OBJECTIVES: Anecdotally the focus on evidence-based practice in many health sciences is not reflected in the availability and usage patterns of electrophysical agents. This proposition is examined in relation to therapeutic ultrasound (US) and microwave (MW). METHODS: Research published in English between 1998 and 2008 and using MW or US to treat musculoskeletal conditions was identified and reviewed. Usage and availability of each modality was also examined and compared with evidence of clinical effectiveness identified in the literature review. RESULTS: While MW is rarely available or used, recent research suggests positive outcomes in treating different musculoskeletal conditions, particularly with a frequency of 434 MHz. By contrast, US is often available and used but the research on this remains equivocal. DISCUSSION: The known effectiveness of MW and US in treating musculoskeletal problems is not reflected in usage patterns. Usage appears to be based on other than evidence of the clinical utility of these two modalities. How much it derives from patients' expectations and issues clinicians may have in using research not targeted at practitioners is unknown. There are implications for educators, clinicians, researchers and journal editors. These may include the need for more syntheses of research findings and books that focus on clinical conditions rather than research per se. These ideas need further exploration. CONCLUSION: The choice of MW or US is apparently based on other than evidence of effectiveness.

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