“I’ve already tried physio. It didn’t really help.”
I hear this constantly. And I don’t dismiss it — because for a lot of people, it’s true. They went, they did the exercises, the pain eased a bit and then came back, and they left the experience thinking physio just isn’t for them.
But “physio didn’t work” usually means a specific approach didn’t work — not that the problem is untreatable. There’s almost always a specific reason. And once you know what it is, you can make a better call about what to try next.
Reason 1: The treatment was exercise-only
The most common reason by a wide margin. A large proportion of physio clinics operate on a high-volume model: quick assessment, exercise program, follow-up in two weeks. It’s efficient, it’s scalable, and for some presentations — acute injuries that just need time and graduated loading — it works fine.
For persistent pain with restricted tissue, it doesn’t. You can’t exercise your way out of a joint that won’t move properly or a trigger point that’s been active for two years. The exercises work around the problem rather than through it.
If nobody put their hands on the area and physically treated the tissue in your session, that’s what was missing. Hands-on treatment first — then exercise as reinforcement — produces different results for chronic pain than exercises alone. More on the difference between manual therapy and exercise therapy →
Reason 2: The cause wasn’t identified — only the symptom was treated
Pain is often a symptom of a problem elsewhere. Lower back pain commonly traces back to hip restriction or thoracic stiffness. Knee pain under load often comes from a glute that’s not firing. Shoulder pain during overhead movement frequently originates in a stiff upper back, not the shoulder itself.
If treatment went to the painful area only, and didn’t find or address what was driving it, the symptom will keep returning because the cause is still there. A good assessment looks past the pain location to understand the mechanical reason it’s there.
This is one of the reasons I take a full history and movement assessment before touching anything. The site of pain is often not where the work needs to happen.
Reason 3: The timeline was unrealistic
Pain that has been around for two years takes longer to resolve than pain that started last month. Tissue that has been loaded in a compensated pattern for years takes time to retrain. This isn’t a failure of physio — it’s biology.
The problem is when this isn’t communicated. People come in expecting significant change after two or three sessions, don’t see it, and conclude the treatment isn’t working. Sometimes treatment is working but the timeline expectation was never set correctly.
A good physio tells you after the first session: here’s what I found, here’s what I’m targeting, and here’s a realistic estimate of how long this takes. Not to the day — but a honest range. If you were never given that, it’s worth asking.
Reason 4: You needed a different type of hands-on treatment
Manual therapy covers a range of techniques — joint mobilisation, soft tissue release, dry needling, manipulation, neurodynamic work. Not all of them suit all presentations.
If you had hands-on treatment but it still didn’t shift, it’s worth asking whether the right technique was used. A trigger point that isn’t releasing with manual pressure often responds to dry needling. A joint restriction that won’t mobilise with passive movement sometimes needs a different grade of mobilisation or a manipulation.
This is a clinical judgement call — and sometimes it takes more than one approach before you find what works for a specific person’s tissue. It’s worth being explicit with your physio: “That approach hasn’t shifted it — is there something else to try?”
Reason 5: The problem isn’t primarily musculoskeletal
Physio is the right tool for musculoskeletal pain — joints, muscles, nerves, tendons, fascia. It’s not the right tool for pain that’s primarily driven by something else: inflammatory arthritis, visceral referred pain, systemic conditions.
If pain isn’t responding to treatment as expected, it’s worth looping back to a GP to rule out non-musculoskeletal drivers. This is rare for the typical presentations I see — but it’s worth knowing the boundary exists.
A physio should tell you if they think the presentation is outside their scope. If they’re not making progress and aren’t flagging it or referring on, that’s a problem.
Reason 6: You stopped too early
Persistent pain often gets better in a non-linear way. The first two or three sessions might produce only modest change while the underlying tissue is being freed up. Then sessions four and five produce a significant jump. People who stopped at session three leave thinking the treatment didn’t work — when the improvement was one week away.
The guideline I use: if you’re not seeing any measurable change — in pain levels, range of movement, or function — after four to six sessions of hands-on treatment, that’s when to have an honest conversation about whether the approach is right or whether something is being missed. Not after two.
What to do if physio hasn’t worked for you
- Ask specifically what was treated and why.If you can’t answer that after a course of treatment, you might not have been given enough information to understand whether the approach was correct for your problem.
- Consider whether hands-on treatment was part of the picture.If every session was exercise-based, that’s worth changing before concluding the problem is untreatable.
- Get a second opinion.Different physios assess differently, use different techniques, and have different clinical strengths. If you’ve had a reasonable course of treatment without progress, a fresh assessment from someone else is a legitimate next step — not a failure.
Most of the people I’ve seen significant results with had already tried physio before. The problem usually wasn’t the body — it was what the previous treatment had and hadn’t addressed.