Chiropractic vs. Physical Therapy: Why the Order of Care Matters

"Should I see a chiropractor or go to physical therapy for my back pain?" It’s a question we hear daily at our Rockford clinic. The truth is, both are powerful tools—but if you use them in the wrong order, you might be training your body to function around a problem rather than fixing it.

In this episode, Dr. Brant Hulsebus breaks down the "Foundation First" philosophy. Using the analogy of a house, he explains why you can't remodel the kitchen if the foundation is cracked. We discuss the mechanical relationship between spinal joints and muscle guarding, and why your PT exercises "stick" much better once the spine is moving properly.

📍 In This Episode, We Cover:

• The Foundation Problem: Why strengthening a "stuck" spine reinforces compensation patterns.
• The Guard Dog Effect: Why muscles tighten up to protect restricted joints.
• Sequence of Care: How to combine Chiropractic and PT for long-term stability.
• The Rockford Reality: Dealing with "Triple Sitting" (Commuting, Desk Work, and Winter Inactivity).

🔗 Resources Mentioned:

• Read the full blog post: https://hulsebuschiropractic.com/chiro-vs-pt-back-pain-rockford/
• The "Pillar" Episode: Why Back Pain is Not Just a Muscle
• Schedule an Evaluation: https://hulsebuschiropractic.com/contact/

www.rockforddc.com

Transcript

0:00

Hello, Dr. Brant Hulsebus here and welcome to another edition of Ask the Chiropractor. Ask The Chiropractor is my little podcast that I do when someone has a question about chiropractic or chiropractic care, I try to answer. I'm a chiropractor here in Rockford, Illinois. I'm a proud graduate of Palmer College of Chiropractic, and I'm happy to be the team chiropractor of the Rockford IceHogs. Let's dive into it. I am Dr. Brant Hulsebus, a Rockford chiropractor, and today we're going to talk about why chiropractic care should come before physical therapy for back pain. Now, physical therapy, when you have back issues is great. Chiropractic though is where you should start, and I want to talk a little bit about. The fact that as a chiropractor, yes, I do like physical therapy, but no, I don't perform it here in my office. There are some chiropractors that do a lot of physical therapy and a little chiropractic. We do a lot of chiropractic and next to no physical therapy because when I went to school, my physical therapy training was 10 days. I had five of active and five of passive physical therapy as an option. I feel like physical therapy is a much bigger thing than my 10 days of training. Now today, physical therapy is a required class in chiropractic college, but I don't want to see a. Physical therapist to manipulate my spine that took one course on it, and I wouldn't want to see a chiropractor do physical therapy that did one course on it. I want to see somebody who studied for that their entire career for both incidents. So I'm a graduate of Palmer College and I practice here in Rockford, Illinois. So I am a fan of physical therapy, but I want you to understand that you shouldn't remodel a house before you fix the foundation. Both chiropractic and physical therapy can help. But you want to go to the chiropractor first and then do the physical therapist. And if you give me a moment here, I'll try to explain the difference., I meet people that come in, they tell me they've tried different stretches, they try different exercise, and maybe their primary physician refer 'em to a physical therapist, and that's a common thing. There's lots of different reasons why , a primary doctor refers someone to a physical therapist first. And the number one reason I've discovered in my community here in Rockford is the fact that it's all in house. Meaning that if I'm a family doctor at this hot healthcare system and we have a physical therapy department in our healthcare system, I signed a contract that's gonna refer people to people within my own network or within my own system, and there's not a chiropractor. Therefore, I'm gonna refer you to the physical therapist. And also there's some, out dates. Guidelines, you've heard me discuss over the years on how to treat people that come in with back issues. And even though the research shows this isn't the best approach, that's still the guidelines that they use. That's what the insurance companies prefer, even though we know the recipe isn't the best for success. So they might come in after they've done some stretches, done some exercise, a little bit of physical therapy, but they say the problem's really not going away. And now I've got bigger problems and now I'm feeling more issues. I'm desperate. So now I'm here at the chiropractor, what can the chiropractor do? Well, as a chiropractor, we look for the cause of what's going on, not so much the symptom. If you were to tell me you're having pain in your SI joint where your tailbone and your hip all come together, you know the SI joint. If you don't know where it is, it's down your, the backside of your back, obviously down by your belt line a little bit off to the side. You got two spots, like you feel a little bump there. A lot of people tell me, I got pain right there. And they've had a lot of people teach 'EM exercises and stretches for SI discomfort. They've had some physical therapists working for SI problems. They might've even had an injection for SI problem. The real problem is your upper lumbar, your L one L two or rotated, and that's pulling on your hip flexors, jamming your SI joint. So as a chiropractor, we look at your L one L two to see if that's causing your SI problems. Because it doesn't matter how much treatment I do to the SI problem, If the L one, L two is the cause of the problem. It'll keep coming back. So as chiropractors, we're looking at the whole spine, top to bottom, knowing how different parts of the spine interact with other parts of the spine and how doing an adjustment here could influence something down there. Did you know in your spinal cord itself, if you looked at a cross section of it, did you know the outside bottom half of it innervates your lower back? So you could have a misalignment in your neck, irritating that part of your spinal cord and have lower back pain. I've helped more than one person with lower back pain. I never even touched a lower back. We just adjusted the neck and it got better. Speaking of that. We also look at neurology components of it as chiropractors, we train inside and out to know every nerve where it comes outta the spinal cord, where it goes, what bodily function, what muscle controls, and the area of skin that it goes to. So it's very important for us to know the neurology of what's going on, not just, it hurts right here. And some physical therapists look at biomechanics, but as chiropractors, like I talked about before, we really look at the biomechanics. We know if your L one, L two is off, we're probably gonna have growing pain, we're gonna have hip pain and probably some bowel issues all at the same time. So again, chiropractic looks at the foundation, both the motion, the neurology, and the biomechanics of what's going on. And see, physical therapy is really good at rebuilding this stuff after the foundation's fixed. Meaning that, let's say you've had your lower back off for a long time and you've had sciatica issues going down your leg. We know the sciatic nerve interval is the back of your leg to your knee, then everything from your knee to the floor. I've had people in, I've had sciatica too long and never got referred to a chiropractor, and when we finally saw'em, they had muscle weakness in that leg. That leg had, like I looked at one diameter of the healthy leg and diameter of the leg with the sciatica, and I noticed that the diameter of the leg was smaller because the muscles over the lacking the nerve supply have gotten weaker over time. It. Now, I could adjust them and teach'em to start walking every day, and eventually they would catch up, but it would require a lot more chiropractic visits and a lot more discomfort. So what I would do in a patient like this is I would do the chiropractic correction and then I'd send 'em to a physical therapist that could work with me. Once they start holding their adjustment, the physical therapist then could start introducing strength things to rebuild that leg and help me hold their adjustment even longer and do better. So the physical therapist will make the chiropractic adjustment behave better, last longer. At the same token, the chiropractic adjustment's gonna reserve the nerve flow going down the leg to make the physical therapy more effective and work better. So it really is a great combination, a good way that each one helps the other. So physical therapy will help relearn movement that's been changed. So if you've been subluxated for a long time, your walk, your gait might have changed. Physical therapy is good to help you relearn that, but you can't relearn it while the subluxation, the neurology part is still there. You just can't, it's an adaptive response to a stressful stimulus. Chiropractor could remove the stressful stimulus and the physical therapist can help relearn the walk. I just talked about building strength. Chiropractic adjustments. Once the nerve is going back the way it's supposed to and you're holding your adjustment, now it's time to rebuild the strength. And I've talked to, I'm blue in the face every day about stability. Muscles. I mean you, when you've got stability muscles really strong, it's hard to knock your back out of alignment. You can hold an adjustment so much better. And physical therapists, the newer ones that they're keeping up with the research understand this as well. And they're able to come up with some massive stabilization. Physical therapy is really good at helping you hold your chiropractic corrections longer, so they're a great compliment to each other. So once the chiropractic fixes the foundation, physical therapy can really remodel the house now and have their work do better. But if you don't have the biomechanics of the spine working the right way, you don't have the neurology function the right way. Then you're just gonna keep having the same problems coming back over and over again because you have to have all of these things in order to heal properly. And together they make a great team. So long-term subluxations, the ones that have been there for a really long time, can create a altered biomechanic pattern. It can might see something with a high shoulder or a low shoulder. That's an adaptative response to a subluxation in either the neck, cervical spine, or the mid back. The thoracic spine. If you see somebody take a long step in a short step, a long ship, or a stewardship step, excuse me, and you see their feet deviated out, left or right, or they walk like a duck with their feet out or in, this is an agitated response to a misalignment, the lower back of the pelvis. You can exercise that all you want, but along as the misalignment's there, it's not gonna correct itself. So as a chiropractor, we will go in there. We will make the correct, make the nervous system work better. I've had hockey players, I take care of the Rockford Ice Hogs. I've had hockey players come in. The trainers is one, their muscles is not activating, no matter how much they massage it, exercise it, and put STEM machine on it. As a chiropractor, I'm able to go in there, remove the interference, do the chiropractic adjustment first, and then the things that the strength coaches and the massage therapists and the athletic trainers are doing afterwards have a huge success. And that's really fun because with them being, high tier athletes, the results happen really fast compared to somebody who's, maybe had a sedentary lifestyle there. The changes aren't as quick, so it's really, really fun. So if you've been told that you should go see a physical therapist 'cause you've had ongoing back pain, or you think maybe going to see a physical therapist is a solution, I would challenge you to go see a chiropractor first. Now, does your primary doctor say you should try a chiropractic and then go see a physical therapist? Most of them, the answer is no. I've only come across a few in my time and those are the ones that I've educated. So it's just not part of the repertoire to think about chiropractic if it's not part of their education. So like always, if you have question about chiropractic or chiropractic care, you don't ask anybody but a chiropractor whether or not you should go. I recommend going to chiropractic.org. That's our national association. You can read much more about chiropractic there than you usually can in your primary's office, just because again, the primary doesn't learn about chiropractic what we do. I've met very few doctors that don't have any idea what we do, so then I can recommend us. But they do know what physical therapy does. When I was having physical therapy on my shoulder, after my shoulder surgery, the med students came and did a rotation in the physical therapy department to learn about physical therapy. So they have a little understanding of what physical therapist do, but they have no understanding of what we do. So go see a chiropractor first, and if you notice the biomechanics have been wrong a long time. Ask the chiropractor about working with the physical therapist to compliment with the chiropractors. Do. Way the chiropractor should have a good heart about this and get you to somebody good. I know here at Rockford, I know exactly where I sent you and the therapist we work with, I was actually at their office the other day just in there signing paperwork for all the people we've referred over to work together. So I hope I answered your question. Thank you for listening to Ask the Chiropractor again. The next episode, we're gonna talk a little bit why stretching alone isn't gonna fix your back problem. What else is missing? If you listen to today, you can probably guess. So we welcome you to come back next week and listen to the next, ask the Chiropractor, hit like and subscribe, and share us if you want to and have more people discover what chiropractors can do and remember, like always if you have question about chiropractic or chiropractic care, only a chiropractor certified to answer. If you have a question about chiropractic or chiropractic care you'd like me to answer or address, feel free to leave a comment wherever you'll watch or listening to this. And maybe next week you'll be , the question of the week. Thank you.