Frequently Asked Questions

You may have seen physiotherapists, osteopaths or chiropractors before – lots of my patients have been “around the houses” before they see me. Please expect an assessment with me to be a bit different!

My assessment sessions are 90 minutes long. This may or may not include some time for treatment – it depends on how complex your case is! If your case is especially complex, then I may ask you to come back to complete the assessment (this is rare but has occasionally happened) – I will not start treating you until I understand your problem as well as I can.

We will start by talking – about your current issues, previous issues and medical issues; about your symptoms; about your lifestyle and about what you are hoping to achieve from physiotherapy. If there are things you really don’t want to discuss, then of course I will respect that. I may make recommendations as we go – videos to watch, equipment to buy, other practitioners or tests to try.

We will then move onto a physical assessment, during which I will look in-depth at your posture and your movement patterns, and will test your muscles and joints as appropriate. I will probably make minor temporary adjustments to your posture, and keep testing relevant movements until I work out what is causing any symptoms. This is how I work out where your problem is really coming from – is it the part that hurts, or is the painful area trying to compensate for an underlying issue elsewhere?

At the end of the assessment, we will discuss the way forward and aim to come to an agreement. The plan may or may not include having physiotherapy treatment with me – if there is something or someone that I feel would be a more appropriate option for you, then I will suggest it.

If there is time, then I may offer some immediate treatment.

Whether we have time for treatment or not, I will write up a report from the session and email or post it to you, depending on your preference. This report will include my findings and recommendations. If you choose to, we can immediately arrange and book a course of treatment; sometimes people prefer to read the report first, and then call to arrange their treatment.

For the physical part of the initial assessment, I will usually ask you to strip down to underwear or shorts; and a bra or vest top for women (ideally not a crop-top style sports bra, in case I need to treat or tape your ribcage!) If removing clothing is an issue for you, then I will of course do my best to work around this.

After this, we will have more of an idea of where we are treating (though bear in mind that this can change as your body adapts to treatment!) and you may be able to cover up more if you prefer. If this is the case, you may find it convenient to bring loose or comfortable clothing such as a t-shirt and shorts. However, lots of my patients prefer to continue just stripping down to underwear, and that’s fine too!

If you have a problem which is related to running or sports, it may also be useful to bring your usual sports shoes with you (and any insoles you may have been prescribed) so that I can examine them, and can examine you in them.

Everything in your body is connected! Some people’s knee problems (for example) are really coming from their knee; but in around 35% of cases, I believe the knee is overloaded because it is trying to compensate for an issue with your foot or your ribcage.

In my clinic, I find that the percentage of people whose problems are driven by somewhere other than the area that hurts is higher than 35%. That’s because if your knee problem is really coming from your knee, then the chances are that you will have already responded to more conventional, knee-focused treatment, and won’t find your way to me.

However – until I assess your whole body, I can’t be sure either way.

My sessions are an hour because this provides better value to my clients.

Most physiotherapists do offer 30-minute sessions, and I used to do this. However in my experience, 30 minutes isn’t long enough for me to make a real difference.

Discussing how things have gone for you since our last session and how you responded to treatment, and getting changed/undressed, takes around 10 minutes for most patients; and getting dressed again and a discussion to remind you of your “homework” often takes a further 10 minutes. Therefore if you only have 30 minutes, this leaves just 10 minutes for actual treatment – whereas in an hour’s session, I can provide 40 minutes of treatment time, which is essential for complex patients.

Interestingly, when I switched to 60-minute sessions in 2011, I also discovered that for many people, the nervous system takes a while to relax into the session – and this often happens after around 20-30 minutes of treatment! This was something I simply hadn’t experienced before, but it does seem to be fairly consistent, and to make a difference.

Essentially – I think the treatment of complex injuries should be a process of teamwork – like a relay race!  If I’m not in the consultant’s clinic or in the operating theatre with you, then I lose the opportunity for the consultant to pass the baton of care onto me.

If you’d like to understand my thought process further, I have a blog post that answers this very question. Click here to read it

In most cases, I will ask you to pay for the session and my team will then provide you with a receipt so that you can claim back from your insurance company – they tend to refund their policyholders quickly, whereas paying clinicians can take as long as 90 days!

We have a blog post that talks about this in more detail, click here to read it.

​The more information I have to work with, the better. So please bring me anything you have – or, if you have a chance, email it to help@nellmead.com in advance, and my team will make sure I see it.

Similarly, if you are currently under the care of any other doctors or healthcare professionals and you are happy for me to talk to them, please let my team know, and they will contact your doctor to ask for any clinic letters that they may have written about you.

I usually work at my clinic in Victoria Avenue, near Liverpool Street and Moorgate stations in central London; but sometimes I may be able to visit you at your home or hotel (I have a special relationship with the Four Seasons in Trinity Square, whereby my patients receive a 25% discount on their residence while they are undergoing treatment); or I occasionally travel with patients who want a period of intensive physiotherapy and rehabilitation.

Please note that because I will be unable to see patients while I am travelling to or from your home or hotel, I will have to charge for this time.

Home visits start at £1500 for a half-day.

Unless your insurance company has agreed that I can invoice them directly, then I will expect you to pay for your session on the day, or in advance if you are booking a course of treatment.

I accept all credit and debit cards, and cash. If I have worked with you before, or if you are paying in advance, then I may also accept payment via BACS.

I hope you will never need to cancel your appointment with me; but should something vital crop up, please call my team on 0207 175 0150 or email help@nellmead.com and give us as much notice as you can. While I really would hate to have to charge you, I also can’t afford to have my time wasted by cancellations.

I will accept cancellations without penalty if you give me or my team more than 24 hours’ notice; however, without that notice, the following charges apply:

• Cancellation within 24hrs of appointment – 50% fee required
• Missed appointments without any notice – Full fee required

Exceptional cancellation circumstances may be considered at my discretion.

Before we start your first session, there are some forms I will expect you to complete. A link to the forms is automatically emailed to you by my diary system when you book your first appointment. Please note that I will not be able to start your assessment unless these have been completed, so please do give yourself enough time to complete them before the start of the session.

If you are paying via insurance and your insurance company has specifically agreed that I can bill them directly, you will need to complete an insurance form

Please email my PA Sarah Harvey at admin@nellmead.com and she will do her best to answer! When she starts receiving the same questions repeatedly, we do add them to this FAQ section, so by asking, you may help others!