Q. What is the most effective treatment for back pain?
A. The treatment depends on what is causing the pain. There are many different causes of back pain. Most require a specific treatment. Success occurs when a treatable cause of back pain is matched with an effective therapy. When the diagnoses and treatment are mismatched, treatment fails.

Q. How can my doctor determine what is causing my back pain?
A. By asking you questions, listening to your answers, and examining you. Each different cause of back pain presents with a characteristic “fingerprint” of symptoms and findings on physical exam. Most of the time the correct cause can be determined, sometimes it is not clear. The doctor treating you must be able to accurately interpret these findings. He also needs to know which treatment is effective for your particular diagnoses.

Q. Are X-Rays, MRI’s, etc., necessary?
A. Not always. X-Rays, MRI’s, etc, are extremely helpful if a patient presents with a very specific group of findings on examination or if the patient has specific symptoms. Testing is used to confirm diagnoses or to establish a new one. In many cases, the diagnosis is clear after the doctor listens to your symptoms and examines you. When this is the case, additional testing is not necessary.

Q. I have back pain, why won’t my doctor order an MRI?
A. When indicated, MRI’s are a very valuable tool. However, over 30% of healthy, pain free volunteers have abnormal back MRI’s. Abnormal findings on MRI’s can lead a doctor away from the correct diagnoses and treatment.

Q. My back MRI showed a bulging disc. Is this serious?
A. Probably not. In most situations, bulging discs are a normal finding. Part of maturing includes changes in joints, bone, and muscle. Bulging discs are not necessarily the cause of your pain and often do not require treatment.

Q. My doctor prescribed physical therapy for my back pain. Can I go to the gym and work out instead?
A. No. If your doctor has accurately diagnosed the cause of your back pain and referred you to a physical therapist, he/she has a specific treatment in mind. Physical therapy can be extremely beneficial and sometimes curative.

Q. Do all physical therapists treat back pain effectively?
A. P.T’s specialize just like doctors. Some PT’s are terrific treating back pain; others are terrific treating sports injuries. It is important to receive treatment that is specific for your unique problem. When it comes to treating back pain, routine treatment is successful only for routine problems. One size does not fit all.

Q. Will I need surgery for my back pain?
A. This depends upon your unique situation. Sometimes surgery is the only appropriate treatment option. However, it is advisable that you first exhaust all appropriate non-surgical treatment options for your back.

Dr. John Liguori is a Medical Doctor who specializes in treating neck and back pain. These questions are ones that are frequently asked. The answers represented are the opinions of Dr. Liguori and are based upon 15 years of experience.