Electrotherapy — an honest assessment.
We offer limited electrotherapy at City Physio. Not because we haven’t got the equipment — because the evidence doesn’t support most of it, and we’d rather use the consultation time doing something that actually works.
Here’s our honest take on electrotherapy, what we do and don’t use, and why.
Electrotherapy is the use of electrical or energy-based devices as a clinical treatment. It covers a range of modalities — ultrasound, TENS, interferential, shockwave, laser therapy — each with different mechanisms, different evidence bases, and different clinical applications.
These treatments have moved in and out of fashion over the decades. Ultrasound was the go-to in the 90s. Interferential dominated the 2000s. Shockwave is the current trend. The technology gets shinier. The evidence base doesn’t always follow.
Genuinely interesting technology — a handheld device delivering targeted acoustic energy to specific tissue. The literature does support it for a specific set of conditions at specific treatment frequencies (typically 2–3 sessions per week over 6–12 weeks). It’s not snake oil.
However — the machine costs around $40,000, which generally means a price bump on your consultation to cover the overhead. And for most of the conditions shockwave is used for, targeted manual therapy and specific loading exercise produces equivalent or better outcomes without the cost, the frequency, or the equipment. That’s what we prefer to do. If you specifically want shockwave and it’s clinically indicated, we can refer you to a clinic that offers it.
These machines provide pain relief while they’re switched on. That’s it. They produce no lasting therapeutic effect, create no structural change, and add nothing to the treatment once the session ends. We don’t use them.
The evidence base here is poor. Multiple systematic reviews have failed to demonstrate clinically meaningful outcomes above placebo. We don’t use it and don’t recommend it.
Therapeutic ultrasound uses ultrasonic pulses via a handheld device to vibrate tissues and produce targeted heat. It increases localised blood flow, can stimulate healing, and at specific settings assists in bony healing and the treatment of mastitis.
We use it selectively — primarily for haematomas and bruising, and occasionally for acute sprains and strains where there’s a specific clinical rationale. It’s a limited but legitimately useful tool in the right context. It’s not something we use routinely.
The reason we don’t lean on electrotherapy is simple — for most presentations, there are better options.
We have a strong preference for interventions that produce lasting structural and neurological change rather than temporary symptom relief. Targeted manual therapy, specific exercise prescription, dry needling, and biomechanical correction consistently outperform passive electrical modalities in the current clinical literature — and they don’t require you to keep coming back just to maintain the effect.
Because most clinics don’t.
A $40,000 shockwave machine needs to earn its keep. Heat packs and TENS units are easy to reach for when an appointment is running long. Laser therapy looks impressive and patients leave feeling like something happened.
We’re not interested in that model. We’re interested in what changes your body long-term — and that’s hands-on clinical skill, specific loading, and honest evidence-based decision making. Not equipment that earns its ROI whether it helps you or not.
If you’ve been somewhere that relied heavily on passive electrical treatment and you’re not getting better — that might be why. Come in and we’ll tell you what we think is actually driving the problem.
Electrotherapy — what you actually want to know.
My previous physio used TENS on me every session. Was that useful?
Probably not in any lasting sense. TENS provides pain relief while the current is applied — some patients find it genuinely helpful in the short term for managing acute pain. But it produces no structural change, no lasting neurological effect, and nothing that changes the underlying problem. If it was used as a time-filler while waiting for something else, that’s not ideal. If you were leaving sessions feeling temporarily better but not actually progressing, that’s worth thinking about.
Should I try shockwave therapy for my Achilles or plantar fasciitis?
Shockwave has reasonable evidence for Achilles tendinopathy and plantar fasciitis specifically — these are among the conditions where the literature supports it. However, a structured progressive loading program (heavy slow resistance tendon loading protocol) also has excellent evidence for Achilles tendinopathy and produces equivalent or better outcomes in many studies — without the cost or treatment frequency. If you’ve already done a properly structured loading program for 12+ weeks without resolution, shockwave becomes a more reasonable next step. We’re happy to discuss where you’re at and whether a referral makes sense.
Do you have an ultrasound machine at the clinic?
Yes. We use therapeutic ultrasound selectively for specific presentations — primarily haematomas and bruising, and occasionally acute sprains and strains where there’s a clear clinical rationale. It’s not something we reach for routinely, but it’s a useful tool in the right context.
What do you use instead of electrotherapy?
Manual therapy, dry needling, specific exercise prescription, load management, and biomechanical correction. These interventions have consistent evidence for producing lasting structural and neurological change — not just temporary symptom relief. For most presentations, they outperform passive electrotherapy in both short and long-term outcomes.
I’ve been told laser therapy will help my injury. Should I try it?
We’d be cautious. The current evidence base for low-level laser therapy (LLLT) doesn’t reliably demonstrate outcomes above placebo in musculoskeletal conditions. That doesn’t mean it can’t help — placebo effects are real and some people report benefit. But we wouldn’t recommend spending significant time or money on it before exhausting evidence-based options first.
If you’ve been relying on electrotherapy without progress, these are more likely to help:
Not getting better with passive treatment?
Come in. We’ll assess what’s actually driving the problem and tell you honestly what’s most likely to fix it.
hello@cityphysio.com.au · Shop 10, Level 6, 25 Martin Place
— The City Physio team