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"My Back Hurts: Should I Go to a Neurosurgery or Orthopedic Clinic?" To Those in Agony Even with Normal X-ray Results

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It is quite strange, isn't it? Your back hurts so much that it feels like it is going to break, so you finally make up your mind to visit a clinic and undergo expensive examinations. However, the doctor looks at the images and says everything looks perfectly fine. They tell you your bones are straight, no discs have slipped out, and they simply hand you a few days' worth of anti-inflammatory painkillers. In moments like this, patients end up feeling incredibly frustrated and wronged. Right now, you are struggling just to sit down and have been losing sleep for days. Hearing that nothing is wrong just because your bones look fine can make you feel so disheartened that you start wondering, "Am I just being overly sensitive?" There are actually so many people drifting from one clinic to another, endlessly scrolling through search tabs trying to figure out whether they should go to a neurosurgery or an orthopedic clinic when their back hurts.

Source: Korean Spinal Neurosurgery Society, Presentation Material – 'A Survey on Psychological Distress and Doctor-Shopping Behaviors in Patients with Non-Specific Lower Back Pain'

In reality, about 85% of the back pain we experience falls under what is called 'non-specific lower back pain.' Simply put, it refers to pain where no distinct structural issues—such as a ruptured disc or spinal stenosis—are visible on imaging screens like MRIs or X-rays. Many people think that your back can only hurt if a bone is damaged or a disc has herniated, but that is a huge misconception. The structures supporting our spine are not just hard bones; they include delicate muscles, ligaments tightly wrapping around them, and countless nerve branches running in between. Because imaging tests are primarily specialized in showing the shapes of 'hard structures,' they very often fail to capture functional inflammation caused by tightly knotted muscles compressing a nerve or microscopic tears in a ligament.

Source: Ministry of Health and Welfare, National Health Information Portal – 'Guidelines for Diagnosis and Classification of Lower Back Pain'

In fact, a case of a patient in his late 30s, an office worker named Mr. Kim who visited our clinic recently, was exactly like this. He was someone who typically sat in front of a monitor working for more than 8 hours a day, and from a certain point onward, he mentioned that sitting for long periods made his glute area tingle and prevented him from bending his waist. He had already received a diagnosis from another hospital's orthopedic department stating there was absolutely nothing wrong with his bones. Thinking it might be stress-related, he even tried acupuncture at a traditional clinic, but it was all in vain. We carefully examined his usual sitting posture, his gait, and the asymmetry of his pelvis by hand, diagnosing him with what is known as 'piriformis syndrome' and 'chronic overload of the lower lumbar muscles.' The problem was not his bones; rather, due to poor posture, a specific muscle had become as hard as a rock, tightly squeezing and irritating the sciatic nerve running beneath it—which turned out to be the real culprit behind his pain.

Source: Seoul Jeil Neurosurgery Clinic, Internal Clinical Case Studies on Outpatient Treatment

I feel like we need to clear up a point here that confuses a lot of people. You often find yourself at a total loss trying to decide whether you should go to an orthopedic clinic, which primarily looks at bones, or a neurosurgery clinic, which deals with nerves and pain, when your back hurts. Let me explain it in a very straightforward way. If you snapped your back while lifting something heavy and feel like a bone might be fractured or a joint itself is twisted, an orthopedic approach can be highly intuitive. On the other hand, if you experience a tingling sensation down your legs, a sharp numbness spreading from your glutes to your toes, or a chronic pain that stems from irritated nerves even though your bones look perfectly fine on tests, a neurosurgical examination—which precisely tracks nerve flow and micro-pain trigger points—can offer a much smoother solution. We do not simply look at the 'spot' where the pain occurs; we focus on finding the exact nerve pathways through which that pain is disrupting your daily life.

Source: The Korean Neurosurgical Society, Published Guide – 'Textbook of Spine and Nerve Pain Management'

Ultimately, the core of pain treatment lies in the persistence of a doctor who refuses to dismiss a patient's pain as a mere complaint and tracks it down to the very end. Clues for mysterious, chronic back pain can be found in a patient's professional environment, their usual sleeping position, and even a single habit in their walking stride. If you leave the pain neglected just because you felt relieved hearing that your bones are normal, your body will automatically overuse other muscle groups to protect the hurting area. This eventually leads to a tilted pelvis and can spark a vicious cycle that ends up causing an actual disc rupture. When there are no answers inside the images, a doctor must physically examine the patient by hand, look closely into their daily routine, release the locked muscles, and soothe the irritated nerve strands using tailored, non-surgical care like injection therapies or manual physical therapy. Only then can you finally break free from that long-standing frustration.

Source: Korea Disease Control and Prevention Agency, Health Information System – 'The Vicious Cycle of Chronic Pain and Tips for Early Intervention'

If you are suffering from back pain with an unknown cause, there is absolutely no need to feel discouraged by the phrase "your imaging results are normal." This is because severe lower back pain can easily be triggered by abnormal interactions of micro-muscles or nerve irritation symptoms, even without structural abnormalities in the bones or discs. To find the true hidden cause of the pain that is consuming your precious daily life, it is absolutely essential to have a precise diagnosis and intensive, non-surgical management that closely analyzes your lifestyle habits and corrects the functional problems of your nerves and muscles.

Source: Seoul Jeil Neurosurgery Clinic, Customized Pain Management Manual for Chronic Lower Back Pain Patients

???? Lower Back Pain Q&A

Q1. If my X-ray results are normal but my back keeps hurting, should I absolutely get an MRI right away? A1. Rather than jumping into expensive examinations right away, physical examinations where a doctor manually evaluates the patient's pain patterns should come first. Muscle knots or ligament inflammation may not show up clearly even on an MRI, so the proper order is to first locate the source of nerve irritation through meticulous palpation and medical consultation.

Q2. My back hurts and the pain radiates down my legs. Is this an orthopedic condition or a neurosurgical condition? A2. Back pain accompanied by a tingling or sharp numbing sensation in the legs or glutes is a strong signal that a spinal nerve is being compressed. Therefore, it is more directly helpful to seek out a neurosurgery clinic, which precisely tracks and treats the pathways and compression status of the nerves.

Q3. Aren't the injection treatments given at neurosurgery clinics just 'bone injections' (steroids)? Isn't it harmful if I get them frequently? A3. This is a common misconception, but recent pain injection therapies do not use steroids at all, or they only use them safely in extremely trace amounts well below the standard limit. They primarily utilize components that calm inflammation around the nerves or proliferative substances that strengthen the ligaments, so you can receive them with peace of mind.

Q4. When my back hurts, is it better to just rest completely, or should I at least do some walking exercises? A4. During the extreme acute phase (2 to 3 days) when the pain is severe, bed rest is necessary. However, staying bedridden longer than that actually weakens the muscles surrounding the spine, making the pain last longer. It is much more beneficial for blood circulation and muscle recovery to engage in light walking on flat ground within a manageable pain tolerance.

Q5. How is manual therapy (Dosu therapy) different from a regular massage? A5. While a massage temporarily relaxes the superficial muscles on the surface, manual therapy performed at a medical clinic is a precise medical act. Under a doctor's prescription, a professional physical therapist equipped with anatomical knowledge manually aligns misaligned spinal joints and strengthens the deep core muscles.