Effectiveness of physical agent modalities for pain relief in injured athletes: A systematic review.

Researchers wanted to know whether physical agent modalities—devices and treatments like shockwave therapy, ultrasound, laser, and electrical stimulation—actually help reduce pain in injured athletes. They searched three major medical databases for studies published up until May 2024 and found 21 rigorous trials involving 806 athletes across different types of injury. The results suggest that these modalities do have some role in managing pain, with extracorporeal shockwave therapy (ESWT) showing potential effectiveness and being the most commonly studied approach.

However, the studies varied so much in their methods and outcomes that the researchers couldn't pinpoint exactly how much benefit each individual modality provides.

If you've been injured and your physiotherapist has mentioned using devices like shockwave therapy or ultrasound to help with your pain, there is emerging evidence that these treatments may genuinely help. Researchers looked at 21 different studies involving hundreds of athletes with injuries and found that physical agent modalities appeared to have a role in reducing pain during recovery.

The strongest evidence so far seems to be around shockwave therapy, which is being used fairly widely in sports medicine settings. That said, because these studies were quite different from each other in how they worked, we don't yet have a completely clear picture of which treatment works best for which injury, so your individual experience may vary.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review suggests that PAMs warrant consideration in an athlete's pain management toolkit, with ESWT appearing most frequently studied and showing potential effectiveness for pain relief. The high heterogeneity among the 21 included studies (ranging from ESWT to cryotherapy to combined approaches) limits the ability to draw firm conclusions about individual modality efficacy or comparative effectiveness.

The authors did not identify a single dominant approach, which reflects the reality that current evidence is still developing and varied in quality across different PAM types. This finding should inform your evidence appraisal: positive signals exist, but they're not yet definitive enough to establish clear hierarchies or predictable outcomes for specific injury presentations.