Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 3 October 2026.
They are not two versions of the same thing. Therapeutic ultrasound delivers continuous low-intensity sound waves and you feel almost nothing. Shockwave delivers short, high-energy mechanical pulses and you feel every one of them. The evidence behind them is also very different, and that is the part worth knowing before you pay for a course.
The difference in one table
| Therapeutic ultrasound | Shockwave | |
|---|---|---|
| What it delivers | Continuous or pulsed sound waves at low intensity | Short, high-amplitude mechanical pulses |
| What it feels like | Usually nothing, sometimes mild warmth | Distinctly uncomfortable at the treatment site |
| How it is thought to work | Tissue heating and micro-mechanical effects at cell level | A controlled mechanical stimulus that restarts a healing response in chronic tissue |
| Typical course | A few minutes inside a longer appointment | Three to five treatments, roughly a week apart |
| Most supported for | Little, in current evidence | Chronic tendon problems, particularly plantar heel pain and calcific shoulder |
| Cost at Phoenix | No extra charge inside an appointment; $50 per area booked on its own | $50 per area added to a physiotherapy appointment; $120 per area booked on its own, after a first appointment |
The two kinds of shockwave
Focused shockwave concentrates energy at a set depth, which suits a deep target such as a calcific deposit in the shoulder. Radial shockwave spreads energy from the applicator outwards and is shallower, which suits the plantar fascia, the Achilles and the lateral elbow. Which one is appropriate depends on how deep the problem is, not on which machine a clinic happens to own.
The honest position on ultrasound
Therapeutic ultrasound has been a fixture in physiotherapy clinics for decades and the evidence for it has not held up well. Reviews of the better trials have generally not found it to outperform placebo for most musculoskeletal conditions. It is comfortable, it is easy to deliver, and that combination is a large part of why it persisted.
We do not build programs around it. If ultrasound is being offered as the treatment rather than as an add-on, ask what else the plan includes.
The one area where low-intensity pulsed ultrasound has a more serious literature is bone healing, and that is a different device, a different dose and a decision for the surgeon managing the fracture, not a physiotherapy add-on.
Where shockwave does earn its place
Chronic tendon problems that have already had a proper loading program and have not responded. Plantar heel pain is the clearest case, with calcific tendinopathy of the shoulder behind it, and some evidence for lateral elbow and greater trochanteric pain.
The important qualifier is that it is an adjunct. The evidence supports shockwave alongside progressive loading, not instead of it. A tendon that gets shockwave and no strength program tends to feel better for a while and then return, because nothing has changed about what it can carry.
Is it meant to hurt?
Shockwave is uncomfortable during treatment and often achy for a day or two afterwards. That is expected. So is some redness or mild bruising over the treated area. What is not expected is pain that escalates over several days, numbness that persists, or skin that breaks down, and those are worth reporting.
Who should not have shockwave
- Over an area of active infection, or over a tumor.
- Over open growth plates in children.
- On anticoagulants, or with a bleeding disorder.
- During pregnancy, over the treated region.
- Directly over a major nerve or blood vessel, or over a pacemaker site.
That list is checked at assessment rather than assumed.
How we decide which, if either
By what has already been tried. If a tendon has never had a structured loading program, that is the first thing, because it has the strongest evidence and no side effects. If it has had one, properly, for long enough, and it is still limited, shockwave becomes a reasonable addition. That is a conversation at the assessment rather than a package sold up front.
An Assessment and Treatment is one 45 minute appointment, $230 nett, no GST, one to one with your physiotherapist for the whole time. Ultrasound adds nothing to that fee; shockwave adds $50 per area, at Orchard and Tampines. More on each: shockwave therapy and ultrasound therapy. What each stage of loading works on is set out in the Phoenix Recovery Protocol.
Related: heel pain, tennis elbow and Achilles problems are the three conditions this question comes up for most.
Where are you with this right now?
1. It is settling on its own
Most injuries and most flare-ups settle over weeks with sensible load management and a return to normal movement. Improvement is judged over a month, not over a day, and good days and bad days inside that are usual. If you are doing more this month than last, and sleeping better, it is behaving the way it should. You do not need us for this, and we would rather say so.
2. It has stopped improving
You have adapted without noticing. The other side takes the load, you plan movements you used to make without thinking, and you have quietly dropped things you used to do.
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the recovery programs, hand and physiotherapy, or the four stages and what each one works on if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
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Where we are
Clinics across Singapore
ORCHARD
400 Orchard Road #12-12
Orchard Towers, S238875
NS22 Orchard MRT
Physiotherapy and hand therapy in Orchard →
WhatsApp 8800 1830TAMPINES
9 Tampines Grande #01-20
Asia Green, S528735
EW2DT32 Tampines MRT
Physiotherapy and hand therapy in Tampines →
WhatsApp 8780 9608SERANGOON
265 Serangoon Central Drive #04-269
S550265 · Lift C only
NE12CC13 Serangoon MRT
Physiotherapy and hand therapy in Serangoon →
WhatsApp 8892 4121TANJONG PAGAR
10 Anson Road #02-77A
International Plaza, S079903
EW15 Tanjong Pagar MRT
Physiotherapy and hand therapy in Tanjong Pagar →
WhatsApp 8227 7074JURONG EAST
2 Venture Drive #02-02
Vision Exchange, S608526
NS1EW24 Jurong East MRT
Opening 20 October 2026
Physiotherapy and hand therapy in Jurong East →
WhatsApp 8242 7340