Shockwave Therapy on Harley Street

A handheld applicator is pressed against the skin over the painful area with a layer of gel between the two, and it fires acoustic pulses into the tissue below. NICE describes two families of device and the difference between them matters more than most quotes admit. Radial machines generate an unfocused pressure wave pneumatically, by firing a projectile at the applicator head, and the energy is strongest at the surface and spreads outward from it. Focused machines generate a wave electrohydraulically, electromagnetically or piezoelectrically and converge it on a point at a chosen depth, which can be aimed using ultrasound.

Dose is described in energy flux density, written in millijoules per square millimetre, and NICE puts the line between low and high energy at 0.12. Below it, treatment can be repeated and needs no anaesthetic. Above it, the treatment can be painful enough that a local anaesthetic is offered, and there is evidence that using one may work against the result. That is a genuinely awkward trade-off and a clinician who explains it to you unprompted is telling you something about how they practise.

What the pulses then do to a tendon is not established. NICE, reviewing Achilles tendinopathy, states that the mechanism by which the therapy might affect a tendinopathy is not known. Clinics offer explanations involving blood flow, nerve endings and the disruption of degenerate tissue. Those are hypotheses.

There are four separate pieces of NICE guidance on musculoskeletal shockwave, and reading them together is more useful than reading any one. Refractory plantar fasciitis and refractory tennis elbow were assessed in 2009 and reached the same wording: no major safety concerns, efficacy evidence inconsistent, use only with special arrangements for clinical governance, consent and audit or research. Achilles tendinopathy was reassessed in 2016 and reached the same place, adding that the evidence was limited in quality and quantity as well as inconsistent. Greater trochanteric pain syndrome came out weakest of the four, with the evidence on both efficacy and safety described as limited in quality and quantity.

The phrase special arrangements is doing real work. It obliges the clinician to inform their governance leads, to make sure you understand the uncertainty about whether it works and to give you that in writing, and to audit the outcome of every patient treated. Ask for the written information. A private clinic that cannot produce it is not applying the guidance it is quoting at you.

Note also the word refractory in three of the four titles. The guidance describes this treatment for a problem that has already failed the treatments tried first. It does not describe it for a tendon that started hurting three weeks ago.

Harley Street runs north from Cavendish Square through Marylebone, and the clustering of medicine along it is older than most of the clinics currently on it. Records show around 20 doctors in the area in 1860, 80 by 1900 and almost 200 by 1914. By the founding of the National Health Service in 1948 there were roughly 1,500. More than 3,000 people work in the district today across hospitals, clinics and paramedical practices.

The reason it stayed put is unusually simple: most of it has one landlord. The Howard de Walden Estate holds and manages a large part of the Harley Street Health District and has actively shaped its medical use, maintaining and adapting period buildings to clinical standards and letting everything from a single consulting room up to a purpose-built clinic. Continuity of freehold is why a Georgian terrace became and remained a medical quarter, and it is also why the buildings are so consistent and the addresses so interchangeable.

None of that is a quality mark for any individual practitioner, and it is not sold as one here. It explains the concentration. It does not certify anybody inside it.

A great many practitioners in this district hire a consulting room by the session or the half-day in a building operated by somebody else. That arrangement is entirely legitimate, it is how a large part of private practice in central London works, and UNTIL runs a version of it in its own clubs. It does mean that an address in W1G describes a building rather than the person who will treat you, and that a website showing a handsome staircase may be showing a shared reception.

The practical consequences are worth knowing before you hand over a card. Ask who will actually deliver the treatment, and whether it is the person named on the site. Ask what their professional registration is, then check it yourself: the HCPC register covers physiotherapists and podiatrists, is public and takes under a minute to search. Ask who holds clinical responsibility and indemnity if something goes wrong, and who you contact in the week after a session if it does. Ask whether the follow-up review is with the same person.

A practitioner who answers all of that easily is not being interrogated, they are being asked normal questions they have answered before. Hesitation on the last two is the useful signal.

People rarely arrive in this district first. They arrive having done six weeks of exercises from a sheet, or a course of physiotherapy that helped and then stopped helping, or having been told to rest and having rested. That is the point in the story at which a second opinion is reasonable, and it is also the point at which the NICE guidance on this treatment starts to apply, because three of its four documents describe a refractory problem.

It is also the point of maximum vulnerability to being sold something. Having already spent months in pain, the appeal of a machine that promises to do something is obvious. Two questions protect you. Has the loading programme genuinely been done properly, at sufficient load, for long enough, which for most tendons means months rather than weeks? And is the diagnosis actually settled, or has the pain simply been labelled? Adding shockwave to a wrong diagnosis produces an expensive nothing.

Where the loading really has been done and the diagnosis really is clear and the pain is still there, this is a reasonable next thing to consider. That is a narrower recommendation than most pages on this treatment make, and it is the honest one.

This site sets no prices and delivers no treatment, so any figure quoted here would be invented. What is worth having is a way to read somebody else's.

Establish whether the price is per session or for a course, and how many sessions a course contains. Establish whether the initial assessment is included or charged separately, and whether the review at the end is included. Establish whether a second area treated in the same appointment costs more. Ask whether the machine is radial or focused, because they are different pieces of equipment at different costs and a quote that will not say is not a quote you can compare. Ask what happens, and what it costs, if the course does not work and a further course is suggested.

Insurance is its own question and the answer is often no. A number of insurers exclude shockwave outright or fund it only against a named diagnosis with documented failure of conservative care. Ask your insurer before the first session rather than after the third, and get the answer in writing.

The district sits between Regent's Park and Oxford Street, and the nearest Underground stations are Regent's Park on the Bakerloo line, Great Portland Street on the Circle, Hammersmith and City and Metropolitan lines, and Oxford Circus. Bond Street on the Elizabeth line brings most of west and east London within a short walk of the southern end. It is a district built for people who work in central London and are trying to fit an appointment into a day.

Two practical things. It sits inside the Congestion Charge zone, on-street parking is metered and scarce, and driving to a mid-morning appointment is usually the slowest way to arrive. And a course of this treatment is not one visit: it is several appointments about a week apart, plus an assessment before and a review after. Before you book the first one, look at whether you can realistically make all of them, because a course abandoned halfway is money spent on an incomplete treatment.

This site is owned by the UNTIL group. It holds no clinic, on Harley Street or anywhere else. It has no treatment room, no machine and no practitioner on its masthead, which is why you will not find a biography or a registration number on it. It sets no prices because it charges nothing, and it publishes no results because it has treated nobody.

What it can do is answer the question properly and then put you in front of somebody who can examine you. Tell UNTIL Health Concierge what has been going on and they will arrange an assessment with a registered practitioner. That assessment should be willing to conclude that shockwave is the wrong answer for you, and if it is not willing to reach that conclusion it is not an assessment.

The advice on this page holds whether or not you ever contact us. Check the register. Ask who is treating you. Ask for the written information about the uncertainty that NICE requires. Those cost nothing and they are the whole of what a smart address does not give you.