A different approach to long term recovery: what to expect at your appointment
You may have seen physiotherapists, osteopaths or chiropractors before — lots of my patients have been “around the houses” before they see me. Please expect treatment with me to be a bit different!
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Just call my London team on
0207 175 0150 or use the form below and let me help you get better.
Just call my London team on
0207 175 0150 or use the form here.
No matter what your issue, I’m not going to start treating you until I understand your problem as well as I possibly can. That’s why my initial 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 even ask you to come back to complete the assessment (this is rare but has occasionally happened).
If we’ve only done one online session (or nothing online) before deciding that you should come see me in the clinic, it’s very likely that your problem will require a full 90 minute in-person assessment. However, if we’ve had a number of online sessions before you arrive for a face-to-face appointment, we will probably be able to move more quickly into treatment.
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 the real issue 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….
Some people come to me having seen a consultant, had a scan, and been given a diagnosis. For others, I’m the first port of call. I’m happy either way. But even if you have a very specific diagnosis, I won’t treat you exactly the same as someone else with the same diagnosis.
Why not? Well, it’s because two patients with identical scan results will experience problems in completely different ways. The problem isn’t usually what’s on the scan — it’s how your nervous system interacts with whatever’s on the scan.
We know, for example, that if you scanned everyone’s low back, we’d see bulging discs in around 80% of the scans. But 80% of people aren’t wandering around with back pain! So, is that bulging disc relevant? In some cases yes, and in some cases no — it depends on how your nervous system reacts to the disc bulge, and on why the disc is bulging. A disc bulge is a symptom of compression — too much sustained or acute force going through that particular area of your back.
But a scan usually won’t tell us why there’s too much compressive force being exerted from that disc — whether it’s in response to muscle tension coming from an old whiplash injury, or a twisted ribcage from a rugby tackle, or a stiff pelvis from too much sitting, or a limp that comes from an ankle you sprained 15 years ago.
In order to achieve a long-term resolution of your problem, my job is to work out not just what hurts, but why it’s a problem — and that’s why I need to look at your whole body, not just the painful area.
As well as a long assessment session, my follow-up treatment sessions in clinic are also longer than normal — always at least an hour.
Think about it: a “standard” physio session is 20-30 minutes long. You might spend the first 5-10 minutes checking in, reviewing how you’ve been getting on since the last session, getting undressed etc. Then the same process in reverse at the end: reviewing what you’ve done during the session, booking the next session, payment, getting dressed. That only leaves a maximum of 15 minutes for treatment.
Whereas, with an hour’s session, assuming you take the same 15 minutes to start and finish the session, you have 45 minutes of treatment. Nothing feels rushed, your nervous system has time to settle, and you can make some real progress. We have time to do some hands-on treatment, and to really practise your rehab exercises so that they make sense to your body — and we’ll video them too, so that you have “pocket Nell” on your smartphone to remind you what you need to do!
My training and experience is quite different to that of most physios – and I use all of it quite regularly! I spent my first 10 years as a physio serving as a Physiotherapy Officer in the British Army. During that time, I completed a Postgraduate Diploma in Sports & Exercise Medicine; set up a residential rehabilitation course for the personnel in British Forces Cyprus where I was head of physiotherapy for the island; became the physio for various Army and Combined Services youth rugby teams and the Cyprus Davis Cup tennis team — and spent 5 months in the desert in 2003 on Op TELIC 1. This all gave me a very broad base of knowledge and understanding of the human body, and in particular the importance of exercise rehabilitation.
When I left the Army in 2010, I began to focus more on learning high-quality manual therapy skills, training in the Sarah Key Method, in Diane Lee’s Integrated Systems Model, in Upledger Craniosacral Therapy and Barral’s Visceral Manipulation. It’s during this training that I learned the techniques of how and why to look at the whole body rather than just the bit that hurts; and this is how I developed my Health & Performance Pyramid model which underpins everything I do in clinic.
My Health & Performance Pyramid model doesn’t just include the things you’d normally associate with physiotherapy. We start by looking at your tissue health — looking at your sleep, stress, hydration and nutrition, as these things govern your resilience and tissue metabolism, and thus affect your response to physio treatment.
We then move onto the physical, looking at your alignment, biomechanics and control. Once we’re on top of these, we start the work to injury-proof you for the future, looking at your flexibility, strength and endurance; and finally (if sports are your thing) we can work with your personal trainer or sports coach to create some movement drills that will help you to return to your sports without breaking down again.
The Pyramid approach is why I don’t offer single, “as and when” treatment sessions — instead, at the end of your assessment session, I’ll be offering you a package of treatment that’s tailored to you, and once we’ve agreed on it, I’ll expect you to commit to it.
You see, a course of physiotherapy is like a course of antibiotics — you get the best results if you finish the course before you can move on, no longer at risk of the original problem recurring. I don’t want to leave anyone half-treated: your injury is likely to come back, and neither of us will be satisfied with that!
Most of my patients need a minimum of 6 sessions to go through restoring normal alignment, biomechanics and control; but it’s very much done on an individual basis, so I can’t predict how many physio sessions you’re likely to need until I go through your history and see and feel you move.
The other important thing I offer in clinic is a collaborative approach. I am a big fan of teamwork, and Team You will definitely include both you and me; but may also include other therapists, doctors, sports coaches, movement coaches etc.
If you need to see a consultant, then I will do my best to come with you and attend the appointment. Similarly, if your injury requires surgery, then I will do my best to observe in theatre. Why? Well, the way I see it, the operating theatre is where the baton of care is passed over from surgeon to physio — and if I’m not there, it’s an opportunity missed.
After all, I’m going to be the one seeing you over the next few months, not your surgeon — so if we do hit any snags, then the more first-hand knowledge I have of the surgery and of the surgeon, the better I can help you over the bumps in the path of rehab.
If you are seeing (or need to see) therapists or trainers from other disciplines, then I will do my best to collaborate with them, and/or to invite them into clinic with us, so that we are singing from the same songsheet when it comes to teaching you how to move more efficiently. In my experience, a joined-up approach gets far better results than a typical disjointed one.
Call my team at (+44) 0207 175 0150, send us an email at help@nellmead.com, or fill in this form, and we’ll get started.
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