Telma Grant Physio & Sports Therapy FAQs

No. Patients receiving publicly-funded clinic-based Physiotherapy under an Episode of Care (EOC) funding model are not limited to a specific number of services per EOC. Funding covers an EOC, not individual visits. The number and frequency of services provided will be determined by the treating Physiotherapist in consultation with the patient and be based on the Physiotherapist’s professional skill and clinical judgment and the patient’s individual needs. Discharge will occur once the therapeutic objectives identified in the treatment plan have been achieved, or when any reasonably equivalent gains could be achieved through self-care or through an exercise, falls prevention, activation, or similar program or when no further gains are likely to be achieved from continuing the Physiotherapy services.

There is no annual funding amount for each patient. Clinics are allocated funding for a specific year under a formal funding agreement between the clinic and the Ministry of Health and Long-Term Care (the “ministry”). The ministry provides funding in the amount of $312 for each EOC; it does not pay for individual visits. TheEOC is comprised of at least, assessment, diagnosis, treatment, and the provision of a discharge summary to the referring provider. Some patients may require only one EOC while others may be referred for multiple EOCs.

Government-funded Physiotherapy may also be provided to eligible patients by, for example:

• Community Care Access Centres to people who require Physiotherapy in their homes due to their condition or injury;
• Long-Term Care homes;
• hospitals to their inpatients or through their outpatient Physiotherapy departments;
• special rehabilitation programs/organizations such as Children’s Treatment Centres;
• some Community Health Centres.

Yes. A patient can receive more than one episode of care in a year provided that all eligibility criteria, including a separate referral, are met for each individual episode of care. Each episode of care is one discrete group of condition/diagnosis specific, time-limited, goal-oriented Physiotherapy services.

A list of all clinics that are eligible for publicly funded Physiotherapy services is posted at www.health.gov.on.ca/en/public/programs/physio/ on the MOHLTC website.

For patients who pay privately, or through their extended health benefits, car insurance or WSIB our policy is to get you booked in within 2 business days.

You can start Physiotherapy immediately usually. It is often advisable to see your family physician who may provide investigative medical tests and prescribe anti-inflammatory, pain and/or muscle relaxant medication.

Shockwave therapy is a non-invasive treatment which involves creating a series of low energy acoustic wave pulsations which are directly applied to the site of injury through the client’s skin via a gel medium. Studies found shockwaves were effective for the treatment of often chronic conditions such as plantar fascitis, Achilles tendonitis, jumper’s Knee’s, calcific tendonitis, bursitis, and trigger points.

Watch this brief introduction to shockwave therapy:

Shockwaves stimulate certain components within the body so the body is able to heal. Shockwave therapy is able to accomplish this even in chronic cases, when the body has demonstrated a previous unwillingness or inability to heal by itself. In addition to stimulating the healing process, shockwave therapy has a direct effect on nerves, diminishing pain.

What makes shockwave therapy unique is that it is one of the very few technologies in any field of medicine that seems to work best when an injury reaches the chronic, non-healing state. Shockwave therapy appears to be able to jump start the healing process in chronic, non-healing injuries and move them back into the acute phase of healing. Treatment produces an inflammatory response. The body responds by increasing metabolic activity around the site of pain. This stimulates and accelerates the healing process.

Shockwave therapy is used to treat many conditions, including:

• Rotator cuff tendinopathy
• Plantar fascitis/fasciopathy
• Tennis elbow (radial epicondylitis)
• Golfer’s elbow (medial epicondylitis)
• Tendinosis Calcarea (painful limitation of shoulder movement due to calcification of shoulder tendons )
• Bursitis ( Bursitis is inflammation of a bursa. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.)
• Patellar tendonitis ( jumper’s knee)
• Tibial Stress Fracture
• Achilles tendonitis
• Achillodynia
• Heel spur
• Various chronic enthesiopathies (painful irritation of tendon attachments due to overexertion and improper strain, or due to a degenerative process)
• Various sports injuries
• Painful trigger points(acute and chronic painful neck, back, shoulder and etc. due to chronically shortened and thickened muscle tissue)

Before treatment with shockwave therapy, a correct examination and diagnosis should be performed. Shockwave therapy is contraindicated for the following:

Do not use shockwave therapy on any body part during pregnancy.

• Hemophilia, or other coagulation disorders.
• Anticoagulant (warfarin, heparin) pharmaceuticals, especially Marcumar.
• Acute inflammations. Do not use over swollen, inflamed, infected tissue, skin eruptions or on other acute tissue lesions.
• Polyneuropathy area. A Diabetes patient often has disturbed sensory and nervous function in the polyneuropathic area.
• Cortisone therapy: Wait for a minimum 6 weeks after local cortisone injection before treatment with radial pressure waves.
• Patients with hemorrhages or risk of hemorrhage.
• Patients with malignant tumors.
• Swellings that still feel warm.
• Implants, areas where implants have been removed, damaged implants, and metal inclusions.
• Over superficial endoprosthesis or metal implants.
• Severe arterial obstructions (stage III and IV ).
• Gynecological disorders involving acute inflammation.
• Deep vein thrombosis, phlebitis, varices.
• Arterial disease, circulatory insufficiency.
• Over eyes.
• Over reproductive organs.
• Over cardiac pacemakers and defibrillators, cochlear implants, bone growth stimulators, deep brain stimulators, spinal cord stimulators, and other nerve stimulators.
• Over open lamina (after laminectomy; spina bifida).
• Directly over the carotid sinuses, cervical stellate ganglion, or Vagus nerve located in the anterior neck triangle.
• Direct application over cancerous tumors or lesions due to its potential to increase blood flow to the area of malignancy.
• Neoplastic tissues or space occupying lesions.
• Occlusive vascular disease, such as arteriosclerosis obliterans and thromboangiitis obliterans, in which organic occlusion and ischemia are evident.
• In the presence of systemic or local infection (sepsis, Osteomyelitis, tuberculosis) or if the patient has an elevated temperature.
• Shock waves must not be applied to target areas located above air-filled tissue (lungs), nor to any regions near large nerves, vessels, the spinal column or head.

A course of shockwave therapy typically consists of four visits – three treatment sessions administered over a three week period after your initial assessment. The painful site is identified and approximately two thousand shockwaves are administered using a hand held applicator in combination with a conductive gel. The process is relatively pain free and can be adjusted for patient comfort. Remember, these are sound “shocks”, not electrical shocks. The treatment lasts between five and seven minutes. Occasionally a fourth treatment may be indicated.

We find that many patients get an initial degree of improvement almost immediately following treatment. This effect is usually (but not always) temporary, and is associated with an anesthesia effect from the hyperstimulation of the tissue from the shock wave therapy.

Shockwave therapy has been subject of many clinical studies that have been published in numerous well respected medical journals. Here are a few examples:

• 91% success rate calcific tendonitis of the shoulder. Journal of American Medical Association 2003
• 90% success rate plantar fasciitis. The Journal of Orthopaedic Research 2005
• 77% success rate tennis elbow. The Journal of Orthopaedics 2005

The basic technology involved with shockwave technology has been used for decades now by millions of people. The technology has been used most extensively in Europe, particularly the German-speaking countries, where this technology originates. In all its use, shockwave therapy of the musculoskeletal system has been found to have virtually no serious side-effects. In fact, even mild side effects like tingling, aching, redness, or bruising are relatively rare, modest and short-lived.

Please have your prescription and insurance card available when you call. This will allow us to verify your insurance benefits and provide you with an estimate of coverage.

To bring/keep in mind on your first visit:

• In case of an automobile accident or worker’s compensation claim, bring any case manager or insurance adjuster contact names, phone numbers, and claim number.
• A prescription (if needed) for Physiotherapy from your referring physician, ARNP, or PA.
• Insurance information (we will make a copy of your card).
• Please arrive 15 minutes early to complete any remaining paperwork, so you can maximize your time in your evaluation.
• Please wear comfortable clothing that allows easy access to your problem areas.
• Print out the patient forms, fill them out, and bring them with you. If you are unable to do this, please allow for extra time to fill these out upon your arrival.

Dress comfortably in clothes that allow easy access for the therapist to examine your problem areas.

For treatments, loose-fitting clothes that are comfortable for gentle exercises and supportive sneakers are often good choices to wear.

Your insurance benefits will be determined before your second visit, and you will be informed of what, if any, payment is necessary on that date.

We accept cash, check, debit card, and credit card. We are happy to discuss payment plan options as well. It is our policy that payment is made at the time of service.

In most cases, insurance will cover a good portion, if not all, of your treatment costs. We understand navigating insurance can be confusing, so Telma Grant Physio & Sports Therapy will be happy to assist in contacting your insurance company and determining your coverage based on your policy.

For more information, visit our direct billing page, and please do not hesitate to contact our Bowmanville, ON Physiotherapy office. We do offer different payment options for your convenience.