What conditions do you treat at InHealth Physiotherapy?

We treat knee pain, back pain, sciatica, shoulder injuries, pelvic floor dysfunction, postpartum pain, pediatric developmental concerns, sports injuries, and chronic pain conditions.

Do I need a doctor's referral for physiotherapy?

No referral is required. You can book physiotherapy, pelvic floor therapy, pediatric physiotherapy, or massage therapy directly. Some insurance plans may request a referral for reimbursement.

Does your clinic offer pelvic floor physiotherapy?

Yes. We provide pelvic floor physiotherapy for pregnancy and postpartum recovery, pelvic pain, urinary incontinence, prolapse symptoms, and core rehabilitation.

Do you provide postpartum physiotherapy?

Yes. We help with back pain, pelvic pressure, diastasis recti, C-section scar tightness, and other postpartum concerns.

Is pediatric physiotherapy available?

Yes. We treat infants, toddlers, and children with delayed milestones, torticollis, toe-walking, coordination issues, sports injuries, and neurodevelopmental concerns.

How long is my first visit and what should I expect during my first physiotherapy appointment?

Your first visit includes a full assessment, diagnosis, movement analysis, and hands-on treatment. You will also receive personalized exercises during the first session. Initial assessments are 45-60 minutes, and follow-up treatments are 30-45 minutes, depending on your condition.

What makes your clinic different?

We provide longer one-on-one appointments, personalized treatment plans, advanced modalities, and a patient-first approach focused on listening, education, and long-term recovery.

Do you accept WSIB and motor vehicle accident (MVA) claims?

Yes. We provide physiotherapy for workplace injuries and car accident rehabilitation, and we handle all required documentation.

Do you accept insurance and direct billing?

Yes. We accept most extended health plans including Sun Life, Manulife, Canada Life, Green Shield, Blue Cross, and more. Direct billing is available for many providers, including WSIB and motor vehicle accident insurers. No referral is required.

How do I book an appointment?

You can book online 24/7, call the clinic, or request same-day availability for urgent concerns.

How long does it take to see results from physiotherapy?

Most patients notice improvement within 3-5 sessions, depending on the condition and severity.

Is shockwave therapy available at your clinic?

Yes. We offer shockwave therapy for chronic conditions like plantar fasciitis, tennis elbow, calcific tendonitis, and stubborn muscle pain. It accelerates healing and reduces inflammation.

Shockwave Therapy for Chronic Pain

InHealth Physiotherapy

Sep 8

4 min read

Updated: Sep 10

Shockwave Therapy for Chronic Pain: What It Is, What It Treats, and What to Expect.

If you have been dealing with persistent tendon pain, plantar fasciitis that has not resolved after months of stretching, a calcific rotator cuff deposit that keeps flaring up, or tennis elbow that standard physiotherapy has only partially addressed - you may have been told that shockwave therapy could help. This article explains the mechanism behind shockwave therapy, the conditions where the evidence is strongest, and exactly what to expect during and after treatment at InHealth Physiotherapy in Etobicoke.

What Shockwave Therapy Is

Shockwave therapy uses a hand-held applicator to deliver high-energy acoustic pressure waves directly into the affected tissue. These waves are not electrical and do not involve needles, incisions, or radiation. The applicator is pressed against the skin with a coupling gel, similar to what is used for ultrasound and the waves are delivered in short pulses.

The mechanism of action is called mechanotransduction: the conversion of a mechanical stimulus (the pressure wave) into a cellular biological response. The shockwave does several things simultaneously in the treated tissue:

Stimulates neovascularization- the formation of new blood vessels in areas of chronically poor circulation (tendons have notoriously low blood supply, which is why they heal slowly)
Disrupts calcific deposits- breaking down calcium build-ups that have accumulated in tendons over time
Reduces substance P- a neurotransmitter involved in chronic pain signalling, which is why many patients report decreased pain after a course of treatment
Triggers a controlled inflammatory response- restarting a healing process that has stalled in chronically injured tissue

This last point is important and often misunderstood. Shockwave therapy intentionally provokes inflammation in order to stimulate healing.

The Conditions Shockwave Therapy Is Most Effective For

Plantar fasciitis (Level 1 evidence) Multiple randomized controlled trials and systematic reviews confirm that shockwave therapy significantly reduces pain and improves function in chronic plantar fasciitis — particularly in cases that have not resolved with stretching, orthotics, and standard physiotherapy. At InHealth, shockwave is one of our primary tools for persistent plantar fasciitis. Learn more about our plantar fasciitis physiotherapy programme.

Calcific rotator cuff tendinopathy (Level 1 evidence) Calcium deposits in the rotator cuff tendons respond well to focused shockwave therapy. Studies show meaningful reduction in calcium deposit size and significant pain reduction in patients who have not responded to conservative treatment. See our rotator cuff and shoulder physiotherapy page for more on how we approach shoulder conditions.

Lateral epicondylitis — tennis elbow (Level 2 evidence) Research supports shockwave therapy as an effective intervention for chronic lateral epicondylitis, particularly in patients with symptoms persisting beyond 3 months. Outcomes include reduced pain with grip and improved function. For more on elbow conditions, visit our tennis and golfer's elbow physiotherapy page.

Other tendinopathies with emerging evidence:

Achilles tendinopathy (mid-portion and insertional)
Patellar tendinopathy (jumper's knee)
Greater trochanteric pain syndrome (lateral hip pain)
Hamstring tendinopathy

Does It Hurt?

Most patients describe shockwave therapy as uncomfortable rather than painful, a deep aching or a strong pressure sensation at the treatment site. The intensity is adjustable and your physiotherapist will check in with you throughout. If the sensation becomes more than uncomfortable, the energy level can be reduced immediately.

What is normal during a session:

A dull ache or deep pressure at the treatment site
Brief sharp sensation when the applicator contacts a particularly reactive area
Some local redness of the skin immediately after (this resolves within minutes to hours)

What to flag to your physiotherapist:

Sharp, shooting pain down a limb (possible nerve irritation — the applicator position needs to move)
Significant bruising or swelling not explained by your underlying condition
Symptoms that are dramatically worse 48–72 hours after treatment

How Many Sessions Are Needed

Most patients require 3 to 5 sessions, spaced 1 to 2 weeks apart.

The response to shockwave therapy is not immediate. Many patients experience an increase in local soreness in the 24–48 hours after the first session- this is the controlled inflammatory response working. Improvement typically becomes noticeable after the second or third session, as the healing process progresses and the inflammatory phase resolves.

Expecting pain relief after the first session is one of the most common reasons patients discontinue prematurely. The clinical evidence for shockwave outcomes is built on courses of 3–5 sessions — single-session outcomes are not what the research supports.

When Shockwave Therapy Is Not Appropriate

Shockwave therapy is contraindicated in the following circumstances:

Pregnancy -acoustic waves should not be directed at or near the abdomen or pelvis during pregnancy
Blood-thinning medications - warfarin, newer anticoagulants (rivaroxaban, apixaban), or injectable blood thinners significantly increase the risk of bruising and tissue injury
Active infection at or near the treatment site
Cortisone injection at the treatment site within the preceding 6 weeks- shockwave and corticosteroid interact adversely; a minimum 6-week gap is required, however this may vary depending on the individual, treatment protocol, and medical plan.
Malignancy at or near the treatment site
Skeletally immature patients (children and adolescents)- shockwave is not delivered over growth plates
Implanted electronic devices (cardiac pacemakers) if treatment is in the chest region

Your physiotherapist completes a contraindication screen before your first session. If any of the above apply, shockwave will not be offered.

How Shockwave Therapy Fits Into a Broader Treatment Plan

Shockwave therapy works best as part of a comprehensive physiotherapy plan, not as a standalone intervention. Research supports combining shockwave with:

Progressive tendon loading exercises- eccentric and heavy slow resistance programmes that rebuild tendon capacity
Manual therapy- addressing any adjacent joint stiffness, muscle tension, or biomechanical factors contributing to tendon overload
Load management- restructuring activities and training volume to allow healing while maintaining function

At InHealth, shockwave therapy is always integrated into a broader treatment strategy. Your physiotherapist designs a plan that combines shockwave with the exercises and hands-on work appropriate to your condition, rather than delivering shockwave in isolation and sending you home.

For an overview of all services at InHealth, including shockwave therapy, see our services page. To ask about shockwave for your specific condition or book an initial assessment, book directly or contact the clinic.