Question 1

How do I know if physical therapy is not helping?

Accepted Answer

Physical therapy progress is usually judged by more than pain alone. Your therapist may track changes in movement, strength, function, activity tolerance, and your ability to return to specific goals. The American Physical Therapy Association notes that treatment goals should be measurable and that physical therapists reassess progress throughout the plan of care.

If you have made little meaningful progress toward your goals, symptoms repeatedly return, movement remains significantly restricted, or you are unable to advance your rehabilitation as expected, it may be reasonable to discuss the treatment plan with your physical therapist and consider a physician reassessment.

Question 2

Should I stop physical therapy if I still have pain?

Accepted Answer

Not necessarily. Having some pain during a course of rehabilitation does not by itself mean that physical therapy should be stopped. Pain is complex, and the amount of pain a person feels does not always correspond directly to tissue damage.

Instead of stopping on your own, discuss persistent or worsening symptoms with your physical therapist. APTA guidance specifically recommends talking with your therapist before changing the frequency of treatment or stopping therapy. Your plan may need to continue as-is, be modified, or be reassessed by another healthcare professional depending on your progress and symptoms.

Question 3

When should I see a physician if physical therapy progress has stalled?

Accepted Answer

A physician reassessment may be useful when symptoms remain persistent or recurrent, your function is not improving as expected, the diagnosis remains uncertain, or new symptoms appear despite an appropriate rehabilitation program.

More urgent medical evaluation may be necessary for certain warning signs. For back or spine-related symptoms, examples include new bowel or bladder dysfunction, saddle-area sensory changes, progressive neurologic weakness, fever or signs of infection, significant trauma, or other findings that raise concern for a serious underlying condition.

The purpose of reassessment is not simply to replace physical therapy. It is to determine whether the current diagnosis and treatment plan still make sense or whether another step should be considered.

Question 4

Do I need an MRI if physical therapy has not helped?

Accepted Answer

Not automatically.

Imaging decisions should be based on factors such as your symptoms, physical examination, medical history, the body area involved, and whether imaging results are likely to change treatment. For uncomplicated low back pain without concerning findings, for example, the American College of Radiology generally does not recommend routine initial imaging.

For certain patients with persistent or progressive low back symptoms after an appropriate period of conservative treatment, MRI may become appropriate, particularly when an intervention is being considered. Imaging may also be needed sooner when red flags or significant neurologic findings are present.

A physician evaluation can help determine whether imaging would actually add useful information.

Question 5

Can Osteopathic Manipulative Treatment be used alongside physical therapy?

Accepted Answer

Yes, in selected patients and when clinically appropriate.

OMT and physical therapy are different forms of care. Physical therapy commonly emphasizes exercise, rehabilitation, strengthening, movement training, and functional progression. OMT is physician-delivered hands-on treatment involving muscles, joints, and soft tissues.

Cleveland Clinic describes hands-on treatments such as OMT as potential additions to, rather than replacements for, conventional musculoskeletal rehabilitation.

At Livo Medical, a physician evaluates the problem first. If relevant musculoskeletal findings are present, OMT may be considered alongside continued rehabilitation rather than automatically replacing physical therapy.

Question 6

What happens during a physician reassessment when physical therapy has not fully helped?

Accepted Answer

The physician can review what originally led to physical therapy, how your symptoms have changed, what has improved, what remains limited, previous testing or imaging, and how you have responded to rehabilitation.

A focused examination may then assess the painful area, movement, function, muscles, joints, surrounding tissues, and relevant neurologic findings. Based on those findings, the next step might be continued or modified physical therapy, OMT when appropriate, additional testing, follow-up, or referral to another specialist. Osteopathic specialty standards similarly emphasize comprehensive assessment, appropriate use of imaging, rehabilitation, referral, and individualized treatment planning rather than assuming every patient needs OMT.

What to Do When Physical Therapy Isn’t Helping?

Still Having Symptoms Despite Physical Therapy

Some soreness can be expected as rehabilitation progresses. But persistent pain, stiffness, restricted movement, or difficulty advancing through therapy may be a reason to reassess the problem rather than simply repeat the same plan.

There May Be More Than One Reason

The Original Diagnosis
May Need Reassessment

Movement Restrictions
May Persist

Recovery May Need More Time
or a Different Plan

Physical Therapy May Still Be the Right Treatment

A Stepwise Approach to Stalled Progress

Can OMT Be Used Alongside Physical Therapy?

OMT

Physical Therapy

Persistent Symptoms Can Show Up in Different Areas

Back Pain

Neck Pain

Shoulder Pain

Hip Pain

Knee Pain

Leg Pain

Working With Your Physical Therapist

Frequently Asked Questions

Not Sure What Should Come Next?