STUDY DESIGN: Systematic review. BACKGROUND: Soft-tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. OBJECTIVE: To evaluate the effectiveness and safety of physical agents for soft-tissue injuries of the lower limb. METHODS: We searched five databases from 1990 to 2015 for randomized controlled trials (RCT), cohort and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with high risk of bias were excluded. We synthesized low risk of bias studies according to principles of best-evidence synthesis. RESULTS: We screened 10,261 articles. Twenty RCTs had high risk of bias and were excluded; 23 RCTs had low risk of bias and were included in our synthesis. The available evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses while those with persistent midportion Achilles tendinopathy may benefit from shock-wave therapy. However, the current evidence does not support the use of shock-wave therapy for recent plantar fasciitis; low-dye taping for persistent plantar fasciitis; low-level laser therapy for recent ankle sprains; and splints for persistent midportion Achilles tendinopathy. Finally, the effectiveness of the following interventions is not established in the current literature: (1) shock-wave therapy for persistent plantar fasciitis; (2) cryotherapy or assistive devices for recent ankle sprains; (3) braces for persistent midportion Achilles tendinopathy; and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. CONCLUSIONS: A number of RCTs evaluated the effectiveness of physical agents for the management of lower limb soft-tissue injuries. Yet, high-quality RCTs are still needed to inform the effectiveness of physical agents for the management of lower limb soft-tissue injuries. The effectiveness of most interventions remains unclear. LEVEL OF EVIDENCE: Therapy, 1a.

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