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Who should I see about my back pain, a chiropractor or an orthopedist?

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Updated May 07, 2011

Question: Who should I see about my back pain, a chiropractor or an orthopedist?
Answer: Patients often ask if they can or should be seen by a chiropractor for the treatment of back pain. There have been a number of studies that show effective treatment of back pain by chiropractors. However, not all causes of back pain should be treated by a chiropractor. There are some conditions that should be identified and treated by an M.D. rather than a chiropractor.

Why should I be seen by a medical doctor?

Most cases of back pain can be effectively treated by a chiropractor. Chiropractors have been shown to be most effective at treating acute back pain. However, there are some conditions, potentially serious problems, which must be considered before initiating any treatment. Most of these conditions can be screened with a thorough history and physical examination.

Symptoms that raise concern include:

  • Any problems controlling bowel or bladder function
  • Numbness around the genitals
  • Pain with fevers, chills, or sweats
  • Pain that awakens you at night
Furthermore, there are some symptoms that are better treated by an orthopedist than a chiropractor. These include:
  • Back pain with associated leg pain
  • Numbness or tingling in the legs
  • Weakness of the muscles of the legs
The above symptoms are found in patients who may have a problem other than a lumbar muscle strain or ligament sprain. When the underlying problem is a muscle strain or ligament sprain, then chiropractic treatments can be very effective.

Patients who have symptoms of nerve or spinal cord compression should not undergo chiropractic manipulations until cleared to do so by a medical doctor. Furthermore, there are rare problems, such as infections and tumors of the spine, that should not be treated by chiropractors. Unfortunately, there are stories of patients who undergo manipulations of the spine and sustain devastating complications because of nerve injury. These cases are rare, but it is important that there is a good understanding of the cause of back pain before initiating manipulations of the spine.

How do I choose a chiropractor?
Choosing a chiropractor can be difficult because there is a wide variety in styles of practice. The American Chiropractic Association can help connect you with a qualified chiropractic doctor in your area:

Sources:

Swenson R, Haldeman S. "Spinal manipulative therapy for low back pain." J Am Acad Orthop Surg. 2003 Jul-Aug;11(4):228-37.

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