The discs are situated between the bones and primarily act as “Shock Absorbers”. They are comprised of an inner nucleus made of a gel like protein substance (like Jell-O) surrounded by a supportive fibrous annulus, which is similar to ligament tissue. (The example of a jelly filled donut comes to mind)

The stages of a disc herniation are that first the outer annulus may tear causing an inflammatory reaction. If it also causes a weakening in the wall of the disc, a protrusion of the disc will occur.

If a complete tear occurs, the disc may come out and compress the nerves or other structures in the area, and this is known as an extrusion.

Treatment of a disc herniation is primarily aimed at resolving the inflammation to allow the disc to heal. Discs have the ability to heal like any other injured structure; however, their blood supply is less than other structures, which means it takes them longer to heal. In addition, pills taken by mouth work by going to the injured structure through the blood supply so discs do not respond as well to oral pills due to the decreased blood supply. For this reason we typically have to place the anti-inflammatory directly into the area of the disc herniation.

This term is used whenever pain starts in the back and goes down into either or both legs. There are many spinal and non-spinal causes of sciatica but the most common cause is a disc herniation. If the nerve coming out of the spine is inflamed, patients will experience pain that shoots down their leg in the distribution of where that nerve goes.

I always explain that the nerve roots are like the tree roots, the sciatic nerve is like the trunk and the nerve branches that go to the skin and muscles are like the leaves on that tree. It is called sciatica because it follows the anatomical path of the sciatic nerve but rarely is the sciatic nerve itself involved since the sciatic nerve is more like a conduit of the nerves, like the trunk of the tree in the example.

Other common causes of sciatica are inflammation of the Sacroiliac Joint followed by inflammation of the Facet Joints. Muscular spasms and Myofascial pain can also give pain down the leg. (More info below)

This condition occurs when the joints of the spine become irritated or inflamed. These joints are often irritated by auto accidents. They also can be affected by wear and tear over time like other joints and this is known as the spinal form of arthritis.

The pain from these joints is usually felt directly in the location of the joint but can also radiate pain in the area. It can even cause irritation of the nerves, causing a chemical radiculitis.

Treatment usually starts with placement of anesthetic and steroid into the joint to confirm the joint as the cause of pain and treat the inflammation. If the placement of the anesthetic and steroids confirms the joint as the cause but does not offer long- term relief, then radiofrequency ablation may be an option.

Radiofrequency Ablation or (RFA) is a new option for treating facet pain and involves cauterizing the medial branch nerve that carries the signal from the joint to the brain. In order to decide if ablation will work, medial branch blocks are usually carried out to anesthetize the nerve and confirm that the pain is coming from the joints.

This condition occurs when the joint that connects the spine to the pelvis is irritated or inflamed. Common causes of irritation are falls or even just missteps that jar the pelvis. An auto accident where one foot is on the brake pedal at the time of impact is a common scenario. In addition, pregnancy is a common cause due to the hormonal changes that affect the ligaments and make the joint more prone to stretching and irritation.

When irritated, the joint most commonly gives pain in the buttocks, but that pain can radiate up into the back or very often radiates down into the leg. There are many physical exam findings that point to the joint as causing the pain, but the only way to be certain that the joint is the cause is by placing anesthetic directly into the joint and seeing the remarkable relief patients receive.

Once the joint is identified as the cause of pain, steroids placed in the joint along with either physical therapy or chiropractic treatment can help to resolve the irritation.

This condition is characterized by localized focal spasms in the muscles and results in pain and stiffness. These spasms can cause pain to radiate into the arms or legs or even up to the head and cause headaches.

Falls or trauma including auto accidents frequently causes muscular strains. These strains often heal over 2-6 weeks but also can result in ongoing localized spasms known as Myofascial Pain Syndrome.

On physical exam, there are often reactive spasms that when pressed cause an abnormal twitch response. Sometimes only localized tenderness and muscle tightness is observed. These are known as Trigger Points.

The best way to identify Myofascial Pain is by placing anesthetic in the muscles and seeing the remarkable change in the tightness and the pain relief that comes with the resolution of spasms. This is done using Trigger Point Injections.

This is a condition that occurs when the structures of the spine begin to crowd the nerves. It can begin with congenital stenosis, which means you are born with a spinal canal that is smaller than normal. In that case, you are more prone to any small irregularity causing crowding of the nerves. It can also occur in the setting of spondylolisthesis. In this condition, the structures of the spine slip in relation to each other so the normal anatomical relationship is disrupted.

Aging degeneration can also cause the ligaments to buckle and narrow the canal, resulting in stenosis. Since this narrowing is often associated with inflammation, steroids placed in the area can often resolve the symptoms. The there effect that steroids can have in this scenario is softening the ligaments, allowing them to stretch and therefore create more room.

When damage occurs to the nerve as it exits the spine, it is known as radiculopathy.

Radiculitis can cause similar symptoms as radiculopathy but the difference is that there is no damage to the nerve. While Radiculitis results from inflammation of the nerve, radiculopathy means that the nerve itself has undergone remodeling related to the damage.

Both conditions can cause pain, numbness, and even weakness. The only way to truly differentiate them is by using EMG Nerve Tests. These EMGs are able to test the physiology of the nerve and determine if there has been damage to the nerve or if the nerve is simply not working well due to conduction block associated with the inflammation of the nerve.

It is key to discover whether the symptoms are due to inflammation or
damage since inflammation often responds to epidural steroid placement but damage often requires decompression to heal the nerve.

This is a non-spinal cause of numbness and pain in one or both hands. When severe, it can cause the hands to become clumsy and difficult to use. It is a very common condition but, at the same time, a very often under-diagnosed condition. It is often missed since the first and most common symptom is numbness. Patients often think it is related to blood flow or the position their arm is in when they sleep since it most commonly starts at night.

The reason it starts at night is due to nerve cooling and the fact that nerves do not work as well when they are cold. In addition, if the wrists are held in an extremely bent condition either down or up, the nerve can be compressed or stretched and cause the numbness at night.

Treatment for Carpal Tunnel Syndrome really starts with an EMG Nerve Test. The reason it starts with a nerve test is because the EMG Nerve Test can not only confirm Carpal Tunnel Syndrome, but also helps “grade” the condition. Grading the condition to determine how badly the Median Nerve is damaged is the key to knowing what treatment will be helpful.

Specialized Therapy from a Certified Hand Therapist trained in Occupational Therapy (OT), or very often physical therapy, can resolve the symptoms. Other than the usual treatments provided by the therapist such as nerve glides and education, the use of iontophoresis to place special anti-inflammatories into the area of the nerve can be very helpful. Wrist braces worn primarily at night can also be part of the healing and calming of the nerve irritation.

The most common conditions we see are disc herniations, sciatica, SI Joint pain, Facet Pain, radiculopathy, and Carpal Tunnel Syndrome as discussed in detail above.

Other common conditions we see are degenerative spine disorders, degenerative disc disease, bulging discs, sacroiliitis, spinal arthritis, and bursitis such as hip (trochanteric) bursitis and shoulder (subacromial) bursitis.

Less common conditions we see are scoliosis, kyphosis, and spinal fractures especially common are compression fractures associated with osteoporosis.

Since we have all completed 4 years of medical school, along with an additional, 4 years of Specialty Training, we are able to recognize more serious, non-spinal conditions that give pain in the back and neck such as tumors, cancer, metastatic disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) known as “Lou Gehrig’s disease”, cardiac pain, atypical migraines, brachial plexus pain known as Parsonage-Turner Syndrome, and even whole body conditions like lupus, rheumatoid arthritis, and fibromyalgia.