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Key points
- Physiotherapy for back and neck pain is mostly about exercise, advice and helping you stay active, with hands-on treatment used alongside rather than instead.
- Exercise has the strongest evidence of any physical treatment for long-standing low back pain, although the benefit is usually moderate rather than dramatic.
- NICE advises against several passive treatments that were once common, including traction, ultrasound and TENS for low back pain.
- In many parts of England you can refer yourself to NHS physiotherapy without seeing your GP first.
What a physiotherapist does
Physiotherapists are healthcare professionals trained to assess and treat problems with movement and function. For back and neck pain, the NHS describes three main parts to their work: exercises to improve movement and strength, manual therapy (using their hands to massage and move the affected area), and advice on managing your symptoms.[1]
At a first appointment the physiotherapist will ask about your symptoms, your general health and your daily life, then examine you. That usually includes watching how you move and checking strength and balance.[1] They should also ask the screening questions that pick up rare but serious causes of back pain, and refer you on if anything worries them.
Most people leave with a short list of exercises, a plan for staying active and an idea of how many sessions they might need. Treatment is something you do between appointments as much as during them.
What NICE recommends
The NICE guideline on low back pain and sciatica (NG59) shapes NHS physiotherapy in England. Its main recommendations for non-invasive care are:[2]
- Give people tailored advice and information to help them manage their own pain, including encouragement to carry on with normal activities.
- Consider a group exercise programme (biomechanical, aerobic, mind-body or a combination), chosen to suit the person’s needs and preferences.
- Consider manual therapy such as spinal manipulation, mobilisation or massage, but only as part of a package that includes exercise.
- Use a risk tool such as STarT Back at first contact, so that people at low risk get simpler support and those at higher risk get more intensive help.
- Help people return to work or normal daily activities.
Just as useful is what NICE says not to offer for low back pain: traction, belts or corsets, foot orthotics, ultrasound, TENS, PENS and interferential therapy.[2] If a clinic builds a course of treatment around these, it is fair to ask why.
What the evidence shows
Low back pain
The largest Cochrane review of exercise for chronic low back pain included 249 trials.[3] It found moderate-certainty evidence that exercise reduces pain compared with no treatment, usual care or placebo, by around 15 points on a 0 to 100 scale, which the authors judged clinically important. The improvement in day-to-day function was smaller. Exercise was probably more effective than advice alone or electrotherapy, and about as effective as manual therapy. Side effects were mostly minor, such as muscle soreness.
The World Health Organization reached a similar view in its 2023 guideline on chronic low back pain, which supports structured exercise programmes, while rating the evidence as low certainty.[4]
Neck pain
For neck pain the research is thinner. A Cochrane review of 27 trials found no high-quality evidence, but moderate-quality evidence that strengthening and endurance exercises for the neck, shoulders and upper back can reduce pain in chronic neck pain. Stretching on its own did not appear to help.[5]
A 2025 Cochrane review looked at manual therapy combined with exercise, mostly for chronic neck pain.[6] Compared with no treatment, the combination may produce a large reduction in pain. Compared with a placebo treatment, it may improve function but made little or no difference to pain. All the evidence was low certainty, and only minor side effects such as short-lived soreness, headache or dizziness were reported.
Physiotherapy does not usually make back or neck pain vanish. What it does well is help you move more, worry less and get back to the things you need to do.
How to get physiotherapy
On the NHS
In many areas you can refer yourself to an NHS community musculoskeletal (MSK) service without needing a GP referral.[1] Search your local NHS trust or integrated care board website for “MSK self-referral”, or ask at your GP surgery reception. Some practices also have a first contact physiotherapist you can book directly. Waiting times vary a great deal between areas.
Privately
If you go privately, check that your physiotherapist is registered with the Health and Care Professions Council (HCPC). “Physiotherapist” is a protected title, so anyone using it must be on the HCPC register.[7] The NHS also suggests looking for chartered status (MCSP after their name).[1] A good private physiotherapist will be clear about how many sessions they expect you to need and what you should be doing at home.
Getting the most from it
- Do the exercises. Most of the benefit in trials came from regular practice, not from what happened in the treatment room.
- Expect some discomfort as you start moving more. Mild, short-lived soreness is normal and not a sign of damage.
- Ask what the plan is if things are not improving after several weeks.
- Be wary of open-ended courses of passive treatment with no exercise component.
- Tell your physiotherapist if symptoms change, especially new numbness, weakness or pain spreading down a limb.
Physiotherapy is often the right first step for acute back pain that is not settling, sciatica and degenerative disc disease. If symptoms do not improve, your physiotherapist can help arrange further assessment.
Seek urgent medical help (A&E or 999) if you have:
- Numbness around the genitals, bottom or inner thighs (saddle area)
- New problems passing urine, or loss of bladder or bowel control
- Weakness in the legs or arms that is new or getting worse
- Clumsy hands, unsteady walking or electric shock sensations with neck pain
- Back or neck pain with fever, unexplained weight loss or a history of cancer
- See our guide to cauda equina syndrome
References
- NHS. Physiotherapy. Page last reviewed 3 April 2025. Link
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, last updated 2026. Link
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. Link
- World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. Link
- Gross A, Kay TM, Paquin JP, et al. Exercises for mechanical neck disorders. Cochrane Database Syst Rev. 2015;1(1):CD004250. Link
- Chacko N, Gross AR, Miller J, et al. Manual therapy with exercise for neck pain. Cochrane Database Syst Rev. 2025;12(12):CD011225. Link
- Health and Care Professions Council. Professions and protected titles. Link
This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP, physiotherapist or specialist before starting a new treatment.
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