Adverse effects of physiotherapy: a systematic review, prevention, and risk management

This article presents a comprehensive analytical review of adverse effects associated with physiotherapeutic treatments. Potential complications of major physiotherapy modalities – including electrotherapy, phototherapy, and ultrasound therapy – are systematically categorized, with detailed descriptions of their underlying pathophysiological mechanisms. Particular emphasis is placed on classifying complications according to the level of tissue involvement, ranging from local tissue reactions to systemic disturbances. A three-tiered prevention framework is proposed, encompassing pre-treatment risk assessment, intra-procedural monitoring, and post-procedural observation. Regulatory and legal aspects of physiotherapy safety are analyzed with reference to current clinical guidelines and standards.

Conclusion. The majority of adverse effects in physiotherapy are predictable and preventable, provided that prescription and procedural protocols are strictly adhered to and a comprehensive risk management approach is implemented in clinical practice.

1. Ponomarenko G.N. General physiotherapy. 5th ed. revised and add. Moscow: GEOTAR-Media, 2014. 368 p. ISBN: 978-5-9704-5479-4 (In Russ.)

2. Ulyanov B.N., Sorokin A.V. Side effects and complications of physiotherapy procedures (diagnosis, treatment, prevention). Moscow: Medicine, 2009. 192 p. (In Russ.)

3. Robertson V., Ward A., Low J., Reed A. Electrotherapy explained: principles and practice. 5th ed. Oxford: Butterworth-Heinemann, 2011. 480 p.

4. Physiotherapy and balneology / Edited by V.M. Bogolyubov. Book I. Moscow: Binom, 2015. 408 p. ISBN: 978-5-9518-0273-6 (In Russ.)

5. Gurlenya A.M., Bagel G.E., Smychek V.B. Physiotherapy in neurology. Moscow: Medical Literature, 2016. 304 p. ISBN: 978-5-89677-123-4 (In Russ.)

6. Watson T. Electrotherapy: evidence-based practice. 12th ed. Edinburgh: Churchill Livingstone, 2019. 416 p.

7. Odinak M.M., Andreeva G.O., Bazilevich S.N. et al. Spinal neurology. St. Petersburg: SpecLit, 2024. 463 p. (In Russ.)

8. Clinical guidelines. Protocol for the management of patients with chronic inflammatory demyelinating polyneuropathy. Ministry of Health of the Russian Federation. 2023. 59 p. (In Russ.)

9. Ponomarenko G.N., Smirnova I.O. Physical methods of treatment in dermatology. Moscow: GEOTAR-Media, 2021. 432 p. DOI: 10.33029/9704-6320-8-PTD2021-1-432. ISBN 978-5-9704-6320-8 (In Russ.)

10. Ponomarenko G.N. Physiotherapy and rehabilitation medicine. National leadership. Moscow: GEOTAR-Media, 2024. 912 p. (In Russ.)

11. Buyavykh A.G. Physical therapy of surgical, traumatological and orthopedic diseases and injuries: а practical guide. Moscow: Medical Information Agency, 2019. 496 p. ISBN 978-5-9986-0369-3 (In Russ.).