Four machines, four different jobs.

TECAR generally reaches deeper. It passes a radiofrequency current at around 500 kHz through the body to generate heat within the tissue itself, so depth is governed by current path rather than by how far light can travel. Laser depends on photons penetrating from the surface, which body composition limits. For a deep hip or lumbar structure, TECAR is often the more practical choice.

High intensity laser has the more defensible evidence base of the two. A 2022 BMJ Open meta-analysis measured a 13.15 mm pain reduction in lower-limb tendinopathy from laser, while a 2020 Cochrane review of therapeutic ultrasound in chronic low back pain concluded the current evidence does not support its use. Given a choice between the two for a tendon or back problem, we would reach for laser.

Therapeutic ultrasound is not a treatment we prioritise. A 2020 Cochrane review of 10 randomised trials in chronic low back pain rated the evidence very low-certainty and concluded it does not support using therapeutic ultrasound for that condition. We would rather spend your appointment on assessment, hands-on treatment, loading, and where a modality genuinely helps, laser, shockwave, or TECAR. Diagnostic ultrasound imaging is a separate technology entirely.

They can be used in the same treatment plan, though usually at different stages rather than in the same session. A common sequence is laser while a tendon is too irritable to tolerate provocation, then shockwave later once the tissue has settled but the problem remains stubborn. Which order suits you depends on how reactive your tissue is when you are assessed.

Laser is the most comfortable of the four, felt as a spreading warmth that most people find pleasant. TECAR also feels warm and is generally comfortable. Shockwave is the outlier: it is deliberately provocative and often uncomfortable during application, with soreness afterwards being normal. If tolerance is your main concern, laser is the gentlest option.

The decision comes from your assessment, mainly from how irritable the tissue is and how deep the target sits. An acutely painful, reactive structure points toward laser. A deep structure under significant soft tissue points toward TECAR. A chronic, stubborn tendinopathy that has plateaued despite good loading points toward shockwave. If nothing points anywhere in particular, the honest answer is that no machine is needed.

Often not. Most musculoskeletal problems improve with accurate assessment, appropriate loading, and time, and none of those require a device. Modalities earn their place when pain or irritability is the specific barrier stopping you from doing the rehabilitation. If you can already do your programme, adding a machine to it is unlikely to change your outcome.

No. TECAR passes a radiofrequency current at around 500 kHz through tissue in capacitive and resistive modes to generate deep heat from within, while laser delivers red and near-infrared light absorbed by mitochondria near the surface and below. They feel similar during treatment, since both produce warmth, but the physics and the depth each one reaches are different.

All four are delivered inside a physiotherapy appointment at Medstar and billed on the physiotherapy line, so ICBC claims, WorkSafeBC claims, and extended health plans treat them identically. There is no separate machine fee and no funder is billed for a modality as its own item. Your coverage depends on your physiotherapy benefit, not on which device is used during the visit.