What does physiotherapy for back pain involve?

The first appointment

The NHS describes physiotherapy as a treatment that uses exercise, massage and other techniques to ease pain and improve movement. At a first appointment the physiotherapist asks about your symptoms, medical history and lifestyle. They may feel the affected area and check things such as strength and balance.

They then talk through the treatment options and advise on how many sessions you may need. After each session you may be given exercises to do at home before the next one, and the NHS says it is important to do them regularly to help with recovery.

What treatment can include

The NHS lists several elements: exercises to improve joint movement and strengthen muscles, manual therapy (the physiotherapist uses their hands to massage and improve movement), and advice on managing symptoms. Some physiotherapists also offer other treatments, which the NHS names as ultrasound, TENS (a device that sends a weak electrical current to the nerves), hydrotherapy and acupuncture.

Guidelines are more selective for low back pain. NICE recommends considering manual therapy such as spinal manipulation, mobilization or massage only as part of a treatment package that includes exercise. It advises against offering traction, acupuncture, ultrasound or TENS for low back pain. The Chartered Society of Physiotherapy likewise says hands-on treatments have a small benefit and only when used within a whole program that includes exercise. So the mix you are offered may differ from the longer list on a general NHS page. For the evidence on exercise itself, see whether exercise helps back pain.

How people get physiotherapy

The NHS says that in many areas people can refer themselves to a community musculoskeletal (MSK) service for help such as physiotherapy, without needing a GP referral. Some GP surgeries have first contact physiotherapists who can assess you and offer advice. The NHS also notes that waiting lists can be long, and that some services offer telephone or video appointments or sessions for several people at once, particularly for long-term pain.

For private care, the NHS advises checking that the physiotherapist is chartered (MCSP after their name) and registered with the Health and Care Professions Council. Arrangements in other countries differ, so local rules and referral routes may not match this description.

Related questions

The NHS says that if back pain has not improved after a few weeks, other treatments may be recommended, including exercise sessions and physiotherapy, manual therapy and cognitive behavioral therapy to help with coping. Pain that continues for months is covered in what chronic low back pain is, and physiotherapy also features after operations, as described in recovery after spine surgery. More topics are gathered under recovery and daily life.

When to get help

The NHS says to see a GP if back pain does not improve after a few weeks of home care, stops you doing daily activities, or if you are worried or struggling to cope. Ask for an urgent GP appointment or call 111 for severe pain that starts suddenly or quickly worsens, or if you feel hot, cold, shivery or unwell. Call 999 or go to A&E for pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, bladder or bowel changes, chest pain, or pain after a serious accident.

The NHS also says to stop exercises and see a GP if pain gets worse. Care differs by country and by clinician, and a physiotherapist who has assessed you is the right person to say what suits your situation.