Should I see a surgeon? Disk herniation part 4

I tried physical therapy/chiropractic and it didn’t help.  Should I see a surgeon?

No two doctors or therapists are the same, but there is more variation between chiropractic doctors than in any other specialty.  Part of the reason is because not all chiropractors receive the same training.  Most chiropractors in the United States focus primarily or exclusively on spinal manipulation as their mode of therapy for any and all cases they see.  Regardless of medical diagnosis, these chiropractors limit their attention to what they term subluxations or ‘spinal misalignments’ which they believe to be the cause of virtually all problems.

Physical therapists, by contrast, are not trained in and are not legally permitted to perform spinal manipulation treatments.  For most physical therapists, patient assessment is approached from the standpoint of strength, flexibility, and postural evaluation.  Pain, they believe, is the result of weakness, lack of mobility, and poor posture.  Exercises and stretches to improve strength, posture, and mobility are the primary or exclusive therapeutic modalities.

While good posture and improved strength and mobility are good things, they will not bring about the resolution of many physical ailments including pinched nerves caused by herniated discs.  Nor will spinal manipulation by itself permanently re-align the spine to decompress a pinched nerve.  Proper conservative care must include strengthening, nerve stretching, traction, manipulation, and management of inflammation.  Each part of the treatment addresses a different but essential component of the problem.  If you have had P.T. or chiropractic treatment but have not been given core strengthening exercises which dramatically push you to improve strength in the lower back, buttocks, and abdomen, or have not been given nerve stretches to be done regularly throughout the day, or have not undergone traction treatments, decompression exercises, or anti-inflammation therapy, then you have not yet undergone a comprehensive course of conservative management and should not seek surgery yet.  On the other hand, if you have undergone comprehensive conservative management for up to 8 weeks without significant improvement in your symptoms (at least 75% recovery), it is time, in my opinion, to seek a surgical consultation.

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