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improving both histological and biomechanical param- Pulsed magnetic field therapy (PMF) uses mag-
eters. [459] netic fields to stimulate metabolism and healing pro-
Therapeutic ultrasound (TU) is frequently used for cesses. It is also used to decrease inflammation and
the treatment of connective tissue such as tendon and pain, and can be combined with other modalities such
ligament injuries or scar tissue. The transmission of the as LT, TU, and others. [463] PMF therapy makes a great
pressure of ultrasonic waves from the skin to deeper combination with LT, and can add to its physiological
layers of tissue improves blood flow, muscle relaxation, effects; the author has observed this effect in musculo-
collagen production, and tissue remodeling through skeletal pain and neurogenic bladder disorders.
thermal and non-thermal mechanisms. Some in vitro Chiropractic and other manipulative techniques
and clinical studies show LT can be superior to ultra- also combine very well with LT. In fact, chiropractors
sound in stimulating fibroblast activity, [136] but compar- have been some of the first to incorporate LT into
ing different parameters necessarily produces different their practices, on both the human and the veterinary
results; for instance, in the treatment of pain, LT is side. Myofascial pain, trigger points, and low back
superior to TU in some studies, [460] but then in others pain are some of the common conditions treated. LT
(with low power and dose) TU has a more marked effect prior to adjustments can help muscle relaxation and
on anti-inflammatory biomarkers. The combination is ease manipulation. A clinical study in human patients
possibly synergistic: a study on experimental tendon suffering from cervical pain due to vertebral facet dys-
injury showed both TU and LT increased the amount function reported a potentiated efficacy when both chi-
of collagen production and the percentage of type I ropractic adjustments and LT were combined: patients
collagen, but the combination of both was even more improved their cervical mobility and reported less
effective, especially if LT was applied prior to TU. [138] A intense pain. [464]
synergy in the analgesic effects was also described in a
clinical trial using LT and TU for the treatment of hand 11.2.5 Stem cells and platelet-rich plasma
osteoarthritis. [461]
Low-level electrical currents are often used in the Some of the most incredible advances in medicine are
form of transcutaneous electrical stimulation (TENS) taking place in the fields of stem cell therapy, tissue
and neuromuscular electrical stimulation (NMES). engineering, and other areas of regenerative medicine.
TENS provides analgesia by affecting the threshold and The aims of LT and other modalities of regenerative
pathway of pain, while NMES use the electric impulse medicine are to increase tissue regeneration and mod-
to stimulate muscle contraction (Fig. 11.15). Laser can ulate inflammation; therefore it makes sense to think
be used with both in the same or separate sessions. LT there could be a potential synergy among them. That
before NMES can potentially help the patient make the is why, among the ways to enhance cell viability and
most of the NMES, since according to animal models proliferation, researchers have investigated LT.
and human clinical studies it will improve the metabo- Stem cells are not just interesting because they can
lism and contraction ability of the muscle and decrease multiply once implanted to replenish a tissue; they also
muscle fatigue, exhaustion, and muscle stress indica- produce trophic factors with a paracrine action, i.e.
tors. [462] they stimulate the growth of the host’s own cells locally,
increase vascularization, and modulate inflammation.
Stem cells can be obtained from embryos, fetuses, or
adults. Most clinical and preclinical studies use cells
from adults, either from the same (autologous) or a
different (heterologous) individual of the same species.
Let’s focus on adult stromal/mesenchymal stem cells
(MSCs): these can be harvested from the bone marrow,
adipose tissue, bone, dental pulp, periodontal ligament,
and other locations. The stem cells we are starting to
use in clinical practice are either from the bone marrow
Figure 11.15 Feline patient receiving TENS therapy and (BM-MSCs) or adipose tissue (AD-MSCs). So we either
simultaneous infrared heating. perform a bone marrow aspirate (easier than it sounds),

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