Which doctor to see for low back pain: how primary care handles it, whether you need an MRI, and whether you can see a physiotherapist directly

Which specialty should I see for low back pain?

Low back pain is first handled in primary care: most of it gets better on its own and is not linked to serious disease, and primary care doctors use clinical assessment to pick out, from the majority with non-specific low back pain, the few patients whose pain is caused by a specific disease or who have radicular (nerve root) pain (Primary Healthcare Commission reference framework on Common Musculoskeletal Problems, 2022, for adults in primary care settings in Hong Kong). About ninety to ninety-five per cent of low back pain seen in primary care is non-specific (summary chart of the reference framework on Common Musculoskeletal Problems, 2022).

Family doctors are the main providers of primary healthcare (Health Bureau Primary Healthcare Blueprint, December 2022); for choosing a family doctor, see How to choose a family doctor, and for public Family Medicine Clinics, see Booking a general outpatient clinic.

Whether an individual patient needs referral, and to which specialty, is decided by the treating doctor.

Can I see a physiotherapist directly for low back pain?

Yes, in specified circumstances. The Government introduced a direct-access arrangement under the Allied Health Professions Ordinance (Cap. 359) in July 2025, under which physiotherapists may provide services without a doctor's referral in specified circumstances; one of these is when the patient's condition is of a kind that a clinical guideline published by a referencing authority recognises as one for which physiotherapy may be provided without referral (Primary Healthcare Commission clinical guideline for first-contact physiotherapists, first issued December 2025).

The reference framework on Common Musculoskeletal Problems covers knee osteoarthritis and low back pain, which together account for more than half of primary care consultations for musculoskeletal problems in Hong Kong; in this circumstance, a physiotherapist may only treat problems consistent with knee osteoarthritis, low back pain or other conditions listed in the clinical guidelines, and must refer the patient to a doctor if treatment does not work as expected or red flags appear (clinical guideline for first-contact physiotherapists, December 2025).

If the problem is still unresolved after one course of treatment (30 days or 10 treatment sessions, whichever comes first), the physiotherapist should refer the patient to a doctor for a detailed assessment (clinical guideline for first-contact physiotherapists, December 2025).

Can I see a chiropractor directly for low back pain?

Yes, directly: Hong Kong law does not require a referral before seeing a chiropractor (see Do you need a referral to see a chiropractor?). Under the Chiropractors Registration Ordinance (Cap. 428), chiropractors are persons trained and qualified in the prevention, diagnosis and treatment of functional disorders of the human body through manipulation of the joints, particularly of the vertebral column and peripheral joints, including the pelvis; a chiropractor should refer a patient whose condition needs alternate care to the appropriate healthcare practitioner (Chiropractors Council of Hong Kong, Code of Practice, Part II).

With warning signs such as difficulty passing urine or incontinence, numbness of the saddle area (perineum, buttocks and inner thighs) or increasingly weak muscles, see a doctor promptly; in an emergency go to A&E (Reference Framework for Common Musculoskeletal Problems, 2022). This site does not compare or rank family doctors, physiotherapists and registered chiropractors; the site's chiropractor list is ordered by English name.

Do I need an X-ray or MRI for low back pain?

Routine imaging is not recommended for low back pain unless the result may change management (reference framework on Common Musculoskeletal Problems, 2022); many imaging findings seen in patients with low back pain are also common in people without low back pain, and studies have not found that imaging improves patient outcomes (reference framework on Common Musculoskeletal Problems, 2022).

Routine imaging and laboratory tests are not recommended unless cancer, spinal infection, cauda equina syndrome, or a severe or progressive neurological deficit is suspected, or there is a risk of vertebral compression fracture (reference framework on Common Musculoskeletal Problems, 2022).

Which test to do is decided by the doctor according to the situation; for private MRI fees, see MRI fees compared.

How is low back pain managed? What should I watch for when taking painkillers?

Non-specific low back pain is first managed mainly through reassurance, staying active and self-management: explaining the nature of low back pain to the patient so that the patient knows it is not a serious disease and that symptoms usually improve with time, and encouraging the patient to avoid bed rest, stay active and continue daily activities (including work); for chronic low back pain, exercise is recommended (reference framework on Common Musculoskeletal Problems, 2022).

Primary care doctors are advised that they may consider prescribing medicine when non-drug management is not effective enough: oral non-steroidal anti-inflammatory drugs (NSAIDs) may be the first choice, but gastrointestinal, liver and cardiorenal risks should be taken into account, and they should be prescribed at the lowest effective dose for the shortest time; for patients with no other safe option, a trial of paracetamol may be considered first (reference framework on Common Musculoskeletal Problems, 2022).

Back pain should be diagnosed and treated early, and people should not rely on over-the-counter medicines for a long time, to avoid side effects; stomach bleeding caused by painkillers is more common in older people (Department of Health Elderly Health Service ‘Low Back Pain’ information); for general reminders on painkillers, see Taking painkillers for a headache: what to watch for.

Which treatment to use is decided by the treating doctor.

When does low back pain need referral to a specialist?

Red-flag symptoms may indicate a more dangerous cause of low back pain and need urgent referral to the appropriate specialist (reference framework on Common Musculoskeletal Problems, 2022); referral to a specialist may be considered if there is no clinical improvement (summary chart of the reference framework on Common Musculoskeletal Problems, 2022). Examples of red flags include difficulty passing urine (urinary retention) or incontinence of urine or faeces, saddle (perineum, buttocks and inner thighs) numbness, increasing muscle weakness, new low back pain in someone with a history of cancer, unexplained weight loss, and fever (reference framework on Common Musculoskeletal Problems, 2022).

Patients with suspected cauda equina syndrome whose neurological function is getting worse need an immediate surgical assessment; intractable pain that does not respond to conservative treatment should also be assessed for surgery (reference framework on Common Musculoskeletal Problems, 2022).

Orthopaedics treats diseases and injuries of the spine and limbs with medication and surgery, and its scope includes spinal surgery; Neurosurgery diagnoses and treats conditions involving the brain, spinal cord and peripheral nerves (Hong Kong Academy of Medicine, Specialty Descriptions, April 2025). Which specialty to refer to is decided by the treating doctor according to the condition; for choosing an orthopaedic surgeon, see How to choose an orthopaedic surgeon; in an emergency, go to Accident and Emergency.

How can low back pain be prevented?

Keeping up adequate physical activity is recommended to prevent low back pain; exercise alone or exercise combined with education is effective for prevention, and smoking, obesity, occupation, psychological distress and low physical activity are all associated with low back pain (reference framework on Common Musculoskeletal Problems, 2022).

Holding a fixed posture or repeating a movement for a long time causes muscle fatigue, and long-term poor posture, unsuitable or overly strenuous exercise and being overweight can cause neck and lower back fatigue and aching; when lifting something heavy, bend the knees to squat down and keep the back straight, and if the pain persists, consult a healthcare professional (Department of Health Student Health Service information for students, ‘Good Posture and Healthy Spine’, June 2022).

Frequently asked questions