Shockwave Therapy

Shockwave therapy at MedRehab Group

Shockwave therapy is a treatment your physiotherapist may add to your plan when a tendon or its attachment to bone has been sore for months and has stopped responding to exercise alone. It is not a separate service you book. At MedRehab Group it happens inside a physiotherapy appointment, chosen by a physiotherapist who has assessed you, and it is one part of a plan that still includes loading the tendon properly, because that is what makes the change last.

The device is at two clinics: Richmond Hill on Major Mackenzie Drive and Georgetown on Sinclair Avenue. If you are being treated elsewhere in the group and your physiotherapist thinks shockwave would help, they can arrange a course at whichever is closer without you starting over.

What radial shockwave therapy actually is

The name puts people off, so to be clear: nothing electrical passes through you. A handpiece pressed against the skin delivers rapid mechanical pulses, a few per second, into the tissue underneath. The pulses feel like a firm, fast tapping. The type used in physiotherapy clinics is radial shockwave, which spreads its energy near the surface, where tendons attach to bone, which is exactly where the stubborn problems live.

Why it helps is still being worked out, but the working explanation is that the pulses provoke a controlled irritation in tissue that has settled into a stalled, poorly healing state. Blood flow increases, the body restarts a repair process it had abandoned, and pain sensitivity in the area drops. Because the effect depends on that healing response, your physiotherapist may ask you not to ice the area or take anti-inflammatories for a day or two after each session.

Conditions it is used for

Shockwave has been studied most for long-standing tendon and attachment problems, and that is where we use it. The strongest evidence is for plantar fasciitis, where reviews find a large effect on pain and function in cases that have not settled with other treatment, and for calcific tendinopathy of the shoulder. The evidence for tennis elbow, Achilles tendinopathy and pain on the outside of the hip is positive but more mixed, which is why in those cases it is offered as part of a rehabilitation plan rather than instead of one.

• Plantar fasciitis (heel pain), particularly when it has lasted more than a few months
• Calcific tendinopathy of the shoulder
• Tennis elbow and golfer’s elbow
• Achilles tendinopathy
• Greater trochanteric pain (the outside of the hip)
• Patellar tendinopathy (jumper’s knee)
• Persistent muscle trigger points that have not released with hands-on treatment

The common thread is chronic: a problem that has been present for months, not a fresh injury from last week. Shockwave on an acute, inflamed injury is the wrong tool, and your physiotherapist will say so.

Shockwave therapy for plantar fasciitis

Heel pain is the most common reason shockwave is added to a plan at our clinics. Plantar fasciitis affects about one person in ten at some point, and most cases settle within months with calf and plantar fascia loading, footwear changes and, where the foot mechanics warrant them, orthotics. The cases that do not settle are where the evidence for shockwave is strongest: reviews find it improves pain and function in chronic plantar fasciitis that has not responded to other treatment. At MedRehab Group that means a trial of loading exercise first, then a course of radial shockwave, usually three to five sessions a week apart, with the exercise continuing throughout. Your physiotherapist reassesses a few weeks after the last session, because the effect keeps building.

What it does, and what it does not

For the right problem, shockwave can shift pain that has been stuck for a long time and let you get back to the exercise that rebuilds the tendon. It is not a cure on its own, it is not instant, and it does not work for everyone. You will see claims of high success rates in a handful of sessions on other websites; the honest position is that a good proportion of people with a suitable chronic tendon problem improve meaningfully over a course of three to six sessions, improvement continues for weeks after the last session, and some people do not respond. If nothing has changed after a full course, the plan changes.

It is not used in pregnancy, over a growth plate in someone still growing, over an infection or a tumour, on people with bleeding disorders or on blood thinners, or directly over major nerves, blood vessels or the lungs. A pacemaker near the treatment area rules it out too. Your physiotherapist screens for all of this before the first session.

What a session is like

Shockwave is delivered within a physiotherapy appointment. Your physiotherapist finds the most tender point, applies gel, and works the handpiece over the area for a few minutes, typically delivering around two thousand pulses. It is uncomfortable rather than painful: most people describe deep, fast tapping that becomes tender at the sore spot, and the intensity is adjusted to what you can tolerate. The area may be red and a little sore for a day or two afterwards. You can walk out and carry on with your day, and you should keep up your exercises between sessions.

A course is usually three to six sessions, about a week apart. Many people notice a change by the third or fourth session; the full effect is often not clear until several weeks after the last one, which is why we do not judge it session by session.

Who provides it

At MedRehab Group shockwave is applied by registered physiotherapists, within their scope and on the College of Physiotherapists of Ontario’s standards for the use of energy-applying equipment, after an assessment that confirms the problem is one shockwave is likely to help. It is never sold as a stand-alone treatment by someone who has not examined you.

Cost, insurance and direct billing

Because shockwave is delivered inside a physiotherapy appointment, it is covered the way physiotherapy is: most extended health plans through work cover it under their physiotherapy benefit, and we bill most major insurers directly. Ask the clinic whether there is an additional charge for the shockwave itself, since plans differ in how they treat it. OHIP does not cover it. After a car accident it can be part of the treatment plan submitted to your auto insurer; under WSIB it can be included in a program of care where the physiotherapist considers it appropriate. Physiotherapy is exempt from HST.

Questions we are asked most

Related services

Shockwave is one tool within physiotherapy. For persistent muscle tension, massage therapy and dry needling are the other options your physiotherapist may suggest, and for a problem that is more about a stiff joint than a tendon, chiropractic may be the better first call.