Back Doctors - With So Many Specialists, Who To Turn To?

Back Pain Doctor
Back Pain Doctor. (c) Anne Asher 2007

When you have back pain, especially for the first time, determining what kind of care you need can be a daunting task. Should you make an appointment with an MD? Would you be better off going holistic? Can you simply walk into a physical therapists office and get treated - without a physician referral? (The short answer to this last question is most of the time yes, though the rules vary per state.)

Do You Even Need a Back Doctor?

Not going to the doctor (or seeing the wrong type relative to your specific problem) can have far reaching effects. If you've been injured but experience no pain or only mild pain, you may erroneously feel you don't need to see anyone at all. But such an attitude can lead to a chronic condition later.

Related: Acute Back Injury? Don't Let it become Chronic Later

By the way, according to David J. Magee in his book Orthopedic Physical Assessment, experts have identified a few things that may determine or influence the risk for a long term back pain. They include: A specific spinal pathology or nerve root pain, pain while you're in the acute stage of an injury, psychological distress, how much time you've taken off work due to your injury or pain, how you're faring with the psychosocial aspects of your work, and compensation related factors. These are called "yellow flags."

Dr. Loren Fishman, an M.D who specializes in physical medicine (and conducts research studies on yoga) say that when your symptoms first appear - or when you are first injured - the best thing to do is see a licensed medical doctor. An MD has the skills and tools for ruling out conditions and/or diseases which in turn may remove much of the guess work from determining your best course of action (i.e., should you have more tests, which treatment should you agree to, etc.) A visit with your doctor early on may also help you understand what you can expect.

(This is called prognosis.)

An MD may also be better equipped than other types of health providers for interpreting your symptoms. Fishman says your symptoms may not indicate what you think they do, and a medical evaluation may clarify provide clarification as to you have going on in your spine.

Related: Signs Your Back Needs Medical Attention

Should You Start with a Specialist?

Many people want to know if they should try to see a rheumatologist, orthopedic surgeon or other specialist right off the bat. The usual protocol is to start with your family physician, and with her, determine what to do next. This may include a referral to a specialist, or to physiotherapy.

Related:  Finding that Perfect Physiotherapist

While in the past, family physicians did not enjoy much of a reputation for effectively treating neck or back pain, things may now be changing. Fishman reports that these days, family doctors are emerging from medical school with more knowledge and better training for treating first time visits from patients complaining about back pain than in previous decades.

If your doctor does refer you to a specialist - especially if that specialist wants to do surgery, administer diagnostic test or prescribe medication, it may be in your best interest to ask her a few questions. After all, medical care is not done in a vacuum. You are a part of the decision making process. Here are the questions Fishman suggests:

  1. How well does this medicine or diagnostic test work?
  2. Does the medicine or test have side effects?
  3. Would it be worth it to wait before taking the medicine or having the surgery?
  4. If less than 7 weeks has passed since the pain started and you have severe nerve symptoms, ask why you need a diagnostic test.
  5. What is the rate of false positives on this test?
  6. Would you please recommend books or websites so I can learn about the suggested treatment?


Fishman, L. and Ardman, C., Back Pain: How to Relieve Back Pain and Sciatica. W. W. Norton and Company, New York, London. 1997

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