Within physical therapy and among physical therapists there is a a lot of variation in treatments that can be implemented. I’ve worked in hospitals and private clinics, and I have yet to meet 2 physical therapists who would approach a patient with low back pain in exactly the same way. A lot depends on the therapists level of experience, continuing education, and clinical training.

When I graduated with my master’s 10 years ago, I could treat a patient with low back pain in a very basic way. I had done one of my clinical rotations at an outpatient clinic in rural Iowa, and I learned entry-level techniques, without a lot of emphasis on manual therapy for the spine. With my low back patients, I would do some stretching, strengthening, modalities (like ultrasound and electric stimulation), and basic soft tissue and joint mobilization. The lower back was certainly not the area I was most comfortable treating.

Then I attended a seminar where I learned muscle energy techniques, and it changed my approach to back pain (and how quickly my patients felt better). A year or so later I learned another type of joint mobilization and again my experience, approach, and effectiveness improved. I also learned myofascial release, a type of soft tissue mobilization, which added another hands on tool for me to utilize. I wonder had I not taken these particular courses, would I still dread evaluating and treating lower back pain.

I recently read an article that talked about how the approach to care for low back pain patients varies greatly. Some practitioners take a very gentle approach to working with these patients, doing aquatic exercise, gentle stretching, heat, ultrasound, and ice. Others use McKenzie exercises, which encourage a lot of back bending type exercises. Some prefer to do all spinal stabilization. Some therapists use only hands on techniques to restore alignment and muscle balance. This is in high contrast to others, such as the New England Baptist Spine Program which takes a very aggressive approach to strengthening and does not use any modalities or hands on treatment (which has very good clinical results for decreasing pain and improving function for patients with chronic back pain.).

I feel very strongly that each patient is unique and their experience of pain must be looked at very individually. My experience has shown that a combination of some manual therapy, stretching, strengthening, and pain management modalities (all specific to the patient’s body and needs) if necessary provides relief for most patients. If you are working with a therapist and not seeing results, it may be that a different approach to your condition may be what you need. If you notice you are only doing exercises and the therapist doesn’t do any hands on work, you may need some specific joint stretching done. If your therapist is only doing hands on work and modalities, you probably need to do exercises to maintain the changes that their hands are invoking. It’s perfectly okay and appropriate to let your PT know that you are concerned about a lack of progress. You can also ask for a second opinion. You may not feel comfortable telling your provider that you want a different PT to see you, but a good therapist should be open to at least getting a colleague’s opinion and suggestions if you aren’t improving. You can always seek treatment at a different facility as well. If you take that route, be sure to communicate with your new therapist about the specifics of prior treatment that weren’t effective so you can start in the right direction. (You will also need to talk with your insurance company as they may not pay for a second evaluation and you may have partially exhausted your benefit.)

There are many options for back pain treatment within and aside from physical therapy. The same treatment doesn’t work for everybody; if it did, there wouldn’t be anybody living with chronic pain. If you can be open to trying new things, be consistent with the requirements of the treatment (if you don’t do any of your exercises and aren’t getting better, that may be the problem), and be proactive in finding the best solution for yourself, over time you should find relief from your pain.