Hi Gabriel

To be honest - it much more depends on the kind of physiotherapy. I'd recommend you take a look at Matrix Rhythm Therapy (scientific discovery und clinical application developement by a gentleman Ulrich Randoll in Munich.

As a matter of fact: most physiotherapies lack a scientific background. Take e.g. shock wave therapy, or take all the machinery for strenthening muscles. If you are familiar with molecular cell physiology you recognize that these therapies - and many others - cannot help cells to get back into a healthy state. And since all disieases happen on a cellular level, it is much smarter to look for therapies that cure cells  - cells of all kind.

With MRT you need less sessions than with conventional PT and in most cases after the first treatment patients get a partial or even full relief that lasts for days or even weeks. This after one single application - well rather treatment.

But look for yourself.

Hans I think you are mistaken to dismiss physiotherapy as lacking a scientific background. There are at least 24,721 RCTs evaluating physiotherapy treatments archived on the Physiotherapy Evidence Database or PEDro. 

The therapy requirements for chronic LBP are dependent on a number of different issues including pain location, frequency, duration, severity, quality and causation. Yet another important consideration is what type of therapy is administered, ranging from totally passive (e.g. massage, electrotherapies, thermal, vibration, lotions-potions-unguents) to intense exercise-based workouts.

Bearing all such considerations in mind, I am prepared to generalise (although with the added caveat that each case is unique, hence  common sense, caution and care are essential). My advice is "use it or lose it" - in other words, appropriately prescribed exercise on a daily and frequent basis is beneficial. However, it would be a dangerous oversimplification to suggest that Pilates, yoga, McKenzie, etc are the best (or even good), so beware of what the spin doctors try to sell you. Whatever approach to exercise you chose to use, remember to warm up first and ease into it gently. Pain is a warning, not a barrier that needs to be overcome!

As for acute LBP - don't do or prescribe anything without a comprehensive pathology report, a trustworthy diagnosis, and exercise prescription provided by an expert who knows their stuff! Seriously. 

Hans, your comment suggesting physiotherapists do not use a scientific rationale/background is very misguided. i am assumming there is excellent scientific credibility for MRT????? Thats quite a suggestion that this method resolves all symptoms in one session - I am somewhat doubtful

The only way to reply this question is by applying the scientific method.

Same diagnose, same severity, same inclusion or exclusion criteria and different therapies or different protocols for the same treatments should be objectivelly controlled before providing a reply.

When, for any treatmen,t you apply different methodologies, different "dosages", different number of sessions", different phsyiotherapy interventions, is very difficult, to no say impossible to isolate what has / have been the factor/s involved in the improvement of our patients.

We have a lot work to do in order to provide these kind of replies.

I thought the question was about frequency of physiotherapeutic intervention, not about the scientific evidence.....

For chronic pain (depending on your frame of refererence) we treat most patients twice a week. Then you have time for sufficient training intensity an recovery in between. And in our experience you get enough grip on the behavioural aspects of the patientens. For comparison: we also have groups that come only once a week (mostly because of travelling distances).

What we see is that in this group behavioural aspects are sometimes more difficult to control. However this can also be because the problems in this once a week group are more complex! 

We have no experience with acute backpain. However, when considering that acute problems actually reflect some tissue damage I would suggest one or two consultations for diagnostics and advice and then have the patient get some rest for a week or so. Then one consultation to judge the status and advice the patient how to continue recovery should do the trick. Okay, one extra consult if you have a stubborn or insecure patient.....

Like I said, based on you frame of reference you might want to have extra visits doing massages, electrical stimulation, or whatever, But the above set should be sufficient in most cases.

Labuschagne's answer sits well with me. Can I rephrase this with S.I.N.S [Severity, Irritability, Nature and Stage]. There is literature on this. My guide in the acute stage is: If the therapy is providing pain relief, then you could justify treating 2-3 times per week... isn't it ethical to provide the service which offers pain relief (use a VAS to be objective), instead of sending them away for a week?

Dear Aubrey,

I agree with you, but please consider that providing pain relief in the acute phase might prolong complaints: when experiencing less pain patients will be tempted to overburden themselves.....

So what kind of pain relief are we talking about  with what purpose (and couldn't a pain killer do the same thing but cheaper?)

As you may guess I am thinking in terms of optimal therapy, not the therapists wallet.

For low back pain, if we can educate, reduce pain and improve movement ASAP, we may avoid protective & catastrophising behaviors. A yellow-flag questionnaire will help identify those who may be tricky [with psychosocial factors]. The sooner we can do this the less chance of them falling into the CLBP sub-group - which as you probably know makes management more difficult and more expensive (in the long run).

Dear Aubrey,

I fully agree with you. Question is: how much time does it take? See my previous input. 

The question was "frequently of treatment". I suggest 2-3 times in the first week of an acute LBP presentation - then 1-2 times per week (hands on & rehab progressions) until they have fully recovered. If they plateau, refer on for second opinion.

Dear Gabriel,

most of the others have already mentioned a lot of issues. I assume you should take an Evidence based practice approach, with a good clinical reasoning. There are probalbly guidelines based on SR of RCTs. The second is your expertise, the third is the patient himself. If you have the impression the patient cannot cope or adhere to your recommendations, program or exercises you have to re-evaluate why. My experience in the acute stage is that counselling how to behave during the rest of the day is very important. You probably see the patient half an hour, what happens the other 23.5h? If you are sure, the patient can manage himself, you can either reduce the frequency or check other "building sites" first. If the patient improves himself, I take him on the long leash and reduce the frequency to once in a fortnight or even less.

Hans, I really looking forward to the first RCT on MRT or whatever. The miracles of new therapies will be put into perspective eventually.

all the best

Markus

The number of physiotherapy sessions per week depends on several factors such as: chronic low back pain or acute; intensity of pain; type of physiotherapy treatment; for availability of the patient, among others.

Dear Amelia,

Your approach of the problem is one found in many therapists. It can be questionned whether this approach is most effective. Your approach might lead to more intensive treatment of patients who show more pain behaviour (intensity of pain). Do these patients indeed need more treatment? Giving more treatment to more pain behaviour might induce adverse effects. My suggestion would be to determine the number of treatment sessions on your therapy goals and expected effort to achieve them.

Dear Jan-Paul

To determine the optimal number of physiotherapy sessions a week is not easy. I believe that the ideal is not to create a session number of protocol but after evaluation of the patient taking into account the intensity of pain, limitation of functioning and quality of life, to propose the number of sessions and follow up the improvement of the patient.

If an acute patient is in severe pain.

Would that be a reason to see him (1) more often? Or (2) less often.

ad 1. It can be argued that more sessions could relieve more pain

ad 2. It can be argued that an acute problem needs time to heal. To many interventions might disrupt the healing process. 

In chronic pain, the patient needs time to perform and adjust to the training program. This leads in most cases to goal based treatment, not to a patient-severity based treatment.

You can follow the recommendations from GUIDE TO PT PRACTICE after which you should bring in your own experience and most of all the response of patient to the treatment.

If you can't have your " non-specific low back pain" patient free of pain in the first three days with appropriate corrective exercises, you probably wont help him/her in the next  three months.  You should probably refer him to someone else.

Thanks for all responses. I quite know from practice evidence that physiotherapy helps significantly, majority of lowback pain patients be it at acute or chronic phase, aside evidence from RCT. I was only trying to if i could get opinion and or possible study findings on studies into frequency-week / duration of physio care for cases of lowback pain. Personally i feel each cases should be treated on its own merit/demand based of observation and/or examination findings. Meanwhile the answers given are quite useful. MORE answers/comments are expected.

THANKS TO EVERYONE FOR YOUR RESPONSES SO FAR. REMAIN BLESSED

I suggest three to five sessions per week for outstanding treatment outcome

The number of sessions depends on various aspects:

1. Low back pain is acute, sub acute or chronic?

2. What type of physiotherapy treatment? For example, Global Postural reeducation proposes once or twice a week

3. Depending on the availability of the patient