Therapeutic modalities used in physical therapy and wellness treatments…
Therapeutic Modalities
Therapeutic modalities are tools and techniques that use different forms of energy to assist with tissue healing, inflammation management, pain relief, and muscle activation following injury or pathology. Depending on the condition and stage of healing, modalities such as ice, Low-Intensity Pulsed Ultrasound (LIPUS), Low-Level Laser Therapy (LLLT), Shockwave Therapy (SWT), Transcutaneous Electrical Nerve Stimulation (TENS), or Neuromuscular Electrical Stimulation (NMES) may be helpful. Dry needling may also be used when clinically appropriate. Selection should reflect the treatment goal, as not all of these interventions are appropriate during the immediate acute phase.
Low-Intensity Pulsed Ultrasound (LIPUS)
Low-Intensity Pulsed Ultrasound (LIPUS) uses high-frequency sound waves to support muscle, bone, ligament, or cartilage tissue regeneration and recovery following inflammation or injury. Its proposed therapeutic effects involve stimulating cellular activity and signaling associated with tissue repair, including processes that influence the energy (ATP) needed for cellular recovery. Studies have explored potential benefits involving cell proliferation, tissue tensile strength, cellular responses to ultrasound energy, enhanced type II collagen synthesis, and accelerated healing following injury (Inceoglu et al., 2021).
Low-Level Laser Therapy (LLLT), or Cold Laser Therapy
Low-Level Laser Therapy (LLLT) uses light within the red and near-infrared spectrum to stimulate therapeutic cellular responses through photobiomodulation. Specific treatment parameters include wavelength, pulse frequency, exposure time, power, and energy dose. Wavelength and tissue characteristics influence the depth of penetration
Cellular photoacceptors absorb the applied light, which may influence mitochondrial activity and the production of cellular energy, or ATP. This biostimulation may support collagen production, vascular responses, pain modulation, and cell proliferation and survival. Potential benefits have been investigated in multiple tissue types, including muscle, tendon, bone, and cartilage, although outcomes depend on the condition and treatment parameters (Lawrence & Sorra, 2024).
Neuromuscular Electrical Stimulation (NMES)
Neuromuscular Electrical Stimulation (NMES) is used in physical therapy to assist muscle activation by electrically recruiting motor units. An electrical waveform delivers pulses through surface electrodes, stimulating motor nerves and producing an involuntary muscle contraction when the electrodes are positioned appropriately.
This can assist with muscle re-education and strengthening following injuries or conditions that impair voluntary muscle activation. Standard NMES generally requires an intact peripheral motor nerve supply (Glaviano & Saliba, 2016).
Pulsed Electromagnetic Field Therapy (PEMF)
Pulsed Electromagnetic Field Therapy (PEMF) uses a device that generates pulsed electromagnetic fields directed toward a targeted area of the body. Depending on the device, the applicator does not need to contact the skin directly and can be placed near the affected area.
At the cellular level, PEMF is thought to influence the body’s natural healing response, in part through changes in cellular signaling, including nitric oxide (NO) pathways. NO is involved in vasodilation, inflammation regulation, and tissue repair. These mechanisms may contribute to pain relief and recovery in selected conditions (Bromley et al., 2026).
Contraindications and precautions depend on the specific device. Particular screening is necessary for patients with pacemakers or other implanted electronic devices. Pregnancy, active bleeding, suspected malignancy, and active infection should also be assessed according to the manufacturer’s instructions and clinical guidance.
Red Light Therapy (RLT)
Red Light Therapy (RLT) is a form of photobiomodulation that commonly uses visible red light, often within the 630–660 nm range, to interact with skin and superficial soft tissue. Red light is distinct from near-infrared light, which generally penetrates more deeply.
RLT may influence soft tissue healing processes through changes in mitochondrial activity and cellular signaling. Proposed effects include changes in collagen production, nitric oxide signaling, local circulation, and inflammatory regulation.
Other potential responses include changes in macrophage activity, cytokine signaling, and tissue repair processes. These effects depend on the wavelength, dose, and tissue being treated. Light penetration also varies, so a fixed treatment depth should not be assumed for every device or application (Curyło et al., 2025; Hernández-Bule et al., 2024).
Shockwave Therapy (SWT)
Shockwave Therapy (SWT) is a modality used for pain management and selected musculoskeletal conditions, particularly persistent soft tissue disorders. Its precise biological mechanisms remain incompletely understood, but proposed effects include changes in local perfusion, new blood vessel formation, bone formation, and fibroblast activity.
SWT has also been investigated for its effects on stem cell activity within soft tissue and nearby bone. Proposed mechanisms of pain relief include changes in sensory nerve activity and the regulation of substance P and other pain mediators at the treatment site (Ryskalin et al., 2022).
Focused SWT transmits acoustic waves with a rapid increase in positive pressure followed by a negative-pressure phase. These waves produce physical and mechanical effects that may stimulate cellular signaling and tissue repair responses. Radial pressure-wave devices, often described as shockwave devices, have different waveform characteristics (Ryskalin et al., 2022; Tenforde et al., 2022).
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) is used to assist with pain relief in acute and chronic conditions. Electrical impulses delivered through surface electrodes stimulate sensory nerves, typically producing a strong but comfortable tingling sensation.
Activation of sensory nerve fibers can reduce pain transmission through spinal pain-modulation mechanisms. TENS may also influence descending pain-control pathways and endogenous pain-relieving chemicals.
These responses can assist with pain relief during or immediately after treatment. TENS is primarily used for symptom management; pain relief does not necessarily indicate reduced inflammation or an improved tissue-healing response (Johnson et al., 2022).
References
Bromley, C., McManus, C., & McManus, D. (2026). Novel approach to plantar fasciitis treatment: Pulsed electromagnetic field therapy. Journal of the American Podiatric Medical Association, 116(4), 24136. https://doi.org/10.7547/24-136
Curyło, W., Chwaleba, K., Kłak, I., Szerocki, J., Milewska-Plis, K., & Mazur, K. (2025). LED photobiomodulation: From dermatological care to neuroprotection and pain management—Review. Our Dermatology Online, 16, e32.
Glaviano, N. R., & Saliba, S. (2016). Can the use of neuromuscular electrical stimulation be improved to optimize quadriceps strengthening? Sports Health, 8(1), 79–85. https://doi.org/10.1177/1941738115618174
Hernández-Bule, M. L., Naharro-Rodríguez, J., Bacci, S., & Fernández-Guarino, M. (2024). Unlocking the power of light on the skin: A comprehensive review on photobiomodulation. International Journal of Molecular Sciences, 25(8), 4483. https://doi.org/10.3390/ijms25084483
Inceoglu, A., Sahin, F., Akkaya, N., Ok, N., Yorukoglu, C., Mete, G., & Akgün, S. (2021). Effects of low-density pulsed ultrasound treatment on transforming growth factor-beta, collagen level, histology, biomechanics, and function in repaired rat tendons. Turkish Journal of Physical Medicine and Rehabilitation, 67(2), 167–174. https://doi.org/10.5606/tftrd.2021.5118
Johnson, M. I., Paley, C. A., Jones, G., Mulvey, M. R., & Wittkopf, P. G. (2022). 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, 12(2), e051073. https://doi.org/10.1136/bmjopen-2021-051073
Lawrence, J., & Sorra, K. (2024). Photobiomodulation as medicine: Low-level laser therapy (LLLT) for acute tissue injury or sport performance recovery. Journal of Functional Morphology and Kinesiology, 9(4), 181. https://doi.org/10.3390/jfmk9040181
Ryskalin, L., Morucci, G., Natale, G., Soldani, P., & Gesi, M. (2022). Molecular mechanisms underlying the pain-relieving effects of extracorporeal shock wave therapy: A focus on fascia nociceptors. Life, 12(5), 743. https://doi.org/10.3390/life12050743
Tenforde, A. S., Borgstrom, H. E., DeLuca, S., McCormack, M., Singh, M., Soo Hoo, J., & Yun, P. H. (2022). Best practices for extracorporeal shockwave therapy in musculoskeletal medicine: Clinical application and training consideration. PM&R, 14(5), 611–619. https://doi.org/10.1002/pmrj.12790
