INDIBA in physiotherapy: what it is, what it's for and when I won't use it on you

INDIBA is probably the word you hear most right now in any physiotherapy clinic. It deserves an honest explanation, because there is a lot of marketing around it and little content that says what it is, what it is really for and, above all, when it makes no sense to use it. I'll tell you from inside the clinic, as one more tool, neither magic nor useless.

What exactly INDIBA is

INDIBA is a radiofrequency technology that works at a very specific frequency: 448 kHz. It is what is called "capacitive-resistive diathermy". In plain language: a device that generates a high-frequency current that passes between two electrodes (an active one, which I hold in my hand, and a return one, which you rest on) and produces a movement of ions within the tissue. That movement generates deep heat and, depending on the dose I apply, also cellular effects without perceptible heat.

The two ways of working are:

• Capacitive mode (CET): the heat is concentrated in more superficial tissues with high water content, such as muscles and soft tissue.
• Resistive mode (RES): the heat reaches deeper, into tendons, joints, bone and areas with less water.

What it does in your body (and what it doesn't)

448 kHz radiofrequency has three described effects:

1. It increases local microcirculation

Deep heat dilates the small blood vessels in the area, more oxygen and nutrients arrive and metabolic waste is cleared faster. This matters when a tissue is "stuck" in an inflammatory phase that never quite resolves.

2. It activates cellular biology

In low-intensity applications (without perceptible heat) there are studies showing changes in fibroblast activity and better cell proliferation. In clinical practice this translates into a faster response from the tissue that is repairing.

3. It relaxes tissue and reduces pain

The deep thermal effect reduces muscle tension and modulates pain perception during the session and for hours afterwards. It is the part the patient notices fastest.

What does the scientific evidence say?

Here I have to be clear. The evidence on INDIBA is growing but moderate. There are studies showing positive results in chronic tendinopathies, low back pain, post-surgery recovery, pelvic floor and improved microcirculation. There are also reviews calling for larger, better-designed studies.

In clinical practice over recent years it has become established as a useful tool when combined with exercise and manual therapy. But serious physiotherapy is not based on a single technology: the foundation is still assessment, therapeutic exercise and patient education. INDIBA speeds up processes, it does not replace them.

When it does make sense to use it

These are the situations where, according to the evidence and my clinical experience, INDIBA adds real value to treatment:

• Chronic tendinopathies (tennis elbow, rotator cuff tendinitis, plantar fasciitis, patellar tendinopathy).
• Post-surgery recovery (cruciate ligament, rotator cuff, hip or knee replacement).
• Chronic low back pain of muscular or joint origin.
• Muscle injuries (muscle tears, deep knots).
• Swelling and bruising in the subacute phase.
• Conditions where microcirculation is compromised and we want to speed up the repair phase.

When I will NOT use it on you

The contraindications for INDIBA are the same as for any diathermy. If you have any of these, we rule it out without discussion:

• A pacemaker or any implanted electronic device.
• Pregnancy (we do not apply it over the abdomen or lower back).
• Active malignant tumours or suspicion of them.
• Acute infection in the area to be treated.
• Active deep vein thrombosis.
• Severely impaired skin sensation in the area (you would not notice if it burned you).
• Over bone growth plates in children.

There are other relative contraindications (such as metal implants in the area, which are assessed carefully). I always ask about this history before the first application.

What a real INDIBA session is like

Here is what actually happens when I apply INDIBA in the clinic:

1. You lie on the couch with the area to be treated uncovered and the skin clean.
2. I apply a special conductive cream (no alcohol, no perfume).
3. I place the return electrode under your body or in a nearby area.
4. I work for 15-30 minutes with circular movements over the area, adjusting the power so you feel a pleasant warmth without it ever burning.
5. I clean the area and, normally, we do manual therapy or exercise immediately afterwards while the tissue is "open".

An isolated INDIBA session has little value. What really works is combining it with the rest of the treatment: dry needling if there are deep knots, manual therapy if there is joint stiffness, therapeutic exercise always.

How many sessions do I need and how often?

It depends on the case. As a general guide:

• Chronic tendinopathies: between 6 and 12 sessions, initially twice a week and then spacing them out.
• Post-surgery: it can be integrated throughout the whole rehabilitation phase, according to protocol.
• Acute muscle injuries: 3-6 sessions in the first 2-3 weeks.

At your initial assessment I give you a realistic estimate for your case. If I see that after 3-4 sessions we are not noticing changes, we rethink it. There is no point continuing to apply a technique that adds nothing.