Yes. You can change physiotherapist whenever you like, without having to justify yourself and without waiting for the end of a package. That is the easy part of the answer.
The useful part is something else: understanding whether what is not working is the person or the plan. The available research says that the relationship with the therapist matters for how you experience the course, but it does not prove that replacing the professional improves your clinical result. Below you will find what the studies really say, the reasons why changing makes sense, those for which it is better to talk first, and what should follow you when you change.
⚠ Important: read this before continuing
The exercises and advice in this article are general guidance and may not suit your situation. Every person has a unique clinical history: what works for others could be counterproductive for you.
Want a professional's opinion? Start from the questionnaire: you sign up and see who will follow you, a physiotherapist registered with the Register, chosen for your case, whom you write to in chat. If you would rather hear their voice, the first consultation is free and we look at your situation together.
First of all: when "I am not improving" is not a relationship problem
The most frequent reason for thinking about changing is that the pain is not moving. Before attributing it to the professional, the signs that point to a cause different from the one being treated must be ruled out. In these cases the problem is not solved either by staying or by changing: a medical reassessment is needed.
Go to a doctor, without waiting for the next session, if any of these signs appear:
- Changes in sensation in the area in contact with the saddle, or difficulty controlling urine and stools. This is an emergency: go to the emergency room, not an appointment.
- Progressive loss of strength. Not the weakness caused by pain, but strength that falls week after week.
- Night pain that does not change with position. Musculoskeletal pain usually changes when you turn over or get up; what stays exactly the same needs investigating.
- Fever, general malaise or unexplained weight loss, together with the pain.
- Recent trauma, especially after the age of 70, if you have osteoporosis or have been taking corticosteroids for a long time.
On this last point it is worth being precise, because all sorts of things are said around. A Cochrane review from 2023 evaluated the diagnostic accuracy of the red flags used to suspect a vertebral fracture in people with back pain: across the 14 studies included, the conclusion is that most red flags, taken individually, are not useful as a screening tool. Only some proved informative, and the data come from single studies: in primary care, advanced age (over 70, positive likelihood ratio 11.19 with a 95% confidence interval from 5.33 to 23.51 for unspecified vertebral fracture), trauma and corticosteroid use, the last with very wide confidence intervals and therefore an imprecise estimate. What is needed is the combination of clinical history and examination, not a box ticked.
There is also a less dramatic but equally important criterion: if after 4 to 6 weeks of a well-run course nothing has changed, there is no emergency, but there is a signal. The 4 to 6 weeks are a practical reference from clinical experience, not a threshold set by guidelines. And the answer is not automatically another therapist: it is to question the starting hypothesis again.
The short answer: yes, you can, and you do not have to justify it
In private practice the relationship with a physiotherapist is a professional one that you can end at any time. You are not signing a commitment, you are not tied to a clinic, and there is no obligation to "finish the cycle". A serious professional knows this and does not take offence.
Two practical things to clarify beforehand, so you are not caught out:
- Sessions already paid for. If you have bought a package and used half of it, ask in advance how the remaining ones are handled. Conditions vary from clinic to clinic: it is a legitimate question, to be asked beforehand and ideally in writing.
- Documentation. Ask for a copy of the health documentation that concerns you: the new professional needs it, and it saves you from starting again from zero.
Changing is not a judgement on anyone's competence. Very often it is simply a matter of fit: communication style, timetables, different expectations.
What the research really says about the relationship with the physiotherapist
Here most articles online write that "the relationship of trust is the key to therapeutic success". It is a phrase that sounds good, and we ourselves used to write it. Looking at the studies, however, the picture is more nuanced, and it is worth knowing before making a decision.
The technical concept is called therapeutic alliance: the quality of the bond between patient and therapist, the agreement on goals and on the tasks to be carried out. It has been measured in musculoskeletal rehabilitation, and this is what has emerged.
The evidence is limited and concerns almost only chronic pain. A systematic review published in Physiotherapy Theory and Practice in 2018 searched eight databases and found just 6 articles, from 4 studies, out of 936 works identified. All the included studies used samples of patients with chronic low back pain. In the two studies in which measures to encourage the alliance during treatment had been applied, a significant improvement in pain was observed; in the others, without incentives, the results were discordant. The authors' conclusion is clear: the existing studies provide no evidence of a strong relationship between therapeutic alliance and pain relief.
A second review is a little more optimistic, but remains cautious. Still on chronic musculoskeletal pain (over 12 weeks), a systematic review from 2020 selected 7 studies out of 451 initial works, 3 of them dedicated to the effect of a good alliance on pain. The authors speak of emerging evidence that a strong alliance may improve pain outcomes. "Emerging" and "may" are words chosen with care: it is not a settled conclusion.
And when it is measured at a distance, the effect is weak. This is the most relevant finding for those who do teleRehabilitation, and therefore for us too. A secondary analysis of a randomised trial examined the 87 patients in the intervention arm alone, with knee osteoarthritis, who received from 5 to 10 telephone consultations with one of 8 physiotherapists over 6 months. The alliance was measured after the second consultation. The result: the scores given by the patients were weakly associated with improvements in some outcomes at 6 and 12 months, and, in one case, with a worsening of fear of movement. The scores given by the therapists showed no strong associations. The authors conclude that the relationships observed were generally weak and probably not clinically significant.
Translated into practice, three things:
- Feeling in tune with your physiotherapist matters for the experience, and plausibly for how consistently you follow the programme.
- No study shows that changing physiotherapist improves your clinical outcome. It has never been measured: the studies look at the quality of the relationship, not at the effect of replacing the professional.
- As a consequence, changing the person hoping that this will solve the pain is an expectation the data do not support. If you change, change something in the plan too.
This is not an invitation to stay where you do not feel comfortable. It is an invitation not to hand over to the change a recovery that depends on something else.
Change the person or change the plan?
When a course is stalled, often what is not working is not who is in front of you: it is what you are doing. No study has measured how often this happens, it is an observation from clinical practice and not a figure, but it is the first thing to check, because it costs one conversation. Before looking for another name, try asking for an explicit reassessment and make sure you get answers to four questions:
- What exactly are we treating, in plain words;
- With which measurable goal: not "feeling better", but "sleeping on my side", "climbing stairs without holding on", "running for twenty minutes";
- In how many weeks a change can reasonably be expected;
- When we will meet again to decide whether the plan is working, and what we will change if it is not.
If these four answers do not exist, the problem is the plan. If they exist and are not respected, then yes, the problem may be the person. We have written in detail about how a sensible course is built in how many physiotherapy sessions you really need.
An important tip: before changing professional, make sure the starting diagnosis has been verified. We often think we have one problem, but the real cause of the pain is another: in that case, changing the person without questioning the hypothesis leads to repeating the same course with a different name.
When changing physiotherapist really makes sense
There are solid reasons, and they do not need to be justified with scientific literature: they concern you.
You do not feel listened to. If you leave sessions with the feeling that your story has not been taken in, that is reason enough. A qualitative systematic review of 13 studies analysed what influences the interaction between patient and physiotherapist and identified four areas: the therapist's communication and relational skills, their practical competence, individualised and person-centred care, and organisational factors such as time and the flexibility of appointments. An interesting detail: the ability to explain well was considered important only by patients, not by therapists. The authors themselves specify that further research is needed to understand which of these factors really affect the interaction.
You are not told what you are doing and why. A course you do not understand is a course you will not carry forward at home, and much of the work happens between one session and the next.
You are not involved in decisions. A systematic review with thematic synthesis from 2022, on 9 articles selected out of 1,508, examined the experience of people receiving musculoskeletal physiotherapy in relation to shared decisions. Most people want to take part in choices about their treatment, and the conditions that make this possible are mutual trust, two-way communication and sharing decision-making power. If you are only told what to do, you are missing half of the course.
You are promised certain recovery in a precise number of sessions. It is a commercial signal, not a clinical one.
Practical and personal reasons. Timetables that do not fit your work, a preference for a professional of the same gender, the need for a language in which you express yourself better, the need for a specific skill on a particular condition. You do not need to explain why: these are legitimate preferences, and in the qualitative review cited above organisational factors appear explicitly among those that influence the relationship.
An approach that does not suit you. Some work a lot with the hands and others mostly with exercise, some are didactic and others brisk. If you have already said so and nothing has changed, changing physiotherapist is reasonable.
When it is better to talk first
There is also the other side, and it is honest to say it: jumping from one professional to another without ever completing a plan is in itself a way of not recovering. Every new start means a new assessment, a new trial period, a new count of weeks. If you have changed several times and always stopped within the first sessions, it is worth asking whether the problem each time was the person.
Before changing physiotherapist, try a direct conversation. It works more often than you might think, and the literature on shared decisions suggests that it is exactly the conversation patients want to have. Sentences you can use as they are:
- "I don't understand what we are treating. Could you explain it again?"
- "Four weeks have passed and nothing has changed. What do we change now?"
- "I can't do the exercises: there are too many and I don't have the time. Can we reduce them?"
- "I would like to know what the goal is and how we will know if we are reaching it."
If the answer is a different plan, you have solved it without changing. If the answer is irritated or evasive, you have had your confirmation.
How to change, in practice
Outside any platform, changing physiotherapist is a straightforward procedure: you contact another professional and book an appointment. No waiver is needed, nothing has to be formally closed. What is needed is to bring the course with you.
Prepare and give the new physiotherapist:
- the report or record of the work already done, if you have one;
- the imaging with its reports (not just the images: the reports);
- the list of exercises you were given, with loads and frequency;
- what you have already tried, for how long and with what result, in date order;
- the medicines you are taking and any other health conditions.
It is the part that makes the difference between a change and starting from scratch. If you have nothing in hand, write a page yourself with the dates: it is worth a great deal.
How it works on Ri-Hub
On our platform the handover happens inside the private area: you go to the section dedicated to sessions, choose another professional from those available, with their skills and time slots, and book the next session with them. There are no additional costs for the change.
The rehabilitation record stays associated with you, not with the individual therapist: it is updated after every session, so whoever takes you on sees what has already been done, what worked and where you are. All the physiotherapists who work with us are graduates and are regularly registered with the Register.
If you are wondering how the professionals at the start are assigned, we discuss it in who will my physiotherapist be. If instead you still have to start, what to expect at the first session tells you what to bring and how to prepare: the same things that are needed when you change too.
What to expect after the change
Expect a new assessment. It is not wasted time and is actually a good sign: a professional who restarts from what another wrote without verifying it in person is giving you a worse service.
Expect also that not everything changes straight away. If the problem is long-standing, the new course will still need weeks, not isolated sessions. The right question to ask at the first meeting is not "how long will it take", but "when do we meet again to see whether it is working".
And expect, this one for sure, to feel different in the relationship: more listened to, more involved in decisions, more informed about what you are doing. It is the aspect on which the change has the greatest impact, and it is a more than sufficient reason to make it.
In summary
You can change physiotherapist at any time: there is no constraint to respect and no explanation to give. Changing physiotherapist makes sense if you do not feel listened to, if you do not understand what you are doing, if you are not involved in decisions, or for practical reasons such as timetables and personal preferences.
But keep two things in mind that almost nobody writes. The first is that the research does not prove that changing the person improves the clinical result: the studies on the therapeutic alliance are few, almost all on chronic pain, and the effects measured are weak. The second is that when a course is stalled, the first thing to question is the plan, or the diagnostic hypothesis, before the person.
So: if you change, change the plan too. And if you are not improving, first of all check that none of the signs listed at the top of this page are present.
You might also be interested in:
First Physiotherapy Session: What to Expect and How to Prepare
How Many Physiotherapy Sessions Do You Need? Numbers by Condition
Online Physiotherapy vs In-Person Clinic: A Practical Guide to Choosing
Stay in touch with us
Join our dedicated Facebook group: we answer all patients, give practical advice and clear up the most common doubts.
Need a consultation?
Start from the questionnaire on Ri-Hub. A few questions about your case, you sign up, and see who will follow you: a physiotherapist registered with the Register, whom you write to in chat whenever you like. If you would rather talk it through by voice, the first consultation is free, lasts 20 minutes and commits you to nothing: they arrive having already read what you wrote, and together you decide whether and how to go on.
Sources
- The role of the therapeutic alliance on pain relief in musculoskeletal rehabilitation: A systematic review, Physiotherapy Theory and Practice, 2018
- The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: A systematic review of the literature, Physiotherapy Theory and Practice, 2020
- Association Between Therapeutic Alliance and Outcomes Following Telephone-Delivered Exercise by a Physical Therapist for People With Knee Osteoarthritis, JMIR Rehabilitation and Assistive Technologies, 2021
- What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis, Physical Therapy, 2016
- People's Experience of Shared Decision Making in Musculoskeletal Physiotherapy: A Systematic Review and Thematic Synthesis, Behavioral Sciences, 2022
- Red flags to screen for vertebral fracture in people presenting with low back pain, Cochrane Database of Systematic Reviews, 2023
Last source check: August 2026.
