Selection of the most appropriate type of health professional - or team of health professionals - largely depends on the patient's symptoms and the length of time the symptoms have been present.
The different types of health professionals who treat back pain tend to have varied training and interests.
While it is common to start off with a primary care provider (a internal medicine doctor or chiropractor), if the symptoms get progressively worse or are concerning it may be time to consider seeing a spine specialist.
Spine disorders require specialized care from a range of medical professionals, each bringing unique expertise to diagnose, treat, and manage these complex conditions.
This article guides you through the types of specialists in spinal disorders, their roles, training, and a discussion of their involvement and expertise.
Some of the following specialists diagnose and treat the same types of symptoms and conditions; however, the training and orientation of each specialist is significantly different.
If someone asks me which doctor to consult first, I usually recommend starting with a physiatrist. A physiatrist specializing in spinal disorders has extensive training in both medical management of musculoskeletal issues and pain as well as physical rehabilitation.
1. Physiatrists (Physical Medicine and Rehabilitation Specialists)
Physiatrists specialize in diagnosis, non-surgical treatment and physical rehabilitation for spine disorders, focusing on restoring function and reducing pain.
The goal of physiatry is mainly to
Training:
- 4 years of medical school
- 4 years of physical medicine and rehabilitation residency
- Optional 1 year fellowship in interventional spine procedures or sports medicine
Many physiatrists pursue additional advanced degrees (MS, PhD) or complete fellowship training in a specific area of the specialty, such as spine medicine/musculoskeletal rehabilitation.
Physiatrists employ a range of techniques, including:
- Physical therapy prescription
- Nonsurgical pain management (e.g. heat therapy, TENS units, massage)
- Medication management
- Interventional procedures (e.g., epidural injections, selective nerve root blocks, basivertebral nerve ablation)
In addition to treating patients with nonsurgical care, many physiatrists treat patients for post-surgery medical management and rehabilitation. Many physiatrists are a good choice for patients who need help with a combination of issues, such as lower back pain and hip pain.
They commonly treat patients with any kind of back pain or neck pain, work or sports-related injuries, fibromyalgia, myofascial pain, arthritis, tendonitis, spinal cord injuries.
See Physical Medicine and Rehabilitation Approach
2. Orthopedic Spine Surgeons
Orthopedic surgeons and neurosurgeons are the two surgical specialists trained in the diagnosis and treatment of spinal disorders, arthritis, sports injuries, trauma, and fractures.
A spine surgeon’s main goal is to address an identifiable anatomical condition that is causing the patient’s pain and/or inability to function.
It is typical for an orthopedic surgeon to specialize and focus their practice in spine surgery, and/or to further subspecialize in treating just disorders of the neck (cervical spine) or lower back (lumbar spine).
Many orthopedic spine surgeons subspecialize in certain types of conditions, such as lumbar degenerative conditions - degenerative disc disease, facet joint arthritis, and spinal stenosis, or spinal deformity and scoliosis. Or they may subspecialize in certain surgical approaches and techniques, such as minimally invasive ACDF and cervical artificial disc surgery, and/or robotic surgery.
Training:
- 4 years of medical school
- 5 years of orthopedic surgery residency
- 1-2 years of spine fellowship
A spine fellowship is an intensive, post-residency training program focused exclusively on spine surgery. During this period, surgeons are taught advanced skills in performing a range of spinal surgeries.
3. Neurosurgeons
Neurosurgeons specializing in spine care focus on the intricate relationship between the spine's structure and its neurological components, including the spinal cord, nerves, and connected structures.
Like orthopedic spine surgeons, many neurosurgeons focus a majority of their practice on treating spinal disorders.
Some subspecialize in treating certain spinal disorders, such as spinal tumors or nerve decompression or spinal cord decompression. Some neurosurgeons have advanced training on minimally invasive techniques and microsurgery approaches, designed to increase surgical precision and minimize damage to the surrounding tissues.
Neurosurgeon training:
- 4 years of medical school
- 7 years of neurosurgery residency
- Optional 1-2 years of spine fellowship
Many neurosurgeons complete additional fellowship training in complex spine surgery, further honing their skills in treating conditions that affect both the spine and nervous system.
Neurosurgeon or Orthopedic Surgeon for Spinal Surgery?
Many people ask if it is better to see a neurosurgeon or an orthopedic surgeon for a spinal operation.
For the most part, an orthopedic surgeon and a neurosurgeon who have completed a spine fellowship have the same training and perform the same operations. There are only a few instances in which one specialty tends to be better trained for specific conditions, such as:
- Orthopedic surgeons do surgery for certain types of spinal deformity, such as scoliosis
- Neurosurgeons do surgery for certain types of tumors, such as intradural tumors (inside the thecal sac).
For most situations, patients are well served to look for a spine surgeon they feel has the right skills, expertise and is well-qualified to provide treatment for their individual needs.
In recent years, spine surgery has become increasingly specialized within the orthopedic and neurosurgical professions, and often a surgeon will focus a majority of his or her practice on spinal surgery.
It is thought that the increasing level of specialization and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (e.g. reduced post-operative pain, faster healing time).
Read more about Orthopedic Surgeon vs. Neurosurgeon for Spine Surgery
4. Pain Management Specialists
A pain management specialist is what it sounds like – an expert focused on diagnosing and treating pain syndromes.
The goal of pain management techniques is to provide enough reduction in pain to allow the patient to return to everyday activities and to engage in physical therapy for rehabilitation.
The types of procedures a pain management performs are called "interventional pain management". For spinal conditions, this means some type of injection or similar procedure.
These specialists focus on medical interventions such as:
- Medication management
- Nerve blocks
- Radiofrequency ablation
- Spinal cord stimulation
- Epidural steroid injections
- Basivertebral nerve ablation
- Additional injections, ablations, and other minimally invasive procedures
Pain management is typically considered for particularly severe pain that causes inability to function in everyday activities, and/or chronic pain that has not gotten better even after a concerted effort at other therapies such as chiropractic treatments or physical therapy.
Examples of diagnoses for chronic pain that may be treated by a pain management experts include:
- Pain that can be diagnosed by a type of injection
- Pain that can be treated by a type of interventional procedure
- Chronic pain that does not respond well to other nonsurgical treatments
- Failed back surgery syndrome
- Complex regional pain syndrome
- Persistent post-surgical pain
A pain management has board certification or eligibility in another specialty, such as anesthesiology, physiatry, or neurology.
Training:
- 4 years of medical school
- 3-4 years of residency in one of the following specialties: anesthesiology, neurology, or physical medicine and rehabilitation
- 1 year pain medicine fellowship
5. Chiropractors
Chiropractors are specialists in spinal diagnosis and treatment. They undergo extensive training to provide manual therapy for spine-related issues. Many have specialized training in areas such as ergonomics, posture, exercise, and diet and nutrition.
Chiropractors are
Training:
- 3-4 years of undergraduate study
- 4-5 years of chiropractic college, resulting in a Doctor of Chiropractic (DC) degree
Chiropractors focus on:
- Spinal manipulation and adjustments
- Soft tissue therapies
- Exercise prescription
- Nutritional counseling
See Questions to Ask About Chiropractic Techniques
They commonly treat:
Chiropractic is considered alternative care in the United States because they are not medical doctors or doctors of osteopathic medicine. Many coordinate care with medical physicians in their area, for example, spine surgeons may refer their patients to a chiropractor for nonsurgical care or to provide rehabilitation following spine surgery.
6. Rheumatologists
Rheumatologists specialize in diagnosing and treating inflammatory conditions that can affect the spine and other joints.
A Rheumatologist specializes in the diagnosis and treatment of arthritis and other musculoskeletal diseases (involving joints, muscles and bones).
Rheumatologists diagnose and treat a wide variety of diseases – many of which end in “itis”. Examples include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and tendonitis.
Many types of rheumatic diseases are difficult to identify, and rheumatologists are trained to accurately diagnose musculoskeletal disorders so that appropriate treatment can begin early.
Training:
- 4 years of medical school
- 3 years of internal medicine residency
- 2-3 years of rheumatology fellowship
Rheumatologists are experts in diagnosing and managing:
- Ankylosing spondylitis
- Rheumatoid arthritis affecting the spine
- Psoriatic arthritis
- Other autoimmune disorders impacting spinal health
7. Physical Therapists
Physical therapists play a central role in the non-surgical management and rehabilitation of most spine disorders.
Training:
- 3-4 years of undergraduate study
- 3 years of Doctor of Physical Therapy (DPT) program
- Optional 1-2 year residency or fellowship in orthopedics or spine rehabilitation
Physical therapists specialize in:
- Manual therapy techniques
- Therapeutic exercises
- Postural correction
- Patient education on spine health
It is not uncommon for insurance companies to require a period of physical therapy prior to more invasive treatment, such as pain management or surgery.
In addition, many surgeons and pain management specialists refer their patients to physical therapy for post-surgical and post-procedure rehabilitation.
See Physical Therapy for Low Back Pain Relief and Physical Therapy for Neck Pain Relief
8. Neurologists
A neurologist specializes in diagnosing and treating disorders of the nervous system, including diseases of the brain, spinal cord, nerves, and muscles (such as strokes, epilepsy, headaches, Alzheimer's, multiple sclerosis, Parkinson's, and various forms of pain). Neurologists may serve as a consultant to other physicians as well as providing long-term care to patients with chronic neurological disorders.
Neurologists are trained to perform a detailed examination of all the important neurological structures in the body. This includes the nerves of the head and neck, the muscular strength and movement, sensation, balance testing, ambulation, and reflex testing. Importantly, an examination by a neurologist can be helpful in distinguishing a primary neurological problem (e.g. multiple sclerosis) from a musculoskeletal disorder that is impacting a nerve (e.g. a herniated disc).
Neurologists play a crucial role in the diagnosis and non-surgical management of spine disorders, particularly those affecting the nervous system.
Training:
- 4 years of medical school
- 1 year of internal medicine internship
- 3 years of neurology residency
- Optional 1-2 year fellowship in specific areas such as neuromuscular medicine, pain medicine, or interventional neurology
Neurologists specialize in diagnosing and treating disorders of the nervous system, including those that originate in or affect the spine. Their expertise is particularly valuable in:
- Diagnostic Evaluation:
- Neurological examinations to assess muscle strength, reflexes, and sensory function
- Electromyography (EMG) and nerve conduction studies to evaluate nerve and muscle function
- Interpretation of imaging studies (MRI, CT) in the context of neurological symptoms
- Non-surgical Management:
- Medication management for neuropathic pain and other neurological symptoms
- Coordination of multidisciplinary care, including physical therapy and pain management
- Patient education on neurological aspects of spine disorders
- Specialized Treatment:
- Botulinum toxin injections for certain types of muscle spasms
- Management of neuromuscular disorders affecting the spine
- Treatment of neurological complications of spine disorders
Neurologists may be consulted for certain types of conditions, such as:
- Cervical stenosis with myelopathy (spinal cord compression)
- Neuromuscular disorders affecting the spine
- A spinal compression fracture or tumor affecting the spinal cord
- Complex regional pain syndrome
In cases where spine disorders have neurological components or implications, a neurologist may be consulted by the treating spine specialist.
What Type of Doctor Should I See for My Back or Neck Pain?
This is one of the most common questions patients have. If you are reading this article, you have already taken an excellent first step in understanding and navigating the health care system so you can find pain relief.
- For anyone new to back pain that is not very bad, I usually recommend starting with a physical therapist or a chiropractor.
- If your back pain is concerning, and if it includes symptoms such as leg pain or arm pain, tingling or weakness, I advise people to see a physiatrist (physical medicine and rehabilitation physician) for a complete workup and diagnosis. A physiatrist can then become the quarterback for your treatment. For examples, a physiatrist may provide or refer to
Some people may develop sudden onset disabling pain. For example, a disc herniates suddenly and you find yourself in severe pain and unable to walk. If this happens you may want to consult a surgeon sooner.
This article is about the topic of typical back conditions. For anyone with urgent or concerning symptoms, get an immediate medical evaluation as it may be a sign of a medical emergency.
For many people, the management of spine disorders requires a multidisciplinary approach. These specialists, with their extensive training and diverse expertise, collaborate to provide comprehensive care. Some spine centers offer this type of coordinated care all in one place, and other spine professionals refer to other providers in the area.
