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.
What We Treat
Arthritis & Chronic Pain Treatment in London
Osteoarthritis and persistent pain respond to the right movement, not rest. A graded, evidence-based plan focused on long-term results, not quick fixes, keeps you active, stronger and back in control.
Overview
Understanding arthritis & chronic pain
What is arthritis and chronic pain?
Arthritis is wear and change within a joint, most often osteoarthritis of the knee, hip or hand, while chronic pain is pain that persists beyond normal healing and becomes sensitised. Both respond best to the right movement rather than rest, and both are far more manageable than they are often made to sound. Keeping older, active adults moving across central London is a large part of what we do.
If rest has not settled a painful, arthritic joint, you are not doing it wrong. Arthritis and persistent pain are widely misunderstood: the instinct to rest and protect the joint is usually the opposite of what helps. The change seen on a scan correlates poorly with how much pain you actually feel.
Under this umbrella we treat a few related problems, and the plan differs for each:
- Osteoarthritis: age-related changes in the knee, hip, hand or other joints that respond to graded exercise rather than rest.
- Deconditioning around a joint: strength lost from avoiding activity because of pain, which leaves the joint less protected and more painful.
- Chronic primary pain: pain that persists beyond normal healing and becomes sensitised, real and disabling even without ongoing tissue damage.
- Lifestyle amplifiers: higher body weight, low activity, poor sleep and stress, which increase joint load and turn up pain sensitivity.
Does exercise really help arthritis?
Yes. NICE recommends therapeutic exercise and self-management as core treatment for osteoarthritis (NG226) and for chronic primary pain (NG193), ahead of imaging, surgery or most medication. We screen for the rare features that need referral, then build a graded, sustainable plan paced to where you start.
That plan is exercise-led: strengthening the muscles that protect and offload the joint through physiotherapy and sports rehab and coached strength training, with controlled Reformer Pilates as a low-impact way in when full-weight work is too much. We start where you are, build gradually so we strengthen you rather than flare you, and hand you a routine you can keep running yourself. We often help alongside related problems such as low back pain and sciatica. We support older adults, desk-based professionals and active people across our Soho, Liverpool Street and Marylebone clinics. Self-referral; no GP letter needed.
Physiotherapy for arthritis and chronic pain can help to:
Replace fear of movement with a plan
The instinct to rest and protect a painful joint is usually the opposite of what helps, and the worry that exercise wears joints out is not supported by the evidence. We show you what your joint can safely do, then build from there at your pace. Confidence usually returns before the pain has fully gone, and that shift is often the turning point.
Strengthen the muscles that protect the joint
NICE names therapeutic exercise the core treatment for osteoarthritis, irrespective of age. Strong muscles offload and protect an arthritic knee, hip or hand, and graded strengthening reduces pain while it restores function. The programme starts wherever you are, including from very little.
Take persistent pain seriously
Pain that has outlasted normal healing is real, even when no scan explains it. For chronic primary pain, NICE recommends supervised exercise and self-management over most medication. We pair a graded movement plan with education that helps you understand and pace your pain.
Keep you moving with low-impact options
When full-weight work feels like too much, controlled Reformer Pilates gives you strengthening under supported load: an accessible way to stay active, build strength and hold onto mobility. It bridges the gap between doing nothing and doing what your joints currently resent. For a lot of people it is the first exercise in months that has not left them sore the next day.
Address weight, sleep and the bigger picture
Body weight, activity levels, sleep and stress all feed into joint load and pain sensitivity. We help you work on the ones that matter for you, with dietitian-led support available in the same practice, because these levers often move pain as much as treatment does.
Put you back in control
The end point is self-management: a sustainable routine you run yourself, the knowledge to handle flare-ups without alarm, and a joint or pain problem that no longer decides your week. We stay available for reviews, but independence is the goal.
Why it happens
What causes arthritis & chronic pain?
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Age-related joint changes of osteoarthritis in the knee, hip, hand or other joints, which respond to graded exercise rather than rest
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Deconditioning and loss of muscle strength around an affected joint, often from avoiding activity because of pain, which leaves the joint less protected
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Persistent (chronic) primary pain that continues beyond normal healing time and becomes sensitised, real and disabling even without ongoing tissue damage
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A previous injury, fracture or joint surgery that has accelerated wear or left a joint less resilient
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Higher body weight and low overall activity levels, which increase load on weight-bearing joints and reduce conditioning
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Poor sleep, high stress and low mood, well-evidenced amplifiers of pain perception that maintain a chronic-pain cycle
What happens at your first physio appointment?
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.
Move better. Train stronger. Live fully. Pain relief that lasts is not enough on its own: we find the cause, then rebuild the strength behind the pain so it stays gone. No guesswork, no generic rehab.
- 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
Ready to optimise you? 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
How physiotherapy works
from assessment to return to sport
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.
What our physiotherapists treat
- 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 arthritis & chronic pain?
Physiotherapy & Sports Rehabilitation
£145Assessment of how your pain affects daily life, education that helps you understand and pace it, and a graded exercise and self-management plan together form the NICE NG226 and NG193 first-line treatment for osteoarthritis and chronic primary pain: exercise reduces pain and protects function irrespective of age.
See treatment detail →Reformer Pilates
£120Reformer Pilates offers controlled, low-impact strengthening and movement under supported load: an accessible, exercise-based way to stay active, build strength and maintain mobility with arthritis or persistent pain, consistent with the NICE NG226 emphasis on therapeutic exercise.
See treatment detail →FAQ
Frequently asked
questions
Is exercise safe if I have arthritis?
Yes, and it is recommended. NICE guidance (NG226) names therapeutic exercise a core treatment for osteoarthritis, irrespective of age, and it is advised even when arthritis shows on a scan. Strengthening the muscles around a joint reduces pain and improves function, and does not wear the joint out. We pace the programme to build you up rather than flare you.
Will exercise make my joints wear out faster?
No: this is a common worry, but appropriately graded exercise does not wear joints out. The change seen on a scan correlates poorly with pain, and strong muscles protect and offload a joint rather than damaging it. Avoiding activity, by contrast, causes deconditioning and weaker support around the joint. We build your load gradually so you strengthen.
Can physiotherapy help chronic pain that has no clear cause?
Yes. NICE guidance on chronic pain (NG193) recommends supervised exercise and self-management over most medications for chronic primary pain. Persistent pain is real even without ongoing tissue damage, and a graded movement programme, paired with education that helps you understand and pace your pain, reduces its impact and helps you return to the activities that matter to you over time.
Do I need a scan or strong painkillers for osteoarthritis?
Usually not as the first step. NICE advises against routine imaging for osteoarthritis because scan findings rarely change treatment, and NICE NG193 steers away from most long-term painkillers for chronic primary pain. Exercise, weight management and self-management are first-line. We reserve onward referral for genuine red flags or symptoms that suggest a specific cause needing further investigation.
What should I do when my joint pain flares up?
Do not panic, and do not stop moving altogether. A flare is your joint being temporarily irritated, not damaged. Ease back the load for a few days, keep gentle movement going, then build back up as it settles. Learning to handle flare-ups calmly is a core part of the self-management plan we build with you.
When should I seek urgent help for joint or chronic pain?
Seek prompt care if a joint becomes hot, swollen and red and you feel unwell with a fever, which can signal infection or acute inflammatory arthritis. Unexplained weight loss, night pain, a history of cancer, or new neurological symptoms also warrant urgent medical review rather than physiotherapy first. We will always direct you to the right care.
Related What We Treat
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in London.
Physio and Performance • 111 Charing Cross Road, Soho, London WC2H 0DT
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