High-Intensity Focused Electromagnetic Energy (HIFEM) Therapy

Strengthen, Retrain, and Support Your Pelvic Floor

High-Intensity Focused Electromagnetic Energy, commonly referred to as HIFEM, is a non-invasive treatment that uses focused electromagnetic energy to stimulate muscles and nerves.

For pelvic floor rehabilitation, you remain comfortably seated and fully clothed while the HIFEM Chair produces repeated pelvic floor muscle contractions. These contractions are designed to help strengthen weakened pelvic floor muscles, improve neuromuscular control, and support better pelvic function.

FDA-cleared HIFEM chair technology is indicated for non-invasive stimulation of the pelvic floor muscles for rehabilitation of weak pelvic muscles and restoration of neuromuscular control in the treatment of male and female urinary incontinence. 

What HIFEM Chair Therapy May Help With

HIFEM Chair Therapy may be incorporated into a pelvic health treatment program for appropriate patients experiencing:

• Urinary leakage
• Stress urinary incontinence
• Urinary urgency or frequency
• Pelvic floor muscle weakness
• Reduced pelvic floor muscle control
• Postpartum pelvic floor weakness
• Pelvic floor deconditioning
• Reduced pelvic stability

Because pelvic symptoms can have different causes, treatment begins with an evaluation to determine whether HIFEM Therapy is appropriate for your individual needs.

How HIFEM Works

During treatment, high-intensity focused electromagnetic energy stimulates the nerves and muscles of the pelvic floor, producing repeated muscle contractions without the need for internal probes or manual activation.

These contractions may help:

Activate
Recruit pelvic floor muscles that may be weak or difficult to contract voluntarily.

Strengthen
Improve pelvic floor muscle strength and neuromuscular control.

Support
Help improve muscular support of the bladder, pelvis, and surrounding structures.

Retrain
Assist the nervous system and pelvic floor muscles in working together more effectively.

The “10,000 Kegels” Claim

The manufacturer markets a typical HIFEM Chair treatment session as producing the equivalent of approximately 10,000 Kegel-like pelvic floor contractions.

This is a manufacturer marketing claim and not a universally verified clinical equivalence. Individual results vary.

What Does Treatment Feel Like?

You remain fully clothed and comfortably seated during treatment.

Patients generally feel repeated pelvic floor muscle contractions along with a pulsing or tingling sensation. Treatment intensity can be adjusted according to your comfort and tolerance.

There are:

• No needles
• No internal probes
• No downtime
• No restrictions after each treatment session

You can return to your normal daily activities immediately afterward.

Treatment Schedule

Treatment starts with six sessions, scheduled one to two times per week.

Your physical therapist will monitor your response throughout the treatment series and may make additional recommendations based on your symptoms, pelvic floor function, and overall goals.

When Might I Notice Improvement?

Response varies from person to person.

Some patients may begin noticing changes during their treatment series, while others may experience improvement gradually afterward.

Results can depend on factors including the cause and severity of symptoms, pelvic floor muscle function, medical history, and participation in the overall rehabilitation program.

Individual results vary, and specific results cannot be guaranteed.

Urinary Health, Pelvic Floor Function & Sexual Wellness

Clinical research has reported meaningful improvements in urinary symptoms following HIFEM pelvic floor treatment.

Research has also reported improvements in certain aspects of sexual function among some patients undergoing pelvic floor rehabilitation. These findings reinforce the important role the pelvic floor plays beyond bladder control.

Healthy pelvic floor muscles contribute to:

• Urinary control
• Pelvic stability
• Sexual function
• Bowel function
• Core support
• Coordination with the abdominal and hip muscles
• Comfort during movement and everyday activities

By helping strengthen and retrain the pelvic floor muscles, HIFEM Therapy may support improved pelvic function as part of an individualized rehabilitation program.

Individual results vary. Improvement in sexual function is not guaranteed.

HIFEM Therapy for Women

HIFEM Therapy may be considered as part of pelvic floor rehabilitation for women experiencing:

• Urinary leakage
• Stress urinary incontinence
• Pelvic floor weakness
• Postpartum pelvic floor changes
• Reduced pelvic floor muscle control
• Pelvic floor deconditioning

Depending on your individual needs, HIFEM may be combined with:

• Pelvic floor muscle training
• Core rehabilitation
• Breathing and pressure-management strategies
• Manual therapy
• Movement retraining
• Bladder and bowel education
• Home exercise

HIFEM Therapy for Men

Pelvic floor rehabilitation is also important for men.

HIFEM Therapy may be considered for appropriate male patients experiencing urinary leakage, pelvic floor weakness, or reduced pelvic floor muscle control, including some individuals recovering from prostate-related procedures.

A pelvic health evaluation helps determine whether HIFEM Therapy or another treatment approach is appropriate for your individual condition and goals.

HIFEM Therapy for Pain Relief

This electromagnetic therapy system is also FDA-cleared for peripheral nerve stimulation for relief of:

• Chronic intractable pain
• Post-traumatic pain
• Post-surgical pain
• Chronic painful diabetic peripheral neuropathy of the lower extremities

The FDA-cleared pain indication applies to adults age 18 and older. 

Treatment recommendations are based on your condition, medical history, symptoms, and physical therapy evaluation.

FDA-Cleared Rehabilitation Applications

Electromagnetic muscle-stimulation technology may also be used for rehabilitation applications including:

• Relaxation of muscle spasms
• Maintaining or increasing range of motion
• Muscle re-education
• Prevention or retardation of disuse atrophy
• Increasing local blood circulation
• Immediate post-surgical stimulation of calf muscles to help prevent venous thrombosis

These are established FDA-recognized indications for powered muscle stimulation used as an adjunct to rehabilitation. 

HIFEM + Physical Therapy

At Spine & Pelvic Physical Therapy, we do not view technology as a replacement for individualized physical therapy.

HIFEM Therapy may be incorporated into a broader rehabilitation program that can include:

• Therapeutic exercise
• Pelvic floor muscle training
• Strengthening
• Mobility and range-of-motion training
• Muscle re-education
• Manual therapy
• Movement retraining
• Bladder and bowel strategies
• Core rehabilitation
• Patient education
• Home exercise programs

Our goal is not simply to stimulate muscles during a treatment session.

Our goal is to help you improve control, strength, mobility, confidence, function, and overall quality of life outside of the clinic.

Is HIFEM Therapy Right for Everyone?

Not necessarily.

Electromagnetic stimulation may not be appropriate for certain patients, including people with some implanted electronic devices, certain metal implants near the treatment area, pregnancy, or other medical conditions.

Your physical therapist will review your medical history and screen for potential contraindications before treatment begins.

Ready to Learn More?

Whether you are experiencing urinary leakage, pelvic floor weakness, changes in pelvic function, chronic pain, or another appropriate rehabilitation condition, our team can evaluate your needs and determine whether HIFEM Therapy should be part of your treatment plan.

Schedule Your Evaluation

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Focused Shockwave Therapy

Targeted Treatment for Pain, Tendon Injuries, and Musculoskeletal Conditions

Focused Extracorporeal Shockwave Therapy (F-ESWT) is a non-invasive treatment that delivers precisely targeted acoustic energy into injured or painful tissue.

Focused shockwave technology can concentrate acoustic energy at a specific depth and treatment location, helping your physical therapist target the tissue involved.

Focused shockwave therapy may be incorporated into physical therapy to help reduce pain, improve function, and support the body’s natural tissue-repair response.

How Focused Shockwave Therapy Works

Focused shockwaves deliver controlled acoustic pulses into the targeted tissue.

The biological response to these pulses is thought to involve several mechanisms that may contribute to recovery, including:

Improved Local Circulation
Shockwave therapy may encourage vascular and cellular responses within the treated area.

Tissue Repair and Regeneration
Mechanical stimulation may promote biological processes associated with tissue healing.

Pain Modulation
Shockwave therapy may influence pain signaling and sensitivity in chronic painful tissue.

Tendon and Soft-Tissue Remodeling
Treatment may support remodeling of chronically irritated or degenerative tissue.

The exact biological mechanisms remain an active area of research.

Conditions We May Treat

Focused Shockwave Therapy may be considered for appropriate patients with chronic musculoskeletal conditions such as:

• Plantar fasciitis
• Achilles tendinopathy
• Patellar tendinopathy
• Calcific rotator cuff tendinopathy
• Other selected shoulder tendinopathies
• Tennis elbow
• Chronic tendon pain
• Myofascial pain
• Selected hip and groin conditions
• Chronic low-back pain in appropriate cases
• Delayed or difficult-to-heal musculoskeletal conditions when clinically appropriate

Research supports ESWT for several chronic tendon and soft-tissue conditions, with particularly established evidence for plantar fasciitis and calcific shoulder tendinopathy. (PubMed)

Research-Supported Benefits

Clinical research has shown that ESWT may help improve:

• Pain
• Function
• Mobility
• Tendon-related symptoms
• Certain chronic musculoskeletal conditions

For calcific rotator cuff tendinopathy, a 2024 meta-analysis found ESWT produced clinically meaningful improvements versus sham treatment at 24 weeks, although the overall certainty of evidence was rated very low. Higher-energy treatment showed better outcomes than lower-energy treatment in that analysis. (PubMed)

For plantar fasciitis and calcific tendinitis, systematic-review evidence supports focused ESWT as a useful treatment option. (PubMed)

Treatment Dose Matters

Shockwave therapy is not simply an “on or off” treatment.

Clinical response can depend on:

• Energy level
• Number of pulses
• Treatment frequency
• Number of sessions
• Treatment location
• The diagnosis being treated
• Patient tolerance and response

Some research has shown better outcomes with higher-energy treatment in selected conditions such as calcific rotator-cuff tendinopathy. However, dose-response relationships are not identical across every condition. (PubMed)

Your physical therapist will select treatment parameters based on your diagnosis and response rather than using the same protocol for every patient.

What Does Treatment Feel Like?

A handheld applicator is positioned over the targeted area after your therapist identifies the appropriate treatment location.

You may feel repeated tapping, pressure, or pulsing sensations as the acoustic energy is delivered.

Treatment intensity can be adjusted based on your comfort and the condition being treated.

Sessions are generally brief, and many patients return to their usual activities afterward.

Temporary soreness, tenderness, or skin redness can occur.

Safety

Focused shockwave therapy is generally considered safe when used appropriately and with established clinical protocols. Reviews of musculoskeletal ESWT report mostly minor and temporary adverse effects. (PubMed)

Your physical therapist will review your health history and screen for conditions that may make shockwave therapy inappropriate before beginning treatment.

Shockwave Therapy + Physical Therapy

At Spine & Pelvic Physical Therapy, shockwave therapy is not treated as a stand-alone solution.

When appropriate, it may be combined with:

• Therapeutic exercise
• Strengthening
• Mobility training
• Manual therapy
• Movement retraining
• Tendon-loading programs
• Patient education
• Home exercise

The goal is to address not only pain, but also the movement, strength, loading, and functional factors that may be contributing to the problem.

Pelvic Health and Men’s Health

Shockwave therapy has also been studied for conditions including erectile dysfunction, Peyronie’s disease, and chronic pelvic pain syndrome.

The evidence in this area is more mixed.

Reviews have found possible benefits for some men with erectile dysfunction and chronic pelvic pain, and pain reduction in Peyronie’s disease, but findings vary and treatment remains more condition-specific than routine musculoskeletal shockwave therapy. (PubMed)

For erectile dysfunction specifically, professional recommendations have historically described the evidence as promising but limited, with variation among studies and treatment protocols. (PubMed)

For that reason, these treatments should be discussed individually rather than presented as guaranteed outcomes.

Why Choose Focused Shockwave Therapy?

Focused shockwave therapy may be especially useful when:

• Symptoms have become chronic
• Exercise and other conservative measures have not provided sufficient relief
• A tendon or soft-tissue condition is limiting activity
• A more targeted non-invasive treatment is appropriate
• Your therapist wants to combine tissue stimulation with progressive rehabilitation

Individualized Treatment

There is no single shockwave protocol that is appropriate for every patient.

Your treatment plan will be based on:

• Your diagnosis
• Duration of symptoms
• Tissue involved
• Treatment tolerance
• Functional limitations
• Response to therapy
• Rehabilitation goals

Individual results vary, and specific outcomes cannot be guaranteed.

Ready to Find Out if Focused Shockwave Therapy Is Right for You?

If chronic pain or a tendon or musculoskeletal condition is keeping you from work, exercise, or the activities you enjoy, our team can evaluate your condition and determine whether Focused Shockwave Therapy should be part of your rehabilitation plan.

BOOK AN EVALUATION

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Dry Needling

Targeted Treatment for Muscle Pain, Trigger Points, and Movement Restrictions

Dry needling is a skilled physical therapy technique used to address painful, tight, or overactive muscles and myofascial trigger points.

A very thin, sterile, single-use needle is placed into or near the involved tissue. No medication is injected. The goal is to reduce muscle tension, decrease pain, improve mobility, and help restore more normal movement.

When We Use It

Dry needling may be helpful for:

• Muscle trigger points
• Neck and back pain
• Myofascial pain
• Muscle tightness or guarding
• Headaches associated with muscle tension
• TMJ and jaw pain
• Tendon-related pain
• Repetitive-use injuries
• Pelvic pain
• Restricted movement

We use dry needling based on what we find during your physical therapy evaluation.

What Does It Feel Like?

Some patients barely feel the needle enter the skin. When a trigger point is reached, you may feel a brief ache, pressure, cramp, or quick muscle twitch.

Temporary soreness, tenderness, or minor bruising can occur afterward.

Dry Needling + Physical Therapy

Dry needling is a tool, not the entire treatment.

When appropriate, we combine it with exercise, strengthening, mobility work, manual therapy, movement retraining, pelvic rehabilitation, and home exercise.

Our goal is not simply to treat a painful spot. We want to identify why the tissue became painful or overloaded and correct the movement or functional problem contributing to it.

Safety

Dry needling is generally safe when performed by a properly trained healthcare professional. Your therapist will review your medical history and determine whether dry needling is appropriate for you.

Our Approach

At Spine & Pelvic Physical Therapy, dry needling starts with an evaluation—not with a needle.

If it is appropriate, we use it strategically to reduce muscle restriction and pain so we can then work on the part that matters most: restoring movement, strength, and function.

Individual results vary.

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Dry Cupping With Myofascial Mobilization

A Targeted Approach to Fascial and Soft-Tissue Restriction

Dry cupping with myofascial mobilization uses controlled suction to lift and mobilize the skin, fascia, and underlying soft tissue.

At Spine & Pelvic Physical Therapy, we may use lotion or oil so the cup can glide over the treatment area while maintaining suction. This allows us to address restricted tissue more dynamically and, when appropriate, combine cupping with active movement or therapist-assisted mobility.

The goal is simple: improve tissue mobility, reduce restriction, and help you move better.

When We Use It

Dry cupping may be useful for:

• Fascial restriction
• Muscle tightness or guarding
• Limited mobility
• Chronic stiffness
• Myofascial pain
• Soft-tissue restriction after injury
• Selected scar-related restrictions
• Hip, back, shoulder, or lower-extremity tightness
• Movement that feels restricted or “stuck”

How We Use It

Depending on what we find, we may:

• Glide the cup along a restricted tissue plane
• Leave the cup in place while you move
• Move the cup while guiding the joint or limb
• Combine cupping with stretching, mobility, or exercise

The treatment should always have a purpose.

What Does It Feel Like?

Most patients describe a pulling, lifting, or stretching sensation. The amount of suction is adjusted based on the tissue and your comfort.

Temporary redness or circular marks may occur. Some patients also experience mild soreness or tenderness for a short period.

The goal is not to create marks. The goal is to improve movement and reduce restriction.

Pelvic, Hip, and Low-Back Applications

In pelvic rehabilitation, the source of restriction is not always limited to the pelvic floor.

When appropriate, dry cupping may be used externally around the lower abdomen, low back, gluteal region, hip flexors, adductors, inner thigh, hamstrings, and thoracolumbar fascia to improve soft-tissue mobility and support better movement around the pelvis and spine.

Our Approach

At Spine & Pelvic Physical Therapy, we use dry cupping when it helps us solve a specific movement or tissue problem.

Sometimes the cup moves. Sometimes the patient moves. Sometimes both happen together.

Our goal is to help you move with less restriction, better mobility, and improved function.

Individual results vary.

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Graston Technique

Instrument-Assisted Soft Tissue Mobilization

Graston Technique is a form of instrument-assisted soft tissue mobilization used to identify and treat areas of soft-tissue restriction.

At Spine & Pelvic Physical Therapy, we use specialized stainless-steel instruments to assess and treat restricted muscles, fascia, tendons, and scar tissue.

The goal is to improve tissue mobility, reduce restriction, and help restore normal movement.

When We Use It

Graston Technique may be useful for:

• Muscle and fascial restriction
• Tendon irritation
• Scar tissue
• Chronic soft-tissue tightness
• Limited range of motion
• Overuse injuries
• Post-injury stiffness
• Areas that feel restricted or difficult to move

We use it based on what we find during your physical therapy evaluation.

How It Works

The instrument is applied directly to the skin and moved across the involved tissue.

This allows the therapist to feel changes in tissue texture and identify areas that may be restricted or sensitive. Treatment is then directed to those specific areas to improve tissue mobility and help prepare the body for movement and exercise.

What Does It Feel Like?

You may feel pressure, scraping, or a firm gliding sensation over the treatment area.

Some areas may feel more sensitive than others. Temporary redness, tenderness, or mild bruising can occur depending on the tissue and treatment intensity.

The treatment should be purposeful—not aggressive.

Graston Technique + Physical Therapy

Graston Technique works best when it is part of a complete rehabilitation plan.

We may combine it with therapeutic exercise, stretching, strengthening, joint mobilization, movement retraining, dry needling, cupping, pelvic floor rehabilitation, and home exercise.

The instrument is simply a tool.

The goal is to create enough change in the tissue so you can move better, load the area properly, and restore function.

Our Approach

At Spine & Pelvic Physical Therapy, we do not treat tissue just because it feels tight.

We first determine whether the restriction is actually contributing to your pain or movement problem.

If Graston Technique is appropriate, we use it to address the specific area and then follow it with movement, exercise, or mobility work so the improvement carries over into function.

Individual results vary. Treatment recommendations are based on your evaluation, medical history, symptoms, and rehabilitation goals.