Chiropractors or Orthopedists?

I pose the question: “If one has back pain should they seek a consult with a chiropractic doctor or an orthopedic surgeon?” In other words, which doctor should be the initial primary care physician?

80 % of adults suffer from back pain, so I must assume that this is a concern pondered by many. As a chiropractic physician, my thoughts maybe somewhat biased, however my intention with this article is to present helpful insight for those who wish to make smart decisions about their back care.

I am not anti-medical and have often referred patients to medical doctors or orthopedists (aka: orthopods) when I deemed it in the patient’s best interest. As a matter of fact, I was one of a handful of chiropractors that pioneered hospital privileges for the purpose of chiropractic spinal manipulation under anesthesia. Thus, I worked successfully with and helped educate members of the medical profession on the benefits of chiropractic.

Quality, Competency and Humility of Physicians

To answer the question regarding chiropractor vs. orthopedist, I will begin my answer by saying it really depends on the doctor and his or her willingness to be open-minded about what is in the best interest of the patient(s). I believe either type of doctor could be an excellent primary care physician for the diagnosis of back pain. Doctors in general need to be aware of their limitations and realize they are not the end-all panacea for all types of conditions. As long as they have humility, and they are known to be competent diagnosticians, their patient(s) should be in good hands. One tenant of the health care profession is to “do no harm” and there is much value in this simple phrase.

Practitioners of either profession are trained to utilize a familiar treatment protocol. In other words, orthopedic surgeons often do surgery and chiropractors like to physically manipulate the spine. There is however no guarantee that a patient’s condition warrants either one of those treatments. Sometimes, the necessary treatment is as simple as applying ice and electrical muscle stimulation to a mild strain of the back. The prudent physician offers both a kind listening ear and competency as a diagnostician. Only with a complete history and thorough examination will a physician be in a position to make an accurate assessment, thus suggesting the next step in the doctor’s decision process -- “Do I treat, or do I refer?”

The Doctor Making a Diagnosis is NOT Always the Best Treating Physician

I’ve heard it said: “What’s you’re not up on, you’re down on.”

I believe it is important for a physician of any type to have knowledge of alternative treatments that are beyond the scope of their own practice. Given this knowledge and an open-mind, prudent recommendations are likely to be forthcoming.

Matching Your Back Condition with the Appropriate Doctor

The majority of back pain cases do not require surgical intervention and they are often best handled by a chiropractor. However, it is good for back pain sufferers to know what cases are predominantly amenable to chiropractic care, as well as those that often require the care of an orthopedic surgeon or perhaps a neurosurgeon. The following chart should be helpful.

Condition/Symptoms	Chiropractor	Orthopedist	Neurosurgeon
back strain/spasm	X
back sprain (1 or 2 grade)	X
back sprain (grade 3)		X
pinched nerve (with foot drop or drag)		X	X
pinched nerve (with just numbness or pain)	X
herniated disk (with pain or numbness as low as knee)	X	X
ruptured disk (pain extends below the knee; weakness)		X	X
fracture of vertebrae		X
bony tumor		X
neurological or soft tissue tumor			X
pulled muscles	X
scoliosis	X	X
auto injury	X	X
arthritis or degenerative disk	X	X
sacro-iliac	X
lumbar facet syndrome	X
infection or hot puffy swelling with or w/o fever		X
spinal cord injuries			X
back pain with loss of bowel or bladder function			X