London shockwave therapy for tendon and heel pain
Shockwave is a second-line treatment in this country, aimed at tendon and heel pain that has already been loaded properly for months without settling. Which conditions it has been assessed for, what those assessments actually concluded, and what a course involves.
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A second-line treatment
It follows a loading programme that has stalled
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Six conditions covered
Each with the guidance that applies to it, or the absence of any
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Judged at week twelve
The review point sits well after the last session
Where it is used
Shockwave Treatments
One treatment,
covered in full
Extracorporeal Shockwave Therapy
EvidenceA machine treatment that puts pressure waves through a painful tendon or heel to provoke a repair response. Used in the United Kingdom as a second-line option for plantar fasciitis, Achilles tendinopathy, tennis elbow, gluteal tendinopathy and calcific shoulder pain, after loading rehabilitation has been tried and has not settled the problem.
About London Shockwave Therapy
What the trials found,
including the parts nobody quotes
Shockwave therapy is a second-line treatment for tendon and heel pain in the United Kingdom. NICE has assessed it separately on four musculoskeletal conditions, in IPG311, IPG571, IPG313 and IPG376, all now renumbered as HealthTech guidance, and three of those four documents carry the word refractory in the title. That word is most of the story: this is a treatment aimed at a problem that has already failed the first answer, usually after at least three months of loading rehabilitation. A course runs to 3 to 5 sessions a week apart and is honestly judged 6 to 12 weeks after the last one.
The evidence is not settled, and it does not fail in the same way everywhere. On 3 of the 4 conditions, plantar fasciitis in IPG311, Achilles tendinopathy in IPG571 and tennis elbow in IPG313, NICE found that the evidence raises no major safety concerns while the evidence on efficacy is inconsistent. On the 4th, gluteal tendinopathy in IPG376, it went further and called the evidence on efficacy and safety both limited in quality and quantity, and asked that patients be warned that symptoms may worsen. For hamstring tendinopathy it has published nothing at all, which is why that page carries no efficacy claim.
Those differences are the single most useful thing to know before paying for a course, because they change what a reasonable clinician should be promising you. Each condition has its own page setting out what was assessed, who should avoid the treatment, and what a course involves. London Shockwave Therapy is part of the UNTIL group and treats at its four central London clubs, in Marylebone, Soho, Liverpool Street and Canary Wharf. Where the treatment looks appropriate, a clinician examines you in person before any course is agreed.
How It Works
Your journey,
step by step
Check where you are in the sequence
The commonest reason this treatment disappoints is that it was given too early. NICE guidance covers the refractory presentation, which means the problem has already been loaded properly for months without settling. If nobody has yet given you a loading programme and watched you do it, that conversation is worth more than the machine.
Assessment with a registered practitioner
Tell us what hurts, for how long, and what has been tried, and we will arrange an assessment with a clinician who can examine you. A shoulder or a knee needs imaging before anyone treats it, because conditions that look alike from the outside take completely different paths.
A course that runs alongside the loading
If the treatment suits you it runs as three to five sessions, roughly a week apart, each about five minutes of machine time. The loading programme continues throughout, because the load is what rebuilds the tendon. Expect the treated area to be sore for a day or two after each session.
The review is where the answer is
Very little changes during the course itself. The honest review point is six to twelve weeks after the final session, and the question is what the tendon will now tolerate rather than only how it feels sitting still. If nothing has changed by then, the answer is a different treatment rather than more sessions.
FAQ
Common
questions
How does shockwave therapy work?
A handpiece delivers acoustic pressure pulses through the skin into the painful tendon or heel. The pulses are understood to provoke a fresh repair response in tissue that has stalled, and to damp down the local pain signalling. Nothing is injected and nothing is cut. A session takes about five minutes.
What is shockwave therapy used for?
Musculoskeletal problems. Plantar fasciitis, Achilles tendinopathy, tennis elbow, gluteal tendinopathy and calcific shoulder pain are the uses assessed in the United Kingdom, so tendons, heels, elbows, shoulders, hips and knees are the whole of the ground covered here. Shockwave has applications elsewhere in medicine and none of them appears on this site.
Does NICE recommend shockwave therapy?
Not in those terms, and not identically across conditions. For plantar fasciitis, Achilles tendinopathy and tennis elbow it found that the evidence raises no major safety concerns while the efficacy evidence is inconsistent. For greater trochanteric pain syndrome it called the evidence on efficacy and safety both limited. Neither is a recommendation.
When is shockwave therapy the right next step?
Usually when a tendon or heel problem has run for at least three months, a proper loading programme has been tried and followed, and the pain has not shifted. Three of the four NICE documents use the word refractory in the title. Given earlier than that, it is being asked to do a job load has not yet been given.
How many sessions of shockwave therapy are usual?
Three to five, spaced about a week apart, with each session delivering roughly five minutes of treatment. Protocols vary between clinics and between machines. What should not vary is that a loading programme runs alongside the course, because the sessions on their own are half the treatment the trials tested.
Does shockwave therapy hurt during the session?
It is uncomfortable while it runs and it is over in about five minutes. The energy level is set to what you can tolerate, so some discomfort is part of the dose rather than a sign something is wrong. Afterwards the area is usually sore for 24 to 48 hours.
Is shockwave therapy available on the NHS?
In some services and not in others, and the same is true of private medical insurance, where cover depends on the policy and usually needs a referral in place first. Both are worth checking before you pay privately, because the answer changes the sensible order of your next few steps.
Can shockwave therapy make the pain worse?
A short flare of the original pain in the day or two after a session is common and settles. A lasting worsening is uncommon. The NICE guidance on gluteal tendinopathy warns specifically that symptoms may worsen, which is why that risk should be put to you before the first session. Tell the clinician if pain climbs instead of settling.
Get Started
Describe the problem and what has been tried.
UNTIL Health Concierge arranges the examination.
London Shockwave Therapy • UNTIL, 280 Bishopsgate, London EC2M 4RB
BookEnquiries reach UNTIL Health Concierge, who arrange the assessment.