Usually I try not to let myself be drawn in to these discussions but I feel compelled-for better or worse-to comment here because of tonyb’s thread. I am a chiropractor. I was a mechanical engineer before so I take an analytical approach to most things that I do. I had a private practice for eight years, several of which were spent working in a pain management clinic. The last 10 years I have worked for the Department of Defense taking care of the men and women who take care of us. It does not pay as well as private practice but has its own rewards and, especially working for the Army, one tends to learn a thing or two about back pain.
The best things you can do to prevent or self-treat back pain are to develop/maintain good core strength, pay attention to posture and ergonomics, and maintain range of motion. Of these, posture and ergonomics are the most important and effective things you can do to avoid needing treatment by any health care practitioner.
MRIs and X-rays, which and when? Despite what your neighbor, co-worker, grocery bagger, audiophile posting buddy, or relative told you, there is actually reasoning behind ordering imaging. X-rays are the standard for evaluating initial injury but even those are not always necessary. Obtaining an MRI without cause does not improve outcomes and adds to the cost of health care. Additionally, just because there is evidence of a disc bulge or herniation on the MRI does not mean that this is the cause of your pain. I cannot stress this strongly enough. About 50% of people off the street, who do not have any back pain whatsoever, will have a demonstrable lesion on MRI so just because it exists does not mean it matters!
What to do if you have back pain?
Study after study supports manipulation (chiropractic adjustments) for back and neck pain – especially on an acute basis. So don’t be a typical male and pretend it is going to go away. If caught early, spinal pain is usually easy to treat. If you have chronic pain things get more complicated, not only because of bad biomechanical habits but because there may be physical and structural changes. This is sometimes where surgery comes in. But…and this is a big but…there is no guarantee that surgery will cure your pain (and of course it comes with its own risks) and even if it does, “fixes” like fusion just means that stress is transferred from one vertebral level to another and you will be in the OR for another fix several years later.
Sometimes this is the only option but studies show that after two years, people who pursue surgery or treat conservatively are in about the same place as far as pain level and function. Those who delay surgery, and end up getting it later, have the same chance of a successful outcome; so there is no downside to delaying surgery to see if you can manage it on your own!
As stated before, I am a chiropractor. I believe in what I do. My patients believe in what I do. The PCMs here believe in what I do. I exist solely on referrals from MDs and PAs (and physical therapists) and I am backed up several weeks, so I have to be doing something right. And I am not unique in this. Also, as I alluded to before, there is a lot of research to support chiropractic treatment of back pain, neck pain, and headaches. Chiropractic treatment is one of the preferred interventions in virtually all back pain treatment protocols. That being said, I am painfully aware of the warts in my profession. Those types are present in any profession: Chiro: come back every day until your insurance runs out. PT: same thing - but no one ever questions them. Plus just do the exercises on this sheet, you’ll be fine. MD: Blah, blah, blah “back pain” take these pills.
Obviously, these are just easy stereotypes and though they are true in some situations, they are not indicative of everybody. Judging by stereotypes is easy and lazy, evaluate people on their merit. Find a provider who THINKS and cares about what he/she does; there is nothing more important than that regardless of degree. If you have specific questions, PM me but there is no substitute for face-to-face evaluation.
This has been a Bavarian Beer sponsored PSA...