The use of electrical modalities such as TENS, laser therapy, bio-electric stimulation and others have long been controversial in rehabilitation. Some have well researched uses and protocols and under those or similar circumstances, stand to help patients in their efforts to recover.
Unfortunately many therapists use electrical modalities for every patient, regardless of injury type. I have seen many therapists use neuromuscular stimulation on ligament strains. Given that a ligament attaches a bone to a bone, why are they dealing with the neuromuscular junction? Had the muscles tested weak? Were they weak due to neuromuscular problems or weak second to instability from the sprain? This type of thinking is required when planning patient treatment to maximize the chances of a positive outcome.
Van tulder et al 2006 in a review of back-pain management determined that TENS had no effect on the long-term management of back pain. Thus, except for providing acute relief in the initial period- why use it? Peter et al 2011 demonstrated that TENS, ultrasound, electromagnetic field and low level laser had no effect on hip and knee osteoarthritis management. Again- if they are repeatedly demonstrated not to help, why use them in the precious minutes we have to treat our patients?
Ediz et al 2012 just published a RCT of ACL rehab patients. 13 went through standard which included manual therapy, exercise therapy and cryotherapy. A second group of 13 also received 30 minutes of electro-stimulation for 30 minutes 5 days a week. After 8 weeks they demonstrated significantly lower oedema and pain in the knee. There was no difference for strength, range of motion or weight bearing. None the less, if reproduced this indicates that a passive electrical modality treatment in conjunction with standard rehabilitation can help control the patient’s pain.