SHOULD I SEE A PHYSICAL THERAPIST OR CHIROPRACTOR FOR MY BACK PAIN?
by onsite, September 7, 2016
When some people think back or neck pain, they immediately think of going to a chiropractor for relief. Many people only think of seeing a physical therapist after a surgery or to rehabilitate something like an ankle sprain, shoulder tendinitis, or plantar fascitis. The reality is that physical therapists and chiropractors both treat chronic pain related to the spine (back or neck), as well as other joints throughout the body. There’s some important similarities and differences betwee
n how these professionals typically treat spine pain & injury. The goal of this article is to give patients an idea of what they should look for in a chiropractor or physical therapist to give them the best results for decreasing pain and improving function.
Being a Doctor Physical Therapy, my answer to this question may surprise you. I am not going to tell patients they should choose a physical therapist or a chiropractor. Rather, I am going to give them and idea of specific things and activities that the professional they choose MUST be doing to help them achieve optimal results and long lasting relief. Here are the major things to look for when choosing someone to help you with your back or spine related pain…
DON’T SEE A CHIROPRACTOR IF THEY ONLY DO ADJUSTMENTS
I am definitely not one of these physical therapists that dislikes chiropractors or is against joint manipulation (“manipulation” & “adjustment” mean the same thing in this article). I use many of the common chiropractic manipulation techniques myself and have great results with patients. However, the problem I see with many chiropractors is a lack of functional movement correction or exercise prescription to follow up the adjustments. If all you are receiving is a manipulation and then some heat or electric stimulation, you are never truly fixing what is causing the spine or joints to get “out of alignment” or stiff in the first place. Especially if we are dealing with an overuse related spinal or joint injury (which encompasses the large majority of back and neck injuries), we MUST correct the movement compensation, postural abnormality, or positional fault. Our joints don’t simply get stiff or out of position for no reason! This happens as a consequence of weak muscles, altered movement patterns, or spending increased time in bad postural positions. If we never correct these things, then we will have to continue going to the chiropractor for “maintenance,” for the rest of our life.
What commonly happens to patients that go down this path of only being manipulated without corrective exercise prescription, is eventually the manipulations stop helping. The manipulations become less effective over time at alleviating pain because there is no carry over with change in functional movement. The cumulative effect of these poor movement patterns or positions are more powerful than the few adjustments they receive from the chiropractor each month. So, the individual’s spine health and tissue quality slowly deteriorates. Let’s use an analogy.
Only getting adjustments from a chiropractor with no follow up exercise, strengthening, or movement re-training is like mopping up a leak on your hardwood floor. The leak is coming from a problem with your water heater, and water is continually leaking out onto your hardwood floor. Because it is not a “quick fix,” and takes more time, effort, and energy to get the water heater fixed you take the easier route and keep only mopping the floor when there is a leak. Eventually, because so many leaks have occurred, the hardwood floor is rotten and ruined. If you would’ve taken the extra time, focus, money, ect to fix the water heater and stopped it from leaking instead of just mopping the floor you would’ve saved a lot of agony in the long run. Fixing a movement dysfunction, gaining strength in a weak area, or correcting a muscle imbalance is not easy or a quick fix, but overuse injuries will continue to develop until these measures are taken to fully correct a problem. Over time, the patient will no longer get results from the adjustments, just like it’s pointless to mop a floor when it is rotten. Mopping up the leak is helpful initially, but what really needs to happen is the water heat needs fixed (just like the CAUSE of your pain needs to be fixed).
DON’T SEE A PHYSICAL THERAPIST THAT ONLY DOES EXERCISES AND PERFORMS NOHANDS-ON TREATMENT
There are a few very rare injuries that may respond to a treatment plan exclusively involving exercises only. However, in a large majority of cases doing some hands-on treatments or techniques like adjustments, active release massage, trigger point dry needling, or instrument assisted soft tissue massage can help patients recover much more quickly. These hands-on treatments can decrease pain more quickly, and help patients develop increased mobility, range of motion, and soft tissue extensibility faster than exercise itself. I see many therapists that choose a generic exercise program for each type of injury they see. If I was a patient I would want a therapist that had a large skill set and could provide any type of beneficial treatment possible. Hands-on techniques like joint manipulations or trigger point dry needling are very powerful interventions that can help make immediate improvements in mobility. Exercises are still crucial for re-training movement patterns and facilitating good movement habits. However, an adjustment, dry needling treatment, or active release therapy is often crucial early on. These hands-on techniques can put our bodies in the best state or position to heal and achieve optimal benefit with exercises.
The crucial part of your decision when deciding who to go see for your back pain is not whether it’s a physical therapist or a chiropractor, but the way the professional actually treats patients. Depending on the patient and what they need, a treatment that I perform may look similar to what a chiropractor does with extensive hands-on techniques. On the same note, I know some great chiropractors that are prescribing follow up exercises and spending time re-training movements rather than just doing a few adjustments and slapping on electric stim.
If any of the following statements apply to your experience with a physical therapist or chiropractor I would recommend going somewhere else:
- My sessions are less than 45 minutes
- My physical therapist doesn’t do any adjustments, trigger point dry needling, or hands on massage techniques
- My Chiropractor only does adjustments followed by a heat or electric stimulation with no follow up exercise instruction
- I spend the majority of my time at the PT or chiropractic clinic with an assistant rather than the Doctor of Physical Therapy or Doctor of Chiropractic
- During my treatment sessions I do simple exercises unsupervised that I could replicate on my own at home
I WOULD NOT ADVISE SIMPLY GOING TO WHOEVER YOUR DOCTOR RECOMMENDS without doing your own research on the facility. It’s very rare the referring doctors actually know a lot about the clinic they are recommending. It’s typically just a facility that the doctor is affiliated with or is within the same hospital system.