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Therapeutic Modalities

Original Editor - Melanie Vaillancourt

Lead Editors - Angeliki Chorti, Melanie Vaillancourt, Malisha van der Berg, Leana Louw, Oyemi Sillo, Kim Jackson, Candace Goh, Alexandra Stead, Admin, Evan Thomas, Scott Buxton, WikiSysop, Yvonne Yap, Manisha Shrestha and Sai Kripa  

Introduction

Therapeutic modalities, also referred to as biophysical modalities/ electrophysical agents (EPAs)/ electrotherapy,[1] are specific techniques, tools or physical agents that utilise thermal, mechanical, and electromagnetic energies to produce biophysical effects.[2] They have formed part of physiotherapy practice for decades and are widely used as an adjunct to other interventions, such as manual therapy, exercise and patient education.[3][4] [5]

The primary aim of therapeutic modalities is to assist patients in achieving therapy goals by supporting recovery and improving functional outcomes. Common applications include:[6]

  • Pain relief and modulation
  • Reduction of oedema and inflammation
  • Improvement of circulation
  • Promotion of tissue healing
  • Scar tissue remodelling
  • Facilitation of increased range of motion (ROM)
  • Enhancement of muscle activation
  • Reduction of unwanted muscular activity
  • Preservation of muscle strength following injury or surgical intervention

Clinical guidelines support the use of therapeutic modalities according to varying levels of evidence,[7] although their effectiveness depends on appropriate clinical reasoning and patient selection. The choice of modality should therefore be guided by the individual’s condition, the clinician’s clinical reasoning, the patient’s goals, and the overall rehabilitation programme.[8] This page outlines the rationale for the use of therapeutic modalities, together with the key safety considerations associated with each modality.

For detailed clinical guidance on specific modalities, see the sub-pages listed below:

A. Thermal Energy

Thermal modalities use hot or cold to produce physiological changes in body tissues. They are amongst the most widely used physical agents in physiotherapy practice and are broadly divided into Thermotherapy (application of heat) and cryotherapy (application of cold).[9][10]

Thermal modalities operate through three physical mechanisms of heat transfer:[11][12]

  1. Conduction: direct contact between a warm or cold agent and the skin surface (e.g., hot packs, ice packs, cold plunges, paraffin bath).
  2. Convection: heat transfer via a circulating medium such as water or air (e.g., whirlpool, fluidotherapy)
  3. Radiation: electromagnetic transfer of thermal energy without direct contact (e.g., infrared therapy). Notably, in whole-body cryotherapy (WBC) chambers, the body radiates heat outward into the extreme cold of the chamber environment.[13][14]

Understanding which mechanism a modality relies upon is important for both clinical selection and safe application, as each mechanism produces a different depth and rate of tissue temperature change.[11]

Thermotherapy

Thermotherapy refers to the therapeutic application of heat to body tissues. It is broadly divided into superficial and deep heating modalities.[10]

  • Superficial heating methods raise tissue temperature to a depth of approximately 1–2 cm and include: warm whirlpool, warm hydrocollator packs, paraffin baths, sauna, infrared radiation and fluidotherapy. [12]
  • Deep tissue heating operates via conversion of non-thermal energy into heat within the tissue and is capable of raising temperature at depths greater than 2 cm. Modalities include ultrasound, LASER, radiowave, microwave and Tecar diathermies.[10][11]

Physiological effects:[9]

  • Vasodilation and increased local blood flow
  • Increased tissue extensibility and reduced joint stiffness
  • Decreased muscle spasm
  • Pain modulation via altered nerve conduction
  • Increased local metabolic rate

Physiological response:

  • Heat promotes tissue healing by stimulating fibroblast proliferation,[15] enhancing endothelial cell growth,[16] and increasing the phagocytic activity of inflammatory cells.[17]
  • Heat is thought to promote muscle relaxation by decreasing muscle spindle sensitivity and gamma efferent activity; muscle relaxation may also occur secondary to pain reduction.[9]

Safety Considerations:[18]

Contraindications Precautions Risks
  • Active malignancy in or near the treatment area
  • Acute inflammation or haemorrhagic conditions
  • Impaired sensation in the treatment area
  • Presence of metal implants (deep heating modalities)
  • Pregnancy (over the abdomen or lumbar region)
  • Deep venous thrombosis or thrombophlebitis
  • Impaired cognition or communication
  • Damaged or at-risk skin (local)
  • Skin disease (local)
  • Infection or tuberculosis (local)
  • Recently radiated tissue (local)
  • Active epiphysis
  • Cardiac insufficiency or failure
  • Pregnancy
  • Eyes, anterior neck, carotid sinus
  • Metal (jewelry, metal implants or staples, bullets)
  • Topical irritants
  • Burn
  • Fainting or dizziness (vaso-vagal response)
  • Bleeding (open wounds)


Additional Considerations:[18]

  • Test sensory integrity prior to application by asking patients to differentiate between hot and cold stimuli
  • Monitor for signs of overheating, particularly in patients with reduced sensation
  • Use appropriate exposure times and intensities to avoid burns
  • Wrap heating pads in 6 - 8 layers of towelling to protect the skin from burns, check patient after 5 minutes for redness, blistering, signs of burning, generalised sweating (increased core temperature)
  • Risk of burn increases with decrease in subcutaneous fat (an insulator)
  • Patients should not lie on top of hot packs or pads as pressure can compresses skin capillaries and compromise the normal vasodilator response

Cryotherapy

Cryotherapy refers to the therapeutic application of cold to body tissues. Common delivery methods include ice massage, cold hydrocollator packs, cold whirlpool, cold spray, contrast baths, ice immersion, cold compression, and cryokinetics.[10] Cold transfer to the tissues operates principally via conduction and convection.[11]

Primary physiological effects of cold include:[9]

  • Vasoconstriction and decreased blood flow (within first 15 - 20 minutes)
  • Decreased metabolic rate and cellular activity
  • Reduced nerve conduction velocity
  • Decreased muscle spasm
  • Local analgesia

Physiological response:

  • Restriction of local blood flow reduces the potential for oedema to develop following acute tissue injury: Slower metabolism releases fewer inflammatory mediators, reducing oedema formation and oxygen demand of tissues, decreasing ischemia and further injury.[19][20]
  • Cold therapy decreases local neural activity by increasing the muscle spindle stimulus threshold and reducing the excitability of free nerve endings, resulting in an elevated pain threshold and reduced muscle spasm.[21][22]

Evidence Considerations:

  1. Cryotherapy remains widely used in clinical practice, however evidence for its effectiveness is more limited than traditionally assumed, particularly for acute musculoskeletal injury.
    • A systematic review of randomised controlled trials found very-low quality evidence supporting the use of cryotherapy for acute ankle sprain and called for further high-quality research.[23]
    • A 2024 narrative review of cryotherapy for soft tissue injuries in sport summarised current evidence and highlighted ongoing uncertainty regarding optimal application parameters and clinical indications.[24]
  2. The proposed approach for acute musculoskeletal injury management involves the PEACE & LOVE framework, this framework deliberately omits ice from its recommendations, as cold application may interfere with the natural inflammatory and regenerative process. However it is important to note that this position remains debated, and clinicians should apply cryotherapy with appropriate clinical reasoning.[25]

Safety Considerations:[18]

Contraindictions Precautions Risks
  • Raynaud’s phenomenon or cold hypersensitivity
  • Deep venous thrombosis or thrombophlebitis
  • Hemorrhagic conditions
  • Chronic wound
  • Impaired cognition or communication
  • Urticaria
  • Vasospastic pathology
  • Cryoglobulinemia or hemoglobulinemia
  • Anterior neck, carotid sinus, regenerating nerves
  • Impaired circulation (local)
  • Tuberculosis (local)
  • Damaged or at-risk skin
  • Cardiac failure
  • Hypertension
  • Impaired sensation
  • Infection
  • Eyes
  • Superficial main branch of a nerve
  • Frostbite
  • Fainting (vaso-vagal response)
  • Negative impact on nerves (superficial)


Additional Considerations:[18]

  • Test sensory integrity by asking patients to differentiate between hot and cold stimuli
  • Rate of skin cooling is reduced with a towel between the agent and skin - 1 or 2 layers of protection is sufficient
  • Water has a higher conductivity than air – apply moisture to the towel
  • Patient will report uncomfortable sensation of cold, stinging or burning, aching sensation, and complete numbness
  • If core temperature is not maintained, reflex shivering results in increased tone
  • Re-warming period should be at least twice as long as the treatment time (too frequent application increases likelihood of frostbite)
  • Hierarchy of cooling, from most to least efficient, is as follows: ice immersion, crushed ice, frozen peas, gel pack – choose an agent with less cooling potential if the patient has risk factors for an adverse reaction
  • Local pain awareness, proprioception, muscle strength, and agility are reduced immediately post-cryotherapy – caution in prescribing activity


Also see page for cryotherapy guidelines.

B. Mechanical Energy

Mechanical modalities produce therapeutic effects through the application of physical forces (pressure, vibration, acoustic vibrations and distraction) to body tissues.[11] This category includes ultrasound, extracorporeal shockwave therapy (ESWT), massage, and traction.

Ultrasound

Ultrasound utilises acoustic energy sound waves created by particles mechanically vibrating through a medium. It may be delivered as an uninterrupted stream (continuous mode) or with periodic interruptions (pulsed mode).[9]

  • Continuous mode produces thermal effects
  • Pulsed mode is used where the primary clinical goal is non-thermal.

Physiological effects:

  • Ultrasound is classified as a deep heating modality in continuous mode, capable of raising tissue temperature at considerable depth due to its ability to travel well through homogenous tissue such as adipose tissue.[26][27] It is also capable of producing non-thermal effects at the cellular level,[28] including increased membrane permeability, stimulation of fibroblast activity, and promotion of tissue repair (increased collagen production).[29] The literature has also proposed reduced conduction of pain transmission as a possible mechanism for its analgesic effects,[30] and nitric oxide released by ultrasound therapy may be a potent stimulator of new blood vessel growth at the site of injury.[31]
  • Low-intensity pulsed ultrasound has been shown to accelerate the rate of healing of fractures by enhancing angiogenic, chondrogenic, and osteogenic activity.[32]
  • Phonophoresis uses acoustic energy in the form of ultrasound to transfer molecules across the skin into the tissues.[9]

Evidence Considerations:

  1. Clinicians should be aware that the evidence base for therapeutic ultrasound is subject to ongoing debate.
    • A 2024 systematic review and meta-analysis found that ultrasound was effective for knee-related musculoskeletal pain with mixed results for shoulder-related pain, however, further high-quality research is needed.[33]
    • There are multiple placebo-controlled trials that found little evidence that active ultrasound outperforms sham ultrasound for musculoskeletal pain.[34][35]
    • Clinicians are therefore encouraged to apply this modality selectively, and in conjunction with active rehabilitation, rather than as a primary or stand-alone intervention.

Safety Considerations:[18]

Pulsed Ultrasound

Contraindications Precautions Risks
  • Hemorrhagic conditions
  • Active epiphysis
  • Acute injury or inflammation
  • Damaged or at-risk skin
  • Infection
  • Skin disease
  • Impaired circulation or sensation
  • Impaired cognition or communication
  • Plastic or cement implants
  • Regenerating nerves
  • Pain
  • Surge

Continuous Ultrasound:

Contraindications Precautions Risks
  • Hemorrhagic conditions
  • Impaired circulation or sensation
  • Impaired cognition or communication
  • Eyes, anterior neck, carotid sinus, reproductive organs
  • Deep venous thrombosis or thrombophlebitis (local)
  • Infection or tuberculosis (local)
  • Active Malignancy (local)
  • Recently radiated tissue (local)
  • Pregnancy (local)
  • Skin disease (local) e.g. psoriasis, eczema, etc.
  • Electronic device (local)
  • Metal or plastic or cement implants (local)
  • Active epiphysis
  • Chronic wound
  • Damaged or at-risk skin
  • Regenerating nerves
  • Burn
  • Pain
  • Surge


Additional Considerations:[18]

  • Test sensory integrity by asking patients to differentiate between hot and cold stimuli or between light touch and painful stimuli
  • Avoid pre-treatment of the area with superficial heating or cooling agents - cumulative effect of a hot pack and ultrasound can lead to skin damage
  • Recommended treatment is 2 – 3x the effective radiating area (ERA)
  • Circular head movement produces more even delivery of ultrasound energy since hot spots are dissipated better
  • To minimise the impedance difference at the steel/air interface, a suitable coupling medium must be utilised
  • Best absorption of ultrasound energy in tendon, ligament, fascia, joint capsule and scar tissue[36] 

Extracorporeal Shockwave Therapy (ESWT)

Extracorporeal shockwave therapy delivers high-energy acoustic waves to targeted musculoskeletal tissues. It is important to note that ESWT waves are lower in frequency but considerably higher in energy than those used in therapeutic ultrasound.[37] ESWT is most commonly used for chronic musculoskeletal conditions, particularly tendinopathies.[38][35][39] For detailed dosage guidance, indications, and contraindications, see the dedicated ESWT sub-page, which cross-references current ISMST guidelines (2023).

Safety Considerations:[18]

Contraindications Precautions Risks
  • Pregnancy
  • Over major blood vessels and nerves
  • Pacemakers or other implanted devices
  • Joint replacements
  • Open wounds
  • Epiphysis
  • Blood clotting disorders
  • Infection
  • Cancerous tissues
  • Cooperation issues
  • Osgood-Schlatter disease
  • Sever's disease
  • Redness
  • Swelling
  • Bruising
  • Soreness
  • Numbness

Massage

Massage involves the systematic manual manipulation of soft tissues for therapeutic purposes. Common techniques used in physiotherapy practice include the following, each with distinct mechanisms and clinical applications:[40]

  • Effleurage (superficial and deep stroking)
  • Petrissage (kneading)
  • Tapotement (percussion)
  • Friction massage
  • Vibration
  • Myofascial release
  • Trigger point therapy
  • Lymphatic drainage
  • Sports massage

For detailed information on indications, techniques, and evidence, see the dedicated Massage sub-page.

Safety Considerations:[18]

Contraindications Precautions Risks
  • Serious circulatory problems
  • Active processes e.g. inflammatory, infectious
  • Fever
  • Cancer
  • Skin infections
  • Severe osteoporosis
  • Hypo/Hypertension
  • Dermatitis
  • Impaired sensation
  • Fibromyalgia
  • Autoimmune disorders
  • Pericarditis/endocarditis
  • Osteopenia
  • Bruising
  • Blood clots
  • Fractures
  • Nerve damage
  • Transmission of infectious skin conditions

Traction

Traction involves the application of a distracting force along the long axis of the spine or a limb, producing separation of joint surfaces, reduction of nerve root compression, and alleviation of pain. It may be applied mechanically or manually and is used for both cervical and lumbar conditions.[41][42]

Physiological Rationale:[43]

Proposed mechanisms of therapeutic benefit include:

  • Distraction of vertebral bodies and widening of intervertebral foramina, reducing pressure on nerve roots
  • Reduction of intradiscal pressure
  • Stretching of paraspinal musculature
  • Temporary relief of muscle spasm

Evidence Considerations:

  1. There is mixed evidence for spinal traction, particularly for lumbar traction.
    • A systematic review and meta-analysis found short-term effectiveness of supine mechanical traction when added to physiotherapist-led intervention for pain and disability in lumbar radiculopathy, although it is noted that evidence quality is variable.[41]
    • A 2024 literature review similarly concluded that spinal traction may be considered a therapeutic tool for short-term pain reduction (within three months) in patients with lumbar pain and radiculopathy.[44]

Traction is therefore best used selectively, with realistic expectations regarding duration of benefit, and as part of a broader rehabilitation programme rather than in isolation.

Safety Considerations:[18]

Contraindications Precautions Risks
  • Acute inflammatory spinal conditions
  • Spinal instability or fracture
  • Spinal malignancy
  • Spinal cord compression
  • Spinal infections
  • Cauda equina syndrome
  • Severe osteoporosis
  • Aortic or iliac aneurysm
  • Elderly
  • Pregnancy
  • Midline disc herniations
  • Abdominal problems (lumbar region)
  • Headache
  • Nausea
  • Fainting
  • Soft tissue injury

Additional Considerations:

Additional Considerations:

  • Begin with low loads and progress gradually
  • Discontinue if symptoms worsen or new neurological signs develop
  • Avoid prolonged application without clinical reassessment

C. Electromagnetic and Light Energies

Electromagnetic modalities produce therapeutic effects through the application of electrical, magnetic, or light-based energy to body tissues.[11][38] This category includes electrical stimulation, magnetic therapy, laser therapy, and biofeedback.[9]

Electrical Stimulation

Electrical stimulating currents, such as transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC), utilise electrical energy (the flow of electrons or other charged particles from one area to another) to cause depolarisation of muscle or nervous tissue.[38] Electrical stimulation has most commonly been used for the modulation of pain through stimulation of cutaneous sensory nerves via the following analgesic mechanisms:[9]

  1. Gate control mechanism: Activation of large-diameter A-beta fibres inhibits pain transmission carried by A-delta and C afferent fibres at the spinal cord level - also known as the gate control theory of pain. This mechanism was first described by Melzack and Wall (1965).[45]
  2. Endogenous opioid release: Low-frequency electrical stimulation promotes the release of endogenous opioids, including enkephalins and beta-endorphins, contributing to central analgesia.[46]
  3. Central nervous system modulation: Repeated stimulation may alter central pain processing through descending inhibitory pathways.[46]

Direct Electrical current:

Iontophoresis is the delivery of ions into body tissues using a direct electrical current. This technique is based on the principle that the therapeutic effects of a medication can be enhanced while reducing the risk of adverse reactions.[47]

Evidence considerations:

  1. A large systematic review and meta-analysis of 381 randomised controlled trials (24,532 participants) found evidence supporting the use of TENS for pain relief , though effect sizes vary considerably depending on stimulation parameters and clinical context.[48]
  2. A WHO-commissioned systematic review also found TENS to be relevant in the management of chronic primary low back pain, but the certainty of evidence remains moderate.[49]

Safety considerations:[18]

Contraindications Precautions Risks
  • Deep venous thrombosis or thrombophlebitis
  • Hemorrhagic conditions
  • Pregnancy (Over abdomen or Lumbar region)
  • Eyes, anterior neck, carotid sinus, head, reproductive organs
  • Impaired cognition or communication
  • Regenerating nerves
  • Cardiac failure (local)
  • Damaged or at-risk skin (local)
  • Infection or tuberculosis (local)
  • Malignancy (local)
  • Recently radiated tissue (local)
  • Electronic device (local)
  • Impaired sensation (local)
  • Active epiphysis
  • Skin disease
  • Impaired circulation
  • Chest, heart
  • Pain
  • Skin irritation
  • Surge

[50]

Additional considerations:[18]

  • Test sensory integrity prior to application by asking patients to differentiate between light touch and painful stimuli
  • Tissue with high resistance to electrical current include skin, bone, and necrotic tissue - electrodes should not be placed directly over bony prominences
  • Factors increasing skin impedance include the presence of hair and oil, and cooler skin temperatures
  • Applying IFC or TENS in combination with a thermal modality is not recommended, as this increases the likelihood of adverse effects
  • Large electrodes are more comfortable and allow current to travel deeper but the target area is less specific - only large electrodes should be used with medium frequencies (IFC) to disperse the current
  • Placing electrodes further apart will allow the current to travel deeper - at least 1 inch apart for pain control
  • With any electrical device, increasing the intensity will first cause an electrical sensation followed by a motor response and finally noxious stimuli
  • Patients with complete paralysis are not suitable candidates for this modality
  • Remember that the modulation of pain is not treating the cause of pain

[50]

Magnetic Therapy

Magnetic therapy involves the use of static or pulsed electromagnetic fields (PEMFs) to produce therapeutic effects in body tissues. In physiotherapy practice, PEMF therapy is the most commonly applied form.[9]

Physiological Effects:[38]

  • Enhance cellular permeability and ability to reduce swelling
  • Regulation of painful stimuli and reduction of pain
  • Improvement of blood circulation through a vasodilating effect
  • Promote muscle relaxation and bone healing[51]
  • Strengthen the immune system

Evidence considerations:

Evidence for physiological effects varies considerably by condition and the electromagnetic field parameters.[38]

  1. A systematic review on PEMF therapy for musculoskeletal pain found reductions in pain in both acute and chronic conditions when low-intensity, low-frequency fields (1–100 Hz) were used, concluding that it can be a useful adjunct to rehabilitation.[52]
  2. A more recent systematic review of 17 randomised controlled trials (1,197 patients) found PEMF to be effective in reducing pain and improving quality of life in osteoarthritis.[53]

Clinicians should note that evidence for static magnetic therapy remains considerably weaker than for PEMF. Claims of immune system enhancement are not currently supported by robust clinical evidence and should not be presented to patients as an established effect of this modality.[38]

Safety Considerations:[18]

Contraindications Precautions Risks
  • Implanted electronic devices (pacemakers, cochlear implants)
  • Pregnancy
  • Active malignancy
  • Haemorrhagic conditions
  • Active epiphysis
  • Skin disease
  • Impaired circulation
  • Chest, heart
  • Pain
  • Irritation

Laser Therapy

Light Amplification for the Stimulated Emission of Radiation (LASER) therapy, utilising electromagnetic energy at specific wavelengths of light to produce therapeutic effects at cellular level.[11] Unlike surgical lasers, therapeutic lasers operate at low power levels and produce no thermal tissue damage.[54]

Physiological effects:

  • Light at the wavelengths commonly used in LASER is readily absorbed by enzymes, haemoglobin, fibroblasts, and neural tissue.[11]
  • Laser therapy has been shown to stimulate cellular degranulation, leading to the release of inflammatory mediators and growth factors,[55] enhance phagocytic activity at the site of injury,[56] and activate fibroblast function to promote collagen synthesis and improve tissue tensile strength.[57]
  • Some studies have also reported a reduction in inflammation-related oedema following laser therapy.[58]
  • In addition, absorption by haemoglobin promotes nitric oxide release, contributing to endothelial cell proliferation and enhanced microcirculation.[59]
  • At lower dosages, LLLT has also been associated with a reduction in sensory nerve conduction velocity, which may contribute to pain relief..[60]

Low-Level Laser Therapy (LLLT): Also Referred to as photobiomodulation.

This low-powered or cold laser seems to have some significant effect on soft-tissue and fracture healing, pain management, and reduction of inflammation.Proposed Mechanisms of Action: [54]

  • Stimulation of mitochondrial activity and adenosine triphosphate (ATP) production
  • Modulation of nitric oxide release, promoting vasodilation and tissue perfusion
  • Reduction of inflammatory mediators including prostaglandins and cytokines
  • Promotion of fibroblast proliferation and collagen synthesis
  • Neurological effects contributing to pain modulation

Evidence Considerations:

  1. A 2024 review of LLLT for acute tissue injury and sport performance recovery found that LLLT modulates cellular metabolism and the tissue microenvironment, thus supporting improvements in muscle endurance and recovery.[54]
  2. A systematic review comparing high-intensity laser therapy (HILT) with LLLT found both modalities to be beneficial across a range of musculoskeletal conditions including low back pain, knee osteoarthritis, and plantar fasciitis.[61]

Safety Considerations:[18]

Contraindications Precautions Risks
  • Direct application over malignant tissue
  • Direct irradiation of the eyes: protective eyewear is mandatory for both patient and clinician
  • Deep venous thrombosis or thrombophlebitis (local)
  • Pregnancy (over the abdomen or lumbar region)
  • Photosensitive patients or those taking photosensitising medication
  • Over the thyroid gland
  • Impaired cognition or communication
  • Infection
  • Photosensitivity or systemic lupus
  • Recently radiate tissue
  • Anterior neck, carotid sinus
  • Eye damage
  • Bleeding (open wounds)


Additional Considerations:[18]

  • Reduce the risk of adverse effect on the eyes by applying laser in a closed environment, providing protective goggles when necessary, and performing an 'in-contact' technique
  • Ensure correct dosage parameters — wavelength, power density, and exposure time must be appropriate to the clinical indication

Biofeedback

Biofeedback uses visual, auditory, or physical feedback in real time to help patients gain voluntary control over physiological processes.[62] The patient must be able to comprehend and follow instructions to participate actively; this is a relative contraindication in acute psychiatric episodes or with complete paralysis.[9]

For detailed information on indications, techniques, and evidence, see the dedicated Biofeedback sub-page.

General Safety Principles

Across all therapeutic modalities, the following principles apply regardless of energy type:[18]

  • Always test sensory integrity prior to application involving heat, cold, or electrical stimulation
  • Obtain a thorough history, including current medications, implanted devices, and relevant comorbidities, before selecting any modality
  • Modalities should complement, not replace, active rehabilitation and patient education
  • Reassess the patient’s response following each application and adjust treatment parameters accordingly

Resources

The focus of this page is the rationale for use of a modality and its safety considerations. Contraindications, precautions, risks, and safety considerations are outlined in detail by the Canadian Physiotherapy Association.[18]

Also Refer to the Electrotherapy Contraindications sub-page.

References

  1. ↑ Abe Y. Changes in availability and usage of electrophysical agents by physical therapists: a 5 year longitudinal follow-up study. J Phys Ther Sci. 2021 Nov;33(11):870–5. doi:10.1589/jpts.33.870
  2. ↑ Bellew J. Therapeutic Modalities Past, Present and Future: Their Role in the Patient Care Management Model. In: Bellew J, Michlovitz S, Nolan Jr. T eds. Modalities for Therapeutic Intervention. McGraw Hill. 2016. 6e. Available from: https://fadavispt.mhmedical.com/content.aspx?bookid=1932&sectionid=141707167 (accessed 11/05/2022)
  3. ↑ Page P. Making the case for modalities: the need for critical thinking in practice. IJSPT 2021; 16(5).
  4. ↑ Watson T. The role of electrotherapy in contemporary physiotherapy practice. Manual therapy 2000;5(3):132-41.
  5. ↑ Lindsay DM, Dearness J, McGinley CC. Electrotherapy usage trends in private physiotherapy practice in Alberta. Physiotherapy Canada. 1995;47(1):30-4.
  6. ↑ American Physical Therapy Association APTA Guide to Physical Therapist Practice Categories of Interventions. Available from: https://guide.apta.org/interventions/categories-interventions (accessed 11/05/2022)
  7. ↑ Page P, Mistretta C, Thompson J, Brittain K. Musculoskeletal clinical practice guidelines recommended therapeutic interventions. (abstract) Poster Presentation presented at: American Physical Therapy Association -Louisiana; August 27, 2021. Baton Rouge, LA.
  8. ↑ Zadro J, O'KeefFe M, Maher C. Do physical therapists follow evidence-based guidelines when managing musculoskeletal conditions?Systematic review. BMJ Open 2019; 9(10):e032329
  9. ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 Prentice WE. Therapeutic Modalities in Rehabilitation. 6th ed. New York: McGraw Hill; 2021.
  10. ↑ 10.0 10.1 10.2 10.3 Vrindten KL, et al. Thermal Modalities Including Hot Baths and Cold Plunges Play a Unique Role in Injury Prevention and Recovery. Arthrosc Sports Med Rehabil. 2025 Apr 18;7(2):101143. doi:10.1016/j.asmr.2025.101143
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 Vrdoljak I, Šipraga T. Implementation of physiotherapeutic methods utilizing forces and pressures. Croatian Regional Development Journal. 2024 Dec 1;5(2):37–51. doi:10.2478/crdj-2024-0007
  12. ↑ 12.0 12.1 Zanoli G, et al. Current Indications and Future Direction in Heat Therapy for Musculoskeletal Pain: A Narrative Review. Muscles. 2024 Jul 16;3(3):212–23. doi:10.3390/muscles3030019
  13. ↑ Elfahem R, Bouchet B, et al. Investigating Heat Transfer in Whole-Body Cryotherapy: A 3D Thermodynamic Modeling Approach with Participant Variability. Fluids. 2024 Mar 1;9(3):61. doi:10.3390/fluids9030061
  14. ↑ Bleakley CM, Bieuzen F, Davison GW, Costello JT. Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access J Sports Med. 2014;5:25–36. doi:10.2147/OAJSM.S41655
  15. ↑ Xia Z, Sato A, Hughes MA, Cherry GW. Stimulation of fibroblast growth in vitro by intermittent radiant warming. Wound Repair Regen 2001; 8(2):138-144.
  16. ↑ Hughes MA, Tang C, Cherry GW. Effect of intermittent radiant warming on proliferation of human dermal endothelial cells in vitro. J Wound Care 2003;12(4):135-137.
  17. ↑ Price P, Bale S, Crook H, Harding KG. The effect of radiant heat dressing on pressure ulcers. J Wound Care 2000;9(4):201-205.
  18. ↑ 18.00 18.01 18.02 18.03 18.04 18.05 18.06 18.07 18.08 18.09 18.10 18.11 18.12 18.13 18.14 18.15 ELECTROPHYSICAL AGENTS - Contraindications And Precautions: An Evidence-Based Approach To Clinical Decision Making In Physical Therapy. Physiother Can. 2010;62(5):1–80. doi:10.3138/ptc.62.5
  19. ↑ Weston M, Taber C, Casagranda L, Cornwall M. Changes in local blood volume during cold gel pack application to traumatized ankles. J Orthop Sports Phys Ther 1994;19(4):197-199.
  20. ↑ McMaster WC. A literary review on ice therapy in injuries. Am J Sports Med 1977;5(3):124-126.
  21. ↑ Ho SS, Illgen RL, Meyer RW, Torok PJ, Cooper MD, Reider B. Comparison of various icing times in decreasing bone metabolism and blood flow in the knee. Am J Sports Med 1995;23(1):74-76.
  22. ↑ Merrick MA, Knight KL, Ingersoll CD, Potteiger JA. The effects of ice and compression wraps on intramuscular temperatures at various depths. J Athl Train 1993;28(3):236-245.
  23. ↑ Miranda JP, Silva WT, et al. Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: A systematic review of randomized controlled trials. Phys Ther Sport. 2021 May;49:243–9. doi:10.1016/j.ptsp.2021.03.011
  24. ↑ Racinais S, Dablainville V, et al. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. Br J Sports Med. 2024 Oct 22;58(20):1215–23. doi:10.1136/bjsports-2024-108304
  25. ↑ Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan 1;54(2):72–3. doi:10.1136/bjsports-2019-101253
  26. ↑ Draper D, Sunderland S. Examination of the law of grotthus-draper: Does ultrasound penetrate subcutaneous fat in humans? J Athletic Train 1993;28(3):248-250.
  27. ↑ Draper DO, Castel JC, Castel D. Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound. J Orthop Sports Phys Ther 1995;22:142-50.
  28. ↑ Partridge CJ. Electrotherapy – foreword. Physiotherapy 1990;76(10):593-600.
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  42. ↑ Rey-Matias R. 16-Manipulation, traction and massage. In: Cifu D, Lew H. Braddom's Rehabilitation Care: a clinical handbook. Elsevier. 2018, p. 111-118.
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  47. ↑ Prentice WE. Chapter 6. Iontophoresis. In: Therapeutic Modalities In Rehabilitation. 4e. Available from: https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=465&sectionid=40195350 (accessed 12/5/2022)
  48. ↑ Johnson MI, Paley CA, et al. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open. 2022 Feb 10;12(2):e051073. doi:10.1136/bmjopen-2021-051073
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  51. ↑ Hannemann P, Gottgens K, van Wely B, Kolkman K, Werre A, Poeze M, Brink P. Pulsed electromagnetic fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomised trial. BMC Musculoskelet Disord 2012; 12;90.
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