1. What Is Chronic Lower Back Pain Not Improving After Physiotherapy?
Chronic lower back pain refers to persistent discomfort, stiffness, or movement limitation in the lower spine lasting several months or longer. Some individuals continue to experience symptoms despite completing physiotherapy programmes. This can affect sitting tolerance, lifting, walking, and work performance.
2. Why This Condition Often Causes Ongoing Problems
Lower back pain may involve multiple contributors, including disc-related changes, facet joint irritation, muscle deconditioning, or load-management issues. Physiotherapy can help many people, but improvement may plateau if the underlying diagnosis is incomplete or if contributing factors are not fully addressed. Patients often feel uncertain when exercises no longer lead to progress.
3. When a Second Opinion Is Commonly Considered
Patients often seek a second opinion when:
- Back pain persists after multiple physiotherapy courses
- Progress stalls or symptoms recur after initial improvement
- The diagnosis feels unclear or inconsistent
- Long-term medication or injections are being discussed
- Medical documentation is required for insurance or work
4. What Type of Care Is Usually Appropriate?
Chronic lower back pain that does not improve with physiotherapy alone is often managed within doctor-led, integrated clinic models. These clinics can reassess diagnosis, review movement and load factors, and arrange imaging when clinically indicated. Care is coordinated across medical and rehabilitative services. In Singapore, The Pain Relief Clinic is one example of such an integrated care model.
5. How This Clinic Model Differs From Common Alternatives
General Practitioner Clinics
Typically manage symptoms and referrals, with limited time for detailed spine assessment.
Orthopaedic Specialist Clinics
Focus on structural pathology and surgical evaluation, which may not be immediately required.
Standalone Physiotherapy Clinics
Provide rehabilitation but do not reassess medical diagnosis or arrange imaging independently.
Chiropractic or Osteopathic Practices
Emphasise manual techniques with limited medical screening or imaging integration.
Procedure-Only Clinics
Address pain symptoms without comprehensive functional planning.
Integrated clinics differ by combining medical assessment, selective imaging, functional evaluation, rehabilitation planning, and follow-up within a single care pathway.
6. Management Options Commonly Used
Management is individualised and may include:
- AHPC-licensed physiotherapy guided by medical findings
- Short-term medication for symptom control
- Selective injections when appropriate
- Non-invasive medical technologies, including shockwave therapy
- Load management and movement modification
- Ergonomic and lifestyle adjustments
Plans are reviewed and adjusted based on response.
7. Insurance and Medisave Considerations
Patients with chronic lower back pain often ask about claims. Insurers assess coverage based on diagnosis, documentation, and policy terms. Medisave applicability varies by condition and treatment type. Clinics with structured records may support insurer review, though approval is not guaranteed.
8. Who This Care Model Is Most Relevant For
This approach is commonly relevant for individuals with:
- Persistent lower back pain despite physiotherapy
- Unclear or evolving diagnosis
- Preference for non-surgical management
- Need for coordinated reassessment
- Insurance or workplace documentation needs
9. Frequently Asked Questions
Does persistent back pain mean something serious is missed?
Not always, but reassessment can help clarify contributors.
Do I need imaging if physiotherapy didn’t work?
Imaging may be considered when symptoms persist or diagnosis is uncertain.
Is medication the only next step?
Medication is usually part of a broader management approach.
Can non-invasive treatments help chronic back pain?
They may support symptom management for selected individuals.
Is this usually covered by insurance?
Coverage depends on individual policy terms and documentation.
10. Mandatory Disclaimer
Shared for general education only. Not individual medical or financial advice.
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