How does back pain care work
in the Netherlands?
Most back pain resolves on its own. But if it doesn’t improve, it’s good to know what help is available and how to get there. In the Netherlands, your GP is your first point of contact, but you can also go directly to a physiotherapist.
The care pathway
Five steps from self-management to specialist, based on the NHG Standard.
Self-management
Keep moving, use heat or an anti-inflammatory if needed, and give it time. Most back pain improves within 4 weeks.
View self-help tipsPhysiotherapist
Not improving? A physiotherapist can guide you with targeted exercises. You don’t need a GP referral (Direct Access Physiotherapy).
More about physiotherapyNote: not covered by basic health insurance. View reimbursements
GP
If exercise therapy isn’t enough, your GP can assess whether recovery-inhibiting factors are at play (such as stress, work problems, or sleep issues) and refer you appropriately.
Psychosomatic physiotherapy or psychologist
For long-lasting symptoms where worry, anxiety, or stress play a role, a psychosomatic physiotherapist or primary care psychologist can help. This combines movement with mental guidance.
More about psychologyRehabilitation physician
For long-lasting symptoms that don’t respond to earlier treatments, your GP can refer you to a rehabilitation physician for a multidisciplinary programme.
Source: NHG Standard for Non-specific Low Back Pain, 2017 (last amended 2024)
Inflammatory back pain: the signal that often gets missed
In a small group of people, back pain is not caused by strain but by inflammation of the joints in the back and pelvis. This is called axial spondyloarthritis, also known as ankylosing spondylitis. It is treatable, but it often takes years to diagnose, because the symptoms disappear into the far larger group of ordinary back pain.
When is it worth considering?
Discuss this with your GP if your back pain has lasted 3 months or longer and started before you were 45, plus at least one of these:
- You are stiff for more than 30 minutes in the morning
- The pain improves with movement and not with rest
- You wake in the second half of the night because of back pain
- The symptoms crept up gradually, not after a particular moment or movement
- An anti-inflammatory (NSAID) helps strikingly well
- You have had psoriasis, chronic bowel inflammation or eye inflammation (uveitis)
- Spondyloarthritis or ankylosing spondylitis runs in your family
This is not a self-test and not a diagnosis. If you recognise this pattern, mention it to your GP: blood tests and imaging can settle it, and early treatment makes a difference.
What these points are based on: the features come from the ASAS work on inflammatory back pain (2009), and the cut-offs of 45 years and 3 months from its classification criteria. How your GP looks at this is set out in the NHG Standard on non-specific low back pain, in the table on axial spondyloarthritis.
Who does what?
The GP
Your first point of contact for back pain. The GP rules out serious causes, gives advice, and refers you if needed. For alarm symptoms, the GP can activate emergency services immediately.
When
When self-management doesn’t help after 4–6 weeks, or with alarm symptoms.
The physiotherapist
Guides you with exercises and movement advice. You can visit directly without a GP referral (Direct Access Physiotherapy). The physiotherapist also screens for alarm symptoms.
When
For back pain lasting more than a few weeks, or if you want guidance with exercise.
Not covered by basic health insurance. View reimbursements
The specialist
A neurologist, orthopaedic surgeon, or rehabilitation physician. You can only see them via GP referral. The specialist is for situations where primary care treatment isn’t sufficient.
When
If nerve compression is suspected, after an accident, or with persistent symptoms that don’t improve.
Frequently asked questions
Want to know more about reimbursements? See our page on insurance and physiotherapy.
Insurance & reimbursements