Back pain can be a pain in the bum…..quite literally. It can prevent us from doing what we want with our lives and enjoying the things that mean the most to us. We don’t know whether to rest, take pain killers, move more, see a doctor or physio. This article attempts to outline who to see for back pain and why.
There are many types of back pain and back pain can be caused by many different processes in the body. The type we are going to focus on today is back pain related to the musculoskeletal system. Other back pain presentations will be covered in later posts.
Who to see for back pain
To make it nice and simple you only really have a few choices.
2) Expert musculoskeletal clinician – Osteopath, Physiotherapist, Chiropractor etc
3) Massage Therapist
4) The local hocus pocus, wave a wand and your cured quack
5) Orthopedic Surgeon
6) Wait for it to get better itself
So let’s talk about the pros and cons of each to really figure out who to see for back pain.
Who to see for back pain – GP
General Practitioners are great. They undergo an extensive period of undergraduate and post graduate training to enable them to be in the position they hold (10 yeas of education in total). They are highly knowledgeable in many areas and their advice and management can be extremely valuable.
GP’s (in the UK) act as the gate keepers to the experts of the medical profession. They act as a filtering system to attempt to recognise signs of sinister pathology and quickly refer you to the relevant branch of the medical professions for a more thorough investigation. There is no denying how hard their work is and I cannot praise GP’s enough for their contribution to the health care system.
Unfortunately GP’s are over burdened. Their work load is immense and they don’t have the resources to spend large amounts of time diagnosing the source of your low back back.
If you back pain is not chronic (3 months or over), progressive (getting worse) and showing more worrying signs (neurological loss, or signs of an underlying condition) then chances are your GP will prescribe some pain relief in the form of tablets . Some GP’s may suggest some dietary and lifestyle changes which may help you with your symptoms.
If your GP deems appropriate, referral to a physiotherapist may be made. This referral will typically take up to 3 months to come through. If you are choosing this route then please be prepared to be patient.
Who to see for back pain – Physiotherapist
You do not have to be referred by a GP to see a private physiotherapist. If you do however want to see a physiotherapist on the NHS then you would need to visit your GP first or be referred from a consultant within the NHS. Physiotherapists are experts in the musculoskeletal system. They spend 3 years at undergraduate level learning about the intricacies of the body and how it can manifest in pain.
Physiotherapists will spend time assessing your body and its movement using a range to clinical tests to diagnose your pain. Once a diagnosis has been reached, physiotherapist tend to take an active approach to treatment. They may prescribe exercises to strengthen areas of weakness in the body and stretch areas which are tight and causing pain. Other exercise programs may be based upon muscular control or stability.
If you are a very proactive individual and are willing to go through a period of daily regular corrective exercise then a physiotherapist/sports therapist will be probably the best person to see. Some times this can be a fairly quick period of rehab, however often extended periods of training is needed to help your pain.
Some physios (private sector) use manual techniques much similar to osteopaths, or chiropractors. Therefore there treatment approach may look fairly similar to to the other manual professions.
You can expect to pay anywhere between £30 – £200+ to see a physiotherapist in private practice. More commonly physiotherapists are priced at around £50 per session, with sessions ranging between 20 minutes – 1 hour.
Who to see for back pain – Osteopath
Not many people are aware of this but osteopaths are also available on the NHS. You would have to check with your local GP to see if osteopathy is an option in your region.
Most osteopaths however tend to work in private practice. Osteopaths complete a 4/5 year masters degree studying all aspects of the human body with a particular focus on human bio mechanics, neurology, pathophysiology and anatomy (The way to body works, moves and functions and what can go wrong)
Like physiotherapists, osteopaths are experts in muscuoskeletal medicine. Conversely to physios, most osteopaths focus on manual treatment of the muscles, joints, ligaments and fascia instead of the exercise based focus of physios. Back pain is an area of particular expertise for osteopaths.
If you like the idea of passive treatment from a clinician then an osteopath would be the appropriate person to see. Although a good osteopath will work in a way which combines multiple treatment approaches (patient specific) in order to achieve the best results. This may include a combination of manual work, exercises, stretching and life style alteration. It is not uncommon for osteopaths to prescribe a tailored exercise program after treatment for the patient to take away with them to help them to reduce their symptoms.
An osteopath will always take a detailed case history to establish the source of your pain followed by a detailed examination process to confirm their diagnosis. This process is needed so that the osteopath can make sure he/she is the right person to treat you and if not refer you onto the correct medical professional. Physiotherapists in private practice may take a similar detailed case history.
Once osteopaths establish the source of your discomfort they will proceed (with your consent) on a treatment plan which can typically take between 2-10 appointments depending on the severity of your pain. The average amount of appointments with an osteopath prior to discharge is 3 appointments.
Osteopaths are priced very similar to private physiotherapists. Prices will depend on location and practitioner.
Who to see for back pain – Chiropractor
Chiropractors are not available through the NHS so you would need to pay privately if you were going to see one. Chiropractors are experts in musculoskeletal medicine with a special interest in treatment of backs. Like osteopaths, chiropractors spend up to 5 years at undergraduate level mastering manual techniques and clinical application.
In fact chiropractors share a common origin to osteopaths with the founder of chiropractic medicine originally trained as an osteopath in the late 19th century. For that reason many of the techniques used by chiropractors may resemble techniques used by osteopaths. The main difference is the clinical application of the techniques and the reasoning behind using techniques.
Chiropractors tend to work as part of a team, so don’t be surprised if you see 3 different practitioners in your consultation. One for the case history, one for soft tissue techniques and one for spinal manipulations. It is likely if you were to see an osteopath or physiotherapist, all care would be given by one practitioner. Some chiropractors may also work in this manner.
It is not uncommon for you chiropractor to be working with a 10, 15 or 20 minute list. This of course means less time with the clinician. If you are an extremely busy person with little time on your hands then this may be an appropriate choice for treatment. If however you have quite a complex case and would like more time with the practitioner then maybe an osteopath would be more suitable. Prices vary but are not too dissimilar to private fees you would pay in seeing an osteopath or physiotherapist.
Osteopathy, physiotherapy and chiropractic are highly regulated professions. It is illegal to practice under any of these titles without the appropriate qualifications, registration with the appropriate governing body and regular criminal record bureau checks. These professions also have to complete an average of 30 hours of continual professional development training annually to keep up with the latest practices and scientific advances.
Who to see for back pain – Massage Therapist
Massage therapists come in all shapes and sizes. There are lots of different types ranging from sports massage therapist (with lots of anatomy, physiology training and sports injury training) to beauty therapists trained in therapeutic massage (less scientific but certainly relaxing and beneficial for stress relief).
For back pain, my personal recommendation in this field would be a sports massage therapist or soft tissue therapist. Normally these therapists are trained to a higher level and will have a better understanding of what is causing your pain. If however you just feels a little tight and you can feel stress effecting your body then maybe a more therapeutic massage may be of benefit to give you an hour or so to relax and let your mind wander.
Massage therapists tend to be a little cheaper than osteopaths, chiropractors or physiotherapists so this may be a cost effective option. Do remember that the latter tend to have a much higher standard of education and experience so working with them, depending on the cause of your pain will likely work out better financially in the long run.
Who to see for back pain – The local hocus pocus, wave a wand and your cured “quack”
Brace yourself, some of you may not like what I am about to say. For back pain I would never recommend the following therapists, 1) Crystal Healers, 2) Reiki practitioners, 3) Ancestral Healers, 4) Jedi’s, 5) Energy Healers, 6) Homeopaths, 7) Ayurvedic Medicine, 8) Biofields etc etc etc.
For each of the above there is absolutely no scientific basis for the claims some of these practitioners make. Also there is no regulation of practice. Therefore anyone can happily call themselves any the above and practice privately with no training or education. More commonly these practitioners would have received some training but there is no regulation on the quality or standard of the training. As these “professions” are not regulated, no health checks or DBS (previously CRB) investigations are needed to practice in these fields.
Personally I see no benefit from paying to see any of the above but if you have tried any of these therapies before and it has helped then by all means, stick with what works for you. Please feel free to comment and tell me how wrong I am about the above if you have had positive experiences.
Who to see for back pain – Orthopedic Surgeon
Most will not have direct access to a surgeon. Unless you are under their care for a previous issue, you will need to be referred via your GP before being considered for surgical opinion. You will normally only be referred to see such a specialist if the issue is getting worse, having a significant impact on the quality of your life/sleep and is showing more worrying signs than a pain only presentation.
I will take this opportunity to stress this one point. SURGERY IS NOT A JOKE. Having had surgery on my hip in 2013 I know first hand how long it can take to recover and feel like yourself post surgery. Surgery should be your last option. An extensive period of exercise/manual therapy, rest, rehab and lifestyle change is recommended for most back pain presentations prior to surgery.
Of course there are some presentations of back pain which require urgent attention. Osteopaths, physiotherapists and chiropractors are all trained to recognise the signs and symptoms related to more serious cases and will refer urgently to the relevant party if they suspect any such issue. Back pain with no other related symptoms is normally benign and should respond to a period of manual or exercise therapy.
Who to see for back pain – Wait for it to get better itself
Most bouts of back pain are short lived and pose no threat to our overall health. It is common for your back pain to last anywhere from a few days up until a few months. Single episodes of back pain rarely last longer than 12 weeks. I would recommend seeing a profession straight away to diagnose your back pain efficiently, quickly and provide effective treatment. Seeing a professional can also be beneficial in reassuring you that your pain is unlikely to be sinister.
If you are patient with it, chances are the back pain will go away by itself eventually so this may be an appropriate choice depending on how long you have had the pain.
Who to see for back pain – Top 3 recommendations
This is tough because there are certain circumstances where I would recommend each of these over their counter parts but as a rule of thumb here are my top 3 recommendations;
#1 – Your local osteopath
My #1 recommendation is to see an osteopath for the following reasons;
1) They will spend a significant amount of time with your discussing your symptoms and the history of your pain in order to gain as much information as they can to rule out any nasties and provide you with a specific diagnosis and prognosis (how long it will take to get better) for you pain.
2) Osteopaths are highly trained in the treatment and management of back pain and will have lots of experience managing patients with similar presentations to your own. This allows for efficient and focused treatment and better prognosis.
3) Osteopaths look at the body in ‘holistic’ way. This means that will not only focus on the area of your back that hurts but also look at other areas in your spine and body which could contribute to the pain. Treating other areas which may be contributing will help to prevent re-occurrence of episodes.
4) No NHS waiting list or drug prescription.
5) If you are happy to wait for an appointment through the NHS osteopaths are available in certain places within the UK (check with your local trust)
#2 – Your local physiotherapist/chiropractor
My number #2 recommendation would be to see either a physiotherapist or chiropractor for the following reasons;
1) They are both highly trained in musculoskeletal pain presentations and despite very different treatment approaches, evidence suggests equal effectiveness in each group. If you want a passive approach then a chiropractor is a better choice, if you want a more active approach then a physiotherapist would be the obvious choice here.
2) If you see them privately you can avoid lengthy waiting lists and drug prescriptions.
3) If you are busy ‘lots’ of chiropractors offer very short appointment times which may suit your needs.
4) If you are happy to wait for an NHS appointment to see a physiotherapist, you can do so for free. Thus saving your hard earned money.
#3 – Your GP
GP would be a good place to go for the following reasons;
1) They can prescribe pain relief. If you are in excruciating pain then this may help you to get through your day and help you sleep in the early stages.
2) GP’s hold the key to referral within the NHS. If they suspect that your pain is more serious they will be able to refer you onto the relevant consultant for further investigations.
3) They can refer you to an osteopath or physiotherapist, free of charge. Do be aware that waiting times are often lengthy and number of appointments is normally limited to 6.
4) They hold details about your past medical history which helps GP’s make decisions quickly and check for progression of symptoms.
Orthopedic surgeons are amazing and do a fantastic job in helping people return to normal life. As a mentioned earlier, these will not normally be your first port of call. Surgery is a last resort due to cost, safety and recovery times. If your osteopath, chiropractor, physiotherapist or GP feel that you require a referral to an orthopedic consultant they will, after discussing this with you, provide this for you.
Massage therapists come in all shapes, sizes and levels of training. I would advise a sports massage therapist if massage is your preferred choice of treatment as this will ensure a higher standard of education and greater understanding of how they can help you with your pain.
So to recap, as a general rule of thumb I would recommend an osteopath over any for the treatment of back pain. I hope this article has been too much of a pain to read and that you have got some good information to take away with you to help you make a decision on who to see for (your) back pain.
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I wish you all the best in your recovery.