My Doctor Told Me Not To Go To a Chiropractor! Why?
Who Should I See First?
When you have ‘done something’ to your back and you are in a lot of pain, what SHOULD you do first? See your GP for pain relief or see a chiropractor?
The ‘something you have done’ may be twisting, lifting something too heavy for you, overdoing exercise – lots of different activities can mean you suddenly can’t move because any movement hurts so much that you can’t contemplate doing anything!
It might seem counterintuitive to subject a joint that is probably inflamed, with protective muscle spasm around it, to further twisting and movement, which is involved in some chiropractic treatments.
However, there is a lot of good quality evidence – (see references below) that manipulation does help to relieve this pain and with better long term prognosis than just resting and taking painkillers.
What We Will Do For You
We at the Avenue Clinic, base our treatment protocols on this evidence and we always adapt how we treat you when you are in a lot of pain so that you can tolerate it. We will always explain what we think is happening in your back to give you this pain and the treatment options available to you. You can then decide how you would like to be treated. We don’t just ‘jump all over you’ to make the pain even worse.
After treatment, when you are already in a lot of pain, of course, short term it might feel uncomfortable, which is why we often advise using ice over the area, moving gently and how best to sleep or sit until the ‘crisis’ is over and you start to feel better. However, we feel as practitioners that it is better to cope with some short term irritation in order to recover quicker and with a more favourable long term outcome.
If you just rest and take painkillers, that may mean that the pain goes away too, however, this kind of passive treatment won’t tell you how you might have caused the problem and advise you how to avoid doing it again and give you exercises to do to try to prevent the pain from returning and discuss your fears and concerns about how you can best cope with the problem. All of these approaches have been found following research, to help us to deal with low back pain.
Why We Do What We Do
NICE guidelines (The National Institute for Health and Care Excellence) say this about manual therapies for managing low back pain:
Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica but only as part of a treatment package including exercise, with or without psychological therapy.
The Lancet says in an article in March 2018 “Disability due to low back pain has risen by more than 50% since 1990. Treatment varies widely around the world, from bed rest, mainly in low income areas, to surgery and the use of dangerous drugs such as opioids, usually in high income countries”.
It goes on to publish three papers one of which highlights how rarely can a specific cause of low back pain be identified and how thus, most low back pain is termed non-specific. If you have wondered why we may say that this is what you are suffering from and you are wondering why it is such an ‘airy fairy’ diagnosis, it is due to this inability to accurately diagnose your pain – by ANYBODY! That goes for whether you have had just an examination or an x-ray or a scan.
If we are worried about your symptoms or if you are not responding to our treatment in a short period of time, we will of course recommend you to go for further tests.
A lot of external factors can influence how you respond to treatment. These can be psychological, genetic, biophysical or social factors or if you have other illnesses in conjunction with your low back pain.
Low back pain is also described as a long lasting condition with a variable course and around half the people in primary care have continuing or fluctuating pain of low-to-moderate intensity, some recover and some have persistent low back pain.
The recommended treatment includes education that supports self-management and resumption of normal activities and exercise and psychological programmes for those with persistent symptoms.
Guidelines also recommend prudent use of medication, imaging and surgery.
Greater emphasis is now on self management, physical and psychological therapies and less emphasis on pharmacological and surgical treatments.
Consistent recommendations for early management are that “individuals should be provided with advice and education about the nature of low back pain and radicular pain, reassurance that they do not have a serious disease and that symptoms will improve over time; and encouragement to avoid bed rest, stay active and continue with usual activities including work”.
This is why chiropractors ‘do what we do’! They are the best recommendations that exist in the treatment of non-specific low back pain.
So Why Did My GP Say Not To See You?
The trouble is that in a lot of countries, although guidelines discourage the use of opioids, the are used widely in many high-income countries, particularly the USA. You are in pain; you want relief; so it seems logical to prescribe pain killers.
General Practitioners are busy people and sometimes they may miss reading the most up to date guidelines. Therefore, if you visit your GP for low back pain and he says that you should not see a chiropractor, don’t get upset or wonder if you have ‘wasted your money’ if you have already seen someone. Instead, tell him that you have actually read how best to take care of low back pain and that your practitioner has told you that you have ‘non-specific low back pain’ and IS giving you lots of advice regarding how to recover from it as quickly as possible and is listening to your concerns and you will be referred back to see your GP if you do not respond well.
Of course, if you have any concerns about your treatment, you are encouraged and welcome to discuss these at any time with your chiropractor.
We are always here for you at the Avenue Clinic!
A few references if you would like to read more:
- Hartvigsen J et al
What low back pain is and why we need to pay attention.
Lancet 2018 March 21st.
Steffens D et al
Prevention of low back pain: a systematic review and meta-analysis
JAMA Intern Med. 2016; 176: 199-208
- Stochkendahl MJ et al
National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy.
Eur, Spine J, 2018; 27: 60-75
- UK National Institute for Health and Care Excellence
Low back pain and sciatica in over 16’s: assessment and management.
November 2016 https:/www.nice.org.uk/guidance/ng59