Frequently asked questions

A physiotherapist for back pain assesses what’s causing the problem, treats it, and gives a plan to recover and prevent recurrence. Treatment typically combines hands-on therapy (joint mobilisation, soft tissue work, nerve mobilisations), targeted exercise (movement, strength and flexibility), posture and lifting advice, and education about what’s going on and what to expect. NICE guideline NG59 recommends exercise-based treatment, often combined with manual therapy, as a first-line treatment for non-specific low back pain and sciatica.

A SMARTPHYSIO back pain appointment normally includes an assessment: a full history of the problem (when it started, how it behaves through the day, what makes it better or worse, what’s been tried, and its effect on work, activity and sleep) plus a physical examination covering posture, range of movement, strength and neurological screening including sensation, reflexes and power, and screening for red flags, which are signs that something needs medical investigation rather than physiotherapy, and a plain-English explanation of what the physiotherapist thinks is going on.

Treatment includes manual therapy to ease joint stiffness and improve spinal mobility, soft tissue techniques to reduce muscle tension, spasm or tightness, guided movement and exercise to rebuild strength, improve posture and support the spine, nerve mobilisations for sciatica or disc-related symptoms, postural retraining for everyday activities such as sitting, standing and lifting, and home exercise planning so you keep progressing between sessions.

The evidence (from NICE NG59) shows exercise in some form is the strongest single intervention for non-specific low back pain, and the specific type matters less than doing it consistently; manual therapy is recommended as part of a treatment package that also includes exercise, not on its own; and self-management advice (staying active, modifying activity rather than stopping it, and returning to normal activity gradually) is core to recovery. NICE doesn’t recommend traction, belts or corsets, foot orthotics, rocker-sole shoes, or paracetamol alone for low back pain, and acupuncture, electrotherapy and ultrasound are also not recommended for low back pain or sciatica.

What changes with the type of back pain: acute non-specific low back pain (less than 6 weeks) focuses on reassurance, staying active, hands-on treatment to ease symptoms, and a graded return to normal activity; sciatica or disc-related symptoms bring an additional focus on nerve mobilisation, position and movement modifications to ease nerve irritation, and a graded loading programme; persistent or recurrent back pain (over 12 weeks) needs a broader assessment of contributing factors (work, sleep, stress, deconditioning), a structured rehabilitation programme, and pacing strategies; and post-surgical back pain is rehabilitated in line with the surgical team’s protocol, with a structured strength and mobility progression.

To start back pain physiotherapy at SMARTPHYSIO, call 020 7435 4910 or use online booking. The team can normally arrange a first appointment within 24 to 48 hours, in clinic or at home anywhere in London.

Some back pain symptoms need urgent medical care, not physiotherapy first. Go straight to A&E or call 999 if back pain comes with numbness around the saddle area (between the legs, around the back passage or genitals), loss of bladder or bowel control, sudden problems with sexual sensation or function, or new severe weakness in both legs. These can be signs of cauda equina syndrome, a rare but serious nerve compression that needs emergency assessment within hours.

Emergency symptoms. Go to A&E or call 999 the same day: numbness or altered sensation in the saddle area (between the legs, around the back passage, genitals, or inner thighs); new bladder problems such as not being able to pass urine, not feeling when the bladder is full, or sudden loss of bladder control; new bowel problems such as faecal incontinence or loss of feeling when you need to pass a stool; sudden-onset sexual dysfunction such as loss of sensation during sex or new erectile dysfunction in this context; severe weakness in both legs that is getting worse (struggling to lift the feet, knees buckling, difficulty walking); or numbness or weakness on both sides of the body at the same time (bilateral). These symptoms can be signs of cauda equina syndrome, a rare condition where the nerves at the base of the spine are compressed; it needs emergency MRI scanning and often emergency surgery to prevent permanent damage to bladder, bowel and sexual function: the threshold for A&E is deliberately low, and it is better to be checked and reassured than to delay.

Urgent symptoms. See a GP the same day or call NHS 111: back pain after significant trauma (a fall from height, road traffic accident, sports impact; suspected fracture); constant severe pain that doesn’t ease with rest or position changes; pain that is worse at night or wakes you from sleep, particularly with no clear position that helps; unexplained weight loss alongside back pain; a history of cancer (especially breast, lung, prostate, kidney or thyroid cancer) with new back pain; fever, chills, or feeling unwell alongside back pain (possible infection); long-term oral steroid use with new back pain (raised fracture risk); IV drug use with new back pain (raised infection risk); pain in the upper or mid back (thoracic spine) rather than the lower back, particularly if persistent; or new back pain in someone under 20 or over 50, particularly if persistent.

What’s normal (and not a red flag) for most back pain: pain that varies through the day and is influenced by movement, position and activity; pain radiating into one buttock, leg or foot (sciatica is uncomfortable but usually not a red flag alone; bilateral sciatica with the saddle symptoms above is); stiffness in the morning that eases after moving around; pain that flares with certain activities (sitting, lifting, twisting) and settles with others; and a previous similar episode of pain that resolved.

If any of the emergency symptoms above apply, don’t wait, don’t book a physiotherapy assessment, and don’t delay to see a GP first: go to A&E or call 999. If you’re unsure whether symptoms count as urgent, call NHS 111; SMARTPHYSIO will also signpost appropriately if you call with these symptoms.

Most acute back pain settles within 6 to 12 weeks, and around 90% of episodes resolve within this window with appropriate management. Physiotherapy can shorten the timeline, reduce pain and disability along the way, and lower the chance of recurrence. For persistent or chronic back pain (over 12 weeks), recovery is more gradual; improvement is usually measured over weeks and months rather than days, with the goal being a meaningful change in function and pain rather than complete resolution.

Realistic timeframes for different back pain categories: acute non-specific low back pain (less than 6 weeks since onset): most people improve substantially within 6 to 12 weeks; NHS guidance from Guy’s and St Thomas’ NHS Foundation Trust notes that most people recover from an episode in 6 to 8 weeks, and physiotherapy can shorten this and ease symptoms along the way. Sciatica: about 90% of cases settle within six weeks with self-management, modified activity and (where indicated) physiotherapy; severe nerve pain with progressive weakness or red flags is different and needs medical assessment. Subacute back pain (6 to 12 weeks): many people continue improving through this window, particularly with structured rehabilitation. Persistent or chronic back pain (over 12 weeks): improvement is more gradual; a typical physiotherapy block is often 6 to 12 sessions over 2 to 3 months for chronic back pain, sometimes longer. Post-surgical back pain: the rehabilitation timeline depends on the operation; discectomy patients often progress quickly over weeks, while fusion patients progress over several months.

What affects the recovery timeline: how early you start (earlier physiotherapy is generally associated with faster recovery and a lower risk of chronic pain), how active you stay (resting completely usually makes back pain last longer; NHS guidance is clear: keep moving, and modify activity rather than stop it), how consistent you are with your home programme (most recovery happens between sessions, not in them), how severe the pain was at first presentation, whether it’s a first episode or a recurrence, and your general health and lifestyle (sleep, stress, work demands and overall fitness all influence recovery).

Recurrence is common: NHS guidance from Guy’s and St Thomas’ notes that 1 in 3 people have another acute low back pain episode within 12 months of an acute episode; this isn’t a sign the first round of physiotherapy “didn’t work”. The most reliable way to reduce recurrence is continuing the strength, mobility and activity habits established in physiotherapy, rather than stopping completely when symptoms ease.

To get a realistic timeframe and recovery plan for your specific back pain, book an initial assessment at SMARTPHYSIO. Call 020 7435 4910 or use online booking. The team can normally see you within 24 to 48 hours, in clinic or at home anywhere in London.

The cost of shockwave therapy in London typically ranges from around £80 to £200 per session, depending on the clinic, session length, and whether the clinician is a physiotherapist or a consultant; a standard course is 3 to 6 sessions, usually weekly. SMARTPHYSIO’s clinic appointment pricing starts from £85, and full current fees are published on the pricing page.

What the total shockwave course cost depends on: the session price (individual sessions at a London physiotherapy clinic are commonly in the £80 to £200 range; consultant-led shockwave at a private hospital is typically at the higher end); the number of sessions (clinical practice typically uses 3 to 6 sessions, delivered weekly; some protocols are shorter, and some run to 8 sessions); the condition being treated (plantar fasciitis and tennis elbow protocols are often shorter, while insertional Achilles tendinopathy or recalcitrant cases may need more sessions); and the clinic (private hospital fees are higher than physiotherapy clinic fees for the same treatment).

For SMARTPHYSIO specifically, the published clinic appointment rate is from £85 for a 30-minute session and from £150 for a 60-minute session; shockwave is typically delivered within a clinic appointment, often as part of a wider session that also includes assessment, exercise prescription and manual therapy.

Two practical points: shockwave on its own, without a rehab programme, is unlikely to produce lasting change. Most clinicians combine shockwave with loading exercises and address contributing factors, so cost should be considered as the cost of the whole rehab plan, not just the shockwave sessions. If you have private medical insurance, shockwave therapy may be covered: see our insurance page and call your insurer to check before paying out of pocket.

To get current pricing and book a shockwave assessment at SMARTPHYSIO, call 020 7435 4910 or use the enquiry form. The team will confirm the figure applying to your specific case and discuss whether shockwave is genuinely the right treatment for your condition.

Shockwave therapy is often described as uncomfortable rather than severely painful; SMARTPHYSIO’s shockwave therapy page describes it as “a bit painful, but most people can normally tolerate this”, and the energy level can be reduced if you find it too uncomfortable. A standard course is 3 to 6 sessions, usually weekly, with most benefit assessed at 3 months after the final session.

What the sensation actually feels like during a session: some patients describe shockwave as a sharp, tapping or rhythmic pressure on the treatment area; others find it uncomfortable but bearable, particularly for shorter sessions or lower energy settings. The exact sensation depends on the energy level, the area being treated (bony areas with thin overlying tissue tend to be more uncomfortable than fleshier areas), and individual pain tolerance. The treatment area may be tender for 24 to 48 hours after a session; this is normal. If shockwave becomes intolerable during a session, tell your clinician. They can reduce the energy level, change the angle of application, or pause and continue more gradually.

On session counts: a standard shockwave course is typically 3 to 6 sessions, delivered weekly. Each session is usually 10 to 15 minutes of actual shockwave application, within a broader clinic appointment that includes review, assessment and exercise prescription. Benefit isn’t always immediate; many patients notice improvement gradually over weeks rather than immediately after the first session, and the full effect is generally assessed at around 3 months after the final session, since the tissue response takes time.

Aftercare advice typically given at SMARTPHYSIO: avoid heavy loading of the treated area for 48 hours after each session (no running on a freshly treated Achilles, for example); continue the rest of your rehab programme (exercises, stretches, pacing) as agreed with your physiotherapist; and avoid taking NSAIDs (such as ibuprofen) around shockwave sessions where possible, since they may interfere with the inflammatory response shockwave aims to provoke, always check with your prescriber before changing medication. If you haven’t noticed any improvement after the planned course, your physiotherapist will discuss alternatives; shockwave doesn’t work for everyone.

To book a shockwave assessment and discuss what a specific course would involve, call SMARTPHYSIO on 020 7435 4910 or use the enquiry form. The team will confirm whether shockwave is the right treatment for your condition before any sessions begin.

Shockwave therapy is used for chronic musculoskeletal conditions that haven’t responded to first-line treatment. Conditions SMARTPHYSIO uses shockwave for include plantar fasciitis, Achilles tendinopathy, tennis elbow, patellar tendinopathy, hip and shoulder bursitis, hamstring tendinopathy, iliotibial band syndrome, shin splints, Osgood-Schlatter disease, calcific shoulder tendinopathy, coccydynia and myofascial trigger points. Shockwave isn’t appropriate for everyone, and there is a specific list of contraindications.

Conditions where shockwave is used: plantar fasciitis, Achilles tendinopathy, carpal tunnel syndrome, coccydynia, hip or shoulder bursitis, hamstring tendinopathy, iliotibial band syndrome, lateral epicondylitis (tennis elbow), medial tibial stress syndrome (shin splints), myofascial trigger points, Osgood-Schlatter disease, patellar tendinopathy, and shoulder tendinitis or rotator cuff problems.

For the two most common indications, NICE has reviewed the evidence: for Achilles tendinopathy, NICE guidance (formerly IPG571, now HealthTech 426) concluded shockwave raises no major safety concerns, but evidence on efficacy is inconsistent and limited, and recommends it is used only with written informed consent and audit of outcomes. For plantar fasciitis, NICE guidance (formerly IPG311, now HealthTech 200) similarly concluded shockwave for refractory plantar fasciitis raises no major safety concerns, but evidence on efficacy is inconsistent, with the same written-consent and audit recommendation.

What shockwave cannot do: it is not a first-line treatment: NICE expects it to be considered only after first-line care (loading exercises, physiotherapy, rest from aggravating activities, footwear and ergonomic changes) hasn’t worked. It is not a quick fix; improvement is gradual over weeks and months, not immediate. It doesn’t work for everyone; even in the conditions where it’s most commonly used, a meaningful proportion of patients don’t benefit. And it is not a replacement for a rehab programme; used on its own, without loading exercises and lifestyle adjustment, it rarely produces lasting change.

Shockwave is not appropriate (contraindicated) if you have a clotting disorder, haemophilia, or are at risk of haemorrhage; are taking an anticoagulant medication such as warfarin or rivaroxaban; have a cardiac pacemaker or other cardiac device; have an unstable heart condition; had a steroid injection at the treatment site within the last 6 weeks; are pregnant or trying to conceive; have cancer or a tumour at the treatment site; or have an active infection at the treatment site. If any of these apply, mention it when you call; the clinician will discuss whether shockwave is safe in your specific situation or whether a different treatment route is more appropriate.

To find out whether shockwave is appropriate for your specific condition, book an initial assessment at SMARTPHYSIO. Call 020 7435 4910 or use the enquiry form. The clinician will discuss the evidence honestly, screen for contraindications, and combine shockwave with a wider rehab programme if that is the right approach.

A weak pelvic floor most often shows up as urinary leakage (when coughing, sneezing, laughing, jumping or exercising), urgency or frequent urination, a feeling of heaviness or “something coming down” in the vagina (indicating prolapse), reduced sensation during sex, lower back or pelvic pain, and an inability to engage the pelvic floor when attempting to squeeze. Many women have one or more of these symptoms but don’t recognise them as treatable pelvic floor problems.

Signs include stress urinary incontinence (leaking with sudden bladder pressure), urgency and frequency (a sudden strong need to pass urine, or going more often than usual), mixed symptoms (a combination of stress incontinence and urgency), pelvic organ prolapse symptoms (heaviness, dragging, a visible bulge at the vaginal opening, symptoms worsening through the day or after prolonged standing), bowel symptoms (difficulty controlling wind or stool, urgency, incomplete emptying, constipation unresponsive to diet), sexual symptoms (reduced sensation, heaviness during or after sex, pain with penetration, reduced ability to orgasm), pelvic or lower back pain (long-term unexplained pain), difficulty activating the muscles (can’t feel the muscles working, or the squeeze is very short), and postnatal symptoms (any of the above after pregnancy or birth, especially if not settled by 6-12 weeks).

These symptoms are common but not normal, and they are treatable. Pelvic floor symptoms aren’t only about weakness. An overactive (tight or hypertonic) pelvic floor can produce different but overlapping symptoms, including pelvic pain, painful sex, urgency and difficulty emptying the bladder or bowel, which need different treatment. Symptoms change with hormones, pregnancy, childbirth, menopause and weight changes.

A Chartered Physiotherapist with specialist pelvic health training can assess and create a personalised plan. SMARTPHYSIO offers women’s health physiotherapy in clinic, at home, and via virtual appointments. NICE guideline NG123 (2019) supports supervised pelvic floor muscle training as a first-line treatment for stress and mixed urinary incontinence and stage 1-2 pelvic organ prolapse.

Pelvic floor dysfunction is an umbrella term for problems with how the pelvic floor muscles work, including muscles that are too weak, too tight (overactive), poorly coordinated, or a combination of these. It can affect bladder and bowel control, sexual function, posture and pelvic pain. NICE has separate guidelines for prevention and non-surgical management (NG210, 2021) and for management of urinary incontinence and pelvic organ prolapse in women (NG123, 2019); pelvic floor physiotherapy is recommended as first-line management for many forms of pelvic floor dysfunction.

The pelvic floor is a group of muscles, ligaments and connective tissue supporting the bladder, bowel and (in women) uterus, wrapping around the openings of the urethra, vagina and anus. These muscles must be strong enough to hold the pelvic organs in place and maintain continence, but also relaxed and coordinated enough to allow normal urination, bowel motions and sex.

The main categories of pelvic floor dysfunction include: pelvic floor weakness (underactive): muscles don’t generate enough force, commonly causing stress urinary incontinence, pelvic organ prolapse and reduced sexual sensation; pelvic floor overactivity (hypertonic): muscles are too tight and don’t relax properly, commonly causing pelvic pain, painful sex (dyspareunia), difficulty emptying the bladder, constipation and urgency; pelvic floor incoordination: muscles don’t contract and relax at the right times, showing a mix of weakness and overactivity symptoms; and coordination problems with surrounding structures, since the pelvic floor works with the abdominal muscles, diaphragm and back muscles.

Causes and contributors include: pregnancy and childbirth (particularly vaginal birth with a large baby, instrumental delivery, perineal tearing or a long second stage), menopause and lower oestrogen levels affecting pelvic floor tissue health, chronic constipation and straining, chronic cough (asthma, COPD, smoking), heavy lifting (occupational or sport), obesity and increased BMI, pelvic surgery (hysterectomy, prolapse repair, gynaecological surgery), older age with natural changes in muscle and connective tissue, pelvic pain conditions such as endometriosis or interstitial cystitis, and high-impact sport (particularly running, gymnastics and trampolining without pelvic floor conditioning).

Pelvic floor physiotherapy provides a detailed assessment to find which type of dysfunction is present (since strengthening an already-overactive pelvic floor worsens symptoms), supervised pelvic floor muscle training (PFMT) when the issue is weakness, down-training, breathing work and manual therapy when the issue is overactivity, behaviour and lifestyle work (fluid intake, bladder retraining, bowel habit, lifting technique), and education so patients understand their situation and what to expect. A SMARTPHYSIO pelvic floor assessment may include an internal vaginal examination, which provides the most accurate information about muscle function. This isn’t compulsory and a chaperone can be arranged if wanted.

To book a women’s health physiotherapy appointment for pelvic floor dysfunction, call SMARTPHYSIO on 020 7435 4910 or use online booking. Clinic, home and virtual appointments are available.

NICE NG123 recommends a supervised pelvic floor muscle training programme of at least 3 months’ duration to assess whether it is working for stress and mixed urinary incontinence, with the standard protocol being at least 8 contractions performed 3 times daily. Most women notice some improvement within 6 to 12 weeks of consistent training, with continued gains over the following months. The single biggest predictor of success is doing the exercises correctly and consistently, which is why supervised training with a Chartered Physiotherapist is recommended.

A more detailed timeline: in the first 4 to 6 weeks the aim is to learn to activate the right muscles. Around one-third of women don’t do pelvic floor exercises correctly without supervision, often squeezing the wrong muscles (buttocks, inner thighs, abdomen) or pushing down rather than lifting up. From 6 to 12 weeks, early improvements typically start appearing: fewer leakage episodes, less urgency, less heaviness from prolapse symptoms, and better sensation. From 3 to 6 months, strength gains become more measurable; many women continue improving with a structured programme beyond this. From 6 months onward is a maintenance phase; once symptoms have improved, NICE recommends continuing pelvic floor muscle training as an ongoing exercise, in the same way as continuing any strength training to maintain gains.

What affects the timeline: how weak or tight the pelvic floor was at the start, whether exercises are done consistently (3 sets of 8 contractions daily is the NICE-recommended dose), whether the right muscles are being activated (supervised training significantly improves outcomes), other factors (constipation, chronic cough, heavy lifting, hormonal status, weight and impact-loading habits all affect progress), and the stage of life (postnatal recovery, peri-menopause and post-menopause each have different starting points and timelines).

If symptoms haven’t improved meaningfully after 3 months of consistent supervised pelvic floor muscle training, the physiotherapist may reassess, refer back to the GP for medical investigation, or discuss other options. A typical SMARTPHYSIO course of pelvic health physiotherapy is structured to last several months, with sessions spaced to fit the supervised PFMT timeframe NICE recommends. Most women need multiple sessions spaced over a 3 to 4 month period.

To start a supervised pelvic floor programme at SMARTPHYSIO, call 020 7435 4910 or use online booking. Clinic, home and virtual appointments are available.

Yes, NHS pelvic floor physiotherapy is available for women in England, either through a GP or specialist referral, and via self-referral in some areas. The trade-off is waiting time: NHS gynaecology and pelvic health services have some of the longest NHS waiting lists, particularly since the pandemic. Private pelvic floor physiotherapy at SMARTPHYSIO is normally available within 24 to 48 hours, with virtual appointments offered for those who would prefer not to attend in person.

NHS pathways to pelvic floor physiotherapy include: GP referral (waiting times vary by area and are often substantial), hospital referral (following gynaecology, urogynaecology, urology or colorectal consultations), self-referral (some NHS Trusts allow direct self-referral; check your local Trust’s website), and the postnatal pathway (some areas now offer postnatal pelvic health checks through GP practices or community services).

What NHS pelvic floor physiotherapy typically offers: free care at the point of use, treatment by NHS-employed Chartered Physiotherapists with specialist pelvic health training, often group classes for initial education with individual sessions for assessment and ongoing care, and a waiting period that varies by area (for NHS gynaecology and pelvic health services, notably long since 2020).

What private pelvic floor physiotherapy at SMARTPHYSIO offers: a first appointment within 24 to 48 hours, with same-day and next-day appointments often available, one-to-one sessions throughout, a choice of clinic, home or virtual appointment, continuity of clinician across sessions, a confidential, unhurried setting that many women particularly value for sensitive symptoms, and sessions spaced to fit the NICE-recommended 3 to 4 month course of supervised PFMT without losing momentum to NHS waits between sessions.

The NHS may be the right starting point if you can wait and symptoms aren’t significantly affecting daily life, if the cost of private care is a meaningful barrier, or if you need consultant-led specialist input for complex prolapse, surgical decisions, or specialist diagnostics. Private care at SMARTPHYSIO often suits better if you want to be seen soon, want continuity with one clinician across the full treatment course, value a confidential one-to-one setting and a longer initial assessment, prefer a virtual appointment from home for any reason, or have private medical insurance that covers physiotherapy (see our insurance page).

The CSP-affiliated Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) network can help you find specialist NHS or private pelvic health physiotherapists in your area. To book a private pelvic floor physiotherapy appointment at SMARTPHYSIO, call 020 7435 4910 or use online booking. Virtual appointments are available for those who would prefer not to attend in person.

On-site workplace physiotherapy with SMARTPHYSIO works by sending a Chartered Physiotherapist (MCSP, HCPC-registered) to your London office, site or store. The physiotherapist assesses and treats employees in a private space at work, runs ergonomic and DSE workstation reviews, and reports back to HR or occupational health with anonymised, themed findings.

A typical on-site programme is set up around three things: issues you already know about (staff complaining of back, neck or wrist pain, return-to-work cases, or an audit by occupational health), a regulatory baseline you have to meet (the Health and Safety (Display Screen Equipment) Regulations 1992 require workstation assessments for employees using DSE daily for an hour or more), and patterns the physiotherapist surfaces once on site.

What’s typically included for an on-site day or block: 30 to 60-minute one-to-one physio appointments with employees, by booking; workstation and DSE ergonomic assessments at each employee’s actual desk; manual handling reviews where a role involves lifting (warehouse, hospitality, healthcare); brief tool-box talks and posture and movement education sessions; and a written report to HR or occupational health on themes and recommendations, with no individual identifying information unless the employee has consented.

The clinic also offers virtual ergonomic and DSE assessments for home-based and hybrid workers, since DSE duties apply to home workstations as well as office desks.

To discuss an on-site workplace physiotherapy programme for your London business, call SMARTPHYSIO on 020 7435 4910 or use the enquiry form. The team will scope headcount, locations and the issues you most need to address, then propose a delivery model.

The case for workplace physiotherapy rests on reducing musculoskeletal absence, presenteeism and long-term claims cost. HSE data show musculoskeletal disorders accounted for 7.1 million working days lost in Great Britain in 2024/25, with an estimated 511,000 workers affected. SMARTPHYSIO doesn’t publish proprietary ROI figures, but the underlying cost base employers can recover against is well documented.

Specific ROI figures vary by industry, role profile and programme design, so SMARTPHYSIO doesn’t headline a single number. What is reliably documentable is the cost base employers can attack: HSE reports 511,000 workers in Great Britain suffering from a work-related musculoskeletal disorder in 2024/25, with 7.1 million working days lost to MSDs in that year, and a total estimated cost of injuries and new ill-health cases in the UK of around £22.9 billion (HSE figure, 2023/24 reference year). Back-related conditions alone accounted for around 41% of MSD-related working days lost in the same period.

Workplace physiotherapy aims to recover some of that lost time and cost through early intervention (treating issues before they become long-term absence), ergonomic and DSE assessment (addressing the cause of new MSD cases), return-to-work planning (getting employees back to full duties faster after surgery, injury or extended absence), and triage (helping line managers and HR decide quickly whether an employee needs medical input or can be managed in-house).

The honest version of the ROI conversation is that workplace physiotherapy is rarely the only intervention an employer should make, but it is one of the few that targets the single largest preventable cause of absence after stress. To discuss what a workplace physiotherapy programme could realistically achieve for your business, call SMARTPHYSIO on 020 7435 4910 or use the enquiry form.

Workplace physiotherapy can support reductions in MSK-related sickness absence by addressing problems earlier than NHS or private self-referral pathways usually allow, and by treating people in the setting where the problem is being caused. HSE data show MSDs cost UK employers around 7.1 million working days a year. SMARTPHYSIO doesn’t guarantee specific absence reductions, since outcomes depend on the workforce, the programme and management engagement.

Three things make workplace physiotherapy useful for MSK absence reduction: speed (workplace physio brings a clinician to the employee, often within days, and early intervention generally improves the prognosis for non-specific back, neck and upper-limb pain); setting (an ergonomic or DSE assessment carried out at the employee’s actual workstation typically identifies real triggers a clinic assessment cannot see); and integration (the physiotherapist can liaise with HR, occupational health and the employee’s GP to plan a realistic return-to-work pathway, including phased return, role modification and equipment changes).

There are limits to what workplace physiotherapy can do on its own; stress-related MSK presentations, complex chronic pain and conditions requiring imaging or a surgical opinion often need broader medical or occupational health input, and SMARTPHYSIO can refer or coordinate where appropriate.

On MSK claims specifically, the relationship between workplace physiotherapy and employers’ liability claims is indirect; good early-intervention physio, alongside a documented DSE assessment programme, demonstrates an employer taking reasonably practicable steps under the Health and Safety at Work etc. Act 1974 and the DSE Regulations 1992. It doesn’t, on its own, defeat or pre-empt a claim, but it strengthens the documentary position.

To explore how a workplace physiotherapy programme could fit into your MSK absence and claims strategy, call SMARTPHYSIO on 020 7435 4910 or use the enquiry form. The team will discuss your absence data, sector, and the specific issues you’re trying to reduce.

Yes, SMARTPHYSIO offers one-off ergonomic and DSE workstation assessments for individuals and small teams, as well as ongoing physiotherapy programmes. Assessments can be in person at the office or home workstation, or carried out virtually by video call. Each assessment ends with a written report covering the workstation, the user’s posture and movement, and specific recommendations.

A one-off assessment typically covers desk and monitor setup (including screen height, distance and glare), seating position and lumbar support, keyboard, mouse and arm alignment, footrest, leg position and circulation, lighting and screen reflections, movement and break habits across the working day, posture during typical tasks observed during the session, and lifting and manual handling reviews where a role involves these (warehouse, retail, healthcare).

This can be useful for employees who have started developing neck, shoulder, back, wrist or hand symptoms but don’t yet need treatment, home and hybrid workers whose employer needs a documented DSE assessment under the Health and Safety (Display Screen Equipment) Regulations 1992, individuals starting a new role with a different workstation setup, and anyone whose pain seems linked to a specific workstation or task.

Most ergonomic assessments produce two outputs: practical adjustments the user can make today (chair height, monitor height, break frequency, posture changes) and equipment recommendations where the existing kit cannot be adjusted to fit (a different chair, a sit-stand desk, an external keyboard for laptop users, a footrest). A user with no current pain often only needs an assessment, while a user already in pain typically needs an assessment plus a physiotherapy course to address symptoms while workstation changes take effect.

To book a one-off ergonomic assessment or a wider workplace physiotherapy programme, call SMARTPHYSIO on 020 7435 4910 or use the enquiry form. SMARTPHYSIO has two London clinics (Hampstead and Highgate) plus on-site and home visits across London, and offers virtual DSE assessments for remote workers anywhere.

Yes, SMARTPHYSIO provides physiotherapy in care homes, nursing facilities and private residences across London. A Chartered Physiotherapist (MCSP, HCPC-registered) visits the resident in their own room or a suitable space in the home, completes a full assessment, and delivers treatment on-site. Visits are arranged at times that fit around the home’s daily routine.

SMARTPHYSIO’s care-home physiotherapy service is built around residents who find it difficult or unsafe to travel to a clinic. The therapist comes to the home, brings portable equipment, and works in the resident’s familiar environment, which is often less tiring, less disorienting and more productive than a clinic visit. This is particularly true for people living with dementia, advanced Parkinson’s, post-stroke fatigue, frailty or significant mobility limitations.

Yes, SMARTPHYSIO arranges continuity of care wherever possible, with the same Chartered Physiotherapist returning for each visit to the resident’s care home. Continuity matters for residents who benefit from familiarity, particularly those living with dementia or cognitive impairment, and it helps care staff and family build a relationship with one named clinician.

At the first visit, the team matches the resident with a physiotherapist whose experience fits the case (for example, neuro-rehab for a stroke survivor, MSK and falls prevention for an older adult with arthritis, respiratory work for someone with a chest condition). That same physiotherapist then returns for follow-up visits, so the resident sees a familiar face rather than a different clinician each time.

Most cases of sciatica improve within 4 to 6 weeks of starting physiotherapy and staying active. The NHS notes sciatica often gets better on its own within that timeframe. With targeted physiotherapy at SMARTPHYSIO, the aim is faster symptom relief, a clearer return to normal activity, and reduced risk of recurrence. Some people, particularly those with disc-related sciatica, take longer.

Sciatica is usually pain referred from the lower back into the buttock or leg, caused by irritation or compression of a lumbar nerve root. Most episodes settle within a few weeks; a minority become more persistent.

Many people with sciatica fully recover and stay symptom-free after a single episode, particularly when the underlying cause is addressed. Others find symptoms return during periods of heavy load, prolonged sitting, or after specific activities. Physiotherapy aims to settle the current episode and reduce the chance of recurrence, but cannot promise sciatica will never return.

Whether sciatica stays away depends on a few things: how well the original cause has been identified and addressed, how the back is loaded going forward, and the strength and conditioning of the muscles supporting the spine. Recurrence is more likely if the original mechanism (such as a disc bulge from repetitive flexion and lifting at work) continues unchanged.

Yes, a physiotherapist can help with sleep problems, but the help is specific. Physiotherapy is most useful when sleep is disrupted by pain, posture, muscle tension, an unsupportive mattress or pillow, or breathing pattern issues. For chronic insomnia where the underlying problem is psychological or behavioural, NICE recommends cognitive behavioural therapy for insomnia (CBT-i) as the first-line treatment. The SMARTPHYSIO sleep service is led by Sammy Margo MCSP, author of The Good Sleep Guide, who has worked with patients on sleep-related physiotherapy for over 25 years.

A physiotherapist helps someone with Parkinson’s disease maintain mobility, balance, posture and confidence, and adapts their plan as the condition changes. The work covers gait and balance retraining, strengthening and flexibility exercises, cueing techniques for movement initiation, falls prevention, and education for the person and their family or carers. NICE NG71 (2017) recommends that people in the early stages of Parkinson’s are referred to a physiotherapist with experience of Parkinson’s for assessment, education and advice on physical activity. SMARTPHYSIO’s specialist neurological physiotherapists offer this in clinic, at home or in care homes across London.

The 5:2:1 rule (or 5-2-1 criteria) is a medication-management screening tool used by neurologists and movement disorder specialists, not a physiotherapy framework. A patient meets the rule if they have at least one of: 5 or more oral levodopa doses per day, 2 or more hours of “off” time per day, or 1 or more hours of troublesome dyskinesia per day. Patients who meet one or more of these criteria may be candidates for a medication review or for device-aided therapies. If you meet the rule, the conversation to have is with your neurologist or Parkinson’s nurse, not your physiotherapist.

The 5-2-1 criteria were developed by a Delphi expert consensus panel of international movement disorder specialists to help identify patients whose Parkinson’s is becoming difficult to control with standard oral medication.

There is no fixed age at which someone needs geriatric physiotherapy. It is recommended whenever an older adult is struggling with mobility, balance, falls, recovery from illness or surgery, or wants to maintain their independence. NICE guidance on falls prevention applies to all adults aged 65 and over, and to people aged 50 to 64 who have specific risk factors. SMARTPHYSIO sees patients from their 60s into their 100s.

The SMARTPHYSIO Highgate clinic is at 244 Archway Road, London, N6 5AX, on Archway Road between Highgate and Archway. By public transport, Highgate tube station (Northern line, High Barnet branch) is about a 2-minute walk in the direction of Archway, and buses 134, 263 and 43 stop close to the clinic on Archway Road. By car, the clinic sits outside the central London Congestion Charge zone, with free 1-hour parking directly in front of the building.

Yes. There is free on-street parking for 1 hour directly in front of the SMARTPHYSIO Highgate clinic on Archway Road. Additional pay-and-display parking is available on surrounding side streets. The clinic is outside the central London Congestion Charge zone, so most patients can drive in without paying a daily charge.

The SMARTPHYSIO Hampstead clinic is at 444 Finchley Road, London, NW2 2HY, at the junction of Finchley Road and Cricklewood Lane in the Childs Hill area. It sits between Golders Green tube (Northern Line) and Finchley Road tube (Jubilee and Metropolitan Lines), and is served by bus routes 13, 82, 328, 245 and 460.

The clinic is on the Finchley Road, which is the main A41 corridor running between Swiss Cottage and Golders Green. The closest tube stations are Golders Green (Northern Line, Edgware branch) and Finchley Road (Jubilee Line), both of which involve a walk or a short bus journey along the Finchley Road.

By bus, the 13, 82, 328, 245 and 460 all stop along the Finchley Road close to the clinic. The 13 and 82 are particularly useful for patients coming from central London.

Physiotherapy helps with both. For arthritis, tailored therapeutic exercise is a core treatment that reduces pain and improves physical function, not just movement. At SMARTPHYSIO, treatment combines hands-on therapy, graded strengthening, mobility work and pain-management strategies to address pain and function together.

The idea that physio for arthritis is only about “keeping things moving” is outdated. NICE NG226 (2022) on osteoarthritis identifies therapeutic exercise and weight management as the two core treatments for the condition, with the goal of reducing symptoms and improving or maintaining physical functioning. NICE NG100 (2018, last reviewed 2024) on rheumatoid arthritis recommends specialist physiotherapy for general fitness, joint flexibility, muscle strength, functional ability, and short-term pain relief methods such as TENS.

A physiotherapist can help with most types of arthritis, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and post-traumatic arthritis (joint damage after injury or surgery). SMARTPHYSIO’s team treats all of the above, working alongside your GP or rheumatologist where medical management is also needed.