Q: I'm having some serious back problems at work. The doctor suggested physiotherapy but my health insurance doesn't cover PT. Is it worth it to pay out-of-pocket for this service?

A: Researchers around the world are studying and comparing costs and types of treatment for back pain patients. It's difficult to compare results of one study to another when different age groups are treated or when the treatment applied isn't the same between studies.

So far it looks like exercise and advice to stay active have the best results. For patients with low levels of disability, advice to stay active may be all that's needed.

Patients with greater pain or more disability may be helped more by joint mobilization or manipulation performed by a PT. The optimum number of visits or treatments with a PT has not been established yet.

More studies are needed to compare and match types of patients with best practice methods of treatment. It may be that certain age groups or conditions will respond to one treatment or a combination of treatments compared to other problems causing low back pain.

Most PTs are very willing to help patients achieve their goals physically and financially. Patients paying out-of-pocket can be given more independence with a home program and follow-up by phone or email. Present your concerns and needs when you make the initial appointment.

Oliver Rivero-Arias, MSc, et al. Cost-Utility Analysis of Physiotherapy Treatment Compared with Physiotherapy Advice in Low Back Pain. In Spine. May 20, 2006. Vol. 31. No. 12. Pp. 1381-1387.