I’ve had two episodes of low back pain in the last five years. The first time I saw a physical therapist and made a very fast recovery. This time I was seen by a physical therapist assistant. My recovery has been much slower. Is there a big difference between the therapist and the assistant?

Studies consistently show that patients with low back pain (LBP) get better faster when treated by a licensed physical therapist (PT) when compared with a physical therapist assistant (PTA).

Some clinics only have PTs, whereas others have PTAs. The therapist is always the professional who evaluates the patient and establishes the plan of care (POC). The therapist supervises the assistant but is not with the patient for each treatment.

There are other variables to consider in the recovery process. First, there are many different causes of low back pain. The source of the pain could be a herniated disc, spondylolysis (slippage of the vertebrae), or sprain/strain. Outcomes can be different based on different diagnoses from episode to episode.

Secondly, patients who have other diseases or conditions may experience complications or problems in the recovery process. For example, patients with heart disease may not be able to exercise in a way that would speed up their rehab and recovery. Patients with diabetes need a careful balance between diet, exercise, and medications.

Even when treated by a licensed physical therapist, the type of clinic makes a difference. A recent study showed that high volume clinics (see many low back pain patients) are more efficient (see the patient fewer times) but not necessarily more effective (have better results).