Physiotherapy Doesn’t Equal Electricity – The Overuse of Electrotherapy Modalities in Physiotherapy

 In Physiotherapy & Clinics

There seems to be a strong relationship in people’s mind that the only thing Physiotherapists do is apply various machines to clients. These machines can be anything like a pain control electrical current (TENS or Interferential Current), Therapeutic Ultrasound, LASER, muscle stimulator, etc. You would be surprised how many clients we see who have had a past experience at a Physiotherapy clinic where the Physiotherapist would see them for about 5 minutes and then have an assistant, student or reception staff apply the above mentioned machines. The unfortunate thing is that most of the people’s experience with this approach is negative, they don’t get better. Why continue treating a certain way if clients aren’t getting better? If something isn’t working isn’t it time for course correction?

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First of all, let’s make this abundantly clear, these machines are not the only thing Physiotherapy is about. In our University training we had 2 electrotherapy courses out of our 48 courses. That means that electrotherapy was less than 5% of our overall training. That being said, electrotherapy should only be about 5% of our overall treatment. What was the other 95% of our training? It involved thorough assessment skills, looking at differential diagnosis, manual therapy treatment, therapeutic exercise, maintaining therapeutic relationships, anatomy and physiology, injuries and conditions, etc. It is quite evident that our scope of practice is much more than just applying machines.

Don’t get us wrong, there is a time and a place for some of these electrotherapeutic modalities. They ‘assist’ in the recovery process, usually just to calm down some of the symptoms especially in very acute situations. The key word in the above statement is ‘assist’. The machines can calm down symptoms but don’t necessarily create enough of a mechanical change to the tissue or joints. Usually when we have an injury or pain there is a biomechanical impact, things aren’t moving as they should. That is where manual therapy comes in to play to allow things to move properly and we reinforce this improved movement with therapeutic exercise to solidify everything. As well, the evidence to support the use of electrotherapy is poor to minimal at best. Why use an approach that shows minimal to no improvement?

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There are some fundamental questions that need to be answered here. Why do clinics continue this approach? Do the therapists lack confidence in manual therapy techniques? All Physiotherapists learn basic manual therapy during their university training, but most acquire their skills in post graduate continuing education courses. Is it a way of seeing multiple people at the same time? More people in a clinic usually equals more revenue.

Conclusion: Some people might get angry about the next statement, but we aren’t here to make friends, only to provide effective treatment. The only positive outcome that electrotherapy modalities have been proven to be 100% effective in producing is……

Dollar, dollar bills y'all

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Showing 10 comments
  • Heather Macauley
    Reply

    The basic manual therapy education and University is way too basic. Certainly people have a great insecurity about manual therapy when they graduate. Most are too afraid to try it at all. Furthetmore, until the insurance companies permit physiotherapists to bill for one on one time units, electrical modalities will be the way to get lots of people through your door. The overhead in physiotherapy is fairly high, and only volume can make it work. I do exclusively manual therapy because I work from my home and that is the only way I’ve been able to make it work financially.

    • Jason Bellefleur
      Reply

      Hi Heather,
      Thank you for leaving feedback on our post. I totally agree with you that the overhead in our industry is quite high and can make it challenging on some practices. We always leave it up to the discretion of the therapists what they do for treatment, but it ends up almost always being manual therapy and rehab exercises. We do have the most common modalities in our clinic: TENS, IFC, Ultrasound and LASER but only use them when needed. Studies don’t necessarily support using them on every single client that walks through the door. We’ve heard so many stories from clients and referral sources that some clinics (not all) will just plug clients to all the machines and otherwise only spend about 5 minutes chatting with clients, reassessing and doing any hands-on work. This does allow for a great volume, but do the clients actually get better? More often then not, they don’t get better and tend to have a negative impression on what we do as Physiotherapists. That negative impression is sometimes difficult to change.

  • Deborah Wilson
    Reply

    Interesting article. One of the physiotherapists I work for uses ultrasound and tens on every patient and spends very little time on manual manipulation. In fact she is only with the patient for a few minutes of the 1 1/2 hours they spend here. She’ll actually hook them up to a tens machine and go home leaving them to unhook themselves!!

    • Jason Bellefleur
      Reply

      That’s very unfortunate. What do you think the clients’ impression of physiotherapy is? Probably not good.

  • Annie
    Reply

    I read this because I’m concerned about my first physio experience, and researching whether my experience was typical. At my visit I got treated with three machines that seemed to do nothing, and was at one point left in a room alone for ten minutes with electrodes (which also seemed to do nothing). I thought I would be learning how to move, stretch, and exercise properly to strengthen myself while also not hurting myself, but I don’t think the phsyio office even has a gym-like area with weights, balls, etc. I certainly didn’t see it. After the appt. the physio then wanted me to come back twice a week for the next few weeks… for what? Sit in a dark room with electrodes that do nothing? I can’t afford that.

    • Bellefleur Physiotherapy
      Reply

      I’m sorry to hear that your first physiotherapy experience wasn’t a good one for you. What each clinic does with their clients can vary, some have more of a hands-on approach while others are very passive. Our clinic prides itself on being very hands-on, providing education and home management strategies as well. Other clinics, especially those that are high volume, spend less one-on-one time and tend to hook you up machines. We have another article on our blog about choosing the right physiotherapist, which provides some tips on how to choose a physiotherapy clinic, check it out here: https://www.bellefleurphysio.com/choosing-the-right-physiotherapist-for-you/
      If you have any other questions, feel free to message us, we would be glad to help you out!
      -JB

  • Linda Yates
    Reply

    The article above says: “The evidence to support the use of electrotherapy is poor to minimal at best. Why use an approach that shows minimal to no improvement?”

    Honest question. If that’s the case then why on on your clinic’s list of services do you offer all those treatments?

    • Bellefleur Physiotherapy
      Reply

      Hi Linda, thank you for your question. The evidence for the effectiveness of some the modalities are usually based on the type of injury and the area that is affected. As an example, ultrasound has been shown to be more effective for something like tennis elbow but not very effective for a low back injury. What we do as part of a treatment is completely based on the injury/problem in question, so we pick and choose what works best to solve that problem and fix the injury. We don’t follow the same “recipe” for everyone who walks in the door. At some big volume clinics, every client will get ultrasound, IFC (or TENS) with some ice or heat, regardless of the injury in question. Some places will only apply the different machines to their clients and never do any hands on techniques. We offer the modalities at our clinic, but we are selective and take into consideration the effectiveness of the treatment approach to the injury. I hope that answers your question.

  • Enza North
    Reply

    Excellent post. I’m bookmarking this for reference.

  • Maria Elliott
    Reply

    Thanks for sharing these tips! I am sure your tips really helpful!

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