How Long Should You Attend Physical Therapy?

I evaluated a patient this afternoon who was dealing with low back pain and sciatica. He states he had pain in his leg for quite some time, and it got significantly worse about 6 months ago. His doctor at the time sent him to physical therapy with a diagnosis of hip bursitis, and the patient reports he did a lot of stretching in physical therapy with no significant relief.

The patient finally saw an orthopedic surgeon, and surgery was performed on his low back to relieve pressure on his sciatic nerve from a herniated disc. My patient reported initial relief from the surgery, but he continues with leg pain and abnormal sensation, so his doctor referred him to physical therapy once again to manage the post operative recovery.

While talking with my patient, I asked him how long he spent in physical therapy. He told me he went to 20 sessions of physical therapy. I was surprised. My patient told me that the physical therapy never made him feel better, and in fact occasionally he left feeling worse.

I asked him why he went for 20 sessions if he was getting no relief. He replied that he went until his insurance company wouldn't pay any longer, and then he was discharged.

Now why would anyone continue with a treatment that wasn't too successful until insurance wouldn't pay? A more important question: Why would a physical therapist treat a patient unsuccessfully for 20 sessions and then discontinue therapy once insurance ran out? Shouldn't your physical therapist be making clinical decisions?

Look, I know that all physical therapists (and other healthcare professionals) practice within strict confines of insurance regulations, and sometimes these regulations seem unfair. But to have a patient contnue on a course of treatment that offered no relief and very little progress seems a bit unfair...to the insurance company.

I know that every condition is different, and that everyone heals at different rates. In my opinion, if you are not making progress in a reasonable amount of time, your physical therapist should refer you on to a more appropriate treatment. If you are progressing and making gains in range of motion, strength and function, surely continue along. If not, ask your physical therapist if you should be continuing in PT. A good physical therapist knows what he or she can treat. A great physical therapist knows his or her limitations.

So how long should physical therapy take? Should you stop PT just because your insurance company won't pay? Let me know what your personal experience has been.