When the Problem Isn't Where the Pain Is

"I'm just getting older." It's one of the most common things I hear from people carrying a low back that's been stiff for a couple of years, and it's usually only part of the story. The stiffness is real. So is the wear on the spine. So, often, is the rest of the picture: a fasting blood sugar that's crept up, weight settling around the middle, years of rushed lunches and short nights.

None of that last part shows on an X-ray. A lot of it can be feeding the fire.

Pain that lingers isn't in your head, and wanting a real answer for it isn't asking too much.

Why the usual answer stops short

Most care is built to quiet a symptom. Inflammation gets an anti-inflammatory. Pain gets an analgesic. A high fasting blood sugar gets a medication to push it back down. Each of those can help, and sometimes it's exactly what a person needs in the moment. What that approach tends to skip is the underlying question: why is the body inflamed, or hurting, or struggling with sugar in the first place?

If the cause is not remedied, the symptom usually returns the moment the medication wears off. That is not a failure of the medicine. The medicine is performing a different job than finding the root cause, and finding the root cause is what I've built my practice around.

What's the difference between chiropractic and functional medicine?

Short version: chiropractic reads the body's structure, and functional medicine reads its chemistry. I trained as a chiropractor more than thirty years ago and added formal functional medicine training in 2023. The reason I use both is that most stubborn problems need to be addressed utilizing both disciplines.

Structural care looks at how the spine and joints are sitting and moving, and where things are restricted or irritated. That's the chiropractic lens. The biochemical lens is functional medicine: how well the cells are making energy, whether there's body-wide inflammation, what a comprehensive set of blood work says when someone actually reads it closely instead of scanning for the one flagged value. Bringing both to the same case is still uncommon in this part of Pennsylvania, and it's where the useful answers tend to hide.

Here's why that matters. An old structural problem can keep tissue inflamed. Years of body-wide inflammation can make that same tissue slower to settle. Blood sugar swings pull down energy and mood. The gut sits quietly under a surprising amount of fatigue. Organ systems lean on one another, so a problem in one place often starts somewhere else. Look through only one lens and you miss half the picture.

I compare the body to fuel. A Formula One engine runs on high-octane gas for a reason. Put ordinary 87 in it and the car will still get around the track, just not at full speed, and it will wear out sooner. We're similar. We run on processed food, seed oils, too much sugar, and not enough movement, and we keep going. We just don't run at our best, and we tend to break down earlier. Sometimes what looks like age is really decades of the wrong fuel.

Sometimes what looks like age is really decades of the wrong fuel.

— Dr. Thomas Rottet, D.C., CFMP

What the research actually says

I'm careful with claims, because the people who find me have usually been oversold before. So here's the honest version, with the limits left in.

For back pain, the major guidelines now put hands-on and non-drug care first. In 2017 the American College of Physicians recommended treating most low back pain with options like spinal manipulation, heat, and exercise before reaching for drugs. A large 2018 trial in JAMA Network Open followed 750 service members with low back pain; the group that added chiropractic care to usual medical care reported better short-term pain and function than usual care alone, with no serious side effects. That study ran over a short window in a young, active population, so it's one piece of the picture rather than the whole thing. For anyone weighing alternatives to back surgery, though, it's a meaningful piece.

On the functional medicine side, a 2019 study, also in JAMA Network Open, looked back at more than 7,000 patients and found that those treated in a functional medicine model were more likely to report a meaningful improvement in their physical health at six months than those in standard primary care. The limits are worth stating plainly. It was a retrospective study, which shows an association rather than proof, and the longer-term differences narrowed. Still, it points in a direction that matches what I see in the room. Food, movement, and sleep aren't soft extras. They're some of the strongest evidence-based tools we have.

What this is, and what it isn't

Functional medicine is not a miracle, and it isn't anti-doctor. Plenty of my patients take a prescription they genuinely need and see a physician they respect, and that's a good thing. My aim is never to talk anyone off a medication or out of a surgery. Those decisions belong to a person and their doctor.

What a root-cause approach can do, over time and alongside the rest of someone's care, is work on the root cause, so there's less to manage in the first place. For some people that eventually means relying on less medication. I won't promise that to anyone, because no one honestly can. What I can promise is careful attention and a straight answer about what I find.

How I work through it, here at Rottet Wellness

We start with a real conversation and a detailed history. Where it helps, we run comprehensive blood work, and when the case calls for it, testing that reads chemical clues about how the cells are working, or that flags foods that may be stirring up inflammation for you. These tests don't diagnose everything, and I'm upfront about what each one can and can't show. The point is to measure instead of guess.

From there we build a plan around the actual person in front of me: structure and chemistry together, with food, movement, and rest as the foundation, and targeted, high-quality supplement support where it's warranted. I keep the practice small on purpose. Root-cause work takes time and attention, and that is hard to give when you're thirty patients deep. It also asks something of the patient, in diet and in daily habits, and I say so up front. This works best with people who want to do the work.

I grew up in Schuylkill County and have practiced here my whole career. People in this area tend to value knowing their practitioner and staying with them over the long haul. That's the kind of care I set out to offer my patients.

This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Never stop or change a prescribed medication without talking to your physician. Always consult a qualified healthcare provider about your own results.