Spine doctor or spine specialist: who should you see for back pain?

First: when you need a hospital or a doctor

See a doctor promptly if you have back pain and:

• you've had a major accident or fall, or a minor fall or lifting injury when you have osteoporosis or take steroids long term
• you have a fever, a recent infection or a weakened immune system
• you've had cancer, have lost weight without trying, have pain at night that disturbs your sleep, have constant pain that doesn't change with position, or your back pain started after age 50
• your pain is in your upper back. Rarely, pain here comes from a problem with the aorta, the body's main blood vessel.

For neck problems, see a doctor if you notice clumsy hands, numbness in both hands, unsteadiness or falls, or an electric-shock feeling when you bend your neck forward. These can be signs of pressure on the spinal cord, which is often missed because people put the signs down to age.

Most back pain isn't caused by anything serious; in primary care, serious causes are well under 1%. But if any of the signs above apply to you, don't wait.

→ Read the full list of back pain red flags

Who's who in spine care

"Spine specialist" is used loosely, so it helps to know who does what.

• Family doctor (GP): often the first point of contact. Checks your general health, can prescribe medicines and refers you on if needed.
• Orthopaedic surgeon: a doctor who specialises in bones and joints. Some specialise in spine surgery.
• Neurosurgeon: a doctor who specialises in the brain, spinal cord and nerves. Some specialise in spine surgery.
• Physical medicine and rehabilitation (PMR) doctor: a doctor who focuses on non-surgical medical care and rehabilitation.
• Pain medicine specialist: a doctor who provides injections and other pain procedures.
• Rheumatologist: a doctor who treats inflammatory conditions such as ankylosing spondylitis.
• Neurologist: a doctor who treats conditions of the nerves and spinal cord.
• Physiotherapist: assesses how your spine moves and how your muscles, joints and nerves are working, and treats you with exercise, hands-on and other physical therapies. Physiotherapists hold a physiotherapy degree (BPT, and sometimes also an MPT), not a medical degree. In India, physiotherapy is regulated as a healthcare profession under the National Commission for Allied and Healthcare Professions Act, 2021.

If someone describes themselves as a spine specialist, it's reasonable to ask what their qualification is.

Who should you see first?

If you have emergency symptoms: go to a hospital, or call 112.

If you have any of the other warning signs above: see a doctor.

For most other back and neck pain, starting with either a doctor or a physiotherapist is reasonable. A few things to know:

• Exercise is central to treatment. The UK's NICE guideline recommends exercise programmes for low back pain, with hands-on treatment such as manipulation, mobilisation or massage only as part of a package that includes exercise. Structured exercise is a physiotherapist's main tool.
• Seeing a physiotherapist first has been studied. A 2024 review of 18 studies, covering about 1.48 million people with low back pain, compared people who saw a physiotherapist first with those who saw a doctor first. The authors concluded that physiotherapy-led care was effective for patients and for time and cost, but the certainty of the evidence was very low. A 2023 review across muscle and joint conditions found similar health outcomes for people who saw a physiotherapist without a doctor's referral, higher patient satisfaction, and no safety problems reported. Both reviews looked at health systems outside India.
• If you need medicines or injections, see a doctor. Physiotherapists at Maana Spine don't prescribe medicines, give injections or perform surgery.
• If surgery has been suggested, a spine surgeon is the right person to discuss it with. NICE suggests considering surgery for sciatica when non-surgical treatment hasn't improved pain or function and MRI findings match your symptoms.

Whoever you see first, get reviewed again if your symptoms get worse, last more than two weeks, severe pain hasn't eased within a week, or new symptoms appear.

→ Do I need surgery for a disc problem?

What Maana Spine is, and what it isn't

Maana Spine is physiotherapist-led. You'll be seen by a physiotherapist with specialist spine training from Maana Spine, not by a doctor.

You get a physiotherapy diagnosis. At your spine assessment, your physiotherapist takes your history, assesses your symptoms, uses special tests to check your spine and nerves, and reviews any MRI, X-ray or lab reports you bring. You'll get a physiotherapy diagnosis and a personalised treatment plan. A physiotherapy diagnosis is not a doctor's medical diagnosis, and it doesn't replace medical care if you need it.

You don't need a referral or a scan. If a scan would help, your physiotherapist will recommend an MRI or X-ray.

We'll tell you if you need a doctor. That includes warning signs, symptoms that don't fit a muscle, joint or disc problem, or a condition that isn't improving as expected. If your assessment suggests you should see a surgeon, we'll tell you honestly.

If you're already seeing a doctor, bring your reports, your doctor's notes and a list of your medicines to your assessment.

→ What happens at your spine assessment
→ How Maana Spine DTX™ works

Questions to ask whoever you see

• What do you think is causing my pain?
• What is your qualification?
• Do I need a scan? Why, or why not?
• What are my non-surgical options?
• When should I expect to feel better, and what happens if I don't?
• At what point would you suggest I see a surgeon?

Book a spine assessment

Spine assessments are available at all five Maana Spine clinics in Kochi, Kozhikode, Thiruvananthapuram, Aluva and Perinthalmanna. An assessment takes 30 to 45 minutes and the consultation fee is ₹250. No doctor's referral is needed.

Book a Spine Assessment · or call or WhatsApp +91 99950 09403