Getting a Second Opinion in Physiotherapy
You've been undergoing physiotherapy treatments for a few weeks, but you haven't seen significant improvement. Perhaps the exercises seem unsuitable, or the explanations given don't match what you're feeling. You're wondering if it would be appropriate to consult another physiotherapist.
This hesitation is perfectly normal. Seeking a second opinion in physiotherapy is not a lack of trust, nor is it questioning your current therapist. It's a proactive step you have the right to take to ensure you're receiving the best possible care.
Here's the good news: as physiotherapists, we actively encourage this approach. A second clinical opinion can confirm an approach, identify missing aspects, or offer complementary perspectives that accelerate your recovery.
This article will help you understand when and how to ask for a second opinion, what to bring to your consultation, and how this process can improve your treatment outcomes.
When to seek a second opinion in physiotherapy?
No improvement after 4-6 sessions
If your pain, mobility, or function hasn't improved after 4-6 sessions, it's a sign that the approach needs to be re-evaluated. Learn more about the effectiveness of physiotherapy.1
Uncertain diagnosis
If your therapist is unsure about the source of your pain or uses vague terms without specifying the affected structures, a second opinion can clarify the diagnosis.2
Worsening pain
If your pain significantly intensifies and persists 24-48 hours after sessions, consult another therapist.
Non-personalized treatment
If your treatment seems the same for everyone without considering your age, activity level, or specific goals, a second evaluation could offer an individualized approach.
Before surgery
Getting a second opinion before surgery is almost always recommended.3 Research shows that up to 30% of orthopedic surgeries could be avoided or postponed with appropriate rehabilitation. An evaluation by a second physiotherapist can identify unexplored conservative options that could delay or eliminate the need for surgery.
Specific situations requiring a second opinion:
Shoulder pain that limits overhead movements but without significant loss of strength warrants re-evaluation, as several conditions can overlap (capsulitis, tendinopathy, bursitis). Knee pain with cracking but without joint instability can benefit from different approaches depending on whether the problem stems from cartilage, the patellar tendon, or muscle control.
Lower back pain with radiating leg pain is not always a disc herniation requiring surgery. A facet syndrome, mild foraminal stenosis, or piriformis syndrome can produce similar symptoms but respond differently to conservative treatments.
How to get a second opinion?
Check your insurance: In Quebec, no medical referral is necessary. If you are covered by private insurance or CNESST/SAAQ, check your terms and conditions.
No permission required: It's your right to consult another physiotherapist. Simply request a copy of your file.
Choose relevant expertise: Look for a therapist specializing in your type of condition (vestibular, sports, orthopedic).
Be transparent: Mention that you are seeking a second opinion when booking your appointment.
Detailed process for obtaining your file:
Contact your current clinic by phone or email and request a complete copy of your file. In Quebec, you have the legal right to access your medical information within 30 days, generally free of charge or for a minimal fee (maximum 25 cents per page according to the law).
Your file should include initial assessment notes, treatment notes for each session, tests performed and their results, prescribed exercises with progressions, and any correspondence with other healthcare professionals. If your current physiotherapist hesitates to provide you with this information, it's a red flag that further justifies seeking a second opinion.
What should you bring?
Medical documents: Imaging reports (MRI, X-rays), test results, medical notes.
Treatment history: List of treatments received, prescribed exercises, notes on what worked or didn't work.
Insurance information: RAMQ and private insurance cards, CNESST/SAAQ number if applicable.
Functional goals: Note what you want to be able to do again ("Lift my child without pain," "Return to running").
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What questions should you ask?
Regarding the diagnosis:
- What is the main cause of my problem?
- How does it differ from the initial diagnosis?
- Are there any other possible conditions?
Regarding treatment:
- What approach do you recommend and why?
- What scientific evidence supports it?
- What is the frequency and duration of treatment?
Regarding expectations:
- When will I see improvements?
- What signs would indicate that it's not working?
- What is the likelihood of a full recovery?
What is Physioactif's Approach to Second Opinions?
At Physioactif, we have a clear stance on second opinions in physiotherapy.
We actively encourage second opinions
We believe that an informed and confident patient achieves better results. If you have doubts, seeking a second opinion is not an affront; it's a responsible step that we fully respect.
Our promise of transparency
When you come to Physioactif for a second opinion, we commit to providing you with an honest assessment, even if it means confirming that your current therapist was correct. Our goal is not to "steal" patients from other clinics, but to help you understand your condition and find the best approach for you.
Evidence-based assessment
Our physiotherapists base their recommendations on current evidence, your objective clinical examination, and your personal goals. We do not systematically criticize another therapist's approach to justify our services. If your current plan is appropriate but simply requires more time, we will tell you.
Specialization and referral
If your condition requires expertise that our team does not possess, we will tell you directly and refer you to a more qualified colleague. Certain complex pelvic conditions, rare vestibular disorders, or advanced neurological problems may benefit from highly specialized therapists.
What to Expect During a Second Opinion Consultation?
A complete 45-60 minute evaluation will include:
Detailed History: A review of your symptoms, how they've progressed, what makes them worse, your medical history, and your functional goals.
Document Review: An examination of your imaging reports, test results, and notes from previous treatments.
Physical Examination: Mobility tests, muscle strength assessment, symptom provocation, postural assessment, and specific orthopedic tests.
Diagnosis Explanation: Understanding the anatomical structures involved, pain mechanisms, and a comparison with your initial diagnosis.
Treatment Plan: Recommended approach, frequency, duration, expected progression, and initial exercises.
What the physiotherapist will specifically assess:
Beyond standard physical tests, a thorough second opinion looks at biomechanical factors that might have been overlooked. The therapist will observe your posture at rest and during movement, analyze your compensation patterns (how your body avoids pain), and test the quality of your movement rather than just the range.
The evaluation also includes questions about your lifestyle and how it affects your recovery. Does your job involve repetitive movements? Is your sleep impacted by pain? Are there any psychosocial stressors that are slowing down your healing? These contextual elements can reveal why a technically correct treatment might not be producing the expected results.
The physiotherapist will compare your current progress with evidence-based data for your specific condition. For example, if you have Achilles tendinopathy, literature suggests that improvement should be noticeable after 6-8 weeks of eccentric exercises. If you exceed this timeframe without progress, it indicates either an incomplete diagnosis or an improperly designed program.
This consultation does not obligate you to start treatment immediately.
What Happens If Your First Therapist Was Right?
Transparency is at the core of our approach.
Confirmation without Professional Ego
In about 30% of the second opinions we provide, our conclusion is that the initial therapist had an appropriate plan that simply requires more time or better patient adherence. When this is the case, we will tell you clearly.
Explaining Discrepancies When They Exist
If our assessment differs, we will explain why factually, without disparaging a colleague's work. Differences can arise from new information, different areas of focus, specializations, or complementary treatment philosophies.
Recommendations for Targeted Modifications
If we identify areas for improvement, we will suggest specific adjustments rather than completely dismissing your current plan.
Returning to Your First Therapist if it's the Best Option
If our evaluation confirms the current approach, we will encourage you to continue with your initial therapist, providing some suggestions you can share with them.
Professional Coordination
With your written authorization, we can communicate directly with your current physiotherapist to share our observations and work together to optimize your plan.
Real-Life Examples of Second Opinions:
Case 1: Plan Confirmation with Minor Adjustment
A patient with patellar tendinopathy had been following an eccentric exercise program for 5 weeks without improvement. Our evaluation confirmed the diagnosis and approach but identified that the exercise load was insufficient. Recommendation: gradually increase resistance and continue with the current therapist, communicating our suggestions for progression.
Case 2: Additional Diagnosis Identified
A patient was being treated for shoulder capsulitis with mobilizations and stretches but showed no progress. Our evaluation confirmed the capsulitis but also identified an unaddressed scapular dyskinesis (poor shoulder blade control). Recommendation: integrate a scapular stabilization program into the existing treatment.
Case 3: Unrealistic Patient Expectations
A patient was being treated for knee osteoarthritis with an appropriate approach but was dissatisfied after 3 sessions. Our evaluation confirmed that the treatment was optimal, but the patient expected a complete resolution in 1 month, whereas the chronic condition requires 3-4 months of rehabilitation. Recommendation: education on realistic prognosis and encouragement to continue the current plan.
Frequently Asked Questions About Second Opinions?
Will my first physiotherapist be offended?
A competent professional should never be offended. Seeking a second opinion is part of responsible health management.
Should I inform my first therapist?
It's not mandatory, but being transparent can make it easier to get your records.
How much does a consultation cost?
Between $75 and $150, depending on the region. Check your insurance coverage beforehand.
How long should I wait before seeking a second opinion?
After 4-6 sessions without improvement, that's a reasonable timeframe. If your pain worsens, don't wait. Understand when to consult a professional.
What if the two opinions differ?
Seek a third specialized opinion, consult your doctor for further tests, or try one approach for 4-6 weeks and evaluate the results.
Can a second opinion identify a medical condition?
Yes. The evaluation includes detecting "red flags" that require medical intervention.4
Should I stop the first treatment?
Generally, yes, to avoid conflicts and allow for a clear evaluation of effectiveness.
What if the second opinion confirms the first?
That's positive. Confirmation strengthens your confidence and adherence to the current plan.
How to Book an Appointment at Physioactif for a Second Opinion?
If you are considering a second opinion, the Physioactif team is available at one of our 5 clinics in the Greater Montreal area.
Our physiotherapists have various specializations (orthopedics, sports, vestibular rehabilitation, chronic pain, perinatal care) and use an evidence-based approach. We are committed to providing you with an honest and transparent evaluation, even if it means confirming that your current plan is appropriate.
To book an appointment, contact us directly or book online. We will be happy to support you on your recovery journey.
References
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Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008;337:a171. doi:10.1136/bmj.a171
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Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011;(2):CD008112. doi:10.1002/14651858.CD008112.pub2
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Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684. doi:10.1056/NEJMoa1301408
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Finucane LM, Downie A, Mercer C, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. doi:10.2519/jospt.2020.9971
