Back pain is one of the most common reasons people seek healthcare. However, one of the biggest challenges patients face is knowing where to start.

Should you see a general practitioner? An orthopedic surgeon? A physiotherapist? A chiropractor?

After more than 36 years in clinical practice, I have learned that patients are often not looking for a specific treatment. They are looking for someone who can answer a much more important question:

“What is actually causing my pain, and what is the right next step?”

This is where the role of a Primary Spine Practitioner (PSP) becomes important.

Back Pain Is Not a Diagnosis—It Is a Symptom

Many people think of back pain as a single condition. In reality, back pain can have many different causes.

It may be associated with:

• Disc-related problems
• Nerve irritation
• Spinal joint dysfunction
• Muscle and movement dysfunction
• Postural and biomechanical issues
• Age-related or degenerative changes
• Inflammatory or other medical conditions

Two people can experience very similar back pain while having completely different underlying problems.

That is why treatment should not come before understanding the problem.

A proper evaluation helps determine what may be contributing to the pain and whether conservative care, further testing, or referral to another healthcare professional is appropriate.

What Is a Primary Spine Practitioner?

A Primary Spine Practitioner (PSP) is a clinician with advanced training focused specifically on the evaluation and management of spine-related conditions.

The PSP approach emphasizes careful clinical decision-making rather than simply providing a predetermined treatment.

A comprehensive spine assessment may include:

• Taking a detailed medical and symptom history
• Performing a thorough physical examination
• Evaluating neurological and orthopedic findings
• Assessing movement patterns and biomechanics
• Determining whether diagnostic imaging may be appropriate
• Identifying situations that require referral
• Developing a conservative care plan when appropriate

The goal is straightforward:

Find the right patient, identify the right condition, and provide the right care.

Why a PSP-Trained Chiropractor May Be Different

Modern chiropractic care has evolved significantly. A chiropractor with Primary Spine Practitioner training does not approach every patient as though they require the same treatment.

The spine is complex. A comprehensive evaluation considers how the spine moves, how it responds to different loads, how the nervous system may be involved, and how everyday activities can contribute to symptoms.

Depending on the patient’s condition, treatment may include:

• Specific spinal adjustments when appropriate
• Cox® Flexion-Distraction Technique for selected patients
• Mobility and stabilization exercises
• Postural correction
• Movement retraining
• Patient education
• Coordination with other healthcare professionals

The important point is that treatment should be selected based on the patient’s individual condition and clinical findings.

Does Every Patient With Back Pain Need a Chiropractor?

No.

A responsible spine provider understands the importance of recognizing when chiropractic or conservative care may not be appropriate.

Some patients require medical evaluation or urgent referral, particularly when there is:

• Significant trauma
• Suspected fracture
• Progressive neurological weakness
• Loss of bowel or bladder control
• Serious systemic symptoms
• A condition that may require surgical assessment

In these situations, the appropriate decision may be to refer the patient to another healthcare professional.

Knowing when to treat and when to refer is an important part of responsible spine care.

Where Do Other Healthcare Specialists Fit?

Different healthcare professionals play different roles in the management of spine conditions.

Orthopedic Surgeons

Orthopedic surgeons are essential when a patient has a condition that may require surgical evaluation or management.

Physiotherapists

Physiotherapists play an important role in rehabilitation, strengthening, conditioning, movement restoration, and functional recovery.

Pain Specialists

Pain specialists can be valuable for patients with complex or persistent pain conditions and for situations where specialized interventions may be appropriate.

Primary Spine Practitioners

Primary Spine Practitioners provide a front-line approach focused on assessment, conservative management, clinical decision-making, and appropriate referral when necessary.

The goal is not for one healthcare profession to replace another. Instead, the goal is to help patients reach the right healthcare professional at the right time.

The First Appointment Should Not Be About “Getting Cracked”

A quality spine consultation should begin with questions—not assumptions about treatment.

A thorough assessment may explore:

• When did the pain begin?
• What makes the pain better or worse?
• Is there evidence of nerve involvement?
• Are there any neurological changes?
• How does the spine move?
• What activities may be contributing to the problem?
• Are there warning signs that require further medical evaluation?
• Is diagnostic imaging appropriate?

These questions help establish a clearer understanding of the patient’s condition.

A treatment plan without first understanding the underlying problem may be incomplete.

Experience Matters, but Assessment Matters More

More than three decades of clinical experience can provide valuable perspective, but experience should be combined with a structured and thorough clinical assessment.

Every patient is different.

Age, activity level, previous injuries, lifestyle, occupation, movement patterns, and the nature of the symptoms can all influence the appropriate approach to care.

There is no single treatment that is right for everyone.

The first step should always be an accurate assessment and appropriate clinical decision-making.

The Future of Spine Care Is Collaborative

The goal of modern spine care is not for one healthcare profession to replace another.

The goal is to ensure that patients receive the right care at the right time.

A Primary Spine Practitioner brings together:

• Advanced spine assessment
• Evidence-informed conservative care
• Non-surgical treatment options
• Recognition of conditions that require referral
• Collaboration with other healthcare professionals

For many patients experiencing mechanical back or neck pain, a PSP-trained chiropractor may be an appropriate starting point for evaluation and guidance.

The most important question is not simply, “Who can treat my back pain?“

It is:

“Who can properly evaluate my condition and help determine the right next step?”

That is where a Primary Spine Practitioner can play an important role.

About Dr. Gerry Nastasia, D.C., DABCO, DIANM

Dr. Gerry Nastasia, D.C., DABCO, DIANM
Primary Spine Practitioner
Dual Board Certified Chiropractic Specialist
Certified Cox® Flexion-Distraction