Q. Who should I go to for my low back pain. My internist or chiropractor, or orthopedic specialist?

A. Acute (recent onset) low back pain (LBP) is one of the most common presenting complaints to physicians. It is usually caused by injury to the soft tissue (muscles and ligaments) in the low back. Strenuous activity preceding the injury is frequent, but not necessary. Much less common are fractures of dislocations of back bones, herniated discs, cancer, and bone infections. Arthritis is common, but is usually more chronic (lasting longer). There are other causes as well.

There are several studies looking at this issue, and the bottom line is that statistically, it really doesn't matter which of the above specialist you see, as the majority of acute LBP patients gradually improves with conservative treatment.

This may include antiinflammatories such as Motrin or Aleve, heat and sometimes muscle relaxants, and rest, only as needed. Bed rest actually can make it worse (likely by deconditioning the back muscles). Chiropractic manipulation is equally effective, but caution must be used to avoid manipulation with some of the other more serious causes of LBP. For acute LBP, physical therapy usually doesn't add much. However for chronic or recurrent LBP, I have found physical therapy to have helped several of my patients. Also, for more chronic cases of LBP (symptoms lasting for several weeks to months), especially if there was trauma, or fever and weight loss, or pain/weakness radiating down a leg, it would be very important to check x-rays of the spine and possibly do blood tests and urine analysis to exclude some of the above more serious causes of LBP.

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