Electrotherapy has been drifting in and out of fashion in the physiotherapy world for years.Old attitudes of a poor evidence base are slowly being challenged by new emerging evidence. At university we were taught by Tim Watson who is well known for his extensive work in this field. His own website is your best resource and can be found below. Your patients will ask you what electrotherapy you are using and how it works so familarise yourself with a condensed layman’s explaination.


A quick overview


Ultrasound is a form of mechanical energy where sound waves transmit through tissues. Parameters can be altered to achieve different physiological effects at different stages of tissue healing.

If used correctly US can :

  • Increases cellular activity
  • During the inflammatory phase, US has a stimulating effect on the mast cells, platelets, white cells with phagocytic roles and the macrophages (Nussbaum 1997, ter Haar 1999, Fyfe & Cahal 1982, Maxwell 1992, Watson 2008).
  • Ultrasound applied to tissues enhances the functional capacity of the scar tissues (Nussbaum 1998, Huys et al 1993, Tsai et al 2006, Yeung et al 2006).
  • Increases tensile strength and enhancing scar mobility (Nussbaum 1998, Wang 1998).



  • US over the uterus during pregnancy
  • Malignancy ( increases cellular activity in an area considered to be malignant may increase growth and reduce the patients prognosis)
  • Over haemotoma/bruised tissue.
  • Significant vascular abnormalities including deep vein thrombosis, emboli and severe arteriosclerosis / atherosclerosis.
  • Haemophiliacs not covered by factor replacement
  • Application over :

The eye
The stellate ganglion
The cardiac area in advanced heart disease & where pacemakers in situ
The gonads
Active epiphyses in children (Ok to use US in children – critical question is whether the applied energy would reach the epiphysis)



  • Always use the lowest intensity which produces a therapeutic response
  • Ensure that the applicator is moved throughout the treatment (speed and direction not an issue)
  • Caution is advised in the vicinity of a cardiac pacemaker or other implanted electronic device
  • Continuous ultrasound is considered unwise over metal implants
Common Conditions it can be used for:
  • Tendinopathies
  • Superficial Ligament Damage
  • Trochanteric Bursitis
  • Facet Joint Inflammation
  • Muscle Tears
  • Fracture Healing

Electrotherapy Modalities



Pulsed short wave

Laser Therapy

Combination Therapy


REVISION DOWNLOADS  – Electrotherapy.org has a extensive selection of downloads that explain in detail the electrotherapies and their benefits/contraindications. Click here to have a further look …..


Anon (1983). “Ultrasonic assessment of stress fractures.” BMJ 286: 1479.

Baker, K. G., et al. (2001). “A review of therapeutic ultrasound: biophysical effects.” Phys Ther 81(7): 1351-8.

Byl, N. N., et al. (1996). “Effects of ultrasound on the orientation of fibroblasts: an in-vitro study.” Eur-J-Phys-Med-Rehabil 6(6): 180-4.

Casarotto, R. A., et al. (2004). “Coupling agents in therapeutic ultrasound: acoustic and thermal behavior.”Archives of Physical Medicine and Rehabilitation 85(1): 162-5.

Ciccone, C. D., et al. (1991). “Effects of ultrasound and trolamine salicylate phonophoresis on delayed-onset muscle soreness.” Phys Ther 71(9): 666-75; discussion 675-8.

Culav, E. M., et al. (1999). “Connective tissues : Matrix composition and its relevance to physical therapy.”Physical Therapy 79(3): 308-319.

Dinno, M., et al. (1989). “The significance of membrane changes in the safe and effective use of therapeutic and diagnostic ultrasound.” Phys Med Biol 34: 1543-1552.

Docker, M. F., et al. (1982). “Ultrasound couplants for physiotherapy.” Physiotherapy 68(4): 124-125.

Draper, D. and e. al (1995). “Rate of temperature increase in human muscle during 1Mhz and 3Mhz continuous ultrasound.” J Orthopaedic and Sports Physical Therapy 22(4): 142-150.

Draper, D., et al. (1993). “A comparison of temperature rise in human calf muscle following applications of underwater and topical gel ultrasound.” JOSPT 17: 247-251.

Draper, D. O. and M. D. Ricard (1995). “Rate of temperature decay in human muscle following 3 MHz ultrasound: the stretching window revealed.” Journal of Athletic Training 30(4): 304-7.

Draper, D. O., et al. (1995). “Temperature changes in deep muscles of humans during ice and ultrasound therapies: an in vivo study.” Journal of Orthopaedic & Sports Physical Therapy 21(3): 153-7.

Dunn, F. and L. A. Frizzell (1982). Bioeffects of ultrasound. Therapeutic Heat and Cold. F. Lehmann J, Rehabilitation Medicine Library386-.

Dyson, M. and J. Niinikoski (1982). “Stimulation of tissue repair by therapeutic ultrasound.” Infections in Surgery: 37-44.

Dyson, M. and D. Smalley (1983). Effects of ultrasound on wound contraction. Ultrasound Interactions in Biology & Medicine. R. Millner, E. Rosenfeld and U. Cobet. New York, Plenum Press151-158.

Dyson, M. and J. Suckling (1978). “Stimulation of tissue repair by ultrasound: A survey of the mechanisms involved.” Physiotherapy 64(4): 105-108.

El Hag, M., et al. (1985). “The anti-inflammatory effect of dexamethazone and therapeutic ultrasound in oral surgery.” Br J Oral & Maxillofacial Surgery 23: 17-23.

El-Batouty, M. F., et al. (1986). “Comparative evaluation of the effects of ultrasonic and ultraviolet irradiation on tissue regeneration.” Scand J Rheumatology 15: 381-386.

Enwemeka, C. S. (1989). “The effects of therapeutic ultrasound on tendon healing. A biomechanical study.”Am J Phys Med Rehabil 68(6): 283-7.

Enwemeka, C. S., et al. (1990). “The biomechanical effects of low-intensity ultrasound on healing tendons.”Ultrasound Med Biol 16(8): 801-7.

Frizzell, L. A. and F. Dunn (1982). Biophysics of ultrasound. Therapeutic Heat and Cold. J. Lehmann. Baltimore, Williams & Wilkins.

Fyfe, M. C. and L. A. Chahl (1982). “Mast cell degranulation: A possible mechanism of action of therapeutic ultrasound (Abstract).” Ultrasound in Med & Biol 8(Suppl 1): 62.

Gomez, M. A., et al. (1989). “Medical collateral ligament healing subsequent to different treatment regimens.” J. Appl. Physiol. 66(1): 245-252.

Harvey, W., et al. (1975). “The stimulation of protein synthesis in human fibroblasts by therapeutic ultrasound.” Rheumatol Rehabil 14(4): 237.

Hashish, I., et al. (1986). “Anti-inflammatory effects of ultrasound therapy: evidence for a major placebo effect.” Br J Rheumatol 25(1): 77-81.

Hill, M., et al. (2003). “Muscle satellite (stem) cell actiation during local tissue injury and repair.” J Anat203: 89-99.

Hoogland, R. (1995). Ultrasound Therapy. Delft, Enraf Nonius.

Huys, S., et al. (1993). “Comparison of effects of early and late ultrasound treatment on tendon healing in the chicken limb.” J Hand Ther 6: 58-59.

Johns, L. D., et al. (2007). “Analysis of effective radiating area, power, intensity, and field characteristics of ultrasound transducers.” Arch Phys Med Rehabil 88(1): 124-9.

Kitchen, S. and C. Partridge (1997). “Ultrasound, shortwave diathermy and laser: a survey to examine patterns of use in England.” Br J Therapy Rehabil 4(2): 75-78.

Kitchen, S. S. and C. J. Partridge (1990). “A review of therapeutic ultrasound:
Part 1 – Background and physiological effects
Part 2 – The efficacy of ultrasound
Part 3 – References.” Physiotherapy 76(10): 593-600.

Klucinec, B., et al. (2000). “Effectiveness of wound care products in the transmission of acoustic energy.”Phys Ther 80(5): 469-76.

Latey, P. (2001). “Aspects of inflammation.” J Bodywork and Movement Therapies 5(2): 124-131.

Lehmann, J. (1982). Therapeutic Heat and Cold. Baltimore, Williams & Wilkins.

Lehmann, J. F. and B. J. de Lateur (1989). Ultrasound, shortwave, microwave, superficial heat & cold in the treatment of pain. Textbook of Pain. P. D. Wall and R. Melzack. Edinburgh, Churchill Livingstone932-941.

Leonard, J., et al. (2004). “A comparison of intramuscular temperatures during 10-minute 1.0-MHz ultrasound treatments at different intensities.” J. Sport Rehabil. 13(3): 244-254.

Leung, M. C., et al. (2004). “Effect of ultrasound on acute inflammation of transected medial collateral ligaments.” Arch-Phys-Med-Rehabil. 85(6): 963-6.

Leung, M. C., et al. (2006). “Therapeutic ultrasound enhances medial collateral ligament repair in rats.”Ultrasound Med Biol 32(3): 449-52.

Lorena, D., et al. (2002). “Nornal scarring : importance of myofibroblasts.” Wound Repair Regen 10(2): 86-92.

Markert, C. D. (2004). “Ultrasound and exercise in skeletal muscle regeneration.”

Maxwell, L. (1992). “Therapeutic ultrasound: Its effects on the cellular & mollecular mechanisms of inflammation and repair.” Physiotherapy 78(6): 421-426.

McBrier, N. M., et al. (2007). “Therapeutic ultrasound decreases mechano-growth factor messenger ribonucleic acid expression after muscle contusion injury.” Arch Phys Med Rehabil 88(7): 936-40.

McDiarmid, T., et al. (1985). “Ultrasound and the treatment of pressure sores.” Physiotherapy 71(2): 66-70.

Meakins, A. and T. Watson (2006). “Longwave ultrasound and conductive heating increase functional ankle mobility in asymptomatic subjects.” Physical Therapy in Sport 7: 74-80.

Mortimer, A. J. and M. Dyson (1988). “The effect of therapeutic ultrasound on calcium uptake in fibroblasts.” Ultrasound in Med & Biol 14(6): 499-506.

Neidlinger-Wilke, C., et al. (2002). “Fibroblast orientation to stretch begins within three hours.” J Orthop Res 20(5): 953-6.

Nussbaum, E. (1998). “The influence of ultrasound on healing tissues.” Journal of Hand Therapy 11(2): 140-7.

Nussbaum, E. L. (1997). “Ultrasound: to heat or not to heat – that is the question.” Physical Therapy Reviews 2: 59-72.

Nussbaum, E. L. and M. Locke (2007). “Heat shock protein expression in rat skeletal muscle after repeated applications of pulsed and continuous ultrasound.” Arch Phys Med Rehabil 88(6): 785-90.

Poltawski, L. and T. Watson (2007). “Relative transmissivity of ultrasound coupling agents commonly used by therapists in the UK.” Ultrasound Med Biol 33(1): 120-8.

Pye, S. (1996). “Ultrasound therapy equipment – does it perform?” Physiotherapy 82(1): 39-44.

Ramirez, A., et al. (1997). “The effect of ultrasound on collagen synthesis and fibroblast proliferation in vitro.” Medicine and Science in Sports and Exercise 29(3): 326-32.

Reher, P., et al. (1999). “Effect of ultrasound on the production of IL-8, basic FGF and VEGF.” Cytokine11(6): 416-23.

Robertson, V. J., et al. (2006). Electrotherapy Explained: Principles and Practice. Oxford, Elsevier.

Schabrun, S., et al. (2006). “Are therapeutic ultrasound units a potential vector for nosocomial infection?”Physiother Res Int 11(2): 61-71.

Srbely, J. Z. and J. P. Dickey (2007). “Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy?” Clin Rehabil 21(5): 411-7.

Straub, S. J., et al. (2008). “Variability in effective radiating area at 1 MHz affects ultrasound treatment intensity.” Phys Ther 88(1): 50-7; discussion 58-62.

ter Haar, G. (1987). Recent advances in therapeutic ultrasound. Ultrasound: Method Applications, Biological Effects and Hazzard Potential. M. Repacholi, M. Grandolfo and A. Rindi. New York, Plenum Press.

ter Haar, G. (1999). “Therapeutic Ultrsound.” Eur J Ultrasound 9: 3-9.

Toumi, H. and H. M. Best (2003). “The inflammatory response: friend or enemy for muscle injury?” Br J Sports Med 37: 284-286.

Tsai, W. C., et al. (2006). “Ultrasound stimulation of types I and III collagen expression of tendon cell and upregulation of transforming growth factor beta.” J Orthop Res 24(6): 1310-6.

Turner, S., et al. (1989). “The effect of ultrasound on the healing of repaired cockrel tendon: is collagen cross-linkage a factor?” J Hand Surg 14B: 428-433.

Wang, E. D. (1998). “Tendon repair.” J Hand Ther 11(2): 105-10.

Ward, A. R. (1986). Electricity, Fields and Waves in Therapy. Marrickville, Australia, Science Press.

Warden, S. J., et al. (2006). “Low-Intensity Pulsed Ultrasound Accelerates and a Nonsteroidal Anti-inflammatory Drug Delays Knee Ligament Healing.” Am J Sports Med 34(7): 1094-102.

Watson, T. (2000). “Masterclass. The role of electrotherapy in contemporary physiotherapy practice.”Manual Therapy 5(3): 132-41.

Watson, T. (2002). “Ultrasound Dose Calculations.” In Touch 101: 14-17.

Watson, T. (2003). “Soft Tissue Healing.” In Touch 104: 2-9.

Watson, T. (2006). “Electrotherapy and tissue repair.” Sportex-Medicine. 29: 7-13.

Watson, T. (2006). “Tissue repair: The current state of the art.” Sportex-Medicine. 28: 8-12.
Watson, T. (2008). “Ultrasound in contemporary physiotherapy practice.” Ultrasonics 48: 321-329

Watson, T. and S. Young (2008). Therapeutic Ultrasound. Electrotherapy : Evidence Based Practice. T. Watson. Edinburgh, Churchill Livingstone – Elsevier.

Werner, S. and R. Grose (2003). “Regulation of wound healing by growth factors and cytokines.” Physiol. Rev 83: 835-870.

Wilkin, L. D., et al. (2004). “Influence of therapeutic ultrasound on skeletal muscle regeneration following blunt contusion.” Int. J. Sports Med. 25(1): 73-77.

Williams, R. (1987). “Production and transmission of ultrasound.” Physiotherapy 73(3): 113-116.

Yeung, C. K., et al. (2006). “Pulsed ultrasound treatment accelerates the repair of Achilles tendon rupture in rats.” J Orthop Res 24(2): 193-201.

Young, S. R. and M. Dyson (1990). “The effect of therapeutic ultrasound on angiogenesis.” Ultrasound Med Biol 16(3): 261-9.

Young, S. R. and M. Dyson (1990). “Macrophage responsiveness to therapeutic ultrasound.” Ultrasound Med Biol 16(8): 809-16.

Zhou, S., et al. (2004). “Molecular mechanisms of low intensity pulsed ultrasound in human skin fibroblasts.” J Biol Chem 279(52): 54463-9.

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