease oxidative stress, improve our muscle fatigue, trying to decrease blood, blood lactate levels, obviously the inflammation that we talked about muscle injuries, etc. But for performance, people don’t realize how energetic the laser can have tremendous impacts on performance. Muscle strength gains speed of muscle adaptation, time to onset of muscle soreness, dramatically decreases time to exhaustion, stress, resistance and recovery and speed. The couple of studies in 2016 really spoke about laser and human muscle tissue having a tremendous advantage. In sports performance, they thought it was such an unfair advantage, they almost want to ban it on an Olympic level. I mean, think about that, and say that they want to ban it. Now from some personal notes. I’ll go to some gyms if they’ve been CrossFit gyms and everybody knows what a TR is a personal, fast or personal record. So I’ll tell some of my friends who want to compete. So let me ladies you before you do your why your workout of the day, let me lazy before you do your deadlift, and to a tee, everybody’s got a PR, I used to do that for my wife, she used to go to the cross my bench, but you gotta do 50 pushups, I can do 30 or 35. And my wife will not do a modified push up. That is just a no brainer not happening. So I’d have to raise her to get to 50. And I can tell you from you know, the weekend warrior, to the Olympic athletes, it’s giving them an unfair advantage in performance, who would want to adapt that into their lifestyle?
Dr. Chad Woolner: So can I can I put up timeout real quick here, just for a second, because the minute you said that, Dr. Silverman, I’m thinking, you know, from a business standpoint, I think you just gave docks here a golden nugget, diamond gem, whatever you want to call it in terms of a marketing opportunity here, I can just see this. And quite frankly, I think this is what we’re going to do. So we’re gonna go to our local CrossFit gym, we have a really good friend of ours who a patient of ours who runs a CrossFit gym here in town, just down the road, set up your laser, and offer that as an opportunity to see, you know, if you can’t help these people, you know, improve their prs. And, you know, boy, what an incredible hands on, you know, demo opportunity to show and showcase the power of these lasers in your practice, no doubt, I guarantee you, you would have these athletes coming into you immediately following that, especially when they see that kind of improvement. That’s that there. So I just wanted to kind of point that out and connect some dots when you said that there I thought that’s a genius idea.
Dr. Rob Silverman: I think that’s a great idea. And you can combine that with sports teams, because their performance base, whether it’s your peewee, your high school, your college, all the way up to your professional Olympic athletes. You know, they start somewhere. And that’s actually why I started my practices with sports injuries with a 10 year old and they grew up. And a lot of them played high school and played college, some even play professional. So I love the idea that you gave a practice management nugget for everybody to noodle on. Because the fact of the matter is, if we don’t see people, we can help them with the laser because the laser is abstractly into a room that I’m by myself. And we want all listeners, especially chiropractors to benefit from the utilization of lasers. And the reason that we want that is because we want to get them matches better. Yeah, there’s nothing better. It’s a non drug approach. Isn’t that what we like to remember? Drugs had their place, but unfortunately, it came with some side effects. There’s been no known contraindication of any of the 20 FDA clearances by our cornea. And without question, that excites me to no end. Because now the safety factor is on my side. There’s no shadow when the patient walks
Dr. Andrew Wells: I think we can have the fortunate benefit of having you Dr. Silverman for another podcast episode here. We’re going to record her very soon. But as we’re wrapping up here, can you just rattle off a list of conditions, other conditions that we maybe haven’t talked about that are useful with the laser,
Dr. Rob Silverman: Absolutely peripheral neuropathy. The Sides add up and I said that word specifically since I added sciatica carpal tunnel, believe it or not, here’s one for you. There’s some data that talks about decreasing tooth sensitivity after a dental bleaching event guy like me, I’m all about it. Vertical tinnitus. Believe it or not TMJ, TMD fibroid and I think we’ll get more into that in the gut, and autoimmune chronic asthma and maybe one of the biggest ones because we always liked that functional medicine overlay. Lasers have an effect on vitamin D and magnesium levels. It increases those levels. And lastly, because of my torticollis most people think I have dystonia, and I don’t buy cervical dystonia, as an FYI, and of course, congenital torticollis go for it guys.
Dr. Chad Woolner: That’s amazing. I love it. Yeah, it’s incredible to hear like again, going back to kind of what Andrew started with. You know, I think most if Doc’s are aware of lasers, most are immediately going to kind of hone in on lasers being used dominantly for aches and pains, musculoskeletal in the you know, but but just the application. And I should say the implications of this are pretty incredible when you hear the wide array of different things that these lasers can be used for.
Dr. Andrew Wells: And one of the reasons we’re doing this podcast is to get the word out, I really wish that as I was going through your chiropractic school and early on in my career, I’d known about this because I would have purchased a laser and used it not just to help more patients, but because I saw it with Chiropractors, we see so many different types of conditions that this can help with. And I just see this is almost an indispensable tool that chiropractors can use for so many different problems that we’re trying to help our patients with. And so Dr. Silverman really appreciates you being on here to help educate doctors and educate patients on the use of laser therapy, and how it can be used for how it works. And why I think this should be a major tool in most, most chiropractic and even physician offices. So is there anything that you want for any parting wisdom that you want to leave us with? As we wrap this episode up?
Dr. Rob Silverman: Absolutely. Here’s something that I tell all my patients, one of my favorites, Jim Rome, take care of your body, it’s the only place in your house to live. Laser is really going to help you take care of it.
Dr. Chad Woolner: That’s amazing. And you have a new book that’s coming out in September, the immune reboot, maybe tell us a little bit about that, what we can expect with that, where we can get all that fun stuff.
Dr. Rob Silverman: Well, over the last two and a half years, something has overtaken the world. And it’s called COVID. But it’s a virus. And one of the biggest problems that we in America had is that, as I alluded to before, we’re an unhealthy population. So I explain how the immune system works, how the immune system should work. And it has a plethora of protocols for everybody to utilize to keep their immune systems balanced, rejuvenated and resilient.
Dr. Chad Woolner: So if I’m hearing you correctly, there’s more that we can do proactively than what we’re hearing in terms of most of the mainstream. Messaging, correct.
Dr. Rob Silverman: What was that question? I was appalled. I loved the medical doctors. But I was appalled by the fact that people did not discuss the idea of ajisen type of functional nutrition to help the immune system in any status, or any desire or what patients wanted to do. I mean, one little study vitamin D levels of over 50, right? Nobody died, whether they were vaccinated or not, if their vitamin D level was over 50. So you know, as basic as vitamin d3 is with King two, let’s talk about sugar, for argument’s sake. 300 calories of carbohydrates at one time, decreased your immune system by 50% over a two hour period. So when I’m traveling two years ago, on a plane wearing a mask, and everyone’s wearing a mask, everybody’s having a frappuccino at Starbucks, it made no sense.
Dr. Chad Woolner: Yeah, yeah, crazy. Well, I’m looking forward to that book, I’m going to make sure we get it and definitely share that with our patients. Because I’m confident that that’s going to provide moving forward. I unfortunately don’t foresee a whole lot changing in terms of the current kind of mainstream paradigm. But at least this is going to be a tool to maybe potentially help combat a lot of that. And I’m going to use this term, very deliberately misinformation that’s out there in that respect. And so we appreciate all that you’re doing Dr. Silverman, we’re super excited for the book. And we’re super excited for Doc’s to get this information into their hands and into their practices and ultimately, so they can help their patients. So Doc’s, we appreciate you listening in. We hope this has been incredibly insightful and valuable for you. Now go and start using these, these lasers and these protocols that you’ve learned here from Dr. Silverman to better help your patients and so we will share more with you guys on the next episode. Have an amazing day. We’ll talk to you later. Thanks for listening to the laser light show. Be sure to subscribe and give us a review. If you’re interested in learning more about our Konya lasers, just head on over to or codea.com. There you’ll find a ton of useful resources including research news and links to upcoming live events, as well as are CONUS e community where you can access for free additional resources including advanced training and business tools. Again, thanks for listening and we will catch you on the next episode.
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Thanks for listening to the laser light show, be sure to subscribe and give us a review. If you’re interested in learning more about our Erchonia lasers, just head on over to Erchonia.com. There you’ll find a ton of useful resources including research news and links to upcoming live events, as well as the Erchonia community where you can access for free additional resources including advanced training and business tools. Again, thanks for listening and we will catch you on the next episode.
