Assessment
A detailed history, then a thorough examination of movement, strength and the affected area. You leave knowing what is wrong, why it happened, and exactly what we are going to do about it.
Concern
Low Back Pain & Sciatica Treatment in London
Most low back pain and sciatica is non-specific and rarely needs a scan. Following NICE NG59, we use exercise and hands-on therapy to get you moving without fear.
Our low back pain and sciatica team
Overview
Understanding low back pain & sciatica
Low back pain is one of the most common reasons UK adults seek help, and most episodes are non-specific, meaning no single structure is to blame. Sciatica is leg pain or tingling along the sciatic nerve, usually from an irritated nerve root. The scan many people dread rarely changes what happens next.
Should I rest or stay active?
Stay active. NICE guideline NG59 recommends exercise, manual therapy and education as first-line care, and advises against routine imaging, opioids and prolonged bed rest. We rule out the rare red flags, then build a plan around graded exercise and a confident return to work and training, supported by hands-on therapy.
We treat professionals, parents and active people across our Soho, Liverpool Street and Marylebone clinics. Self-referral; no GP letter needed.
Why it happens
What causes low back pain & sciatica?
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Sustained postural loading: long desk hours, commuting or repetitive manual work
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Sudden mechanical overload: lifting beyond current capacity or abrupt twisting under load
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Irritation or compression of a lumbar nerve root, the usual driver of true sciatica
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Deconditioning: reduced strength and movement after time off, illness or surgery
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Pregnancy and the post-natal period, which alter how the lumbar spine and pelvis are loaded
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Stress, poor sleep and low mood: well-evidenced amplifiers of pain perception
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Recurrent flares from a long-standing weakness or an unhelpful movement pattern
Physiotherapy for low back pain and sciatica can help to:
Settle pain and keep you moving
Hands-on treatment and clear education calm the early, guarded phase, and we keep you as active as your pain reasonably allows. NICE guidance is clear that movement beats prolonged rest for both back pain and sciatica, so your plan is built around it from the first session.
Make sense of your sciatica
Leg pain, tingling or numbness usually comes from an irritated nerve root, and most cases settle without surgery or injections. We explain what is happening in plain English, screen carefully for the rare red flags, and give you an honest projection at your first appointment.
Avoid scans you do not need
Most low back pain is non-specific, and routine imaging rarely changes what happens next. We assess how your back moves and what your life loads onto it, then reserve scans for the few cases where something in your history or examination genuinely warrants one.
Rebuild a stronger back
Graded strength work rebuilds the load tolerance of your lumbar spine and trunk, from controlled work on the Reformer through to coached strength training. The aim is a back that finishes this episode more capable than it started, so the next flare is smaller and rarer.
Break the recurrence cycle
A previous episode is the strongest predictor of the next one. We look at the desk hours, commuting and lifting patterns behind your pain, adjust the loads that keep setting it off, and leave you with a short home programme you can actually keep doing.
Support you through pregnancy and after
Pregnancy and the postnatal period change how the lumbar spine and pelvis are loaded, and back pain in this window responds well to the right physiotherapy. Tell us when you book and we will pace the plan around the stage you are at.
At your first appointment we look for the cause: your history, how you move, and what your work, sport and life ask of your body.
The assessment covers a detailed history and a thorough examination of movement, strength and the affected area. We explain what we find and agree a working diagnosis and plan you understand before you leave.
You go home with a written summary and a home-exercise programme built around your diagnosis and goals, so progress continues between visits.
From pain to performance. Pain relief that lasts is not enough on its own: we rebuild the strength behind the pain so it stays gone.
- Three central London clinics: Soho, Liverpool Street and Marylebone, plus home visits across London and online sessions.
- Led by physiotherapist Sam Harvey: 15 years of clinical practice and an elite-sport background across football, rugby and GAA.
- Physiotherapy, strength and nutrition under one roof: three clinicians, three disciplines, joined-up care.
Fees and booking
You can self-refer and book directly: no GP letter needed, and every new patient can start with a free 15-minute consultation call. The same fees apply across our Soho, Liverpool Street and Marylebone clinics.
- Physiotherapy: a full 60 minutes for £145, whether it is your first visit or a follow-up
- 30-minute follow-ups at £90, with video appointments from £70
- Strength training and Reformer Pilates £120, sports massage from £75
- VALD performance and strength testing with a written report, £195
- 5% off a block of five sessions, 10% off a block of ten
- An itemised receipt with every session, for claiming back where your policy covers physiotherapy
Your journey
with Physio and Performance
Everything starts with finding the cause. Whether the goal is a marathon start line or a week at your desk without pain, we treat what is driving the problem, then build the strength that keeps it fixed.
Treatment
Hands-on manual therapy combined with a progressive, tailored exercise programme. Sports massage, dry needling, shockwave or Reformer Pilates are added where they help your specific problem.
Rebuild
Coached, progressive strength work restores the load tolerance your body lost, paced to where you start. This is the stage that decides whether the fix lasts.
Perform
Each follow-up reassesses you against your baseline, with VALD testing where useful, so your return to work, sport or training rests on measured readiness. Discharge happens by mutual agreement when you can manage independently.
We specialise in:
- Physiotherapy and sports rehabilitation
- Coached strength and conditioning
- Reformer Pilates
- Sports massage and soft-tissue therapy
- Dry needling and shockwave therapy
- VALD performance and strength testing
- Post-operative rehabilitation
- Running and gait analysis
- Sports nutrition and dietetics
Treatment approach
How do we treat low back pain & sciatica?
Physiotherapy & Sports Rehabilitation
£145Combined assessment, education, manual therapy and progressive exercise is the NICE NG59 first-line treatment for both non-specific low back pain and sciatica.
See treatment detail →Strength Training
£120Graded strength training rebuilds the load tolerance of the lumbar spine and trunk and supports a confident return to work and sport, an exercise-based way to stay active and reduce the likelihood of recurrence, consistent with the NICE NG59 emphasis on exercise.
See treatment detail →Reformer Pilates
£120Reformer Pilates rebuilds controlled trunk and lower-limb strength under supported load: an exercise-based way to maintain movement and reduce flare-ups, consistent with the NICE NG59 emphasis on exercise.
See treatment detail →FAQ
Frequently asked
questions
When should I go to A&E for back pain or sciatica?
Go to A&E or call 999 immediately if you develop loss of bladder or bowel control, numbness around the saddle or genital area, or progressive weakness in both legs. These can signal cauda equina syndrome: a rare emergency needing urgent imaging and surgery within hours. Also seek urgent care after significant trauma.
Do I need an MRI scan for my back pain or sciatica?
Usually not. NICE NG59 advises against routine imaging for non-specific low back pain and sciatica, because it rarely changes treatment and often shows incidental findings: disc bulges or mild degeneration, that are common in pain-free people. We reserve imaging for genuine red flags or symptoms suggesting a specific cause needing further investigation.
Should I rest or stay active when my back or leg hurts?
Stay as active as your pain reasonably allows. NICE NG59 advises against prolonged bed rest, which slows recovery and raises the risk of persistent problems. Walking, gentle movement and keeping to your normal routine where possible are recommended even during an acute flare. Your physiotherapist will guide what to modify and what you can safely keep doing.
How long does sciatica take to get better?
Most sciatica improves over several weeks, and the majority resolve without surgery. With physiotherapy, an acute first episode of low back pain often settles within a handful of sessions, while recurrent or longer-standing pain responds more gradually over a longer course of structured exercise. Your physiotherapist will give you an honest, individual projection at your first appointment.
Related Concerns
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Physio and Performance • 111 Charing Cross Road, Soho, London WC2H 0DT
BookAppointments typically available within 1–2 weeks