“If it’s a pinched nerve in the back or neck with pain going down the arm or leg, I might refer the patient for a specialized injection such as cortisone injections near the spine," says Fish. "That takes the pressure off the nerve and helps relieve the arm and leg pain.”
One of the most important treatments for chronic low back pain is physical therapy. Almost every back pain clinic or spine center will have a physical therapist on staff. Physical therapists are state-licensed health professionals whose primary focus is keeping people mobile and functioning using a variety of exercise and movement therapies.
Your physical therapist will design a program for you that combines core strengthening exercises, aerobic exercises, and “back school,” which builds your awareness of your posture and teaches you what you should -- and shouldn’t -- do to maintain a healthy back.
“They’re our eyes and ears,” says Fish. “They’re spending most of the time with the patient.” Usually, you will see a physical therapist approximately three times a week for three weeks, then ramp down to two times a week for the next three weeks, and once a week for the last three weeks. Nine weeks is the standard course of PT for back pain.
At many back and spine clinics, the physiatrist, anesthesiologist, or pain medicine specialist who administers the specialized pain-relieving spinal injections is also specifically trained as an “injectionist.”
You can become an injectionist via several paths, says Johnson. After completing physical medicine and rehabilitation training, a physiatrist may also undergo a pain management and injection training program that lasts another 1 to 3 years. A doctor may also start out in anesthesia and then do a fellowship in pain management, which offers more experience and training in complex injections.
In addition to epidural injections of cortisone, an injectionist might inject medication into the facet joint [located on each side of the vertebrae] to relieve irritation and inject local anesthetics and steroid medications into specific “trigger points.”
These injections don’t actually heal anything, Fish says. “It’s like putting a Band-Aid over a blister when your shoe doesn’t fit well. That doesn’t change the fact that the shoe (foot interface) doesn’t seem to fit but it blocks the pain so that over time a callous can develop on the foot and the shoe will stretch.”
A chiropractor receives a doctor of chiropractic degree from a 2 to 4 year accredited institution. Chiropractic training focuses on the musculoskeletal system, and chiropractors primarily use spinal manipulation and adjustment to relieve back pain. They also use soft tissue therapies, and frequently also offer massage therapy and exercise training.