Electrotherapy

Much as electrotherapy has been a component of physiotherapy practice since the early days, its delivery has changed remarkably and continues to do so. The most popular modalities used these days are in many respects quite dissimilar to those of 60 or more years ago.Modern electrotherapy practice needs to be evidence based and used appropriately. Used at the right place, at the right time for the right reason, it has phenomenal capacity to do good. Used unwisely, it will either do no good at all, or worse still, make matters worse. The skill of electrotherapy is to make the appropriate clinical decision as to which modality to use and when.

A simple, but effective clinical decision making model (represented in the diagram right) can be utilised. All electrotherapy modalities (with the exception of biofeedback) involve the introduction of some physical energy into the system. This energy brings about one or more physiological changes, which are used for therapeutic benefit. Clinically, it is probably more useful to work the model in reverse - determine first the nature of the problem to be addressed. Then establish the physiological changes that need to take place in order to achieve these effects. Lastly, the modality which is most able to bring about the changes in the tissue(s) concerned should be a relatively straightforward decision. Electrotherapy treatment effects appear to be dose dependent and therefore having identified the most appropriate modality, it is important to deliver the appropriate dose. There are numerous examples of research papers that have demonstrated a significant effect at dose (a) yet almost zero effect at another dose (b).