When it comes to back pain, most people think of having a herniated disc, but the pain from a herniated disc can be identical to the pain from a ligament injury or bruised muscle. We have to determine where the pain is coming from. This is why a physical examination of the body is so important because here is where we find where the cause of the pain is coming from, and each structure that has been injured may need a different type of treatment to help resolve the pain.
The most common type of back pain is called “mechanical pain” which stems from soft tissue strains and sprains and disc herniation from bending and lifting and wear and tear. 90% of low back pain is of this type. The degree of pain can vary from patient to patient as some patients can have muscle spasm from simple back strain which can give them excruciating pain and may limit their ability to walk or even stand while another patient may report that the lower back is only sore after they have been seated or driving for a while. Some patients are bent over to one side and often locked in this position while others can still stand perfectly straight.
MRIs have been disappointing because often times, they show us too much! MRI’s attribute back pain due to herniated disks and spinal stenosis, which shows up commonly on these scans; however, a lot of these are often asymptomatic and not the cause of the patient’s pain. We now know that most of the problems are caused by ligament and tendon laxity around the bones. Oftentimes MRIs show us pathology that is present anatomically (such as there are many times herniated disks that show on MRI in which the patient is pain-free) but which are not problematic. Again this is why the physical examination is important. Some patients complain of what we call radicular pain, which is pain that follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness. This is what we call sciatica. It is pain that radiates down the course of the sciatic nerve down the back of the thigh and calf into the foot. Oftentimes this type of pain is due to disc protrusion or bulge, arthritic changes or narrowing of the opening through which the nerves exit’s.
With Physical Examination, we determine the specific structure that is affected and causing pain and then address therapy and treatment protocols towards healing this area. Oftentimes prolotherapy combined with platelet rich plasma and if necessary, stem cell prolotherapy can be used to prevent a complex surgical procedure from being performed and having the patient end up still suffering from pain and now carrying a diagnosis of “Failed Back Surgery”. We see many patients like this in our office and many patients who come to us with lots of X-rays, CT scans, MRI’s, etc and now scheduled for surgery but who want one last chance to prevent or delay a big surgery and the complications that can happen with it. If we feel that Prolotherapy and our more advanced Regenerative Injection Therapies can offer some help and treat the root cause, we will make recommendations to guide our patients to the best decision for their health and happiness.