Why Does My Back Hurt When I Stand or Walk but Feel Better When I Sit?

Why Does My Back Hurt When I Stand or Walk but Feel Better When I Sit? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

You walk through the grocery store and notice your lower back becoming uncomfortable. After several minutes, the discomfort may spread into your buttocks or legs. Your legs might begin to feel heavy, tired, or unusually weak.

You find somewhere to sit, and the symptoms gradually improve.

Perhaps you've also noticed that leaning forward onto a shopping cart makes walking easier, or that standing in the kitchen causes more discomfort than sitting at the dining table.

You may wonder whether this is normal aging, a pinched nerve, a problem with your posture, or something more serious.

One possible explanation is lumbar spinal stenosis, particularly when symptoms involve the back, buttocks, or legs and become worse during standing or walking.

However, this symptom pattern does not automatically establish a diagnosis. Several musculoskeletal, neurological, and vascular conditions can produce similar complaints.

At Nova Physical Therapy in North Hollywood, California, we focus on evaluating movement, muscle performance, walking tolerance, functional limitations, and other findings relevant to physical therapy. When symptoms suggest a condition requiring additional medical assessment, appropriate referral is an important part of care.

Nova provides outpatient physical therapy and orthopedic rehabilitation for patients in North Hollywood and nearby communities, including Burbank, Toluca Lake, Studio City, Valley Village, and surrounding Los Angeles neighborhoods.

Learn more about Nova Physical Therapy services.

Patient Question

"My lower back and legs start hurting when I stand or walk for more than a few minutes. When I sit down or lean forward, the pain gets better. Could this be spinal stenosis, and can physical therapy help me walk longer?"

The Short Answer

Possibly.

Pain, heaviness, numbness, tingling, or fatigue in the buttocks or legs that develops during standing or walking and improves with sitting or bending forward is a pattern commonly associated with neurogenic claudication.

Neurogenic claudication is a clinical symptom pattern frequently seen in people with lumbar spinal stenosis.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases describes lumbar spinal stenosis symptoms as potentially including lower-back pain, radiating leg discomfort, numbness, tingling, cramping, and weakness that may worsen with standing or walking and improve with forward bending. NIAMS

However, these symptoms can also occur with other conditions, including peripheral artery disease, hip disorders, and certain neurological conditions.

A physical therapist can evaluate the physical and functional presentation, screen for concerning findings, and determine whether rehabilitation is appropriate.

For selected patients, physical therapy may help improve walking tolerance, lower-extremity strength, mobility, and participation in daily activities.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis refers to narrowing of spaces within the lower spine that contain or surround neural structures.

These changes may involve the central spinal canal, lateral recesses, or openings through which spinal nerves exit.

Age-related changes in the intervertebral discs, facet joints, and surrounding ligaments can contribute to narrowing.

However, not everyone with narrowing on an MRI experiences symptoms.

Some people have substantial imaging findings but relatively little pain or disability. Others experience significant walking limitations.

This is why a medical diagnosis should consider the clinical presentation alongside imaging and other relevant findings.

For physical therapy, the important question is not simply how narrow a spinal canal appears on a scan. It is also how the patient's symptoms affect movement, walking, strength, endurance, and daily function.

Why Does Standing Make My Lower Back Hurt?

Standing places the lumbar spine in a different position from sitting.

For some people with symptomatic lumbar spinal stenosis, an upright or extended lumbar position may aggravate symptoms.

The resulting discomfort may involve the lower back, buttocks, thighs, calves, or a combination of these areas.

Patients sometimes describe standing limitations during everyday activities such as preparing meals, washing dishes, waiting in line, attending social events, or standing at work.

One person may tolerate standing for 20 minutes, while another begins experiencing symptoms after only a few minutes.

The duration, location, intensity, and behavior of symptoms are useful details during an evaluation.

Why Does Walking Make My Legs Feel Heavy or Weak?

Walking requires repeated movement, lower-extremity muscle activity, cardiovascular endurance, and coordination.

In people with neurogenic claudication, walking can reproduce symptoms such as leg heaviness, aching, tingling, or fatigue.

Patients may describe the sensation as their legs becoming increasingly difficult to move, even when they do not experience severe back pain.

For example, someone may be able to walk from the bedroom to the kitchen but struggle to walk through a supermarket or parking lot.

This is one reason walking tolerance is an important functional outcome when evaluating patients with suspected lumbar spinal stenosis.

A physical therapist may document how long or how far someone can walk before symptoms begin, what happens when they stop, and how quickly symptoms improve.

Why Does Sitting Make the Pain Better?

Sitting usually places the lumbar spine in a more flexed position.

For some people with symptomatic lumbar spinal stenosis, lumbar flexion may reduce irritation associated with upright positioning.

This can explain why symptoms sometimes improve when a person sits down or bends forward.

However, improvement with sitting is not exclusive to spinal stenosis.

A physical therapist should consider the entire clinical presentation rather than relying on one symptom.

It is also important to understand whether the patient improves specifically with sitting, simply by stopping activity, or through another positional change.

Those differences can help guide screening and referral decisions.

What Is the Shopping Cart Sign?

The shopping cart sign describes a situation in which someone can walk more comfortably while leaning forward onto a shopping cart.

A patient may report that walking through the grocery store is difficult without support but noticeably easier when pushing a cart.

This pattern is associated with neurogenic claudication because forward bending may temporarily reduce symptoms in some people.

However, the shopping cart sign is not a stand-alone diagnostic test.

It should be interpreted alongside the patient's history, neurological findings, functional examination, and other relevant information.

Can Spinal Stenosis Cause Leg Pain Without Back Pain?

Yes.

Some people with lumbar spinal stenosis experience substantial buttock or leg symptoms with relatively little lower-back discomfort.

They may report aching, burning, tingling, heaviness, or fatigue in one or both legs.

Symptoms may be more noticeable during walking than during rest.

Because the presentation can involve the legs more than the back, some patients initially assume the problem is located entirely in the hips, knees, or calves.

A comprehensive evaluation helps determine which regions and systems require further assessment.

Is This the Same as Sciatica?

Not necessarily.

The term sciatica is commonly used to describe pain that travels from the lower back or buttock into the leg.

Lumbar radicular symptoms and neurogenic claudication can overlap, but they are not identical presentations.

Neurogenic claudication is particularly associated with symptoms that worsen during standing or walking and improve with sitting or lumbar flexion.

Other nerve-related presentations may behave differently.

A physical therapist may evaluate lumbar movement, lower-extremity sensation, muscle performance, reflexes when indicated, and other neurological findings to help determine whether physical therapy is appropriate or further medical assessment is needed.

Could My Leg Pain Be Caused by Poor Circulation?

Yes, and this distinction is important.

Peripheral artery disease can cause vascular claudication, in which leg discomfort develops during walking because of reduced blood flow.

Both vascular and neurogenic claudication may cause walking-related leg symptoms.

However, their typical symptom patterns can differ.

These are general tendencies, not definitive diagnostic rules. Some patients may have more than one condition.

The 2024 American College of Cardiology/American Heart Association guideline for peripheral artery disease emphasizes evaluating exertional leg symptoms and distinguishing vascular causes from other conditions. PubMed Central (PMC)

A patient with possible circulation-related symptoms should receive appropriate medical evaluation rather than assuming the symptoms are caused by the spine.

Does Lumbar Spinal Stenosis Always Get Worse With Age?

No.

Although age-related changes can contribute to spinal narrowing, the clinical course varies.

Some people experience relatively stable symptoms for extended periods. Others experience changes in walking tolerance or function.

It would be inappropriate to tell every patient that spinal stenosis inevitably progresses to severe disability or surgery.

Likewise, it would be inaccurate to promise that exercise will reverse anatomical narrowing.

Physical therapy generally aims to address modifiable physical and functional limitations, not to guarantee that the spinal canal will become wider.

For many patients, meaningful progress may involve walking farther, improving strength, tolerating daily activities more comfortably, or becoming more confident with movement.

Do I Need an MRI?

Not everyone with lower-back or leg pain requires immediate imaging.

Medical decisions about MRI depend on the history, physical examination, neurological findings, symptom severity, progression, and other clinical considerations.

When lumbar spinal stenosis is suspected, MRI may help a medical provider evaluate the spinal anatomy.

However, imaging should be interpreted in clinical context.

A study from the NORDSTEN research group involving 437 surgical candidates found that MRI severity measures had limited association with patient-reported pain and disability at baseline. PubMed

This reinforces an important point: an MRI finding alone does not tell the complete story of a person's symptoms or functional abilities.

Can Physical Therapy Help?

Physical therapy may help selected patients with lumbar spinal stenosis-related functional limitations.

Treatment should be based on the individual's presentation rather than applying the same exercise program to everyone with back or leg pain.

Depending on the evaluation, rehabilitation may address:

• Lower-extremity and trunk muscle performance
• Walking tolerance and functional endurance
• Lumbar and hip mobility when relevant
• Balance and functional mobility
• Sit-to-stand and stair performance
• Progressive aerobic conditioning
• Activity pacing and symptom management
• Education and a sustainable home exercise program

The goal is not necessarily to eliminate every symptom immediately.

Instead, rehabilitation may focus on progressively improving the patient's ability to participate in meaningful activities while monitoring symptoms and neurological findings.

For one person, that may mean walking through the grocery store without frequent breaks. For another, it may mean standing long enough to prepare a meal, walking around the neighborhood, or returning to recreational exercise.

What Exercises May Help Lumbar Spinal Stenosis?

There is no single exercise that works for every patient.

Research suggests that rehabilitation programs commonly combine several components, including strengthening, aerobic conditioning, mobility exercises, and education.

Flexion-Based Exercises

Some people with neurogenic claudication experience symptom relief in positions involving lumbar flexion.

A physical therapist may consider flexion-based exercises when they are appropriate for the patient's presentation.

However, this does not mean everyone should permanently avoid lumbar extension or maintain a bent-forward posture.

The objective is to identify useful symptom-management strategies while improving overall function.

Lower-Extremity Strengthening

Strengthening may address limitations involving the hips, knees, ankles, and trunk.

Depending on the patient's ability, exercises may include variations of sit-to-stand movements, supported squats, step-ups, or other functional strengthening activities.

The specific exercises and dosage should be individualized.

Stationary Cycling

Some patients tolerate stationary cycling better than upright walking because cycling generally involves a more flexed trunk position.

A systematic review of exercise interventions for lumbar spinal stenosis identified aerobic fitness exercises, particularly cycling, among components frequently included in successful programs.

That does not mean cycling is superior for every patient or that walking should be abandoned. Sage Journals

Walking Progression

Walking remains an important functional goal for many patients.

Rehabilitation may involve gradually increasing walking duration or distance, with adjustments based on symptoms, safety, and the individual's response.

The goal is to improve real-world walking tolerance rather than simply performing exercises that do not reproduce symptoms.

Should I Stop Walking When My Legs Start Hurting?

Not necessarily, but the answer depends on the presentation.

For someone with an appropriately evaluated musculoskeletal condition, modifying walking distance, pace, or frequency may be useful.

However, severe or progressive neurological symptoms, suspected vascular problems, or other concerning findings require additional medical consideration.

Patients should not assume that pushing through increasing leg weakness or numbness is always beneficial.

An individualized rehabilitation program can help establish an appropriate level of activity and progression.

Is Sitting Too Much Making My Spinal Stenosis Worse?

Sitting may temporarily relieve symptoms in some people with neurogenic claudication.

That does not mean prolonged inactivity is the best long-term strategy.

If someone progressively avoids walking, exercise, and other activities because symptoms occur during standing, their overall physical capacity may decline.

The goal is to identify tolerable ways to remain active and gradually improve function.

This may involve alternating activities, using temporary rest breaks, improving strength, or choosing aerobic exercises that are better tolerated.

Does Everyone With Spinal Stenosis Need Surgery?

No.

Surgical treatment may be considered when symptoms are severe, neurological findings are concerning, or appropriate nonsurgical management has not provided sufficient improvement.

The decision depends on medical evaluation, imaging, clinical findings, patient goals, and shared decision-making.

Physical therapy can be part of nonsurgical management for selected patients.

However, rehabilitation should not be presented as a guaranteed way to avoid surgery.

Some patients may ultimately benefit from surgical consultation or another medical intervention.

What Does Research Say?

2026 Systematic Review: Nonsurgical Treatment Evidence Remains Uncertain

A systematic review and network meta-analysis published in September 2026 included 35 randomized controlled trials involving 3,147 participants with lumbar spinal stenosis and neurogenic claudication.

The researchers compared multiple nonsurgical interventions.

The analysis found low-certainty evidence suggesting potential benefits from acupuncture for certain pain and function outcomes. However, no other intervention demonstrated clear benefits over placebo in the network comparisons, and no intervention showed a clear improvement in walking distance.

The authors emphasized that the evidence was characterized by substantial uncertainty, with certainty ranging from low to very low.

This does not prove that physical therapy is ineffective. It means that comparisons across varied interventions and trials do not establish one consistently superior nonsurgical treatment.

For patients, the practical takeaway is that treatment claims should remain measured and individualized. PubMed

2024 Exercise Systematic Review: Multicomponent Programs Are Common

A systematic review published in Clinical Rehabilitation examined 13 randomized trials involving 1,440 participants.

The researchers identified 23 exercise interventions containing 60 different treatment components.

Programs commonly included supervised exercise and lumbar flexion-based movements. Components more frequently found in successful interventions included strengthening, stretching, aerobic fitness activities such as cycling, and psychologically informed approaches.

However, the authors noted that the number of studies and differences between interventions limited their conclusions. They could not determine an optimal exercise dose or whether supervision itself was necessary. PubMed

2022 Updated Systematic Review: Support for Multimodal Rehabilitation

An updated systematic review of nonsurgical care found moderate-quality evidence from three trials supporting certain multimodal rehabilitation approaches.

Programs combining manual therapy and exercise demonstrated clinically important short-term improvements in symptoms and function compared with selected alternatives.

Some programs incorporating education and exercise also improved walking distance compared with self-directed home exercise.

The review supported multimodal rehabilitation but found insufficient evidence to draw firm conclusions about many other interventions. PubMed

2019 Randomized Trial: Individualized Exercise and Manual Therapy

A randomized clinical trial published in JAMA Network Open included 259 adults with lumbar spinal stenosis, with an average age of approximately 72 years.

Participants received medical care, group exercise, or manual therapy combined with individualized exercise.

At two months, the individualized exercise/manual therapy group demonstrated greater improvements in symptoms and physical function than the other groups.

However, differences between groups were not maintained across all outcomes at six months.

This study supports the potential value of individualized rehabilitation while reminding us that short-term improvements do not guarantee superior long-term results. JAMA Network

2025 Study: Which Patients Respond Best?

A December 2025 secondary analysis examined 216 participants from the earlier randomized trial.

The researchers investigated whether baseline characteristics were associated with different responses to nonsurgical treatment.

Certain characteristics were associated with larger improvements in symptoms or walking capacity, but the findings were exploratory and require confirmation in additional trials.

This reinforces the importance of individualized clinical assessment rather than assuming every patient will respond similarly to the same rehabilitation program. Springer

What Does the Evidence Mean Overall?

The evidence supports considering individualized, active rehabilitation as part of nonsurgical management for selected patients with lumbar spinal stenosis-related symptoms.

However, the research does not establish one universally superior exercise, technique, or treatment program.

The most appropriate plan depends on the patient's functional limitations, clinical findings, medical history, response to treatment, and goals.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, an evaluation for lower-back pain and walking-related leg symptoms may include a detailed history, functional movement assessment, and screening for findings that warrant medical referral.

Depending on the presentation, the examination may include:

• Lumbar and hip movement assessment
• Lower-extremity muscle-performance testing
• Walking and standing tolerance
• Sit-to-stand and stair performance
• Balance and functional mobility
• Relevant sensation, reflex, and neurological screening
• Assessment of symptom response to different positions
• Review of activity limitations and rehabilitation goals

We may ask how long you can stand before symptoms begin, whether sitting provides relief, how far you can walk, and whether bending forward changes the discomfort.

We may also ask whether you experience numbness, tingling, progressive weakness, changes in walking ability, or symptoms that suggest a possible vascular or other medical condition.

Why Measuring Walking Distance Matters

A patient may report that pain has decreased from 7/10 to 4/10 but still cannot walk farther than before.

That is useful information.

For patients whose main complaint is walking limitation, measuring functional walking capacity can help determine whether rehabilitation is producing meaningful improvement.

Possible measures include a six-minute walk test, a self-paced walking test, or another appropriate standardized functional assessment.

The specific test should be selected according to the patient's safety, ability, and clinical presentation.

When Should You Seek Medical Attention?

Although many back and leg symptoms can be managed conservatively, certain findings require prompt or emergency medical assessment.

Seek emergency medical care for new urinary retention or loss of bladder or bowel control accompanied by concerning neurological symptoms, new numbness in the saddle region, or rapidly progressive weakness in the legs. These findings may indicate a serious neurological condition.

Sudden severe leg pain accompanied by a cold, pale, or markedly discolored limb may also represent a vascular emergency.

Other findings that warrant timely medical evaluation include:

• New or progressive leg weakness
• Increasing difficulty walking
• Significant neurological changes
• Severe pain after trauma
• Fever or systemic illness associated with back pain
• Unexplained weight loss or persistent unexplained pain
• Exertional leg pain with symptoms suggesting poor circulation
• Symptoms that continue to worsen despite appropriate care

A physical therapist should not assume that every patient with standing-related back or leg pain has lumbar spinal stenosis.

Appropriate screening and referral are essential parts of responsible care.

Why Patients Choose Nova Physical Therapy

We Care.

Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, providing evidence-informed rehabilitation for appropriate orthopedic, musculoskeletal, movement, and functional conditions.

Our clinic serves North Hollywood and nearby Los Angeles communities, including Toluca Lake, Burbank, Studio City, and Valley Village.

We understand that two patients with similar lower-back symptoms may have very different limitations.

One patient may struggle to stand long enough to prepare dinner. Another may need to sit after walking through a parking lot. Someone else may experience leg heaviness during shopping, while another may have progressive weakness requiring medical evaluation.

Those patients should not automatically receive identical treatment.

At Nova Physical Therapy, our approach emphasizes individualized physical therapy evaluation, progressive exercise, functional strengthening, mobility, walking tolerance, patient education, and appropriate referral when needed.

We also believe rehabilitation goals should reflect the activities that matter to each patient.

For one person, success may mean walking comfortably around the neighborhood. For another, it may mean standing at work, shopping independently, traveling, or participating in family activities.

We Care means looking beyond the pain score and understanding how the problem affects everyday life.

Frequently Asked Questions

Why does my lower back hurt when I stand but not when I sit?

Several conditions can cause this pattern. Lumbar spinal stenosis is one possibility, particularly when standing or walking also produces buttock or leg symptoms that improve with sitting or bending forward. An evaluation is needed to determine the appropriate next steps.

Why do my legs feel heavy when I walk?

Leg heaviness during walking may be associated with neurological, vascular, muscular, or other conditions. Neurogenic claudication is one possible explanation, but symptoms alone cannot establish the cause.

What is neurogenic claudication?

Neurogenic claudication describes symptoms such as leg pain, heaviness, tingling, or fatigue that commonly worsen with standing or walking and improve with sitting or lumbar flexion. It is frequently associated with lumbar spinal stenosis.

Why does leaning on a shopping cart make walking easier?

Leaning forward changes lumbar positioning and may reduce symptoms in some people with neurogenic claudication. This pattern is sometimes called the shopping cart sign, but it does not independently diagnose spinal stenosis.

Can spinal stenosis cause leg pain without back pain?

Yes. Some patients experience predominantly buttock or leg symptoms with relatively little lower-back pain.

Is spinal stenosis the same as sciatica?

No. The terms describe different clinical concepts, although symptoms may overlap. A physical and neurological examination can help identify relevant findings.

Can physical therapy improve walking tolerance?

Physical therapy may improve walking tolerance in selected patients through progressive exercise, conditioning, strengthening, mobility work, and individualized activity progression. Outcomes vary.

Is stationary cycling good for spinal stenosis?

Some patients tolerate cycling better than upright walking because of the trunk position. Cycling may be incorporated into rehabilitation when appropriate, but it is not necessarily the best exercise for everyone.

Should I avoid standing or walking completely?

Not automatically. Activity modification may be appropriate, but prolonged avoidance can reduce physical capacity. The safest approach depends on the clinical presentation and any concerning neurological or vascular findings.

Do I need an MRI for spinal stenosis?

Not everyone needs immediate imaging. A medical provider determines whether MRI is appropriate based on symptoms, examination findings, neurological changes, and other considerations.

Can spinal stenosis improve without surgery?

Some patients experience improvement in symptoms or function with nonsurgical management. However, results vary, and some presentations require surgical or other medical evaluation.

When should I worry about back pain with leg weakness?

New or progressive weakness warrants medical evaluation. Sudden neurological changes, saddle numbness, or new bladder or bowel dysfunction associated with neurological symptoms require emergency assessment.

Schedule an Evaluation

If lower-back or leg symptoms are affecting your ability to stand, walk, shop, work, climb stairs, exercise, or participate in everyday activities, an individualized physical therapy evaluation may help identify relevant functional limitations and determine whether rehabilitation is appropriate.

At Nova Physical Therapy, we focus on helping patients understand their movement and functional challenges while developing evidence-informed rehabilitation plans based on their individual needs.

Our North Hollywood clinic serves patients from surrounding communities, including Burbank, Toluca Lake, Studio City, Valley Village, and the greater Los Angeles area.

Explore Nova Physical Therapy services to learn more about outpatient physical therapy and orthopedic rehabilitation.

Disclaimer

This article is provided by Nova Physical Therapy in North Hollywood, California, for general educational purposes only.

It does not constitute medical advice, medical diagnosis, imaging interpretation, individualized treatment recommendations, or clearance to exercise.

Lower-back pain, leg pain, heaviness, numbness, tingling, weakness, or symptoms associated with standing and walking cannot independently establish lumbar spinal stenosis, neurogenic claudication, lumbar radiculopathy, peripheral artery disease, or another medical condition.

Under the California Physical Therapy Practice Act, physical therapists evaluate and treat physical impairments and functional limitations within their professional scope. A physical therapy license does not authorize the diagnosis of disease.

Physical therapy does not guarantee pain relief, reversal of spinal narrowing, improved walking distance, avoidance of surgery, or prevention of future symptoms.

Patients with progressive neurological symptoms, suspected vascular problems, or other concerning findings should seek appropriate medical evaluation.

Individual results vary.

References

1. Chen H, Chen X, Fang J, et al. Nonsurgical Interventions for Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Review and Network Meta-Analysis. Integrative Medicine Research. September 2026;15(3):101321. DOI: 10.1016/j.imr.2026.101321.
   Read the systematic review
2. Comer C, Williamson E, McIlroy S, et al. Exercise Treatments for Lumbar Spinal Stenosis: A Systematic Review and Intervention Component Analysis of Randomised Controlled Trials. Clinical Rehabilitation.2024;38(3). DOI: 10.1177/02692155231201048.
   Read the exercise review
3. Ammendolia C, Hofkirchner C, Plener J, et al. Non-operative Treatment for Lumbar Spinal Stenosis With Neurogenic Claudication: An Updated Systematic Review. BMJ Open. 2022;12:e057724.
   Read the updated systematic review
4. Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Network Open.2019;2(1):e186828.
   Read the randomized clinical trial
5. Roseen EJ, Smith CN, Rahim A, et al. Which Lumbar Spinal Stenosis Patients Will Improve With Nonsurgical Treatment? A Secondary Analysis of a Randomized Controlled Trial. Chiropractic & Manual Therapies.December 9, 2025;33:57. DOI: 10.1186/s12998-025-00620-0.
   Read the 2025 study
6. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Spinal Stenosis: Symptoms, Causes, and Risk Factors. National Institutes of Health.
   NIH spinal stenosis information
7. American Academy of Family Physicians. Lumbar Spinal Stenosis: Diagnosis and Management. American Family Physician. 2024.
   Read the clinical review
8. American College of Cardiology/American Heart Association. 2024 Guideline for the Management of Lower Extremity Peripheral Artery Disease.
   Read the vascular guideline
9. Physical Therapy Board of California. Physical Therapy Practice Act.
   California Physical Therapy Practice Act