Back Pain

When to See a Doctor about Your Back

Sometimes it is obvious when you should consult a physician about a back problem. You or someone close to you may have had an accident and you suspect a broken back or other serious injury. Or you may have back pain or stiffness so severe that you cannot continue your normal activities. The following are some specific danger signs or symptoms of possible back disease that should prompt you to consult a physician:

  • A backache that persists for more than two weeks. Most backaches, like colds, go away by themselves in a few days or weeks. If a backache lasts longer, it may mean that it is caused by some more serious back disease that should be treated. 

Back Pain Causes and Remedies

  • Pain that shoots down your leg toward your foot, or down your arm toward your hand, whether accompanied by a backache or not. Such pain may mean that a herniated disc or other diseased tissue is pressing against a nerve in your back or neck. 

pinched nerve

  • Pain that shoots down your leg toward your foot, or down your arm toward your hand, whether accompanied by a backache or not. Such pain may mean that a herniated disc or other diseased tissue is pressing against a nerve in your back or neck. 
  • Muscular weakness in your leg or foot, or in your arm or hand. This can mean that something is pressing upon a nerve carrying messages from your brain to that limb.
  • A backache so severe that it wakes you in the night. Most backaches feel better when you he down. One that does not might be caused by some more serious disease, such as an infection or tumor, that should be treated without delay. 
  • Inability to control urination or defecation. Again, this is a sign that some diseased tissue may be compressing crucial nerves in your back.
  • Neck pain or back pain in a child. While most adults, particularly as they get older, do have backaches from time to time, back pain is much less common in children, and is more likely to be caused by a specific disease that should be treated. 

Whom to See about Your Back ?

Most people probably first consult the family doctor. There are several types of medical doctors (M.D.s) who are likely to serve as physicians of first contact. While the number of general practitioners (G.P.s) in the United States is diminishing, new specialists called family physicians (F.P.s) have been trained to take care of all family members, whatever their age, and also to treat many kinds of disease. As a formal medical specialty, family practice dates back only to 1969; today it includes about 131400 practitioners and is growing rapidly. Internists (who number about 75,000) usually take care of adults from adolescence on, and specialize in internal medicine. They primarily treat disorders of the internal organs (such as the heart, kidneys and gastrointestinal tract) and also such diseases as arthritis and cancer. Pediatricians treat newborns through adolescents for all sorts of diseases.

Depending upon the particulars of your back problem, these primary-care physicians may or may not refer you to another specialist. Rheumatologists are internists who have taken two years of additional training to specialize in treating the many forms of arthritis. Orthopedists or orthopedic surgeons, who receive a total of five years training after medical school, specialize in treating people with injuries and diseases of the musculoskeletal system: the bones, joints and related nerves, ligaments and muscles.

Neurosurgeons, who also receive five years of postdoctoral training, specialize in surgery involving the brain, spinal cord and other nerves. Physiatrists specialize in physical medicine, the use of physical agents such as heat, sound, electricity and exercise to rehabilitate disabled and handicapped people.

doctor talk to patient

Many people alternatively consult doctors of osteopathy (D.O.s) about back problems. Osteopathy was founded in 1874 by Dr. Andrew Taylor Still, a Kansas frontier physician who had served in the Civil War. Dr. Still’s original philosophy emphasized the central role of the musculoskeletal system in health and disease and the use of spinal manipulation—forcefully bending, twisting and stretching the spine—as therapy. Today, osteopathy has evolved into a parallel system of medical care utilizing all conventional methods of diagnosis and treatment (including drugs and surgery) while retaining an emphasis on the musculoskeletal system and spinal manipulation. Osteopathic physicians receive a scientific education and training generally similar to that of M.D.s: usually four years of college, four years at an osteopathic college, and at least a year’s internship training in an osteopathic or other approved hospital before they can be licensed.

Osteopathic physicians can also, like M.D.s, take additional residency training and become certified as specialists in fields like rheumatology and orthopedic surgery. In contrast to M.D.s, however, most D.O.s are not specialists: 90 percent are in general, family practice. There are far fewer osteopathic physicians than M.D.s in the United States (about 20,000 D.O.s, compared with more than 485,000 M.D.s), but their numbers are growing. Nearly two-thirds of them are concentrated in only seven states (Michigan and Pennsylvania have the most), and half of them practice in rural areas or in small cities and towns.

Many people also consult doctors of chiropractic (D.C.s) for back problems. Chiropractic was founded in 1895 by Daniel David Palmer of Iowa, who claimed that he had cured a man of deafness by manipulating his spine. Today chiropractic has evolved into a field of health care licensed by all states and recognized by federal government agencies (chiropractors can receive Medicare reimbursements). Chiropractors, however, are more limited than medical doctors and osteopathic physicians both in their schooling and in what they do.

Chiropractors usually receive six years of education after high school: two years of college plus four years at a chiropractic college, with the fourth year including an internship in the college’s outpatient clinics. Chiropractors do not employ as wide a range of diagnostic methods as do M.D.s and D.O.s, nor do they prescribe drugs or perform surgery. Their primary method of treatment is spinal manipulation. There are approximately 80,000 chiropractors in the United States.

What to Tell Your Doctor ?

Some of the clues most useful to your physician in tracking down the cause of your backache come from what only you know about its history and its patterns. Be prepared to give your doctor the following information:

When to See a Doctor about Your Back

  • What is the quality of your pain? Is it sharp? dull? knifelike? throbbing? intense? burning?
  • How long—how many days? weeks? months?—have you had this spell of backache?
  • Did the pain come on gradually or suddenly? If it started suddenly, what were you doing when it began? Did it follow an injury or any other unaccustomed activity?
  • Exactly where is the pain? What region of the spine? neck? chest? low back? Does it extend to any other part of your body? hips? buttocks? Does it radiate down your arm toward your hand, or down your leg toward your foot? (Pain shooting down the back of  the thigh, following the course of the sciatic nerve, is called sciatica and is often caused by  a protruding intervertebral disc.) 
  • Is the pain constant, or does it come and go in the course of the day?
  • If it comes and goes, what is its daily pattern? Is it better or worse in the morning? late in the day? Does it wake you at night? As mentioned earlier, a backache that wakes you in the night is more likely to be caused by some serious disease, such as a tumor or an  infection, that should be treated promptly. 
  • Does your backache feel better or worse when you He down? Lying down relieves most backaches. If it makes yours worse, this is an important clue. What is the most comfortable position for you in bed?
  • What else makes your backache feel worse? coughing? sneezing? straining on the toilet? bending or lifting? exercise generally? standing? sitting? walking? Most backaches are not aggravated by walking. If yours is, this is an important lead. 
  • What else makes your backache feel better? exercise or activity?
  • Have you had previous spells of back pain? How often? How long have they usually lasted? hours? days? weeks?
  • Do you have any other symptoms? Stiffness? What is its pattern? Is it better or worse when you get up in the morning? What makes it feel better? exercise or another activity? How long does it usually last? Do you have any numb areas on your body? If so, where?  Are you aware of any muscular weakness in your arms or legs? Do you have any trouble  with urination or defecation? 

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