Assessment
Your physiotherapist discusses your symptoms, goals, medical history and lifestyle, then completes a thorough assessment. Initial appointments are typically 45 to 60 minutes, so there is time to do it properly.
What We Treat
Low Back Pain Treatment in London
Most low back pain is non-specific and responds well to physiotherapy, exercise, and education, but a previous episode is the single strongest predictor of the next one, so the rehab you skip now is the flare you feel in six months. We deliver NICE-aligned low back pain treatment in London and Henley across our three clinics, without unnecessary imaging, opioids, or specialist referral.
Overview
Understanding low back pain
Low back pain is one of the most common reasons adults seek physiotherapy: around 60 to 80 % of UK adults will have an episode at some point. The reassuring part is that the vast majority is non-specific, meaning no single structure can be pinned as the cause, and it responds well to the right care. Getting an accurate assessment early is what turns a frightening flare into a clear plan.
NICE guidance (NG59) is explicit about first-line care, and it shapes how we treat every back:
- Movement and exercise over rest: staying active supports recovery, while bed rest beyond a day or two slows it.
- Manual therapy plus progressive loading: hands-on work to settle the guarded early phase, then graded strengthening that rebuilds tolerance.
- Education, not routine scans: NG59 advises against routine imaging and opioids, because scans rarely change the plan and often show changes that are just as common in people with no pain at all.
Most acute episodes settle within 6 weeks, and a first episode usually takes 3 to 6 sessions. Recurrent or persistent back pain responds more slowly but well. Because a previous episode is the single strongest predictor of the next one, we do not stop at symptom relief: we rebuild the strength and capacity that make a repeat less likely, filmed for you through Track Rehab so the programme is easy to follow between visits.
The same evidence-based approach scales from desk-bound professionals to marathon runners and elite multi-sport athletes. Physiotherapy leads most cases; where stiffness or a postural pattern dominates we may add osteopathy or soft tissue therapy as an adjunct. Back pain often travels with spinal osteoarthritis, and we rehabilitate it after spinal surgery through post-operative rehabilitation.
Excellent
From 4 five-star Google reviews
Source: Google
I first started using Tom last year to help relieve back pain, he has been extremely helpful and now he's supporting me with sprint and fitness training, whilst helping with any minor injuries. Can't recommend him and his team more highly.
I went to Tom with a shoulder injury that had not improved for several months. Tom is very knowledgeable and quickly identified the issue and put me on a course of exercises that, in conjunction with a couple more sessions, steadily resolved the problem. I would highly recommend him.
Parinita was brilliant! Identified my knee problem immediately, used a range of equipment and exercises not only to strengthen my knee, but to maintain it and improve my running long-term.
Excellent service! Sanchez is a true professional who helped me heal a previous injury. Highly recommend!
Physiotherapy for low back pain can help to:
Settle the current flare
Hands-on treatment and guided movement calm the early, guarded phase. Most acute episodes settle within 6 weeks, and staying active is part of the treatment, not a risk to it. We show you what to keep doing and what to ease off, usually less than you think.
Skip the scans you do not need
NICE guidance advises against routine imaging and opioids for most low back pain, because scans rarely change the plan and often show changes that are just as common in people with no pain at all. We assess first and refer for imaging only when your history or examination warrants it.
Rebuild strength and tolerance
Once symptoms ease, we load the back gradually until it can handle your job, your training and everything between. A first episode usually takes 3 to 6 sessions over 4 to 8 weeks. The target is a back that finishes the process stronger than it started.
Cut the risk of the next episode
A previous episode is the single strongest predictor of the next one. Finishing the rehabilitation rather than stopping when the pain eases, keeping the strength you have rebuilt, and adjusting the loads that set it off all make a repeat less likely and less severe.
Manage the loads that drive it
Long hours at a desk, driving, repetitive lifting and sudden overload are the usual suspects. We map your week, find the pattern behind the pain and adjust it with you: sensible changes to how you sit, lift and train rather than a list of things to avoid.
Support you through pregnancy and after
Back and pelvic girdle pain are common in pregnancy and respond well to physiotherapy at any trimester. Treatment is adapted to your stage: positioning, hands-on care and exercise that respects how the load on your spine and pelvis is changing. Mention pregnancy when you book.
Why it happens
What causes low back pain?
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Sustained postural loading (long-haul desk work, driving, manual labour)
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Sudden mechanical overload (lifting beyond capacity, abrupt twisting under load)
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Deconditioning: reduced strength and movement after time off, illness, or post-surgery
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Pregnancy: biomechanical changes loading the lumbar spine and pelvis
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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 movement pattern
What happens at your first physio appointment?
Initial appointments are typically 45 to 60 minutes. You leave with a clear explanation of your condition, treatment recommendations, a report explaining it in simple language, and a personalised rehabilitation plan.
Follow-ups run 30 to 45 minutes, and we reassess at every visit rather than selling you a block of sessions up front.
A thorough, honest, and understandable explanation. Then the best treatment to get you back to a level of activity beyond your pre-injury status. If we can't get you better, we will recommend the world's leading healthcare professionals in London that can.
- Founded in 2015 by Tom Astley: 7 clinicians working across 3 clinics in Crouch End, Marylebone and Henley-on-Thames.
- Our team has successfully worked with local, national and international athletes at 6 major multi-sport events, from London 2012 to Gold Coast 2018, and we bring that expertise to everyone who enters our service.
- Rated 4.9 from 88 Google reviews; recognised by 5 major UK insurers, and self-funded patients book online with no GP referral.
Fees and insurance
Book directly online through Splose. Self-funded patients need no GP referral; if you are claiming through insurance, obtain prior authorisation before booking.
- Physiotherapy with Tom Astley: £85 initial consultation, £77 follow-up
- Sports and dance therapy with Laura Fornoni: £75 initial consultation, £70 follow-up
- Shockwave therapy: £230 for the initial consultation plus 3 sessions, then £80 per further treatment
- Running gait and performance reviews: £80 Base, £135 Intermediate, £185 Expert
- Recognised by Bupa, Cigna, Vitality, WPA and Simply Health
How physiotherapy works
from assessment to return to sport
Book today to get an assessment, advice, a report and a rehabilitation plan. We combine hands-on treatment with gym-based rehab to get you well, today, and we reassess at every visit.
Advice and report
A clear explanation of your condition and a report explaining it in simple language, alongside hands-on treatment: manual therapy, soft tissue techniques and joint mobilisation where they help.
Rehabilitation plan
Exercise rehabilitation tailored to your goals and condition, delivered through Track Rehab. Our clinics sit inside gym facilities, so the plan has the equipment and technology it actually needs.
Return
Structured programmes and return-to-sport testing before you go back, so you return safely and confidently. The goal is a level of activity beyond your pre-injury status, not just less pain.
What our physiotherapists treat
- Manual therapy and joint mobilisation
- Exercise rehabilitation through Track Rehab
- Dry needling for stubborn trigger points
- Shockwave therapy for chronic tendinopathy
- Sensor-based running gait analysis
- Sports massage, scar work and soft tissue therapy
- Women's health, Mummy MOT and postnatal rehabilitation
- Post-operative and ACL rehabilitation
- Return-to-sport testing
Treatment approach
How do we treat low back pain?
Physiotherapy & Sports Therapy
From £75Combined manual therapy and progressive exercise rehab is the NICE-aligned first-line treatment. Most episodes resolve in 3 to 6 sessions over 4 to 8 weeks.
See treatment detail →Osteopathy
Price on enquiryFor cases where joint stiffness or postural pattern is the dominant driver, osteopathic case-history-led assessment and joint articulation often complements the physiotherapy plan.
See treatment detail →Soft Tissue Therapy
Price on enquiryUseful as an adjunct for muscular guarding or chronic paraspinal tension: not as a stand-alone treatment for low back pain.
See treatment detail →FAQ
Frequently asked
questions
Do I need an MRI for my back pain?
In most cases, no. NICE guidance specifically advises against routine imaging for non-specific low back pain because it rarely changes management and frequently shows incidental findings (disc bulges, mild degenerative change) that are present in pain-free people too. Imaging is appropriate when there are red flags: significant trauma, suspected fracture, neurological deficit, or a pain pattern suggesting a specific cause.
When should I worry about back pain?
Seek urgent medical attention (A&E or 111) if you experience: loss of bladder or bowel control, numbness around the saddle/perineal area, progressive leg weakness, or back pain after significant trauma. These can indicate cauda equina syndrome or fracture and require imaging within hours, not days. Routine physiotherapy is not appropriate in these cases: go to A&E first.
Should I rest or stay active when my back hurts?
Stay as active as the pain allows. Bed rest beyond 24 to 48 hours actually slows recovery from low back pain and raises the risk of chronic problems. Walking, gentle movement, and continuing your normal routine where possible help even during an acute flare. Your physiotherapist will guide what to modify: usually less than you think.
How long should I expect treatment to take?
For an acute first episode, most people are substantially better within 3 to 6 sessions over 4 to 8 weeks. Recurrent or chronic low back pain responds more slowly: expect 6 to 12 sessions over 8 to 16 weeks for meaningful change. The goal is not just symptom relief; it is restoring strength, capacity, and confidence in your back so flares become less frequent and less severe.
Related What We Treat
Get Started
Book a physiotherapy appointment
in Crouch End, Marylebone or Henley.
Tom Astley Physiotherapy • Park Road Pools & Fitness, Crouch End, London N8 8JN
BookAppointments typically available within 1–2 weeks