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I went to a physical therapy clinic for my back pain problem where I was treated by three different therapists. They all did something different for the same problem. How do therapists know what treatment to provide for each of us patients? If it's the same person with the same problem, shouldn't the same treatment be given?

Physical therapists are indeed commonly involved in the treatment of patients with low back pain. Like all health care professionals, therapists must base treatment on evidence that the treatment is beneficial to the patient. The evidence we have so far suggests that not all low back pain should be treated the same. Sometimes manipulation is the best approach whereas in other cases, exercises are advised. And even within those categories of treatment, there are subgroups to choose from. For example, exercise could include stretching for flexibility or strengthening to improve stability. How does the therapist know what treatment to provide for each individual patient? The answer to that question can be found in the recently published document: Low Back Pain. Clinical Practice Guidelines (CPGs) Linked to the International Classification of Functioning, Disability, and Health (ICF) from the Orthopaedic Section of the American Physical Therapy Association (APTA). Risk factors, clinical course, diagnosis, examination, and outcomes are all discussed in detail. Information provided and recommendations made are all based on current evidence available. The approach taken is toward returning patients to their previous level of function. This is a shift from the past when everything was viewed as disability and dysfunction rather than ability and function. This publication is a must-read for all physical therapists who are working with patients who have low back pain. As the name implies, the 57-page document is a guide to assist therapists in knowing how to approach each patient with low back pain. This clinical practice guideline for low back pain treated by the physical therapist was written by eight physical therapists best-known for their research, knowledge, and understanding of low back pain. An even larger group of names well-known to physical therapists are listed as reviewers. As more research is done and evidence becomes available, these guidelines will be updated. You may want to ask your therapists if they are familiar with this document and/or using the guidelines to plan treatment for you. Patient education should be a feature of every physical therapy program provided to patients with low back pain. This would be an opportunity for your therapist to provide additional information as requested by you.

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