Is there a future for electrophysical agents in musculoskeletal physiotherapy?

Electrophysical agents (EPAs) are part of the arsenal of techniques that manual therapists have at their disposal for the management of neuromusculoskeletal disorders. An argument can be made that when used judiciously and appropriately as one part of a multimodal approach to treatment, EPAs have the potential to enhance patient care. For the discerning manual therapist, there are several issues to reflect on when considering the use of EPAs as an adjunct to other techniques. One of the main criticisms levelled at EPAs has been that they have little to no evidence of effect. However, one could argue that the swing away from using EPAs in the last 20 years has been as little evidence-based as their prior overuse in the 1970 and 80s. Drill down into the evidence argument and there are many flaws and misconceptions. An evaluation of the Cochrane database and the research into transcutaneous electrical nerve stimulation (TENS) provides a good example.