For back pain without warning signs, e.g. after overload or with desk work, a physiotherapist can be the first step, because about 90% of low back pain has no single specific structural cause. It is worth seeing a neurologist if you have numbness and weakness in your limbs, an orthopaedic surgeon after an injury or with a deformity, and going to A&E (SOR, the hospital emergency department) if you have numbness in the groin area and bladder problems.
In this article we compare the roles of the physiotherapist, orthopaedic surgeon, neurologist and GP in a table using the same criteria, explain when a referral is needed and suggest how to prepare for your first visit.
In brief
- Most low back pain, about 90%, is so-called non-specific pain, which is treated conservatively.
- Physiotherapist: mechanical pain without red flags; a consultation at the clinic in Rydułtowy costs PLN 180, no referral needed.
- Neurologist: numbness, loss of strength, symptoms in both limbs; orthopaedic surgeon: injury, deformity, assessment for surgery.
- A&E / 112: numbness in the groin area, urinary retention or incontinence, rapidly increasing weakness.
- The clinic offers private visits only (not covered by NFZ, the Polish public health fund), Mon–Fri 7:00–20:00; home visits up to 15 km from Rydułtowy.
Contents
Who should you see first with back pain?
If the pain appeared after overload, gets worse with movement or sitting, and there is no numbness in the groin area, leg weakness, fever or injury, a physiotherapist is a sensible first step. Guidelines, including those of the British NICE, recommend activity, exercise and education for this kind of pain, and routine imaging is not needed. The physiotherapist will also assess whether you need to see a doctor.
Physiotherapy is a medical profession. Under the Polish Physiotherapist Profession Act, a physiotherapist can independently carry out a functional assessment and plan and deliver therapy. However, they do not prescribe medication or make a medical diagnosis. That is why a good visit to a physiotherapist starts by ruling out symptoms for which the patient should see a doctor first.
A GP (primary care doctor, POZ) is a good first choice when the pain comes with other general symptoms, such as fever or weight loss, when prescription painkillers are needed, or when the patient wants to be treated under the NFZ and needs a referral to a specialist. You can read more about the pain itself and its causes in our guide back pain — causes and treatment.
How does a physiotherapist differ from an orthopaedic surgeon and a neurologist?
A physiotherapist assesses movement and function and treats with exercise, manual therapy, education and physical therapy modalities. An orthopaedic surgeon deals with bones, joints and ligaments, including surgical treatment of injuries and deformities. A neurologist diagnoses and treats diseases of the nervous system, including nerve compression with neurological symptoms. Doctors can prescribe medication and order tests.
| Criterion | Physiotherapist | Orthopaedic surgeon | Neurologist |
|---|---|---|---|
| When to see first | mechanical, overload-related or recurring pain without red flags | injury, suspected fracture, deformity, considering surgery | numbness, tingling, loss of strength, symptoms in both limbs |
| What they do | functional assessment, exercise, manual therapy, education, physical therapy modalities | orthopaedic examination, imaging, medication, injections, surgery | neurological examination, tests (e.g. MRI, EMG), medication |
| Prescription medication | no | yes | yes |
| Ordering imaging tests | no | yes | yes |
| Referral under the NFZ | a doctor’s referral is needed for NFZ physiotherapy | needed | needed |
| Referral for private visits | no | no | no |
| At the “W zdrowym ciele” clinic | consultation PLN 180 | not applicable | neurologist listed under “Recommended specialists” |
The rules on NFZ referrals are given as of October 2026. In practice these three roles complement each other. A patient diagnosed with a disc problem after a neurological consultation usually ends up in physiotherapy anyway, and a physiotherapist refers the patient to a doctor if there are worrying symptoms.
When should you see a doctor or go to A&E first with back pain?
Go to A&E or call 112 immediately if you have numbness in the groin area and inner thighs, sudden problems passing urine or stools, or rapidly increasing weakness in your legs. See a doctor urgently if you have pain after an injury, fever, night pain with weight loss, or a history of cancer.
Red flags:
- Numbness in the groin, buttocks or inner thighs, problems passing urine or stools — A&E / 112 (suspected cauda equina syndrome).
- Progressive weakness in one or both legs, foot drop, tripping.
- Pain after a fall, accident or injury, especially with osteoporosis and in people over 65.
- Fever, chills, feeling generally unwell, unintentional weight loss.
- Constant, night-time pain that does not depend on position or movement.
- A history of cancer, long-term steroid treatment, weakened immunity, intravenous drug use.
- Pain in the chest or between the shoulder blades with shortness of breath, sweating, or pain spreading to the arm or jaw — 112.
The last point is important, because back pain does not always come from the spine. It can be a symptom of heart, kidney or aortic disease, so these symptoms must not be ignored in the hope that they will pass.
When to choose a neurologist?
It is worth seeing a neurologist when back pain comes with neurological symptoms: numbness or tingling spreading to the arm or leg, loss of muscle strength, sensory disturbances, unsteady walking or symptoms in both limbs. The neurologist will carry out a neurological examination, may order an MRI or EMG and decide on medication.
Typical situations include sciatica or femoral nerve pain with loss of strength, neck pain with numbness in the fingers, balance problems, or symptoms that persist despite conservative treatment. We describe the differences between the two types of nerve pain in our post femoral nerve pain or sciatica — how to tell them apart. In its Recommended specialists section, the “W zdrowym ciele” clinic lists a neurologist, Radosław Bienek, MD, PhD.
When to choose an orthopaedic surgeon?
An orthopaedic surgeon is the right specialist after a spinal injury, when a fracture is suspected (including an osteoporotic one), with a visible deformity such as progressive scoliosis, and when surgical treatment is being considered. An orthopaedic surgeon also deals with pain that may come from the hip or shoulder joint but is sometimes mistaken for back pain.
Some orthopaedic surgeons and neurosurgeons specialise in spinal surgery. A patient is usually referred for a surgical consultation when severe nerve root pain persists despite conservative treatment or neurological deficits are increasing. Physiotherapy is also needed after surgery, but its scope is agreed with the operating surgeon.
What does a first visit to a physiotherapist with back pain look like?
The first visit is a physiotherapy consultation, which costs PLN 180 at the clinic in Rydułtowy. The physiotherapist takes a medical history, checks for red flags, assesses posture, mobility, strength, sensation and reflexes, and then discusses the therapy plan with the patient. Usually the patient receives simple advice and home exercises at the very first visit.
Steps of the consultation:
- Medical history: how and when the pain started, what makes it worse or better, illnesses, medication, work, activity.
- Examination: posture, range of movement, neurological and orthopaedic tests, McKenzie method tests.
- Decision: whether therapy with a physiotherapist is appropriate or a doctor is needed first.
- Plan: exercises, possibly manual therapy or treatments, activity guidelines. The number of visits is set individually.
We describe the course of the visit in detail in our article your first visit to a physiotherapist. If the pain makes it impossible to travel, the physiotherapist can come to your home.
Physiotherapy consultationmedical history, functional assessment, therapy plan180 PLNHome physiotherapyup to 15 km from Rydułtowyapprox. PLN 200 for up to 5 km, then + PLN 2/km; the exact price is agreed when bookingGood to know: bring your X-ray, CT or MRI results with the report and a list of medications to the visit. If you have not had any tests, this is usually not a problem, because they are not done routinely for pain without red flags.
Summary
For back pain without warning signs, the first step can be a physiotherapy consultation, which costs PLN 180 in Rydułtowy, with no referral needed. Numbness and weakness in the limbs are a reason to see a neurologist, an injury or deformity a reason to see an orthopaedic surgeon, and numbness in the groin area with bladder problems a reason to go to A&E immediately.
Frequently asked questions
Do I need a referral to see a physiotherapist?
No referral is needed for a private visit to a physiotherapist. A doctor’s referral is required if the patient wants physiotherapy under the NFZ. The “W zdrowym ciele” clinic in Rydułtowy has no contract with the NFZ and sees private patients only, so you can book a consultation directly via Booksy or by phone.
Can a physiotherapist prescribe medication or refer me for an MRI?
No. A physiotherapist does not write prescriptions for medication or order imaging tests under the NFZ – that is the doctor’s job. They can, however, assess whether your symptoms require a medical consultation and point you to the right specialist. The physiotherapist uses any test results the patient already has when planning therapy and choosing exercises.
Do I need a spine X-ray before physiotherapy?
Usually not. For low back pain without red flags, guidelines do not recommend routine X-rays or MRI, because the result rarely changes the treatment. Imaging is ordered by a doctor when they suspect an injury, an inflammatory disease, a tumour or nerve compression with worsening symptoms. If you have results, bring them to your visit.
Will the physiotherapist send me to a doctor if something worries them?
Yes. Checking for red flags is part of every physiotherapy consultation. If the symptoms point to a possible serious cause of pain, for example nerve compression with weakness, an injury or a general illness, the physiotherapist will stop therapy and tell the patient which doctor to see and how urgently.
How much does a consultation for back pain cost in Rydułtowy?
A physiotherapy consultation at the “W zdrowym ciele” clinic costs PLN 180, manual therapy also PLN 180, and manual therapy combined with TECAR PLN 210. A home visit costs approx. PLN 200 for up to 5 km, then PLN 2 per kilometre. Prices are valid from 08.2026 and it is worth checking them in the current price list.
What are the opening hours for back pain appointments?
The clinic at ul. Strzelców Bytomskich 11 in Rydułtowy is open Monday to Friday, 7:00–20:00. You can book an appointment via Booksy or by phone on 505 417 624. In the case of sudden, severe pain with warning signs, do not wait for a visit – contact a doctor or call 112.
Sources
- NICE. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, updated 2020.
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389:736–747.
- Finucane LM et al. International framework for red flags for potential serious spinal pathologies. JOSPT. 2020;50(7):350–372.
- Act of 25 September 2015 on the profession of physiotherapist (Ustawa o zawodzie fizjoterapeuty; consolidated text — Dz.U.).
About the author: Tatiana Grabowska, MSc — master’s degree in physiotherapy; since 2013 she has run the “W zdrowym ciele” physiotherapy and rehabilitation clinic in Rydułtowy (about 12 years of practice), PWZFz 11646 (Polish physiotherapist licence). Her work includes treating back pain using the McKenzie method, the Dorn method and manual therapy . Physiotherapist’s profile
- Consultation180 PLN
- Referralnot needed
- ReceptionMon–Fri: 7.00–20.00
