Energy–Tissue Interaction in Physiotherapy: A Proposed Conceptual Framework for Electrophysical Agents
- 1Department of Health Sciences, School of Life and Health Sciences, European University Cyprus, 6 Diogenous Str., 2404 Nicosia, Cyprus
- 2Department of Life and Health Sciences, School of Health Sciences, Frederick University, 3080 Limassol, Cyprus
Abstract
Electrophysical agents (EPAs) are widely used in rehabilitation, yet their selection is frequently guided by diagnostic labels, established protocols, or device-specific parameters, with comparatively limited consideration of how the delivered energy physically interacts with the intended target tissue. This narrative review examines energy–tissue interactions underlying six commonly used EPAs: therapeutic ultrasound, photobiomodulation (LASER), diathermy, capacitive–resistive electric transfer (TECAR/CRET), extracorporeal shockwave therapy (ESWT), and pulsed electromagnetic fields (PEMF). Relevant literature was identified through searches of PubMed and Scopus, prioritising publications from 2016 to 2026 while incorporating earlier foundational studies. Experimental investigations, computational models, and relevant reviews were narratively synthesised to examine energy propagation, attenuation, distribution, tissue-specific interactions, and the resulting physical and biological stimuli. Based on this synthesis, the Tissue Energy Interaction Framework (TEIF) is introduced as a proposed conceptual model requiring further validation rather than an established clinical decision-making tool. The framework describes a pathway from energy generation and delivery through tissue propagation, attenuation/distribution, target interaction, physical or biological stimulus, biological response, and potential clinical effect. The reviewed evidence indicates that tissue depth, composition, interfaces, and modality-specific characteristics substantially influence the physical stimulus reaching a therapeutic target. Energy penetration should therefore be distinguished from effective target interaction, while measurable interaction does not necessarily establish clinical effectiveness. The TEIF proposes that physical and biological plausibility should inform EPA selection alongside, but never supersede, evidence of clinical effectiveness and patient-specific considerations. Further research is required to validate the framework and determine whether tissue-informed EPA selection improves clinical outcomes.
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BibTeX
@article{rentzias2026energytissue,
title = {{Energy–Tissue Interaction in Physiotherapy: A Proposed Conceptual Framework for Electrophysical Agents}},
author = {Panagiotis Rentzias and Stelios Hadjisavvas and Kyriakos Pavlou and Charalambos Papacharalambous and George M. Pamboris and Christos Karagiannis},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218216},
url = {https://www.mdpi.com/2077-0383/15/21/8216},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Energy–Tissue Interaction in Physiotherapy: A Proposed Conceptual Framework for Electrophysical Agents
AU - Panagiotis Rentzias
AU - Stelios Hadjisavvas
AU - Kyriakos Pavlou
AU - Charalambos Papacharalambous
AU - George M. Pamboris
AU - Christos Karagiannis
PY - 2026
DA - 2026/10/22
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218216
UR - https://www.mdpi.com/2077-0383/15/21/8216
AB - Electrophysical agents (EPAs) are widely used in rehabilitation, yet their selection is frequently guided by diagnostic labels, established protocols, or device-specific parameters, with comparatively limited consideration of how the delivered energy physically interacts with the intended target tissue. This narrative review examines energy–tissue interactions underlying six commonly used EPAs: therapeutic ultrasound, photobiomodulation (LASER), diathermy, capacitive–resistive electric transfer (TECAR/CRET), extracorporeal shockwave therapy (ESWT), and pulsed electromagnetic fields (PEMF). Relevant literature was identified through searches of PubMed and Scopus, prioritising publications from 2016 to 2026 while incorporating earlier foundational studies. Experimental investigations, computational models, and relevant reviews were narratively synthesised to examine energy propagation, attenuation, distribution, tissue-specific interactions, and the resulting physical and biological stimuli. Based on this synthesis, the Tissue Energy Interaction Framework (TEIF) is introduced as a proposed conceptual model requiring further validation rather than an established clinical decision-making tool. The framework describes a pathway from energy generation and delivery through tissue propagation, attenuation/distribution, target interaction, physical or biological stimulus, biological response, and potential clinical effect. The reviewed evidence indicates that tissue depth, composition, interfaces, and modality-specific characteristics substantially influence the physical stimulus reaching a therapeutic target. Energy penetration should therefore be distinguished from effective target interaction, while measurable interaction does not necessarily establish clinical effectiveness. The TEIF proposes that physical and biological plausibility should inform EPA selection alongside, but never supersede, evidence of clinical effectiveness and patient-specific considerations. Further research is required to validate the framework and determine whether tissue-informed EPA selection improves clinical outcomes.
SN - 2077-0383
ER -