Forgive me - I’ve been to the doctor for unplanned things maybe three times in my life, and I don’t know what kind of doctor/specialist to see. I appear to be having problems with my sacro-iliac joint (pelvic). It might be something else, but all of my research, starting with a acute injury when I was pregnant 7 years ago, points to that joint and associated movements.
So - do I see my GP, with an eventual referral to a physical therapist? I would like to avoid any kind of surgery or injections or painkillers, and start a course of strengthing exercises. But, because of how the joint works, it could be overstretched or understretched - I’d hate to do the wrong exercises and make it worse. I’d also like to get moving now, as opposed to waiting the 4-6 weeks it will take to get both appointments completed.
How about a chiropractor? I am crazy suspicious of chiropractors, but this seems like it would be something right in their wheelhouse. I have no problems walking out if I hear something about how my allergies are caused by unhappy lumbar discs, but this is something that is strictly ligament and muscle related. Also, because of the nature of the joint, the tests are all manipulation based - different poses and pressures designed to elict specific pain responses to narrow down the possibiities. Xrays and MRIs are useless because of the size of the joint and the amount of surrounding tissue.
I also have a million questions about chairs and tables and postures and core muscles and everything else, and I have a feeling that an MD may not be willing to take that much time - I’m afraid I would just get a recommendation of a back Xray, and then I would enter the costly World of Low Back Pain.
Your thoughts? I never know when to go to the doctor and in this case, I don’t know where to start.
Speaking about medical doctors only, in most country’s systems you don’t get to choose. You go to a GP and they will refer you to specialists as they see appropriate. You can’t just walk into a neurosugeon’s office and say you want X or Y.
A physical therapist is not a medical doctor, and you can go see one without a referral from anyone. But you should be at least as wary of self-diagnosis as you are (quite rightly) of chiropractors. Saying stuff like
limits your options and may well be a complete waste of your time and money.
I’m in the USA, and I have a GP that I see for physicals. Nice guy, but I’d like a little more time than the standard 15 minute slot most GP patients get.
Self-diagnosis is a fool’s game, but one I quite enjoy. And while I would not refuse any treatment if it looks like the best thing for me, the first steps for most non-acute back pain is exercise and stretching. Unfortunately, most people I know go straight for injections and/or surgery on the suggestion of a somewhat disinterested doctor, much like some doctors pass out antibiotics like candy.
That’s what I trying to avoid, if for no reason than the time I will waste as I cross doctors off my list. I literally would like to talk about the position of my keyboard, my workbench and such for a while, to see if I can isolate the causes of the pain and what might be hurting it. An MRI won’t tell me any of that.
My brother (33) has been having problems in the same general area for a while now. Maybe like 5 years. His GP gave him pain meds and sent him to, I think, an orthopedic surgeon who took an X-ray and gave him some exercises to do that didn’t help.
It took a while but eventually he went to an ortho who specializes in non-geriatric hip issues (think more like sports medicine) and this guy did pain shots, which didn’t help, and then did an MRI and discovered that he has a torn labrum in his hip and recommends surgery over therapy as with this sort of injury, therapy while there is still a tear can make it worse.
Anyway, from his experience it seems to me that an MRI of the area then an actual diagnosis is what you really want. An x-ray isn’t going to cut it and if therapy could make it worse, wouldn’t you want to know?
ETA: I posted this while you were typing. I still think a sports medicine doctor could be helpful. If you don’t want surgery you don’t have to have surgery - no one can make you!
I had been experiencing some back pain for a few months, nothing serious. When it suddenly got bad enough to keep me awake all night, I went to my primary care physician and was referred to PT. She said the problem was with my sacroiliac joint, and everything added up. PT, Mobic, and the occasional hydrocodone made things much better.
After a few months of ups and downs and a little more lifting than I should have done with a bad back, it got bad enough that I needed to take off from work. At that point, I was sent for an MRI. It turned out that I had a very nasty ruptured L5/S1 disk. I tried more PT for a while, but ended up needing surgery.
Did I ever have an SI joint problem? I really have no idea. The symptoms and PT treatment are similar for that and ruptured/herniated disks in the lower back. What I do know is that I wish I had gotten that MRI a lot sooner.
In the US, I would try a DPT (Doctorate of Physical Therapy), who has the ability to diagnose as well as treat. Also, he/she would probably know the good orthopedists around you and could offer recommendations if you think you want additional testing.
This is my somewhat biased recommendation, but if you consult a orthopedist, try to find one who isn’t completely “sports-medicine-y”. I was recently thoroughly ignored by an orthopedist who is apparently great at treating sports injuries, but apparently regards premature serious arthritis as beneath him and refused to discuss causation, treatment/pevention options, or an actual plan.
I’m posting because 1) I’m the most annoying pain on the board & I feel threatened 2) I’m thrifty, kinda-sorta. I’d hope the OP would go to his PCP first & go for a referral, but I’d hint very strongly that he wanted a scrip for PT at the very best place that was in my plan w/i 20 miles.
I’d then let the PT people have at me & see what they could do.
Unless…
…the OP’s Dr sees something or notices something (hey, he does this stuff all day long). Then I hope that the OP ought to go the suggested medical route with noted objections that shoot-em-ups / carve-em-ups be the last resort possible.
And if the Dr (off the record) says Chiropractor might work best for what you have, why not? All you have to lose is a pain in the [del]neck[/del] back.
You could also ask around for a doctor who favors non-invasive procedures. For a variety of reasons, I was seeing two podiatrists. One decided that my foot problem was getting worse, and I needed surgery. The other looked at the orthotic inserts the first one made, and correctly determined that they were made with a weight bearing form. He explained he views that as less accurate, and suggested I have them redone with a non weight bearing cast system. I let him make a new set, and I haven’t had problems since.
This podiatrist does do surgery…he just prefers to exhaust the non-invasive options first.
YMMV, of course. And you don’t want a podiatrist, of course.
You don’t mention whether or not you have insurance, but that might dictate your path. Most insurance companies - HMO or not - have moved to a “medical home” model, where you see your PCP and s/he writes referrals to specialists. The insurance may not cover a PT if you don’t have a prescription from your PCP.
I would strongly recommend letting your doctor know that you are very interested in Physical Therapy - in my experience, lots of doctors don’t even mention it as an option because many patients won’t do it, so they consider it a waste of time.
Most of the physical therapists my patients work with are simply amazing, scary smart and well-educated. Often they are physicians from other countries (one of the companies we contract with seems to have an unending supply of Egyptians on staff) who came here and couldn’t jump through all the hoops to get licensure as MD’s here, but they still know their stuff inside and out.
And yes, if you can afford it or have coverage for it, acupuncture would be a good adjunct to explore. To find a reputable acupuncturist in your area, you can do a search at NCCAOM’s website.
No, I guess I just misinterpreted what’s going on. Sorry 'bout that. Most of the time when people talk about ligament and muscle “problems”, acute injuries, X-rays, MRI’s and avoiding surgery and medications, they’re having moderate to severe pain.
If you’re not having pain and you simply feel like you need strengthening, I’m not sure you need a doctor at all. Sounds more like a job for pilates or yoga.
I know - I’m going crazy with this. My main issue is that, for once, I’d like to consult with a doctor before starting an exercise regimen, because if it’s too tight, then stretching is fine, but if it’s too loose, then stretching is not so good, etc. or, maybe I have the most referred back pain ever, and it’s actually my neck or something, which could make it worse.
I’m mostly worried about degenerative problems if it’s untreated or treated improperly. It’s way better now than when I couldn’t roll over in bed last year, but it just seems…troubling that I’m still having some pain and stiffness and occasional sciatica issues after so long.
Mostly, I just hate doctors and going to the doctor and am nervous and uncertain and all kinds of blah. I would just love to see someone who can address my specific questions about mobility and long term movement without a bunch of trouble and mess.
Is that a physical therapist, and can I just call one for an appointment? I would imagine that if there is concern of something more, they can refer me back to my GP or a specialist, right?
See your PD first. Your insurance coverage will then lead you down the yellow brick road of who you can see, when. Without the cortisone shots I eventually got I probably would have no longer been able to walk.
Sounds like you need a really good physical therapist also, somebody who will work with you and listen to your concerns. They are out there and help tremendously.
I’d agree that a physical therapist (or, as we call them 'round these parts, a “physiotherapist”) is the way to go. I was involved in a car accident a number of years ago that resulted in damage to my right SIJ. After a number of tries, I finally found a physio who specialized in SIJ dysfunction, and I had an excellent outcome.
Yes, and I don’t know, in that order. In Illinois, you need a doctor’s order for PT. In some other places, you don’t. In some of those places where you don’t need a doctor’s order by law, you still need one by the policies of your insurance company.
Best place to start is with your insurance company. If you don’t have one and you’re planning on paying out of pocket, call up a physical therapy provider (here we have large clinics of them on nearly every other street corner) and ask them if you need a referral or physician’s order.
And yes, if for some reason PT thinks you need to see a doctor, or you need medical tests that have to be ordered by a doctor, they will tell you, and probably have a name or three they can recommend.
I’d like to add to the folks recommending chiropractors, osteopaths, and acupuncturists. Also I think you should see a voodoo witch doctor, you might have a curse. Also, you should get some of those magnet bracelets and see a faith healer.
Or, make an appointment with an orthopedic group, they have physical therapists who are managed by an orthopedist.
Seeing a chiropractor if you’re “crazy suspicious” of them may be counterproductive anyway. Would you trust their recommendations? I’d start with a primary care physician.
Please don’t group osteopaths with purveyors of woo like chiropractors and acupuncturists. In the United States, osteopaths are practitioners of evidence-based medicine who can practice in all specialties, some of whom do osteomuscular manipulation as part of their practice.
ETA: In other words, it might make sense to see an osteopathic physician, because they are qualified to determine whether your self-diagnosis is accurate or whether you have some unrelated medical issue causing your pain.
