Back pain and disorders of the spine can be treated by an array of practitioners.
But in many cases of backache, experts caution, the most important "practitioners" are the patients themselves. Most of the factors in back pain are related to the patient's own behavior -- from excess weight to a sedentary job.
Unfortunately, says Dr. Alfred Pavot, chairman of rehabilitation medicine at Greater Southeast Community Hospital, patients tend to look to the doctor "as someone who is going to single-handedly get rid of all that pain completely, forever, for good.
"It's an unrealistic expectation. The patient must be involved."
Here are some of the specialists who treat bad backs:
* Chiropractors have at least two years of undergraduate education, plus at least three years of study leading to a doctor of chiropractic (DC) degree. The training covers such subjects as anatomy and physiology but not pharmacology or surgery. Chiropractors' primary form of treatment is spinal manipulation or "adjustment" to move bones and joints of the spine back into alignment. They often use the terms "misalignment" or "vertebral subluxation" to describe the cause of back pain.
* Neurologists have a bachelor's degree and four years of study leading to a doctor of medicine (MD) degree, followed by a four-year residency. They are trained in diagnosing and treating diseases of the nervous system, including the spinal column.
* Neurosurgeons have a bachelor's degree and an MD degree, followed by a residency of at least six years. They have specialized training in illnesses of the nervous system and their treatment by surgery.
* Occupational therapists have a bachelor's or master's degree in occupational therapy, with specialized training in adapting body mechanics to tasks in the home and work place. They specialize in helping injured people regain the skills, mobility and strength needed to return to normal activity, and in preventing injuries and pain.
* Orthopedic surgeons or orthopedists have a bachelor's degree and an MD degree, plus a residency of at least five years in orthopedic surgery. They specialize in diagnosing and treating illness of the musculoskeletal system. Some specialize in surgical treatment of back injuries and disorders.
* Osteopathic physicians or osteopaths have a bachelor's degree and four years of study leading to a doctor of osteopathy (DO) degree, plus a one-year internship. Those who specialize also undergo a residency of two to six years. Osteopathic physicians are trained to use spinal manipulation along with traditional medical care to treat back problems. Like medical doctors, osteopathic physicians can write prescriptions and perform surgery.
* Physiatrists (pronouced fizz-EYE-uh-trists) have a bachelor's degree and an MD degree, plus a four-year residency with special training in physical medicine or rehabilitation medicine.
* Physical therapists have a bachelor's or master's degree in physical therapy. They use various techniques, including exercise, massage and application of heat, to reduce pain and enhance mobility and strength in joints and muscles.