Class IV Laser & Photobiomodulation

What if healing requires energy?

Your body is repairing itself right now.

Old cells are being replaced.

Muscles are recovering from yesterday.

Tiny areas of damage are being repaired.

Your immune system is monitoring, responding and adapting.

You don't have to think about any of it.

Your body already knows what to do.

But there is something every one of those processes has in common:

They require energy.

And that raises an interesting question.

What if we could influence the way your cells produce and use that energy?

Welcome to photobiomodulation.

Light Isn't Just Something We See

Most of us think about light as illumination.

Turn on a light and you can see.

Go outside and sunlight hits your skin.

Pretty simple.

Except biology has been interacting with light for billions of years.

And certain wavelengths of red and near-infrared light can interact with molecules inside human cells.

That's the basis of photobiomodulation, or PBM.

“Photo” means light.

“Bio” means life.

“Modulation” means influencing or changing a biological process.

Put it together:

Using light to influence biology.

That sounds futuristic.

It isn't.

Scientists have been studying it for decades.

Now We Need to Talk About Mitochondria

You probably remember these from biology class.

The powerhouse of the cell.

It's become almost a cliché.

But your mitochondria really are remarkable.

They take the fuel and oxygen available to your cells and participate in producing ATP—adenosine triphosphate, one of the principal forms of usable cellular energy.

You need ATP to contract a muscle.

Maintain cellular function.

Move molecules.

Build proteins.

Maintain ion gradients.

Repair and remodel tissue.

In other words:

Healing isn't passive.

It's work.

And work requires energy.

So What Does Light Have to Do With It?

This is where photobiomodulation becomes fascinating.

Red and near-infrared photons can penetrate tissue and interact with cellular components.

One of the leading proposed targets is an enzyme associated with the mitochondrial electron transport chain called cytochrome c oxidase.¹

Research suggests that appropriately dosed light can influence mitochondrial activity, ATP production, nitric-oxide signaling, reactive-oxygen-species signaling and downstream cellular pathways.¹ ²

That's a mouthful.

So let's make it simpler.

The light isn't “healing” you.

Your body is doing the healing.

The light is providing an input that may influence some of the cellular processes involved in how your body responds.

And that distinction matters.

Because once again, we're not trying to replace what your body does naturally.

We're trying to create a better environment for it to do what it already knows how to do.

What if pain relief isn't the most interesting part?

Photobiomodulation has been studied for pain.

And that's valuable.

If something hurts, I absolutely want it to hurt less.

Research has found beneficial effects for pain in a number of musculoskeletal conditions, although results vary depending on the condition, wavelength, dose and treatment protocol.³

But pain isn't actually the part of PBM that interests me most.

The biology is.

Because pain relief asks:

“Can we make this feel better?”

Photobiomodulation makes me ask:

“Can we influence the environment in which recovery is taking place?”

That's a much more interesting question.

Your Body Doesn't Heal Because We Tell It To

Think about what happens after an injury.

You don't consciously instruct cells to migrate.

You don't tell proteins when to be synthesized.

You don't manually regulate inflammatory signaling.

You don't command mitochondria to produce ATP.

The entire process happens below conscious awareness.

Your job is mostly to provide the conditions.

Enough nutrition.

Enough oxygen.

Enough movement.

Enough rest.

Enough time.

And then your biology does the work.

What if light could become another input into that environment?

That's the reason PBM earned a place in my office.

This Isn't Just a Red Light Bulb

The term “red light therapy” has exploded in popularity.

You can buy panels online.

Masks for your face.

Belts for your back.

Helmets for your head.

Some of those devices may be useful.

But photobiomodulation isn't simply:

Red light = good.

Wavelength matters.

Power matters.

Dose matters.

Treatment time matters.

Distance matters.

The tissue being treated matters.

And interestingly, more isn't always better.

Photobiomodulation appears to have a dose-dependent response.

Too little energy may not produce the desired biological effect.

But continually increasing the dose doesn't necessarily produce an increasingly better result either.

There is a therapeutic window.

That's why I don't think of PBM as “shine a bright red light on it and hope.”

Dose is part of the treatment.

Why Class IV?

In my office, I use a Class IV therapeutic laser to deliver photobiomodulation.

The higher output gives me the ability to deliver a clinically useful dose efficiently and treat larger or deeper musculoskeletal areas within a practical treatment time.

The important part isn't the Roman numeral.

The important part is delivering the appropriate wavelengths and dose to the tissue we're trying to influence.

The laser is simply the tool that lets me do that.

What Do We Use It For?

Photobiomodulation has been investigated across an enormous range of conditions.

In a musculoskeletal practice like mine, I'm particularly interested in its potential role around:

Muscle and soft-tissue injuries

Joint pain

Tendon problems

Neck and back pain

Knee osteoarthritis

Post-exercise recovery

Persistent painful areas

Tissues recovering alongside other treatment

And this isn't based solely on a handful of interesting laboratory experiments.

A major umbrella review published in 2025 examined 15 meta-analyses incorporating 204 randomized clinical trials and more than 9,000 participants across 35 different health outcomes.⁴

That's a substantial body of research.

It does not mean PBM has been proven to fix everything.

Far from it.

The strength of evidence varies considerably depending on what is being treated.

But it does tell us something important:

This is real biology worth paying attention to.

What About Arthritis?

This is one area where the research gets particularly interesting.

A 2024 systematic review and meta-analysis of placebo-controlled trials found that photobiomodulation reduced resting pain in people with knee osteoarthritis and may improve disability, although the researchers rated the overall certainty of evidence as very low.⁵

Another 2024 network meta-analysis found that certain wavelengths produced significantly greater reductions in knee osteoarthritis pain than sham treatment, while also emphasizing that the overall quality of evidence remains limited.⁶

That's exactly how I want to look at emerging technology.

Not:

“This cures arthritis.”

It doesn't.

And not:

“There isn't enough evidence, so ignore it.”

Instead:

There is a biological mechanism.

There are human clinical trials.

There are positive findings.

There are still unanswered questions.

And if the potential benefit is meaningful and the intervention makes clinical sense for the person sitting in front of me…

I'm interested.

What About Tendons?

Remember what we talked about with shockwave?

Sometimes tissue seems to get stuck.

Photobiomodulation gives us a completely different way into that problem.

Shockwave introduces a mechanical stimulus.

PBM introduces light energy that interacts with cellular biology.

A systematic review of randomized trials involving tendinopathy found evidence ranging from very low to moderate quality supporting PBM as a standalone or adjunctive treatment, with some studies showing greater reductions in pain and improvements in function when PBM was combined with exercise.⁷

More recent research has continued to find a pain-relieving effect in chronic tendinopathy, while emphasizing that treatment parameters matter.⁸

Now think about that for a moment.

What if the tissue needs more than one kind of input?

Mechanical.

Neurological.

Cellular.

Movement.

Recovery.

Suddenly treating everything with one tool starts to seem like a strange limitation.

Why I Added Photobiomodulation to the Muhr Method

This is where my thinking changed.

I could deliver an excellent adjustment.

I could change movement.

I could influence mechanical and neurological input.

But then I'd look at an irritated knee…

A stubborn shoulder…

An old injury…

A tendon that wasn't progressing the way I wanted…

…and think:

What about the tissue itself?

What is happening at the cellular level?

What resources does that tissue need to respond?

And is there another way I can support the biological processes already taking place?

Photobiomodulation gave me another tool.

Not instead of my hands.

Because of what my hands can't do.

My hands can deliver an adjustment.

They cannot deliver photons into tissue at selected therapeutic wavelengths.

So I use both.

And This Is Where Things Start Connecting

Imagine someone with a painful shoulder.

We could shine a laser on the shoulder.

Maybe that helps.

We could adjust the shoulder and spine.

Maybe that helps.

We could improve mobility.

Maybe that helps.

We could stimulate a stubborn tendon with focused shockwave.

Maybe that helps.

But eventually I started wondering:

Why are we pretending these things have to compete?

What if the better question is:

What does this particular person need in order to change?

Maybe the joint needs better movement.

Maybe the nervous system needs different input.

Maybe the tendon needs mechanical stimulation.

Maybe the tissue could benefit from photobiomodulation.

Maybe the person needs better recovery.

Maybe several of those things are true at the same time.

That's the thinking behind the Muhr Method.

Different Inputs. One Body.

This is one of the most important ideas behind NeuroBalance.

Your body doesn't know that chiropractic belongs in one professional category…

laser belongs in another…

exercise belongs somewhere else…

and recovery belongs at a spa.

Your biology doesn't care about our categories.

It simply responds to inputs.

Mechanical input.

Neurological input.

Light.

Oxygen.

Movement.

Rest.

Stress.

Recovery.

So rather than organizing your care around what traditionally belongs in a chiropractic office…

I organize it around what I'm trying to accomplish.

That's a very different way of practicing.

Can I Just Come In for Laser?

Absolutely.

Maybe you already know what PBM is.

Maybe another healthcare provider recommended it.

Maybe you're curious about red-light therapy and want to experience a clinical Class IV system.

Maybe you've got one stubborn area you'd like me to evaluate.

Come in.

We'll talk about what you're trying to accomplish and whether I think photobiomodulation makes sense.

You don't have to enroll in the Muhr Method to receive laser therapy.

But I may ask you a few more questions.

Because if that knee keeps hurting…

what's loading the knee?

If that shoulder keeps getting irritated…

how is the shoulder moving?

If the tissue keeps struggling to recover…

what else is influencing recovery?

And once we start answering those questions…

we may discover that shining light on the painful spot is only one piece of a much more interesting puzzle.

What if we could support both sides of healing?

There is the mechanical side.

How you move.

How your joints function.

How muscles coordinate.

How forces travel through your body.

And then there is the biological side.

How tissues respond.

How cells communicate.

How energy is produced.

How recovery unfolds.

I've spent nearly 30 years working on the first side.

Technology now gives me remarkable ways to influence the second.

The Muhr Method brings them together.

Adjust.

Move.

Stimulate.

Support.

Challenge.

Recover.

Measure.

Not because more treatment is automatically better.

But because sometimes the right combination of inputs creates an opportunity that one intervention alone cannot.

So here's the question.

Your body already knows how to heal.

It's been doing it your entire life.

What if our job isn't to heal your body?

What if our job is to identify what's getting in the way…

give it better information…

provide the right stimulus…

support the biology…

and then give your body the opportunity to do what it was designed to do?

That's what makes photobiomodulation interesting to me.

And that's why it's part of the Muhr Method.

Explore Class IV Laser / Photobiomodulation →

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Research

1. Photobiomodulation CME Part I: Overview and Mechanism of Action.
2024 review describing red and near-infrared light interactions with endogenous photoreceptors, including mitochondrial cytochrome c oxidase, and downstream effects involving ATP, reactive oxygen species, calcium and cellular signaling.

2. Proposed Mechanisms of Photobiomodulation or Low-Level Light Therapy.
Review of proposed mitochondrial and cellular mechanisms including cytochrome c oxidase, nitric oxide, electron transport, mitochondrial membrane potential, ATP and downstream signaling.

3. Quality Appraisal of Systematic Reviews on High-Intensity Laser Therapy for Musculoskeletal Pain Management: An Umbrella Review.
Review of systematic reviews examining high-intensity laser therapy and musculoskeletal pain.

4. Effects of Photobiomodulation on Multiple Health Outcomes: An Umbrella Review of Randomized Clinical Trials.
2025 umbrella review including 15 meta-analyses, 204 randomized clinical trials, more than 9,000 participants and 35 health endpoints across 15 conditions. Evidence strength varied substantially by outcome.

5. Effectiveness of Photobiomodulation in Reducing Pain and Disability in Patients With Knee Osteoarthritis: A Systematic Review With Meta-Analysis.
Physical Therapy, 2024. Ten placebo-controlled studies involving 542 participants. PBM significantly reduced resting pain compared with placebo, although certainty of evidence was rated very low.

6. A Systematic Review and Network Meta-analysis on the Optimal Wavelength of Low-Level Light Therapy in Treating Knee Osteoarthritis Symptoms.
2024 analysis of 13 studies involving 673 participants. Certain wavelengths significantly reduced knee osteoarthritis pain compared with sham treatment; evidence quality remained low to very low.

7. The Effect of Low-Level Red and Near-Infrared Photobiomodulation on Pain and Function in Tendinopathy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Seventeen trials involving 835 participants. Evidence ranged from very low to moderate quality, with beneficial findings in several comparisons, particularly when PBM was combined with exercise.

8. Shedding More Light on the Short-Term Effect of Low-Level Laser Therapy on Pain in Tendinopathy: A Systematic Review With Meta-analysis.
2025 meta-analysis of 35 controlled trials. LLLT produced superior pain relief versus minimal intervention in chronic tendinopathy; total treatment sessions were associated with the magnitude of pain relief.