Getting a Second Opinion in Physiotherapy

Is it normal to want a second opinion in physical therapy?

Seeking a second opinion in physical therapy is a legitimate step toward better understanding your situation and your treatment options.

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.

You have the right to consult another physical therapist, even if you are satisfied with your current therapist. Article 21 of the Code of Ethics protects this right and requires the professional to facilitate this consultation.

A second review can confirm the current plan, clarify any remaining uncertainties, or suggest adjustments. This consultation does not guarantee a faster recovery.

This article explains when to seek a second opinion, how to prepare your case, and what questions to ask to decide on the next steps.

When to seek a second opinion in physiotherapy?

A second opinion may be helpful if your progress has stalled, if the explanations remain unclear, or if you are unsure which treatment to choose. A significant worsening of your condition requires prompt reevaluation; a medical emergency should not wait until your next appointment.

No improvement after several sessions
New-onset back pain often improves over the course of several weeks, but not always as quickly as one might think.¹ If your pain, range of motion, or ability to perform daily activities isn’t improving, discuss the possibility of a reevaluation. Also mention any exercises you find difficult to do and any obstacles to following through with your treatment plan. Learn more about the effectiveness of physical therapy.

Uncertain Diagnosis
A second opinion can reevaluate the proposed explanations for your pain. However, tests do not always allow for the definitive identification of the tissue responsible for back pain. This limitation does not prove that the evaluation was performed incorrectly.²

Certain tests can increase or decrease the likelihood that a disc or a pelvic joint is the cause. Discs are cushions between the vertebrae, the stacked bones of the spine. However, the cited review does not clearly establish that this information improves treatment decisions. The physical therapist must explain what is known and what remains uncertain.²

Worsening Pain
If the pain increases significantly after sessions and this worsening persists, contact your therapist or a healthcare professional right away. A second opinion can complement this reevaluation. It does not replace urgent care if new, concerning symptoms appear.

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
Before scheduled surgery, a second opinion can help you weigh the benefits, risks, and non-surgical options. It should not delay an emergency procedure. In a trial involving 351 people aged 45 or older, a meniscus tear—a cushioning structure in the knee—coexisted with mild to moderate osteoarthritis, a long-term change in the joint that can cause pain and stiffness. At six months, physical function had improved in both groups, with no clear difference between surgery followed by physical therapy and physical therapy alone. However, 30% of the group initially assigned to physical therapy had undergone surgery before this follow-up. These results do not guarantee that surgery can be avoided.³

Medical imaging produces images of the inside of the body. MRI, or magnetic resonance imaging, uses a magnetic field to produce detailed images. A study of 555 workers with recent back pain who were on sick leave compared early MRI with no MRI. In the absence of a clinical indication for this early test, an MRI within the first 30 days was associated with longer sick leave and higher medical costs. This observational study does not prove that MRI alone causes these differences. Ask what information the test would provide for your treatment.⁴

Examples of situations to discuss during a reassessment:

Difficulty raising the arm can have several causes. Capsulitis affects the shoulder joint capsule and limits its movement. Tendinopathy affects a tendon, the tissue that connects a muscle to a bone. Bursitis is inflammation of a small sac that helps tissues glide smoothly. A physical examination helps distinguish between these possibilities; the absence of muscle weakness alone is not enough to differentiate them.

When it comes to knee pain, cracking sounds alone do not indicate which tissue is affected. The physical therapist examines movement and strength, among other things. He or she seeks to determine whether the problem lies in the joint, the cartilage covering the bone surfaces, or the tendon located beneath the patella, the bone at the front of the knee.

Lower back pain that radiates down the leg does not automatically require surgery. A herniated disc occurs when part of a disc protrudes beyond its normal outline. Other problems can also cause referred pain: facet joint syndrome involves the small joints at the back of the spine and can cause pain in the buttock or thigh. Foraminal stenosis is a narrowing of the nerve channel where the nerve exits the spine. Piriformis syndrome refers to irritation or compression of the sciatic nerve near a deep muscle in the buttock. These conditions cannot be confirmed based solely on the presence of leg pain.

In a study of 283 people with sciatica—pain that radiates down the leg—and a lumbar disc herniation, the treatment options compared were surgery versus extended care without initial surgery. At one year, 84% reported complete or nearly complete resolution of symptoms. The presence of a herniated disc on the MRI performed at that same follow-up did not distinguish those who had improved from the others. This result is based on follow-up images, not on a prediction of recovery based on the initial MRI.⁵

How to get a second opinion?

You can request a second opinion by contacting a physical therapist and explaining the reason for the consultation. In private clinics in Quebec, you do not need a doctor’s referral to see a physical therapist; however, you should check the reimbursement requirements.

Check your coverage: The Ordre professionnel de la physiothérapie du Québec (OPPQ) explains the rules for private consultations and reminds you that some insurance policies require a prescription. For a work-related injury, the CNESST, which administers workers’ compensation, requires a prescription from the treating health professional. For a traffic accident, the Société de l’assurance automobile du Québec (SAAQ) specifies its requirements for prescriptions and reimbursement. Confirm coverage for a second evaluation before your appointment.

You do not need permission from your first therapist: You can see another physical therapist. Ask for a copy of your medical records to help the new therapist understand the care you have already received.

Choose a therapist with relevant experience: Ask if the physical therapist regularly treats conditions like yours—such asbalance issuesor dizziness, sports injuries, or muscle or joint pain.

Be transparent: Mention that you are seeking a second opinion when booking your appointment.

Detailed process for obtaining your file:

Submit a written request for a copy of your records to the clinic’s privacy officer. The clinic may verify your identity. Sections 32 through 36 of the Health and Social Services Information Act require a prompt response, no later than 30 days after receipt. This timeframe applies to the response to the request; any denial must be supported by a written explanation.

For your own records, copies of the information to which you are entitled are provided free of charge, as specified by the OPPQ since 2025. Request evaluation and follow-up notes, tests, exercises, and relevant communications with other professionals. If information is not disclosed, ask for a written explanation and information on available remedies. A request for identity verification or clarification does not indicate a problem with your care.

What should you bring?

You can bring your medical reports, a list of treatments and exercises you’ve already tried, your insurance information, and the activities you’d like to resume.

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.

Administrative Information: Bring your private insurance information and your CNESST or SAAQ case number, if applicable. Ask the clinic what form of identification is required, such as your Régie de l’assurance maladie du Québec (RAMQ) card. This card does not automatically make private care free of charge.

Functional goals: Note what you want to be able to do again ("Lift my child without pain," "Return to running").

What questions should you ask?

Useful questions include those about the causes of your pain, the proposed treatments, their benefits and limitations, and the progress you should monitor.

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 would a good result look like in my case, and what should I be able to do again?

What is Physioactif's approach to second opinions?

Physioactif accepts requests for second opinions and explains its assessment, even when it confirms the current treatment plan.

The purpose of this meeting is to help you understand your options and decide on your next steps for care.

We actively encourage seeking a second opinion
If you have any doubts, seeking a second opinion is not an insult; it is a responsible decision that we fully respect.

Our Commitment to Transparency
We explain the assessment findings, the proposed options, and their limitations. Confirmation of the current plan is also one of the possible outcomes.

Evidence-Based Assessment
Our physical therapists take into account research findings, your examination results, and your goals. If the current plan remains appropriate, we’ll explain the expected progress and when to reassess it.

Referral to Another Specialist
If your condition requires expertise that our team does not have, we will refer you to a professional who does. This may involve a complex issue related to the pelvis, balance, or nerves.

What to Expect During a Second Opinion Consultation?

The second-opinion consultation reviews your medical history, assesses your range of motion and strength, and then compares treatment options with your current plan.

Ask about the estimated duration when you make your reservation. The assessment includes the following items, depending on your situation:

History of your symptoms: Onset, progression, actions that increase or decrease the pain, health issues, and activities you would like to resume.

Document Review: An examination of your imaging reports, test results, and notes from previous treatments.

Physical examination: An assessment of your movements, strength, and the actions that trigger your symptoms. Tests of your joints, muscles, or nerves may be part of the examination.

Explanation of the results: What the examination suggests, what it does not allow us to conclude, possible causes of the pain, and differences from the initial evaluation.

Disc changes are visible on imaging in people without pain. A review of 33 studies involving 3,110 asymptomatic individuals estimated the prevalence of age-related disc changes at 68% by age 40. It estimated the prevalence of a bulging disc—one whose edge protrudes—at 40% by age 30. These percentages are derived from a statistical model combining the studies; they do not predict your pain. Imaging results must be interpreted in conjunction with your symptoms and physical examination.⁶

Treatment Plan: Recommended approach, frequency, duration, expected progression, and initial exercises.

What the physiotherapist will specifically assess:

The physical therapist may observe how you walk, raise your arm, or perform another difficult movement. They assess the movements you avoid, the distance you can walk, and the level of exertion you can tolerate. These observations complement measurements of movement and strength.

The physical therapist will also ask you about your work, sleep, and any concerns that make it difficult for you to carry out your activities or follow through with your treatment. For example, repetitive movements at work may make it hard to fit an exercise into your daily routine. This information helps tailor the treatment plan; it does not mean that your stress is to blame for a treatment failure.

For recent back pain, the cited review found modest benefits in terms of pain relief and physical function when patients are advised to stay active rather than stay in bed. For sciatica—pain that radiates down the leg—the review found little or no difference between these recommendations. Activities should be tailored to your symptoms.⁷

The physical therapist will review your progress, your goals, and the known outcomes of the proposed treatment to discuss the next steps.

This consultation does not obligate you to start treatment immediately.

What if your first therapist was right?

Physioactif explains why the current plan remains relevant once the second opinion confirms this, and then discusses with you how to proceed and any possible adjustments.

Transparency is at the core of our approach.

Confirmation of the current plan
The second opinion may confirm the approach and suggest only a few adjustments. We then explain the reasons for this conclusion.

Explanation of Discrepancies, When They Exist
If assessments differ, we explain the observations that support our opinion. New information, aspects examined differently, or different experience may explain the disagreement. Uncertainties must also be discussed.

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.

Examples of Second Opinions: The following situations illustrate issues to consider. They do not describe actual patient cases or guaranteed outcomes.

Example 1: Adjusting a Program
A person with patellar tendinopathy—pain in the tendon beneath the kneecap—is not making progress after five weeks of exercises. Eccentric exercises work the muscle as it lengthens under resistance. A second opinion can assess the technique, the resistance used, and the response after each session. The adjustment may involve the load or frequency; a lack of progress does not automatically mean that the intensity needs to be increased. Recommendations can be forwarded to the primary therapist.

Example 2: Supplementing the Assessment of Movement
A patient being treated for frozen shoulder is not making progress with the stretches and therapist-guided movements. A second opinion can examine the movement of the scapula—the flat bone behind the shoulder—and the difficulty in raising the arm. A different pattern of scapular movement alone does not prove the presence of another condition. The program can be tailored to the person’s abilities and goals.

Example 3: Specifying Expected Progress
A person with knee osteoarthritis remains dissatisfied after three sessions. The second opinion can revisit the plan and agree on concrete outcomes, such as walking longer distances or climbing stairs more easily. Confirming a plan does not require the person to ignore the lack of progress: a date for reassessment and possible adjustments should be discussed.

What are some common questions about second opinions?

The most common questions concern the initial therapist's reaction, the obligation to inform them, the cost and timing of the consultation, discontinuing the initial treatment, and what to do if the two opinions differ.

Will my first physical therapist be offended?
Your right to consult another professional does not depend on his or her personal reaction. The Code of Ethics requires him or her to facilitate this process.

Should I let my first therapist know?
You don't need to get their permission. However, you can explain your decision to them and ask them to share any information that might be helpful for your second evaluation.

How much does a consultation cost?
Each private clinic sets its own rates. Ask about the expected cost of the evaluation before making an appointment, and check what your insurance covers. The OPPQ does not publish a fee schedule.

How long should you wait before seeing a therapist?
The reasonable waiting period varies depending on your condition; discuss this with your therapist. If your pain worsens, don’t delay in seeking help. Understanding when to see a professional.

Back pain may sometimes require urgent care. Seek medical attention immediately if you also experience an unusual sensation of heat or cold, chills, or general malaise, or if the pain is very severe and sudden or worsens rapidly. Go to the emergency room if your back pain is accompanied by pain, tingling, weakness, or numbness in both legs; loss of sensation in the genitals or anus; changes in urination, bowel movements, or sexual function; or chest pain. Pain that develops after a serious accident also requires emergency care. These changes include difficulty urinating, leakage of urine or stool, changes in sensation during sexual intercourse, or new difficulty achieving an erection or orgasm. Do not drive yourself; call 911 if you need an ambulance. These signs, as described by the NHS (the UK’s public health service), should not be delayed while waiting for a second opinion from a physical therapist.

What if the two opinions differ?
Ask for the reasons behind the disagreement and the consequences of each option. A third opinion or a medical consultation may be helpful if a question remains. Additional tests are not automatically ordered. You can also agree on a plan, measurable goals, and a date for reevaluation.

Can a second opinion identify a medical condition?
The physical therapist looks for signs that may require a medical evaluation, sometimes an urgent one. No single sign or second opinion can identify all serious illnesses with certainty.⁸

Should I stop the initial treatment?
A second opinion does not automatically mean you should stop your current treatment. Discuss which exercises and treatments to continue or adjust, and then agree on a coherent plan with the relevant professionals. If an exercise makes the pain worse, stop doing it and seek advice. A medical emergency should be evaluated immediately, without waiting for the second opinion.

What if the second opinion confirms the first?
Ask what justifies continuing treatment, what progress to monitor, and when to reevaluate the plan. A confirmation can help you decide; it does not obligate you to accept a treatment that does not meet your needs.

How do I make an appointment at Physioactif for a second opinion?

You can schedule an appointment for a second opinion by contacting a Physioactif clinic or booking online, and then specifying the reason for your visit.

Our team welcomes you to our clinics in the Greater Montreal area.

Our team helps people with muscle or joint pain, sports injuries, balance issues, chronic pain, or needs related to pregnancy and the postpartum period. When making your appointment, please request a physical therapist whose expertise matches your needs. We’ll explain our assessment, even when it confirms your current treatment plan.

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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1. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in patients with recent-onset low back pain in Australian primary care: an inception cohort study. BMJ. 2008;337(7662):a171. (Back to section: 1)
2. Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, et al. Systematic review of tests to identify the disc, SIJ, or facet joint as the source of low back pain. Eur Spine J. 2007;16(10):1539-50. (Back to sections: 1, 2)
3. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine. 2013;368(18):1675-1684. (Back to section: 1)
4. Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38(22):1939-46. (Back to section: 1)
5. el Barzouhi A, Vleggeert-Lankamp CL, Lycklama à Nijeholt GJ, Van der Kallen BF, van den Hout WB, Jacobs WC, et al. Magnetic resonance imaging in the follow-up assessment of sciatica. N Engl J Med. 2013;368(11):999-1007. (Back to section: 1)
6. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6. (Back to section: 1)
7. Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated Cochrane review of bed rest for low back pain and sciatica. Spine (Phila, Pa, 1976). 2005;30(5):542-6. (Back to section: 1)
8. Finucane LM, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. (Back to section: 1)
9. 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;2011(2):CD008112.