Should I Go See a Doctor?
Disclaimer: If you think you are having a medical emergency, dial 911 or go to your nearest emergency room.
I get this question at least once a day. I think it is normal to wonder if you should see an orthopedist and/or get imaging. People often do not know the medical protocols for pain and have a hard time knowing when physical therapy exercises are appropriate. Let’s break it down.
Unless you are having a medical emergency, there is a process that everyone has to go through to get to an orthopedist. Rarely do people get direct access to an orthopedist unless it is an orthopedic urgent care in which case you usually see a physician assistant, not an orthopedist.
First, you would go see a doctor who will usually order an x-ray and write a referral for physical therapy. Most insurances require six weeks of physical therapy before they will authorize an MRI/CT scan. An x-ray will only show issues with the bones themselves - they will not show anything related to “soft tissue” which essentially includes everything that is not bone. If you have done six (sometimes more) weeks of physical therapy and are still in pain, typically your doctor will refer you to an orthopedist who may order an MRI, schedule a cortisone injection, and, in some cases, talk about surgery. Typically, you need to have “failed” conservative approaches before surgery is even on the table.
A physical therapist knows (more or less) the same testing as an orthopedist and usually can give you a good idea of the severity of the issue. Most injuries do not require surgery and there are some pretty obvious signs of when someone does need surgery. For instance, if someone cannot hold their arm up, it is often an indication of a complete rotator cuff tear. Or, if someone has significant movement in their knee in a certain direction, it is often an indication of an ACL tear. A physical therapist can administer these tests and, if you have these findings, they often will talk to your doctor to get you an orthopedic referral faster. However, most of the time, people heal with physical therapy alone and do not need to consult an orthopedist at all.
Now, let’s talk about when you should go to the emergency room or urgent care.
If you have low back/hip/butt pain AND have changes to bladder/bowel control OR numbness/tingling in the part of you that would make contact with a saddle on a horse, go to the emergency room. Make sure to mention numbness and bladder/bowel control.
If you fall and you have immediate swelling and/or bruising around the area, go to urgent care to rule out a fracture.
If you have a stabbing or ice-pick headache, you should go to the emergency room, especially if this is a new symptom. While it might be a migraine, it could also indicate a neurological injury such as a stroke.
If you are in a car accident, you should go see a doctor to screen for injuries. Your primary care doctor should be okay to do this if you did not go to an urgent care/emergency room right after the accident.
TL;DR:
Usually, you need at least six weeks of physical therapy before you can see an orthopedist.
An x-ray only shows issues with the bones, it will not show anything wrong with soft tissues (e.g. ligaments, muscles, tendons, etc.).
Most people fully recover with physical therapy alone and do not need to see an orthopedist at all.
Resources:
