Do I need surgery, or should I try conservative treatment first?
For many people with low back pain, surgery isn't the first treatment recommended. Conservative options such as staying active, exercise, rehabilitation and movement, and chiropractic care may be appropriate depending on the cause of the problem.
But there are also situations where evaluation by a spine specialist or surgeon is important.
The key is determining what is causing your symptoms and which treatment makes sense for your specific condition.
Most Low Back Pain Doesn't Automatically Mean Surgery
Back pain can come from many different structures and conditions.
These may include:
- Muscle or soft-tissue irritation
- Joint-related pain
- Disc problems
- Nerve irritation
- Spinal stenosis
- Spondylolisthesis
- Degenerative changes
- Injury or overuse
Two people can have similar pain while having very different underlying problems.
That's why treatment shouldn't be based simply on the fact that your back hurts.
When Is Conservative Care Appropriate?
For many musculoskeletal causes of low back pain, conservative treatment is a reasonable starting point.
Depending on your examination and diagnosis, that could include:
- Staying active within tolerable limits
- Chiropractic treatment
- Mobility exercises
- Progressive strengthening
- Rehabilitation
- Activity modification
- Massage therapy
- Education about managing symptoms
Certain patients with disc-related symptoms may also be candidates for spinal decompression.
The objective isn't simply to temporarily reduce pain. It's to help restore movement and gradually improve your ability to tolerate the activities that matter to you.
Where Does Chiropractic Care Fit?
Chiropractic care is one conservative option for certain types of low back pain.
Treatment may include spinal manipulation or mobilization, but an effective treatment plan doesn't necessarily stop with an adjustment.
At Northwood Chiropractic & Wellness, we may combine chiropractic care with exercise and rehabilitation and movement based on the patient's condition and goals.
As symptoms improve, treatment should generally progress toward greater activity and independence.
Can Chiropractic Care Prevent Back Surgery?
This requires an important distinction.
Some observational research has found lower rates of surgery among certain patients who initially received chiropractic care compared with patients who initially saw a surgeon.
However, that doesn't prove chiropractic treatment prevented those surgeries.
Patients who see a surgeon first may have more severe conditions or may already be more likely to require surgery.
A more useful takeaway is that many patients with uncomplicated low back pain can appropriately begin with conservative treatment when there isn't an indication for immediate surgery.
If conservative treatment isn't helping, the plan should be reassessed rather than simply continuing the same treatment indefinitely.
When Might Spine Surgery Be Appropriate?
Surgery can be an important and appropriate treatment for certain spinal conditions.
A surgical consultation may be considered when there is:
- Significant or progressive neurological weakness
- Severe nerve compression
- Certain structural problems
- Persistent disabling symptoms despite appropriate conservative treatment
- A condition where surgery offers a reasonable likelihood of meaningful improvement
The decision depends heavily on the diagnosis, symptoms, imaging findings, neurological examination, overall health, and goals of the patient.
When Back Pain Requires Urgent Medical Attention
Some symptoms shouldn't be managed as routine low back pain.
Seek prompt medical evaluation for symptoms such as:
- New loss of bowel or bladder control
- Numbness around the groin or saddle region
- Rapidly progressing leg weakness
- Significant neurological changes
- Severe pain following major trauma
- Back pain accompanied by other concerning systemic symptoms
These findings may require urgent medical evaluation.
What About a Herniated Disc or Sciatica?
A disc problem doesn't automatically mean you need surgery.
Some people with disc-related pain or sciatica improve with conservative treatment.
Treatment may include activity modification, movement, progressive rehabilitation, chiropractic treatment, or—in selected cases—spinal decompression.
However, significant or worsening weakness, severe neurological findings, or symptoms that aren't responding appropriately may require additional imaging or referral.
How Long Should You Try Conservative Treatment?
There isn't one number that applies to everyone.
Your progress should be measured.
Depending on the condition, we may look at changes in:
- Pain
- Range of motion
- Strength
- Neurological symptoms
- Ability to sit or stand
- Walking tolerance
- Sleep
- Work
- Exercise
- Normal daily activities
If you're improving, treatment can usually progress and become less frequent.
If you're not improving as expected, that's information too. Your diagnosis and treatment plan may need to be reconsidered, and additional imaging or referral may be appropriate.
Chiropractic Care for Low Back Pain in Maple Grove, MN
The decision shouldn't simply be “chiropractor or surgeon?”
The better question is:
What is causing your back pain, and what level of treatment does it require?
At Northwood Chiropractic & Wellness, we'll evaluate your symptoms and examination findings and determine whether conservative treatment is appropriate.
If your condition requires additional imaging, medical evaluation, or a surgical consultation, we'll recommend that instead.
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Your first visit includes a consultation, comprehensive exam, X-rays if needed, and your first chiropractic adjustment when clinically appropriate.
Dr. Greg Beenken
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