Choosing a Doctor Who Treats Neck and Back Pain
Informed choice can help you choose a trustworthy provider
So who do you go to? There are as many choices as there are colors in the rainbow. There are a number of distinct physicians within the medical world (including medical doctors and doctors of osteopathy) that you have a choice from. Internists, family physicians, orthopaedists, neurosurgeons, spine surgeons, physical medicine and rehabilitation specialists, neurologists, anesthesiologists, and even some psychiatrists that treat lower back disorders. There are places that have multiple specialists who treat these disorders as a group.
There are many types of nonmedical practitioners to choose from, and they vary greatly even within their own specialty. You can go to a chiropractor, physical therapist, massage therapist, athletic trainer, acupuncturist, Feldenkrais or Pilates practitioner, personal trainer, or even an aroma therapist.
Internists and Family Practice Physicians
Internists and family physicians are the most typical entry into the world of medical treatment. The second most common reason for a visit to your primary care doctor is back pain. These individuals have one of the most difficult jobs. These doctors have to know about heart disease, circulation, lungs, liver, kidneys, diabetes, infectious disease, as well as spine. They have the hardest job in medicine.
These docs might initially use medications and activity restrictions. If their treatment is not effective, they might refer to a physical therapist. Some may refer to chiropractors. Osteopaths may treat the problem themselves with manipulation and muscle techniques. No matter to which you go, if the problem is resolved, obviously there is no further need of treatment.
- The physical medicine and rehabilitation (PM&R) doctor has a four-year residency after medical school that is different from the orthopaedist, spine surgeon, or neurosurgeon. They are not surgeons and are given a comprehensive education in spinal disorders. These doctors can specialize in nonsurgical treatment of the back. Many perform EMGs that are electrical nerve diagnostic tests to help understand the source of nerve pain. Others have taken fellowships in interventional spinal injections to complement their treatment programs. These individuals are a good choice for initial treatment.
- The neurologist also can have an excellent understanding of spinal disorders. They have a four-year post-medical school residency. Most specialize in the diagnosis and treatment of neurological disorders of which spinal disorders are a component. Some can have extensive training in spinal biomechanics, and many gain this knowledge in their practice. They are the true experts in diagnosing specific nerve disorders such as peripheral neuropathy and multiple sclerosis. They specialize in EMGs. Most times, you would be referred to this specialist by your family doctor or specialist.
- The rheumatologist is another choice as a treating physician. He or she is a specialist in joint disorders that include the spine. They first do a residency in internal medicine and then do a fellowship in rheumatology. These are the true specialists in autoimmune joint disorders such as rheumatoid arthritis and SLE (lupus) among others. Again, you normally would see this specialist by referral from another physician.
- Doctors of osteopathy are probably one of the most misunderstood of all the physician groups. They are trained in in anatomy, physiology, and pathology in osteopathic schools exactly the same as in medical schools. After graduation, many take residencies in the medical world, and some take osteopathic residencies. In general, they are essentially medical doctors with the initials DO (doctor of osteopathy) instead of MD. All are trained in osteopathic manipulation, but many don't use this form of therapy in their practice. Many are specialists after taking a residency such as PM&R, neurology, or orthopaedics. Many are a good first choice for back care.
The physical therapist spends four to six years in college before getting a bachelor's or master's degree in PT. These individuals are very well trained in anatomy, biomechanics, and exercise therapy. They have therapeutic machines at their disposal to reduce swelling and promote healing. Some therapists strictly specialize in spinal rehabilitation, and others are generalists treating all joints in the body, as well as stroke patients and cardiac rehabilitation.
They are the experts in looking at the body for injuries and developing a treatment protocol to help heal and compensate for injury. They are the mainstays for many physicians to treat the lumbar spine.
If personal trainers have been through an athletic training degree, they are normally well educated about the body. They have not had formal diagnosis courses, but if something is painful, most will avoid that activity. Many are great at core training; the training of the muscles around your "core."
Donald S. Corenman, MD, DC is a practicing orthopaedic spine surgeon and chiropractor in Vail, CO and the author of Everything You Wanted to Know About The Back, a consumer's guide to the diagnosis and treatment of lower back pain. Click here for more information about the book.