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Class IV · Non-Invasive · Photobiomodulation

MLS Laser Therapy

MLS laser therapy uses synchronized near-infrared light as a non-invasive adjunct for musculoskeletal pain and recovery. At Pacific Bone & Joint, we use it as part of an orthopedic plan—not as a stand-alone cure.

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Evidence is condition-specific and individual results vary. We pair laser therapy with diagnosis-driven care, rehabilitation and other proven treatments.

Common goals

  • Reduce musculoskeletal pain
  • Calm inflammation and swelling
  • Support recovery after injury or surgery
  • Complement physical therapy, PRP or BMAC when appropriate

A Short History

From a 1960s lab discovery to modern photobiomodulation

Laser therapy did not start as a marketing idea. It started with a surprising result in a laboratory, and it has been studied for more than 50 years.

  1. 1960

    The first working laser

    Physicist Theodore Maiman demonstrates the first laser, using a ruby crystal.

  2. 1967–1968

    Mester’s mouse experiments

    In Budapest, Endre Mester finds that low-power laser light speeds hair regrowth in mice, the first hint that light can stimulate biology rather than only cut or heat it.

  3. 1971

    Wound healing

    Mester’s group reports faster wound healing with laser light, launching decades of “low-level laser” research.

  4. 2001

    NASA-funded light research

    Researchers study light-emitting diodes for wound healing, broadening interest in light-based healing beyond lasers.

  5. 2009

    A Lancet meta-analysis

    Sixteen randomized trials of low-level laser for chronic neck pain, with 820 patients, show meaningful pain relief.

  6. 2011

    FDA clearance for 808/905 nm systems

    The FDA clears ASA’s dual-wavelength therapeutic laser family through the 510(k) process for temporary pain relief, circulation, and muscle relaxation.

  7. 2015

    “Photobiomodulation” becomes the standard term

    Researchers adopt the name photobiomodulation (PBM) therapy, and the term is added to PubMed’s medical vocabulary.

  8. 2019

    Knee osteoarthritis meta-analysis

    Twenty-two trials with more than 1,000 patients show pain relief in knee osteoarthritis, larger at recommended doses.

Understanding the Technology

What “Class IV” and photobiomodulation mean

Class IV describes laser power and safety requirements; it is not a score of clinical effectiveness. MLS therapy uses that light for photobiomodulation (PBM)—a process in which red or near-infrared photons interact with tissue and may alter cellular signaling.

1

Light reaches tissue

Near-infrared light is delivered through the skin to the targeted musculoskeletal tissues.

2

Cells respond to photons

Photobiomodulation research suggests light can influence mitochondrial activity, ATP production and cell signaling.

3

Pain and inflammatory signaling may change

Those cellular effects may influence local circulation, inflammatory signaling and pain processing. The clinical effect depends on the diagnosis, dose and treatment protocol.

808 nm · Continuous

Biostimulation / inflammatory signaling

MLS device literature associates the continuous 808 nm wavelength with circulation, cellular metabolism and inflammatory signaling.

  • Inflammatory cytokines
  • Lymphatic vessels
  • Swelling
  • Blood circulation

905 nm · Pulsed

Pain modulation

The pulsed 905 nm wavelength is used for deeper tissue delivery and is described as influencing nociceptive pain signaling. MLS synchronizes both wavelengths in one treatment pattern.

  • Nociceptors (pain receptors)
  • Sensory nerve fibers
  • Deep joint tissue
  • Pain threshold

Targets above are as described in MLS device literature; human evidence for each is summarized in the science section below.

Laser classes at a glance

ClassPowerExamplesWhat it means
Class IVery low powerLaser printers, CD playersNo hazard under normal use
Class II1 mW or less (visible light)Barcode scanners, some pointersThe blink reflex protects the eye
Class IIIa (3R)1–5 mWLaser pointersLow hazard; avoid direct viewing
Class IIIb5–500 mW“Cold” or low-level therapy lasersTherapeutic, but limited power for deep tissue
Class IVAbove 500 mWMLS® and other high-power therapy lasers, surgical lasersReaches deeper tissue; requires eye protection and trained staff

Class describes power and safety requirements under federal laser standards. It is not a measure of how well a treatment works.

The Science

What research shows about inflammation, swelling, and pain

Here is what the studies actually measured, with links to the sources, and where the evidence is still thin.

Inflammatory cytokines

19 of 22laboratory studies showed dose-dependent reductions in inflammatory markers

A 2006 review found that laser light lowered prostaglandin E2 (PGE2), COX-2, interleukin-1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α), the chemical messengers that drive inflammation and pain. Most of that work was in animals. In people, small randomized trials have shown lower PGE2 around an inflamed Achilles tendon, and lower TNF-α and IL-8 after hip replacement, although IL-6 did not change.

Keep in mind: Human cytokine data are small and mixed, so we describe laser as something that may influence inflammation, not a guaranteed anti-inflammatory.

Bjordal 2006 review · Achilles PGE2 trial · Hip replacement trial

Swelling and lymphatic flow

≈91 mLgreater reduction in arm swelling with laser in a lymphedema meta-analysis

Swelling is fluid that the lymphatic system has not yet cleared. In breast-cancer-related lymphedema, a meta-analysis of nine studies found greater reductions in arm volume with laser. In animal models, laser light encouraged new lymphatic vessels to form and reduced joint swelling in arthritic knees. After hip and knee replacement, small trials suggest less early swelling.

Keep in mind: Lymphatic effects in orthopedic conditions come mainly from animal research and lymphedema trials, not large orthopedic trials.

Lymphedema meta-analysis · Lymphatic vessel study (animal) · Arthroplasty review

Cellular energy and signaling

ATPthe cell’s energy currency, produced in mitochondria

Near-infrared light is absorbed by cytochrome c oxidase, an enzyme in the mitochondria. Laboratory research shows this can increase ATP production, release nitric oxide, which widens blood vessels, and trigger a brief burst of signaling molecules that switch on repair-related genes.

Keep in mind: The dose response is biphasic: too little light does nothing, and too much can suppress the same effects. More is not better.

Karu 2008 · Hamblin 2017

Pain relief

≈20 mmaverage pain reduction on a 100 mm scale for chronic neck pain

The best human evidence is for pain. A Lancet meta-analysis of chronic neck pain and a BMJ Open meta-analysis of knee osteoarthritis both found clinically meaningful relief, with knee benefit rising from about 14 mm to about 19 mm when recommended doses were used. Shoulder tendinopathy responds to adequate doses but not low ones.

Keep in mind: Not every study is positive. Laser added nothing to exercise for Achilles tendinopathy in one trial, and evidence for low-back pain remains uncertain.

Neck pain (Lancet) · Knee OA (BMJ Open) · Achilles trial

What to Expect

Comfortable, brief and non-invasive

01

Brief treatment

A treatment area commonly takes about 5–15 minutes. There are no needles or incisions.

02

Targeted light energy

The MLS system delivers synchronized 808 nm and 905 nm infrared wavelengths over the treatment area.

03

Back to your day

Most patients need no recovery period after a session and can return to normal daily activity.

A clinician applies a handheld MLS laser to a patient's shoulder; both wear protective glasses
Handheld mode: the applicator is guided over the treatment area with protective eyewear.
An MLS robotic laser unit positioned over a patient on a treatment table while a clinician operates the console
Robotic scanning can deliver treatment over a defined area without an injection or incision.
Diagram of the MLS pulse: a continuous 808 nm emission and a pulsed 905 nm emission delivered together
MLS combines a continuous 808 nm emission with a pulsed 905 nm emission in a synchronized pattern.

Why We Use the MLS System

How MLS differs from other therapy lasers

We chose MLS for its synchronized dual-wavelength design, its robotic scanning head for consistent dosing, and its device-specific clinical research. Here is how it compares with other therapy lasers.

Low-level laserTypical Class IV laserMLS laser
Power classClass IIIb (500 mW or less)Class IV (above 500 mW)Class IV
WavelengthsUsually oneVaries by device808 nm continuous and 905 nm pulsed, synchronized
DeliveryLow power means longer treatment times for deep tissueMany devices use high continuous power, which can build heat, so the applicator must keep movingDesigned by the manufacturer to reach deep tissue with pulsed high-peak-power emissions while limiting heat build-up
ApplicationHandheld probeUsually handheldHandheld, or a robotic scanning head that repeats the same dose over a defined area
Device-specific human trialsVaries widelyVaries widelyIts own randomized trials, plus laboratory and animal research

Why we chose the MLS system

  • Two wavelengths, one synchronized pulse. The continuous 808 nm and pulsed 905 nm emissions are locked together, pairing anti-inflammatory and pain-relieving effects in every session.
  • Consistent, reproducible dosing. The robotic scanning head delivers the same energy over the same area every visit, which matters because laser results depend on dose.
  • Device-specific research. MLS has been studied in its own randomized trials, laboratory studies, and animal models, rather than relying only on research from other lasers.
  • FDA-cleared. The 808/905 nm MLS family is FDA-cleared for temporary relief of muscle and joint pain, arthritis pain, muscle spasm, and for increasing local circulation.
  • Built to pair with orthobiologics. MLS fits naturally around PRP and BMAC treatment, as described below.

MLS randomized trial, neck pain (2017) · MLS and nerve pain (2019) · FDA 510(k) summary

Common Orthopedic Uses

Where MLS laser may fit

Laser therapy is not equally supported for every diagnosis. The labels below reflect the current strength of published evidence. We first identify the source of your symptoms, then decide whether PBM is a reasonable adjunct.

Stronger evidence

Knee osteoarthritis

Meta-analyses of randomized trials show short-term pain relief, especially at recommended doses and alongside exercise.

Stronger evidence

Neck pain

A Lancet meta-analysis found pain relief for chronic neck pain. MLS-specific trials are mixed.

Moderate evidence

Shoulder & rotator cuff tendinopathy

Benefit appears dose-dependent: adequate doses helped, while low doses did not.

Moderate evidence

Tennis elbow

Some randomized trials report less pain, usually as part of a rehabilitation program.

Emerging evidence

Post-surgical recovery

Small trials after hip and knee replacement suggest short-term improvement in pain and swelling.

Emerging evidence

Low-back pain

A randomized MLS trial found greater pain reduction than exercise alone after 12 sessions. Results vary between studies.

Mixed evidence

Achilles tendinopathy

Laser added no clear benefit to eccentric exercise in one controlled trial.

Supporting role

Sports strains & contusions

A non-invasive option alongside activity modification and rehabilitation.

Limited evidence

Hip pain & bursitis

May be considered for selected soft-tissue and degenerative hip symptoms alongside strengthening.

Limited evidence

Plantar fasciitis

Sometimes added to treatment for persistent heel pain; stretching and loading remain the foundation.

Early research

Nerve-related pain

Animal studies of the MLS system show effects on nerve pain; human evidence is limited.

Limited evidence

Carpal tunnel symptoms

May help symptoms in selected cases, but it does not release a compressed median nerve.

Key application

PRP & BMAC support

We frequently pair MLS with PRP and BMAC to calm inflammation, improve comfort, and support recovery, an approach backed by laboratory and animal research.

Synergy

Laser works best as part of a plan

Laser therapy is rarely the whole answer. Its value comes from what it is paired with.

Laser + physical therapy

This is where laser has the most support. Many positive knee osteoarthritis and neck pain trials paired laser with exercise, and a randomized MLS trial for neck pain combined it with an exercise program. Laser can make movement more comfortable, but strengthening and loading do the long-term work. At Pacific Bone & Joint, MLS treatment is delivered within our physical therapy program.

PB&J Physical Therapy →

Laser + PRP or BMAC

We consider MLS an excellent adjunct to PRP and BMAC. The orthobiologic delivers concentrated growth factors and cells from your own blood or marrow; the laser targets the inflammation and pain around the treated area and supports the recovery that follows. In laboratory studies, MLS light increased the growth of mesenchymal stem cells at therapeutic doses. In animals, laser combined with PRP preserved cartilage better than either treatment alone, and dogs with arthritis did better with both. We dose it deliberately around your injection as part of a structured recovery plan. Individual results vary.

PRP & BMAC →

Laser + a correct diagnosis

Laser cannot fix a torn ligament, a loose joint replacement, or a pinched nerve that needs release. The most important part of any plan is identifying what is actually causing the pain, which is why laser therapy at our practice starts with an orthopedic evaluation.

All orthopedic care →
Watch: how MLS laser therapy works. Manufacturer video; the strength of evidence varies by condition.

MLS Laser Therapy at a Glance

Treatment is individualized. These figures describe common protocols rather than a guarantee of what any one patient will need.

5–15 min
Typical Time Per Area
Brief, non-invasive treatment with no incision or injection
6–12
Common Treatment Range
Acute problems often use fewer sessions; chronic conditions may need a longer course
808 + 905 nm
Synchronized Wavelengths
Continuous and pulsed near-infrared emissions delivered together by the MLS system
0
Needles or Incisions
A non-pharmacologic adjunct that can be paired with physical therapy and other orthopedic care

What the Research Says

Promising, but condition-specific

There is meaningful human research on photobiomodulation and high-intensity laser therapy, but protocols and devices differ. We do not treat every positive laser study as proof that every MLS protocol will produce the same result.

2009 meta-analysis · The Lancet

Low-level laser therapy for chronic neck pain

Sixteen randomized trials with 820 patients. Laser reduced pain by about 20 mm on a 100 mm scale immediately after treatment, with benefit lasting up to 22 weeks in some trials.

Read the study →

2019 meta-analysis · BMJ Open

Laser therapy for knee osteoarthritis

Twenty-two randomized trials with 1,063 patients. Pain fell by about 14 mm overall and about 19 mm when treatment followed recommended dosing. The authors note that laser is not yet part of major knee osteoarthritis guidelines.

Read the study →

2023 systematic review & meta-analysis

High-intensity laser therapy for symptomatic knee osteoarthritis

Nine studies were included. The review found short-term pain improvement versus sham or conventional therapy, with benefit also seen when laser was combined with exercise. This literature evaluates high-intensity laser therapy broadly and is not specific to every MLS device or protocol.

Read the study →

2025 randomized double-blind study

MLS laser for chronic low-back pain

Thirty patients were studied. After 12 MLS sessions, the laser group had a larger reduction in pain scores than the exercise group. The study was small, and the authors specifically called for larger trials.

Read the study →

2026 systematic review

Photobiomodulation after hip and knee replacement

Four randomized trials with 133 total participants suggested promising short-term improvements in pain, edema and some functional outcomes after arthroplasty. The review concluded that treatment protocols remain heterogeneous and the evidence is not yet conclusive.

Read the study →

FDA context: FDA 510(k) clearance for ASA 808/905 nm therapeutic laser families includes temporary relief of muscle and joint pain and stiffness, arthritis pain or muscle spasm, temporary increase in local blood circulation, and muscle relaxation. FDA clearance is not the same as proof that the device heals every orthopedic condition.

View FDA 510(k) summary →

Safety and precautions

Across large meta-analyses, side effects of therapeutic laser were mild and similar to placebo. Because MLS is a Class IV laser, we follow these precautions and review your history before treatment:

  • Protective eyewear for everyone in the room, because Class IV light can injure the eye, including by reflection
  • Not over a known or suspected cancer
  • Not over the abdomen or low back during pregnancy
  • Not over the thyroid gland
  • Extra caution with photosensitizing medications and areas of reduced sensation
The Pacific Bone & Joint team at the clinic in Hawai‘i
The Pacific Bone & Joint team

Rehabilitation & Recovery

Physical therapy for laser therapy and recovery

PB&J Physical Therapy works inside our Honolulu and Waipahu/Kunia clinics, so your rehabilitation is planned with the same orthopedic team that treats you. Many orthopedic problems improve with therapy alone, and Hawai‘i allows direct access to physical therapy without a physician referral (some plans still require one for coverage).

PB&J Physical Therapy →

Patient Reviews

What patients say

4.9 average across 509 ratings on 8 review sites

“I have had knee problems for years as a powerlifter, plus a recent wrist strain. I had laser treatments to my knee and wrist — this was my first session and I felt a huge difference! My joints feel amazing.”

— Luvi· Google review

Review excerpts reflect individual patient experiences and may be lightly condensed. Results vary.

Questions, Answered

Frequently asked questions

What does “Class IV” laser mean?+

Class IV is a laser safety/power classification, generally used for lasers above 500 mW. It does not by itself prove that a treatment works. High-power therapeutic lasers must be used with appropriate protocols and eye protection.

What is photobiomodulation?+

Photobiomodulation (PBM) is the use of red or near-infrared light to influence cellular activity. Proposed mechanisms include mitochondrial signaling and ATP production, with downstream effects on pain and inflammatory signaling. The clinical evidence varies substantially by condition and treatment protocol.

What is different about MLS laser therapy?+

MLS stands for Multiwave Locked System. The system synchronizes an 808 nm continuous emission with a 905 nm pulsed emission. Device literature describes complementary effects from the two wavelengths, while the clinical benefit still depends on the condition being treated.

Does MLS laser therapy hurt?+

Most patients experience little or no discomfort. Treatment is non-invasive and does not require needles or an incision. Protective eyewear is used because this is a high-power laser.

How long is each session?+

A treatment area commonly takes about 5–15 minutes. The exact time depends on the body area, diagnosis and treatment settings.

How many sessions will I need?+

Protocols vary. Many practices use approximately 6 sessions for acute problems and 10–12 for longer-standing conditions, but we individualize the course based on your diagnosis and response.

Can laser therapy replace surgery for arthritis?+

No. Laser therapy may help symptoms and function for some patients, but it does not restore severely damaged cartilage or correct structural problems that require surgery. We use it as one option within a broader orthopedic treatment plan.

Can MLS laser therapy be used with PRP or BMAC?+

Yes. It is one of the most common ways we use MLS. Sessions are scheduled around your injection to help with comfort and inflammation and to support your rehabilitation. Your plan is individualized to the diagnosis being treated.

Is MLS laser therapy FDA approved?+

Therapeutic laser devices are generally marketed through FDA 510(k) clearance rather than a drug-style “approval.” For example, FDA-cleared ASA 808/905 nm laser families have indications that include temporary relief of muscle and joint pain and stiffness, arthritis pain or muscle spasm, temporary increases in local circulation, and muscle relaxation. Clearance and indications vary by specific device model.

Does laser therapy reduce inflammation?+

It may. Laboratory and animal research consistently shows lower inflammatory markers such as PGE2, COX-2, IL-1β, and TNF-α, and small human trials show similar changes in some conditions. Human data are limited, so we use laser as one part of a plan, not as a replacement for diagnosis-specific treatment.

Can laser therapy help swelling?+

Possibly. Trials in lymphedema and small trials after joint replacement suggest less swelling, and animal studies show effects on lymphatic vessels. Elevation, compression, movement, and physical therapy remain the foundation for managing swelling.

What sets MLS apart from other therapy lasers?+

MLS synchronizes a continuous 808 nm wavelength with a pulsed 905 nm wavelength in one locked pulse, pairing anti-inflammatory and pain-relieving effects. Its robotic scanning head repeats the same dose over the same area at every visit, and the system has its own published randomized trials and laboratory research. It is FDA-cleared for temporary pain relief, arthritis pain, muscle spasm, and increasing local circulation.

Why do you combine MLS with PRP or BMAC?+

Because they work on different parts of the healing process. PRP and BMAC deliver concentrated growth factors and cells to the injured tissue, while MLS targets inflammation, pain, and local circulation around it. Laboratory research shows MLS can increase stem-cell growth at therapeutic doses, and animal studies show better cartilage preservation when laser and PRP are combined. We consider MLS an excellent adjunct to orthobiologic treatment. Individual results vary, and no treatment can guarantee a specific outcome.

Who should not have laser therapy?+

Laser is not applied over a known or suspected cancer, over the abdomen or low back during pregnancy, or over the thyroid. We take extra care with photosensitizing medications and areas with reduced sensation. Everyone in the room wears protective eyewear.

Is it covered by insurance?+

Coverage varies and many plans treat musculoskeletal laser therapy as a non-covered service. Our team will explain any patient cost before treatment.

Could MLS laser fit your recovery plan?

We’ll identify what is actually causing your symptoms and tell you whether laser therapy is worth adding—or whether another treatment makes more sense.

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