What You've Already Spent, and What You Have to Show for It
Add it up for a moment.
The private physio course three years ago. The one before that. The sports massage you book when the back tightens. The osteopath a colleague recommended. The orthotics. The six weeks you didn't train, and the six weeks after that spent rebuilding what you'd lost.
Most people have never totalled it, because it arrives in small instalments spread over years and each one feels like a one-off.
Here's what the figures actually look like. Private physiotherapy in London typically runs £60 to £120 per session, with an initial assessment in London at £90 to £140 and follow-ups at £65 to £95. A course of treatment for persistent lower back pain is commonly six to eight sessions, £420 to £750. A straightforward ankle sprain, three to four sessions at £220 to £370.
Three episodes across a decade, which is unremarkable for someone who plays sport in their forties, lands somewhere between £1,500 and £2,500. That's before scans, before anything surgical, and before counting the training time lost.
None of that money was wasted
This needs saying clearly, because the obvious version of this article says the opposite and the obvious version is wrong.
Your physio resolved the episode. That is what treatment is for, and when you walked out pain-free, it worked. The money bought exactly what it was meant to buy.
The issue isn't that the spending was pointless. It's that at the end of it, nobody could tell you whether anything about your underlying capacity had changed, because measuring that isn't what treatment is for, isn't what the appointment covers, and in most settings isn't funded.
So you have three courses of treatment, three successful outcomes, and no data. The episodes resolved. The question of what you're actually working with was never asked.
Why the system is built this way
Healthcare, public and private, is organised around presentation. Something hurts, you seek help, help is provided. The entire apparatus activates after the symptom.
That's not a failure of design; for acute problems it's the correct design. But it means the period between episodes, when nothing hurts, is unattended by anyone. Your physio's remit ended at discharge. Your trainer has no way to measure limb symmetry or reactive quality. The equipment isn't in the gym and it isn't in the qualification. So nobody's job covers the gap.
The scale of what sits in that gap is substantial. An estimated 511,000 UK workers suffered work-related musculoskeletal disorders in 2024/25, costing 7.1 million working days, and musculoskeletal conditions overall account for around a fifth of all sickness absence in the UK economy. Office for National Statistics figures put 23.3 million working days lost to MSK conditions in 2021.
Those are workplace figures and they aren't about recreational sport. I cite them for one reason: they show a system that spends enormous sums reactively. There is no equivalent figure for what's spent proactively, because very little is.
The cost you can't invoice
The treatment bill is the visible part, and usually the smaller one.
A six-week layoff isn't six weeks of lost fitness. It's six weeks lost plus the weeks spent rebuilding to where you were. Do that three times in a decade and you've spent a meaningful fraction of your training life getting back to a baseline rather than past it.
Then there's the quiet adaptation. You stop chasing the wide ball. You ski three days and write off the fourth. You drop the thing you used to enjoy most and replace it with something safer. Nobody bills you for that, and if you're the sort of person who has organised a significant part of your life around physical activity, it's the expensive part.
Workers affected by musculoskeletal disorders lose an average of 14 working days per case. For someone whose work is demanding and whose training is the thing that makes the rest tolerable, the number that matters isn't the days off. It's the years of reduced participation that never appear in any statistic.
What an assessment actually buys
Let me be precise about this, because it's where most writing of this kind overreaches.
It does not prevent injury. No test in the battery, alone or combined, has demonstrated adequate sensitivity to predict injury in this population, and I'm not going to tell you otherwise. Anyone selling assessment as injury prevention is selling something the evidence doesn't support.
It does not guarantee you'll spend less. I can't know that and neither can anyone else.
What it buys is narrower and, I'd argue, more valuable to someone used to evaluating spend.
A baseline. An objective record of what you can currently produce: force each side, how quickly you produce it, how efficiently you absorb load, how fast you recover. Not an impression. Numbers.
A measurable answer at eight weeks. The same tests, same conditions, compared. Did the training do anything? Without a baseline you're asking whether it felt like it did, and feeling is a poor instrument, heavily influenced by sleep, mood, and what you expected to feel.
The ability to tell a working plan from a plausible one. Hip abduction symmetry moving 71% to 84% is a result. It staying at 71% is also a result, and a more useful one, because you've learned in eight weeks rather than in a year that something needs changing.
That's the honest proposition. Not that measurement makes the next episode disappear. That you stop spending years on training you can't evaluate.
The framing that actually fits
If you run anything (a business, a portfolio, a budget), you don't assess spending by whether it felt productive. You measure the output.
Your training is probably the largest recurring investment of time you make that has no measurement attached to it at all. Several hours a week, every week, for decades. The only feedback loop is whether you feel better, and feeling is exactly the signal you'd distrust anywhere else.
£400 for an assessment is not an insurance premium against future healthcare costs. I'd be making something up if I framed it that way.
It's the cost of finding out what you're working with, and of being able to answer, in eight weeks and with numbers, whether what you're doing about it is working.
Most people spend a decade on the question and never get an answer.
Common questions
Is a performance assessment worth the money?
It depends what you want from it. If you want a guarantee against future injury, no assessment can honestly offer that. If you want an objective baseline and the ability to tell at eight weeks whether your training changed anything measurable, that's precisely what it provides.
How much does private physiotherapy cost in London?
Typically £70 to £120 for an initial assessment and £60 to £100 per follow-up, with central London clinics at the upper end. The UK median initial fee is around £74, with London averaging £84.22, a 21.3% premium.
Does assessment replace seeing a physiotherapist?
No, and it isn't meant to. If something currently hurts, a physio or GP comes first. Assessment is for afterwards, once treatment has done its job and you want to know what you're returning to load with.
Will this stop my injury recurring?
Nobody can promise that honestly. What measurement gives you is a specific, numbered deficit to work on and a date to check whether working on it changed anything.
Giacomo Di Mauro holds an MSc in Clinical Exercise Science and previously worked as a cardiac rehabilitation exercise physiologist in the NHS. FORMA, The Performance Clinic, runs objective performance assessment in Blackfriars, London, working alongside, not in place of, your physiotherapist or GP.