Which Health Professional Should I See?

If you are experiencing pain or have an injury, there are many options for health professionals to treat your painful condition. So who should you see first? Going to your family doctor is usually the best first step, and he/she will direct you with initial treatments and referrals. However, sometimes you can go straight to another health professional or ask your doctor for a referral to someone on this list. I selected these few to emphasize because many patients have asked me about these options.

1. Physical Therapist: joint pain, new injury, old injury, chronic pain, weakness, balance/walking issues, shoulder pain, elbow pain, neck pain, mid back pain, low back pain, sciatica, pelvic pain, hip pain, knee pain, ankle/foot issues, gross motor delays in babies or children, muscle pain/strain, neurological injury (such as a stroke) 

2. Occupational Therapist: pain/injury of any part of the arm/hand, difficulty with fine motor tasks, hand/arm weakness, difficulty performing usual daily tasks, neurological injury (such as a stroke), developmental delay in babies or children

3. Chiropractor: new episode of spine pain, car accident, whiplash, chronic back pain, some areas of joint pain, alignment issues, low back/pelvis pain, sciatica

4. Massage Therapist: fibromyalgia, chronic pain, tight muscles, stress

MD Specialists for some common painful conditions:

1. Neurologist: nerve problems (numbness, tingling), neuropathies, neurological conditions (stroke, TIA, MS), unexplained weakness

2. Pain Management: chronic pain, need for injections (such as Cortisone), back pain

3. Orthopedist: specific for each joint. For example, find a shoulder specialist/surgeon if you have shoulder pain.

4. Neurosurgeon: new or chronic spine pain that may radiate away from the spine into the arm(s) or leg(s)

Always remember that you can choose your own health professional just like you select your pharmacy. Even if your doctor refers you to a specific therapist or specialist, you can request a referral to someone of your choice.

What Are The Treatment Options For Low Back Pain?

1. Oral pain medicine, which may include non-steroidal anti-inflammatories (NSAIDS like Ibuprofen), steroids, narcotics, muscle relaxers, etc.

2. Physical Therapy, which may include exercise, joint mobilizations/manipulations, modalities (such as electric stimulation, lumbar traction), postural corrections, body mechanics, education about cause of pain and forms of self-treatment/prevention, hands-on techniques, taping, functional activity training, aquatic/water therapy.

3. Injections to the lumbar spine (such as Cortisone).

4. Surgery (more common with major spine trauma or with chronic low back pain that has failed to improve with conservative treatments).

5. Chiropractic care, including manipulations and decompression (a form of lumbar traction).

6. Alternative therapies, including massage, accupuncture, etc.

7. Advertised home treatments, such as an Inversion Table, Back2Life, etc.

8. TENS (transcutaneous electrical nerve stimulation) unit, which is a device that you connect to electrodes placed on the skin of the low back. This is similar to the electric stimulation at Physical Therapy and Chiropractor offices.

9. Over-the-counter creams, medications, heat/ice, patches, supplements.

10. Bracing (more common after certain low back surgeries).


My biggest advice for you is 3-fold:
Prevent low back pain; it can be prevented!
If you have occasional low back pain, read the book "Treat Your Own Back," by Robin McKenzie.
Try Physical Therapy before other treatment options.

The difference between Chiropractors and Physical Therapists

Let's imagine you have back pain, and you need some help. Who do you call? The good news is that you have options: primary care doctor, spine specialist, physical therapist, chiropractor or even alternative medicine (such as accupuncture).

So what is the difference between the treatment you get from a chiropractor and a physical therapist?

Chiropractors specialize in manipulating (popping) various joints and segments of the spine and pelvis. They usually take x-rays to determine the areas that are not properly aligned. Then they develop a treatment plan, which includes manipulations to many different joints of your back. Depending on the chiropractor, you may also get electric stimulation, heat, ice, and decompression (a form of traction). More rarely, you may get some exercises. Most health insurances cover chiropractic care, but you will likely have co-pays. And anything your insurance does not cover (certain procedures), you pay out of pocket. Many chiropractors recommend that you continue treatment for weeks-months and then come back periodically for spine adjustments.

Physical Therapists specialize in decreasing pain and restoring normal physical function through exercise, education, hands-on techniques (which may include tissue or joint mobilization and joint manipulations), posture/body mechanics training, functional activities, modalities (such as electric stimulation, heat, ice, decompression/traction, ultrasound), gait training (improving walking patterns), balance training, stretching and/or strengthening. All health insurance covers Physical Therapy, but you will likely have co-pays. To see a PT, you simply need a doctor's prescription (if you want your health insurance to pay for it). PT's aim to find out the cause of your pain/symptoms, to treat them and to teach you how to prevent them again in the future. The goal is to make you independent in managing your own symptoms so that you no longer need PT. Depending on your injury/surgery, you may need PT for 1-2 visits or up to several months.



References:
American Physical Therapy Association (www.apta.org)
American Chiropractic Association (www.acatoday.org)