Recently, a patient visited our office who wrestled while in High School and believes the disc problem in his neck resulted from years of abusing himself. He was in his 20's and experienced neck and shoulder pain after weight training his upper body. After seeing multiple providers for his problem, he had disc surgery on his neck. Years later, he developed these same symptoms from weight training and decided to visit a chiropractor first. Upon careful evaluation, I explained how his lower back and gait likely caused his current neck problem. After fitting him for an appropriate off the shelf insert to level his hips, some muscle work, and an adjustment to his lower back, his neck pain improved. The evidence suggests his original neck problem may have been caused by mechanical dysfunction in the lower back. Another patient had over the years endured multiple joint replacements in her hips, knees, and shoulders. Our evaluation showed her that the problems that resulted in these damaged joints had to do with foot posture and poor adaptive patterns. She has slowly been improving although joint replacements permanently change how you move and function. The damaged joints she replaced may have been preventable as her problems began in the legs and lower back as well. Another patient who has visited me in the past developed sciatic pain due to a herniated disc in his back and could not stand up for any period of time without leg pain. Strangely enough, his disc issues should have caused sciatic pain on the opposite side, making the reason why he was hurting unclear. The evidence for lower back surgery is unclear, yet is has scheduled for it just in case. The patient endured months of medication, pain management, and physical therapy and finally decided to visit our offices again based on his previous experiences. Would things be different had he visited us first? What do these people all have in common? The Annals of Internal Medicine in 2017 offered primary doctors guidance for people suffering from back pain and even sciatic pain. They suggested a number of methods that have been shown to reduce pain in the medical literature and suggested that medication and procedures are performed last. What did all their recommendations have in common: Movement. The book Cheating Mother Nature, what you need to know to beat chronic pain explained that pain is a result of function, structure, and how we adapted. In other words, it showed that pain is caused by problems with movement. The book was written many years before the Annals of Internal Medicine published their report The enlightened practitioner as the book explains, is one who evaluated people, not just their parts to fully understand why you hurt and guide you to a treatment and rehabilitation regimen that can improve the way you move, resolving pain. Improvement in movement will also significantly reduce the risk for herniated discs and other problems in the body such as neck pain, shoulder pain, arm pain, leg pain, hip pain, and even foot pain. It can also pay off years later with healthier joints, better balance, and fewer falls which is a concern with the elderly. Who you visit first in our healthcare system will determine your cost and experience with resolving a health problem. This is especially true with the musculoskeletal system. Problems such as back pain, sciatic pain, hip pain, foot pain, shoulder pain, elbow and wrist pain are all examples of this. Most primary doctors still continue to recommend medication and exercises using a physical therapist. For many patients, this not only does not resolve their problems but also makes their pain more chronic. As the Annals of Internal Medicine suggests, you should have medication and medical procedures last, yet many doctors continue to practice as if these guidelines never existed, recommending medications and specialists and advanced imaging first. Perhaps, this is who a holistic approach that is more thorough is more likely to lead to better treatment of the problem. Healthcare provider's treatment recommendations are only as good as their understanding of why you hurt. Ignoring the rest of your body which may show why you hurt can lead to unnecessary therapies, testing, and invasive treatments that may do more harm than good. Many people continue to believe that when their shoulder, foot, knee, or hip become painful, the pain is the problem while it is really only the tip of the iceberg. Often, the reason you hurt exists in another part of the body that is not in pain at all. Remember this when you experience foot, knee, hip, or back pain and you visit a practitioner who only looks at that area. They are likely to be only evaluating and treating a symptom of why you hurt. Who should you see first for sciatic pain and back problems? If you see a medical provider, they are more likely to use medication and send you for therapy, which sometimes includes a chiropractor. If you do not improve, the next approach is to do an MRI which leads to riskier and more invasive methods of care. If you see an orthopedic, or a neurologist, you are more likely to be on medication and then after that does not work, injections and other more invasive and riskier methods are considered which do not necessarily improve the way you move. Most physical therapy will include protocols to the area of complaint according to the prescription. Most chiropractic visits will include a holistic evaluation and a multi-faceted approach to improve the way you move and function after reducing your pain. Chiropractors have the best reputation for resolving problems such as sciatic pain and back pain according to Consumer Reports and other trusted consumer sources. They are the only practitioner category to use a number of these different approaches interchangeably to improve movement and reduce pain. What should you expect from a chiropractic visit? On your initial visit, we will do a thorough history of the main problem and ask about previous problems you may have experienced. Your blood pressure and temperature are taken and then a thorough evaluation using active methods to see how you function. Functional tests include squatting, bending and patterns of movement, neurological screens, and orthopedic tests are part of our evaluation X rays may be taken if needed. Usually, treatment is performed on the same day. Prescription off-the-shelf foot orthotics may be suggested if medically necessary. Our chiropractic approach includes manipulation of the spine and extremities to improve how you move, myofascial release to improve movement patterns, and exercises to retrain and strengthen the main problem areas. Diagnostically, we use treat test treat protocols to evaluate the effectiveness of what we do on a visit by visit basis. This assures consistent and effective care. Typically, once our goals are reached, patients are discharged and a follow-up visit is often recommended to evaluate how you are doing weeks and months later which is important for long-term successful outcomes. Most patients feel better in a matter of days or in more complex cases, a few weeks. Our goal is for you to be independent and have the tools you need to feel your best. Chiropractors are primary care for your musculoskeletal system. Who should you see first for back pain and sciatic pain? All roads lead to the chiropractor.