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Saturday, 18 August 2012

Which is better for Lower Back Pain – Chiropractic Manipulation or Physical Therapy?

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back_painIt’s an age-old question among people who suffer from lower back pain; which works better – physical therapy (PT) or seeing a chiropractor?  While there is never a one-size-fits-all solution to back pain, it’s usually a good idea to get an MRI first, just to see what is really going on in there.  Back pain can come from myriad causes, from arthritis to sciatica, a too-soft mattress or a herniated disk.  Until you know exactly what you’re dealing with, it is a good idea to proceed with caution.

Looking at the two options – physical therapy and chiropractic manipulation – most doctors will feel more comfortable recommending physical therapy.  But remember, this is only because PT is considered a “medically sound” or “medically necessary” procedure by most healthcare institutions and insurance companies.  Chiropractic is not a mainstream medical practice and it does not require a medical degree, therefore it is often lumped together with holistic or New Age practices.  Don’t let this slight from the medical community fool you; chiropractors really can help you with back pain.  Just ask anyone who has ever found relief from chiropractic treatment.  It may be a little less “orthodox” than physical therapy, but it works much faster.

What to expect from medical professionals

When you are experiencing extreme lower back pain, it’s tempting to seek help from your primary care physician, but this might just delay a lasting cure.  Your typical family doctor might diagnose you with sciatica and send you on your way with a few prescription-strength anti-inflammatories and muscle relaxing meds.  Rather than risking addiction, you might benefit from starting out with a neurologist or an orthopedic surgeon.  Rather than focusing on your symptoms, they will set out to find the cause of your problem.

Your typical orthopedist or neurologist will send you for an MRI first, just to rule out a spine problem or discover a herniated disk.  If standing or sitting has become too painful they may recommend surgery, but be careful about this.  When it comes to back surgery, it is always necessary to get a second opinion.  I’ve seen patients get a referral for surgery only to find lasting relief from a chiropractor.

Can a chiropractor “work around” herniated disks or other spine injuries?

The most common questions I hear about lower back pain focus on whether a chiropractor could make their condition worse.  While it might be possible if you go to the wrong person, it is certainly not likely.  Just because chiropractors don’t graduate from an accredited medical school doesn’t mean they are any less educated about the body.  In fact, they are trained to diagnose problems that many medical professionals miss because they rely on a greater variety of different diagnostic modalities.  For example, where your doctor will simply interpret the radiologist’s findings, a chiropractor relies on sight, touch and manipulation, as well as imaging.

Can a physical therapist replace a chiropractor?

Physical therapy, also known as “PT”, is more commonly used for sports injuries or post-surgical rehabilitation.  However, it will not be as effective as chiropractic manipulation unless your main issue is a muscle problem.  If you are suffering from a degenerative disk disease, chronic arthritis, or anything that puts pressure on your spinal cord, then the better solution would be chiropractic manipulation or surgery.  Some doctors recommend a course of physical therapy paired with personal training to build up the muscles in the “core” before surgery as it will strengthen the body for recovery, but this is not always possible when a patient is experiencing severe pain.

A 1998 study, published in the New England Journal of Medicine, is often cited when people ask for information about chronic back pain.  “A Comparison of Physical Therapy, Chiropractic Manipulation, and Provision of an Educational Booklet for the Treatment of Patients with Low Back Pain” was published by the NEJM to help medical professionals learn about the best treatments for various groups of patients. The publication recommends physical therapy for less severe symptoms and studies the clinical outcomes of people in the year following treatment by either method.

From the booklet, “For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group.”

Consult with a medical professional first

Patients are seeking information about medical treatments from online resources more than ever; which can be risky when the problem requires surgery.  In all cases of severe lower back pain, it’s best to seek out a specialist who will diagnose the cause of the pain.  An experienced physician will help you make the best decision about physical therapy vs. chiropractic care.

Image Courtesy of graur razvan ionut/ http://www.freedigitalphotos.net/

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