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FAQs:

What is a Back and Spine Specialist?

A back and spine specialist completes many different procedures, all with the same goal. They aim to eliminate or decrease back pain through medical treatment. They target a specific condition or injury before referring patients to lower levels of care to continue treatment. They often treat many of the same conditions as chiropractors but for those requiring more intensive care. Their treatment may result from a traumatic injury or for conditions that do not improve with less invasive forms of therapy from providers like chiropractors.

What is the Difference Between a Back and Spine Specialist and a Chiropractor?

Chiropractors and back and spine specialists treat back and musculoskeletal issues, but their roles and approaches differ significantly. Chiropractors focus on non-invasive techniques, often the first to address back pain through spinal adjustments and holistic treatments like massage or physical therapy. They generally handle minor injuries and musculoskeletal pain but lack medical privileges such as ordering advanced imaging or prescribing medication.

In contrast, back and spine specialists, typically M.D.s, have broader medical authority and treat more severe conditions. They can prescribe medication, order MRIs or CT scans, perform blood work, and, when necessary, conduct surgeries. While chiropractic care may be sufficient for everyday aches, individuals with serious injuries from accidents may require immediate evaluation by a back and spine specialist for appropriate imaging and potentially surgical interventions. Both providers prioritize non-invasive treatments, with chiropractors addressing broader wellness and spine specialists focusing on specific, often critical, medical issues.

What is the Most Common Cause of Back and Spine Pain?

Most short-term back and spine pain results from strains or sprains to the soft tissues (i.e. the muscles or ligaments) that support your spine. Also, mechanical issues, such as disc degeneration, can change the structure of the spine, thus affecting joints, vertebrae, and the nerves that pass through the spinal column.

How Do I Know If I Need Back and Spine Surgery?

Back surgery might be an option if other treatments haven't worked, and your pain is disabling.

Many people with back pain also have pain that goes down a leg. These symptoms are often caused by pinched nerves in the spine. Nerves may become pinched for a variety of reasons, including:

1. Disk problems. Disks are the rubbery cushions that separate the bones that make up the spine. A bulging or herniated disk sometimes can get too close to a spinal nerve. This can cause pain and affect how the nerve works.

2. Overgrowth of bone. Osteoarthritis can result in bone growths, often called spurs, on the spine. This excess bone can reduce the amount of space available for nerves to pass through openings in the spine.

Can the Weather Affect My Back and Spine Pain?

When we get cold, our bodies constrict the blood vessels in our extremities, and the body directs more blood toward the internal organs (vasoconstriction). This lack of blood in the muscles and supportive tissues surrounding your spine will cause them to stiffen and be less flexible. As muscles, ligaments, and tendons stiffen, it can put a strain on the supportive structures of your spine and irritate nerve roots, causing pain. You may feel the effects of this stiffening more keenly in an area that has been previously injured.

There is no hard scientific evidence connecting a drop in barometer to back pain, but many people notice that their arthritis or injuries hurt more right before a storm comes in, even if they are in a warm place. Some have suggested that barometric pressure changes may increase inflammation, but again, this hasn’t been proven.

How Long Does Back and Spine Pain Last?

When back pain is related to sprains and strains, it may only last for a few days to a couple of weeks. With rest and self-care, many back issues will resolve as the irritated tissues heal. 80% of those with acute back pain will feel better within six weeks. If your pain persists for longer or is particularly bothersome, you know it’s time to see a doctor.

Can Bad Posture Cause Back Pain?

The complications of poor posture include back pain, spinal dysfunction, joint degeneration, rounded shoulders, and a potbelly. Suggestions to improve your posture include regular exercise and stretching, ergonomic furniture, and paying attention to the way your body feels.

Types of Back and Spine Specialists

In simplest terms, a spine specialist is a health professional who primarily focuses on treating spine-related conditions. It’s a good idea to see such a specialist when your back pain is becoming progressively worse or not responding to initial treatments. Now comes the hard part – deciding what particular “spine specialist” is most likely to be able to address your needs, and, more importantly, offer treatment options possible to lead to meaningful relief.

Chiropractors

Chiropractors can offer safe ways to strengthen muscles and tendons supporting your spine for spine-related pain resulting from strained muscles or herniated discs that do not require surgery. Since chiropractors are trained to treat and diagnose patients, it’s not unusual to be referred back to your PCP when a spine problem has been ruled out or to another specialist if a diagnosis can’t be made.

Neurosurgeons and Orthopedic Surgeons

You’ll likely be referred to a neurosurgeon or an orthopedic surgeon after you’ve been diagnosed with a spinal condition, such as spinal stenosis, spinal cord injury, or disc herniation, not responding to conservative treatments and requiring surgical intervention. Anesthesiologists and related support staff can also be considered spine specialists if they primarily assist with spine-related surgeries.

Rheumatologists

When spine pain is related to conditions like spinal osteoarthritis or inflammation affecting nerves supporting the spine, you’ll likely be referred to a rheumatologist. This particular specialist is trained to diagnose and treat conditions affecting any of the joints, bones, and muscles within the human body, including those supporting your spine and neck.

Physical Therapists

If your spine condition doesn’t require immediate surgical intervention, you may be referred to a physical therapist. These particular professionals are trained to recommend controlled movements and exercises in a supervised setting to increase muscle strength and flexibility. You may be referred to a physical therapist if more serious spinal conditions have been ruled out or while recovering from recent spine surgery.

Symptoms of Back and Spine Pain

Back and spine pain are not the only indications of a spinal condition or injury.  Common symptoms can include:

1. Neck and arm pain, weakness, and tingling

2. Difficulty with fine movements in the hand

3. Back pain after sitting or after a fall

4. Chronic aches in the middle or lower back

5. Weakness and difficulty moving leg or foot

6. Shooting pain that makes it difficult to stand

7. Pain and difficulty with walking

8. Leg and buttock pain or numbness

9. Curvature of the spine

Common Issues that a Back and Spine Specialist Treat

Back and spine specialists often see patients with a variety of advanced and challenging conditions, including those affecting the neck and spine. Here are the common issues that a back and spine specialist treats.

1. Disc Herniation: With a disc bulge, a patient typically experiences a localized dull or aching pain as a weakened disc bulges out, putting pressure on the spine. If left untreated, the outer layer of the disc could weaken further and turn into a protrusion or herniation, placing pressure on a nerve root, and causing shooting or radiating pain down the arm or leg.

2. Annular Tear / Disc Tear: An annular tear is a tear or rupture in the tough, outer ring of an intervertebral disc called the annulus fibrosus. This condition causes localized pain or muscle spasms that are exacerbated by movements like bending or twisting. Sleeping may be difficult due to pain.

3. Stenosis: Spinal stenosis is the narrowing of the spaces within the spine which puts pressure on the spinal cord and nerves. Symptoms generally include radiating pain or paresthesias down the legs or arms.

4. Sciatica: Sciatica is a condition characterized by pain that radiates along the sciatic nerve, typically running from the lower back through the buttocks and down the leg to your foot. Common symptoms include sharp, shooting pain, tingling, or numbness along this nerve pathway.

5. Pinched Nerves: Known by many names, a pinched nerve usually causes sharp shooting pain, or pins and needles sensation or numbness. A back and spine specialist can relieve the pressure on the nerve from surrounding tissues, bones, muscles, and tendons.

6. Degenerative Disc Disease: Degenerated discs are not normal, but more common with aging, and typically cause chronic back pain, stiffness, and reduced flexibility. A back and spine specialist can offer non-surgical solutions to reduce pain and return the degenerated disc to better health.

7. Lower Back Pain: Lower back pain can be caused by a variety of issues like pinched nerves, strained muscles, or ligament sprains. The two most common causes of generalized lower back pain are sacroiliac joint dysfunction and facet syndrome. These 2 conditions are greatly affected by posture, spinal alignments, and even leg length inequalities.

Treatments that a Back and Spine Specialist Use

Treatment recommendations from spine specialists will vary based on their practice philosophy, your condition, and your treatment goals. In this section, we’ll briefly explore some of those treatment options.

1. Physical Therapy

Physical therapy is often used as part of a conservative treatment plan. A favorite approach of physiatrists and orthopedists, it can be used to treat a wide array of conditions including scoliosis, sciatica, and kyphosis.

2. Prescription Medications 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or naproxen, COX-2 inhibitors, and muscle relaxants are all non-opioid medications a spine specialist might prescribe for pain management.

3. Injections

Corticosteroid medications, when injected into the epidural spaces in the spine, can provide significant medium-term pain relief for chronic pain caused by inflammation of the spinal nerves.

4. Surgery

Sometimes conservative methods of care aren’t enough to relieve chronic back pain. In these cases, surgery may be the best option to improve your quality of life. Some procedures performed by spine surgeons are:

a) Discectomy – removal of the damaged portion of a herniated disc

b) Kyphoplasty – vertebral augmentation for compression fractures

c) Spondylodesis – joining together two or more vertebrae, also called spinal fusion

d) Laminectomy – removal of part of the laminal arch to relieve pressure in the vertebral canal

Diagnostic Tools Used by Back and Spine Specialists

Back and spine specialists employ several tools to diagnose the cause of your back pain. Let’s take a quick look at the most useful tools.

1. Physical Exam

Your physical exam will begin with your doctor going through your complete medical history. They’ll want to know about any previous medical conditions as well as your current symptoms. Your doctor will then physically examine your body, paying special attention to the bones, joints, and muscles of your back. They may observe your posture, ask you to move in different ways to test your range of motion and see what kind of movements cause you pain, and palpate your spine as well as the muscles that support it.

2. Neurological Exam

A neurological exam can aid your doctor in pinpointing the cause of your back pain. You might be asked questions that specifically relate to neurological symptoms, such as if you’ve noticed weakness in your arms and legs. Your doctor may also ask you to walk around the room in different ways so they can examine your gait and balance, test your reflexes, and do a sensory exam using tools like alcohol swabs or tuning forks.

3. Imaging

Sometimes the best way to figure out what’s going on inside your body is to take a visual look. Your doctor may use any combination of X-rays, CT scans, or MRI imaging to aid in diagnosing the cause of your back pain.

When to See A Back and Spine Specialist

If you’re experiencing back pain, have a chronic condition, or have an acute injury, you may be wondering if you need to see a back and spine specialist or a chiropractor. The most important thing to note is that if another M.D., such as an emergency room doctor or your primary care physician, refers you to a spine specialist, you follow their recommendation to receive proper treatment.

However, you may need to see a back and spine specialist if:

1. You have back or neck pain that doesn’t respond to lower levels of treatment, such as chiropractic care.

2. You have a degenerative medical condition that continues to worsen despite other forms of treatment.

3. You experience severe symptoms such as your foot dropping when you try to lift it or your leg giving out entirely when walking on the stairs.

4. The movement and ability of your hands or fingers change without a known cause–you may notice a difference in your handwriting or ability to grasp items.

5. A doctor or chiropractor notices signs and symptoms that are beyond their scope of ability to treat.

What to Expect At Your First Back and Spine Specialist Appointment

If you’re about to have your first appointment with a spine specialist, here are 5 things to expect will happen.

1. A Longer Appointment

First and foremost, expect your appointment to take a bit longer than usual as your doctor will spend time getting to know you and your health history. During this first appointment, your doctor will also answer any questions or hesitations you may have.

2. Talking About Your Medical History

Be prepared to discuss your medical history with your back and spine specialist. This includes talking about any past treatments or surgeries you’ve undergone to manage your pain symptoms, as well as in general getting a better gauge of your pain symptoms (when they started, any event that may have led up to your pain, etc.). Understanding your medical history more thoroughly will allow your pain specialist to create a more tailored treatment plan to effectively manage your pain.

3. Physical Exam

You will also likely undergo a basic physical exam. This physical exam will help your spine specialist gain a better understanding of your health as a whole and why you may be experiencing your pain symptoms.

4. Create An Initial Treatment Plan

If you are going to a spine specialist to better manage your pain symptoms, during your first appointment the back and spine specialist may create an initial treatment plan to start working on treating and relieving your pain symptoms. It’s important to understand that depending on how you react and improve (or not) to this initial treatment plan will determine future action. For example, if you do not experience any signs of improvement after this initial treatment plan, your spine specialist may modify and make certain changes as needed.

5. Opportunity to Ask Questions

You likely have several questions of your own regarding your health, and now during your first appointment is the time to ask them! Whether you have questions about your pain, your treatment plan, or whatever it may be, be sure to ask your questions during this first appointment.

How to Prepare for Your First Back and Spine Specialist Visit

Now that you know more about what to expect during your first appointment with a spine specialist, here are some top tips to keep in mind when seeing your back and spine specialist.

1. Bring Your Imaging and Radiology Reports

Be sure to bring any copies of imaging and radiology reports you may have on hand so your spine specialist can better work to diagnose your condition and provide a proper treatment plan to effectively manage your pain symptoms. While discussing your pain symptoms can help, having physical copies of your diagnostic imaging is one of the most important pieces of information your doctor needs to accurately provide a diagnosis.

2. Gather Your Personal and Family Medical History

During your appointment, the back and spine specialist will ask about your personal and family history. Therefore, come prepared with any pertinent history that may be helpful to the spine specialist. For example, knowing if anyone in your family had similar back pain issues.

3. Write Down A List Of Symptoms

Consider writing down a list of symptoms before your appointment to discuss with your specialist. Writing down a list of symptoms will help to ensure you discuss all important details on the day of your appointment. For instance, do you have any mobility issues? Is your pain dull or sharp? Do you experience a numbness or tingling sensation?

4. Write Down A List Of Questions

Your back and spine specialist is here to help you every step of the way in better managing your pain symptoms. This includes answering any questions you may have or clarifying any parts of your treatment or diagnosis you may be confused about.

Some common questions patients may have include:

- What is the cause(s) for my pain?

- What are my treatment options?

- Are there any risks or side effects to this treatment?

5. Be Prepared to Discuss Past Treatments You’ve Had

If you’ve undergone any past treatments or surgeries, be sure you are prepared to discuss these details with the back and spine specialist. This will help them get a better idea of what has and hasn’t worked for you in the past at treating your pain.

6. Write Down A List of Medications Your Take

If you are currently taking any medications, or have taken any medications in the past to reduce your pain symptoms, be sure to bring a list to discuss with the specialist.

7. Always Be Honest

Last but not least, always be honest and upfront with your back and spine specialist about any medical conditions or medications you are taking. This will not only be helpful for them to create a more tailored treatment but withholding this information can be potentially life-threatening!

Sources:

Chiro Care Florida

Pain and Spine Specialist

Aligned Medical Group

MMI Docs

Dorsal Health

Laspine

Mayo Clinic

The Advance Spine Center

Better Health

All-Star Chiropractic