Back Pain & Sciatica

Almost everyone gets back pain at some point but it’s important to remember that back pain is not a diagnosis. It is a symptom of one or more underlying problems and not all back pain is the same. Here’s a list of some of the more common causes of back pain:

• Disc herniation compressing a nerve and causing sciatica.
• Arthritis of the joints of the spine, which is also known as lumbar spondylosis.
• Degeneration of the discs of the spine.
• Lumbar stenosis with neurogenic claudication.
• Sacroiliitis and musculoskeletal pain from the ligaments, tendons, and muscles of the back.
• Scoliosis and spasticity related to a neurological condition or stroke.

Most patients with back pain have a combination of these problems. Rarely is the pain caused by just one thing.

Aside from pain related to problems in the back itself, patients can also get back pain from serious conditions such as cancer, aortic aneurysm, Parkinson’s Disease, peripheral artery disease, and many others.

This is why we recommend looking into the cause of your back pain rather than simply accepting a diagnosis of “back pain” and leaving it at that. Understanding what’s causing the pain can help guide the right treatment and make it much more effective in providing relief and improving your quality of life.

When exercise and oral medications don’t help, it’s hard to decide where to go. Some people go to chiropractors, which might help sometimes, particularly for soft tissue pain, whereas others go to surgeons, which will start them on the road to spine surgery while ignoring less invasive alternatives.

The first thing to do is try to figure out if something you’re doing is causing back pain. Do you have bad posture? Are you lifting or carrying things properly? Are you under a lot of stress and tightening your muscles? If correcting your posture, using good ergonomics, and avoiding stress don’t help, it’s time to get some help.

Many people start with rest and taking over-the-counter medications. Some will apply heat or cold, or both. It’s good to try to resolve problems on your own but, if the pain doesn’t improve in 3-5 days, continues to get worse, or you develop weakness, numbness, or incontinence (loss of control of your bowel or bladder), get help. In such cases, it’s usually not something that will go away on its own.

Many people don’t have the option of going directly to a specialist and are forced to go to a primary care physician in order to get a referral. Some may choose to start with a chiropractor with the idea that this is a more natural form of treatment. Both primary care physicians and chiropractors can be a good place to start but, if the pain doesn’t get better, you will need more specialized care.

We are fellowship trained specialists in pain management, neurology, and orthopedics. Calling our office directly for an appointment, if that’s an option, allows us to get the most effective treatment started sooner rather than trying things that might not help and eventually needing a referral to a specialist anyway, which just delays care.

Many people with back pain wind up going to the emergency department because the pain keeps getting worse and they can’t get an appointment in a reasonable timeframe. Out of desperation, they go to the ER thinking someone can help them there.

Unfortunately, they usually get sent home with instructions to make an appointment with a hospital employed specialist after getting some IV medications. Sometimes, if they’re lucky, they might get a CT or MRI. For this limited service, they will typically pay thousands of dollars and then have wait weeks or months for the appointment with the right specialist.

There are times, however, when an ER visit is absolutely necessary. If the back pain is accompanied by a fever, weakness, loss of sensation, or incontinence (loss of bowel or bladder control), or if it started suddenly after trauma, this might be an emergency. If the primary care physician or specialist says go to the ER, then treat it as an emergency and go to the ER.

Those with access to a good medical practice should be able to call the office to get a quick overbook appointment, either in person or via telehealth, so they can avoid an unnecessary visit to the ER. This can be difficult if the practice in question relies on a call center that is not very responsive or is part of a large, bureaucratic organization that does not have much flexibility to accommodate urgent cases.

Spine surgery is indicated when there is a risk of permanent neurological deficit if a particular condition is left untreated. For example, someone will be left with permanent weakness, inability to walk, or unable to control the bowel or bladder. Pain alone is not a firm indication for spine surgery.

A lot of spine surgery is done simply to alleviate pain, with mixed results. This is because the surgery itself alters the patient’s anatomy. That brings other problems over time so many patients find they have some pain relief for a limited time and then the pain comes back worse than ever. At that point, treatment options are much more limited. This is why the goal is to avoid spine surgery as much as possible.

Most patients do not realize the main goal of spine surgery is to preserve neurological function so the patient can continue to walk and avoid incontinence. Pain control is a secondary consideration, although it’s a very important one.

Studies have shown that up to 70% of patients have the same or more pain 5 years after spine surgery as they did before surgery. The degenerative changes that caused the need for spine surgery continue to progress after surgery so the pain control aspect of spine surgery rarely lasts a lifetime. Eventually, the pain usually returns.

For patients who are not at risk of permanent neurological injury, which is the majority of spine surgery patients, surgery might not be the best approach to provide pain control. We provide variety of treatment options that can be used to help control pain while avoiding opioids and maximizing the ability to remain physically active.

We also offer a Second Opinion Program for those contemplating surgery who want a second opinion from experienced specialists who can help determine whether surgery is the best option.

Many patients believe spine surgery is about relieving their pain. This is not correct.

The point of spine surgery is to preserve function. An example of a successful spine surgery is if a patient with severe back pain who was going to wind up paralyzed can continue to walk because of the surgery, even if the back pain does not improve at all.

Another consideration is that, if the surgery does not resolve the underlying degenerative condition, the patient will likely need additional surgery or procedures in the future. For these patients, spine surgery is not a permanent solution to their problem, although it can be a useful part of an overall treatment plan.

Sciatica is a term used to describe pain that travels along the sciatic nerve, which is the longest nerve in your body. This nerve starts in your lower back, goes through your hips and buttocks, and runs down the back of the leg.

When something puts pressure on or irritates this nerve—like a herniated disc or a bone spur—it can cause discomfort. People with sciatica often feel pain, tingling, or numbness in their lower back, buttock, or leg on one side of the body. It’s a bit like when your leg “falls asleep,” but the sensations can vary from mild to very painful.

Yes, any problem with the discs in your spine can lead to sciatica. Sciatica happens when the sciatic nerve, which runs from your lower back down your leg, gets irritated or compressed.

One common cause is a herniated disc. Think of a disc like a jelly-filled cushion between your spinal bones. It has a tougher outer layer made of cartilage and a softer, gel-like center. If the outer layer gets weak or tears, the gel can leak out. This leak can irritate nearby nerves or even press directly on them, leading to pain that travels down your leg. This is sciatica.

Over time, the damaged disc can wear down further, which might cause ongoing back pain from the disc degeneration.

Epidural steroid injections or spinal endoscopy are safe and effective options that can reduce inflammation and allow the body to naturally heal itself while avoiding spine surgery.

Physical therapy, a home exercise program, and good posture along with good ergonomics at work help prevent disc herniations from coming back or getting worse.

Most people around the world have disc herniations. Over time, disc herniations, bulges, and even disc extrusions tend to come and go.​ Many studies have shown the presence of disc herniations alone does not necessarily correlate with pain.

That being said, there are disc herniations that can compress a nerve root and cause sciatica or even a radiculopathy (pain going down the leg accompanied by weakness or numbness). In those cases, we use epidural steroid injections or spinal endoscopy to reduce inflammation and allow the body to naturally heal itself while avoiding spine surgery.

Yes, when there is a risk of permanent neurological deficit such as weakness or loss of bowel or bladder function. We also consider surgery if there is no improvement despite having tried several more conservative treatment options.

Always remember that spine surgery simply to alleviate pain has typically had mixed results. At times, a small surgery to remove a disc fragment that keeps irritating a nerve can be very helpful. Surgery will permanently change the anatomy of the spine and cause additional problems in the future, although the risk is lower with a small surgery.

People with lumbar spondylosis have difficulty moving without pain. It’s typically worse in the morning when first getting out of bed. As the day goes on, they “loosen up” or “warm up” and the pain gets better.

Bending or twisting of the waist provokes pain. Sitting down helps alleviate the pain, as does putting cold packs on the affected area. Sometimes, people with spondylosis notice a grinding or cracking sound on movement.

The pain is usually located in the lower back but can also go into the buttocks. In some cases, bone spurs form and irritate nerves, causing pain that radiates down the legs (sciatica).

We offer multiple treatment options to control the pain related to lumbar spondylosis including epidural steroid injections, medial branch nerve blocks, facet joint injections, and radiofrequency ablations. If the pain is not controllable with blocks and medications, we will consider using a spinal spacer or possibly referral to spine surgery.

We often include physical therapy and a home exercise program as part of the overall treatment plan. Our goal is to address the various aspect of this pain and allow patients to remain mobile.

There are 25 discs in the spine (7 cervical, 12 thoracic, 5 lumbar, and 1 sacral). These discs account for about 25% to 33% of the length of the spine. They allow the spine to be flexible while acting as shock absorbers and preventing the vertebral bones from grinding together. With increasing age, the cartilage of the discs wears out (just like in other joints) and you tend to get shorter.

This degeneration of the discs can cause two types of pain – discogenic pain and vertebrogenic pain.

Discogenic pain occurs when the cartilage in the disc tears (like a torn meniscus in the knee), becomes inflamed, or wears out. This can irritate the nearby nerves, causing low back pain or even sciatica (pain that runs down your leg).

The pain is typically worse when sitting, bending, or twisting. Standing or walking might relieve the pain going down the leg temporarily, but then low back pain starts after a while and you have to sit again. Lying flat may make it worse but lying on your side with the knees bent can help. Long trips by car or airplane, or sitting on a boat, can make the pain worse.

Low back pain can be caused by damage to the cartilage on the top and bottom of the vertebral bones in your spine. As the discs between the vertebral bones wear out, this damage can irritate a nearby nerve called the basivertebral nerve, leading to vertebrogenic pain.

Vertebrogenic pain is often worse when sitting for a long time, bending forward, or being physically active. The pain is usually deep, aching, burning, or twisting, but it doesn’t spread into the legs like sciatica might. Since other conditions can also cause similar symptoms, we typically use an MRI to check for damage to the cartilage.

Fortunately, we have a very effective treatment option called the Intracept procedure for vertebrogenic pain.

We have a variety of treatment options available, including epidural steroid injections, spinal spacers, endoscopy, and the Intracept procedure. Our goal is to reduce inflammation and help keep the discs as healthy as possible.

Good nutrition, physical therapy, a home exercise program, and good posture along with good ergonomics help prevent disc degeneration. These are a very important part of the treatment plan because they are the most effective way to avoid further damage.

Yes, if the disc degeneration is too advanced and does not respond to less invasive treatments, spine surgery might be an option. Often, the surgery is a spinal fusion with hardware, which can result in reduced mobility of the spine but still preserve the ability to walk and stand.

As the spine ages, the discs wear out and arthritis develops. This causes the space for the nerves in the spine to become narrower over time. The resulting condition is known as lumbar stenosis.

While standing or walking, the weight of the body on the spine causes the space for the nerves to narrow even further and begins to put even more pressure on the nerves. This pressure causes pain which gradually increases until the person is no longer able to stand or walk.

Sitting down for a few minutes can alleviate the pain and the person is able to get up again but, after a few minutes of standing or walking, the pain comes back. This is known as neurogenic claudication. Over time, it can become so severe the person is unable to walk.

In the past, the main treatment options were to either live with it or have spine surgery. Now, we can combine epidural steroid injections with lumbar decompression, spinal spacers, or endoscopy. These are very effective treatment options that can control neurogenic claudication without needing major spine surgery. They are particularly useful for older patients who cannot have or do not want to risk spine surgery.

Sometimes, back pain is caused not by a problem in the spine itself, but rather in the joints that connect the spine to the pelvis. This is known as the sacroiliac joint.

When these joints become irritated, it can cause pain in your lower back, buttocks, or even down your legs. The pain might feel worse after sitting or standing for a long time, climbing stairs, or twisting your hips. Some people also feel stiffness in the morning or after staying in one position for a while.

Sacroiliac joint injections can be very effective in helping to control pain, ease inflammation, and promote natural healing. In some cases, radiofrequency neurotomies of the nerves to the sacroiliac joint can be helpful, as can prolotherapy. The goal is to use treatments tailored to your needs.

Alongside these treatments, good nutrition, physical therapy, a home exercise program, and good bone health play a vital role in managing sacroiliac joint pain. They can strengthen your muscles and bones, improve flexibility, and support proper movement. This is important because conditions such as osteopenia and osteoporosis can accelerate joint degeneration.

Some patients with autoimmune conditions such as ankylosing spondylitis tend to develop sacroiliitis more readily. Controlling any autoimmune conditions that affect your joints is vital to preventing back pain from sacroiliitis.

Back pain is often caused by problems with the ligaments, tendons, and muscles that support the spine. Over time, the ligaments and tendons that connect to the spine can wear out, leading to strain and discomfort.

Weak back muscles can also contribute to pain by making it harder for your back to stay stable and supported during everyday activities. Muscle spasms can cause sharp or ongoing pain, making it even harder to move comfortably.

For many people who experience back pain, these musculoskeletal issues play a role, even if there are other underlying causes like arthritis or disc problems. Addressing these issues is crucial for finding relief and improving your quality of life.

We offer a variety of targeted soft tissue injections to help control pain, ease inflammation, and promote natural healing. These treatments are directed at the ligaments, tendons, fascia, and other tissues in the body that have become inflamed, injured, or damaged. They include non-invasive procedures, interventional treatments, and in certain cases prolotherapy, tailored to your needs.

Alongside these treatments, good nutrition, physical therapy, a home exercise program, and good posture along with good ergonomics play a vital role in managing musculoskeletal pain. They can strengthen your back muscles, improve flexibility, and support proper movement.

By doing specific exercises and stretches regularly, you can help your body rebuild its strength and reduce the strain on your spine. Over time, these small but consistent efforts can make a big difference in controlling pain and preventing it from coming back.

Scoliosis is a condition where the spine curves abnormally, and there are several types that can develop:

Juvenile Scoliosis: This occurs in young children who have neurological conditions that weaken the muscles supporting the spine. As these muscles lose strength, the spine may start to bend or deform. In other cases, spasticity from conditions such as cerebral palsy can cause spinal deformities over time.

Adolescent Scoliosis: This type begins during the teenage years and is not caused by any neurological condition. It is often discovered during school health screenings or when teens notice their formal clothing doesn’t fit correctly. In severe cases, it may require wearing a brace or even undergoing corrective spine surgery.

Degenerative Scoliosis: This form is very common as people get older. It happens when the discs and joints in the spine wear down (due to arthritis or aging), causing the spine to curve to one side. In some cases, the spine develops an S-shaped curve as the body tries to balance itself.

Note that schools no longer screen for scoliosis. Parents should have their children’s pediatrician screen them during their regularly scheduled visits.

The mainstay of treatment for scoliosis is major spine surgery, including rod placement. This can be very successful for adolescents but is much less effective after adolescence.

Similarly, bracing can be very helpful in adolescents but is also not as successful in adults. Patients find it hard to tolerate the braces needed and there is a risk of muscle atrophy with chronic bracing in adults who do not have spasticity.

Scoliosis can become worse if you also have osteoporosis or even osteopenia. That’s why keeping your bones healthy is so important to control back pain. Regular exercise, good nutrition, and good posture help strengthen your bones. It’s a good idea to check your vitamin D level regularly, as having too little can harm your bones, but too much can also cause problems. Some patients also benefit from hormone treatments to maintain good bone health.

People with spasticity may feel their muscles pulling or twitching on their own, making movement harder. It can also cause discomfort or pain and may limit flexibility in the joints.

For patients with spasticity, a combination of bracing or splinting, botulinum toxin injections, and intrathecal baclofen (if indicated) can help prevent deformities. This should be coupled with an ongoing physical and occupational therapy program to get the best results. It’s important to address spasticity as soon as it develops. Waiting too long can lead to potentially irreversible changes.

We work with your neurologist or rehabilitation specialists primarily by performing intrathecal baclofen trials, implanting baclofen pumps, and managing intrathecal baclofen therapy (if asked to do so by your neurologist or rehabilitation specialist).