Back Pain

Back pain is becoming a common complaint among people around the world, and it accounts for the majority of doctor visits in the United States. Yet most back pain is non-specific in nature, meaning that no specific mechanical or pathological cause can be identified. There is a growing consensus that back pain is multifactorial, meaning there are multiple factors at play.

Types of Pain

Pain is an umbrella term that conveys physical and/or emotional discomfort. But science has uncovered a number of subcategories of pain, based on which physiological mechanisms are responsible for creating the perception of pain.

  • Non-specific pain has no identifiable root. The patient experiences pain, yet no mechanical cause can be determined by medical practitioners.
  • Myo-fascial pain has its origins in the fascia, the thin tough sheath of tissue that encases muscles. Myofascial pain often stems from trigger points, tiny knots in fascia that sensitize nerves in local muscles or connective tissue.
  • Mechanical pain originates from behaviors that place abnormal stress on muscles surrounding the vertebral column. Mechanical pain is often caused by daily habits such as poor posture, poorly-designed workstation ergonomics, or faulty lifting techniques.
  • Nociplastic pain arises from heightened activation of peripheral nociceptors, despite no clear evidence of tissue damage.
  • Neuropathic pain is caused by disease or damage that affects the somatosensory nervous system.
    Nociceptive pain is the most common type of pain experienced by humans. It arises from physical damage to the body through trauma or invasive procedures.

Categories of Back Pain

The road to successful outcomes in back pain treatment lies in accurately identifying the specific category of a patient’s back pain.

Some of the most common categories of back pain include:
  • Poor posture
  • Gait deficiencies
  • Weak spinal stabilization
  • Poor sleep habits
  • Poor motor control
  • Overuse from exercise or occupation
  • Erroneous beliefs about back pain
While anyone at any age can suffer back pain, certain people are at higher risk:
  • Smokers
  • Obese individuals
  • People with physical and mental comorbidities
  • People with physically demanding jobs

Causes of Back Pain

Back pain can arise from many causes, and all back pain should not be treated equally.

Underlying causes of back pain include:
  • Sedentary lifestyle with excessive sitting
  • Lifting objects with poor technique
  • Poor workspace ergonomics
  • Poor posture when sitting or standing
  • Weakened deep spinal muscles and core musculature
  • Dysfunctional locomotor control within the central nervous system
  • Faulty gait mechanics
  • Motor deficits in the lumbopelvic-hip region
Structures within your body that often generate back pain are:
  • facet joints
  • costotransverse joints
  • muscles
  • spinopelvic ligaments
  • sacroiliac joints
  • intervertebral discs
  • lumbodorsal fascia
  • nerve roots
  • cluneal nerves

Oftentimes, a combination of the above behaviors and conditions coexist, compounding your pain and complicating treatment.

Back Pain Diagnosis

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Initial back pain diagnosis begins with a clinical exam. Radiology rarely adds useful information unless conservative care fails to resolve the pain, and epidural steroid injections or surgery are considered as the next step.
Since the first line of defense for back pain treatment is always conservative care, imaging with MRI or Xray is rarely necessary.

Diagnostic ultrasonography can be used to potentially identify soft tissue involvement, or to provide differential diagnosis as sono palpation screening for disc bulges or canal stenosis. It can also guide pain-blocking interventions.

Please explore more advanced diagnostic option unavailable anywhere else:

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Back Pain Treatment

Most traditional treatments for back pain centers on pain management, based on the idea that back pain often resolves itself over time. However, addressing pain without treating the underlying causes of back pain can lead to recurrent episodes, with chronic pain and disability.

Excessive use of MRI and surgical interventions have proven to be no more effective than conservative care for improving patient outcomes. Excessive use of prescription pain medications appear to be fueling the current global opioid epidemic.

Many people stop moving when they are in pain, but with back pain, active treatments are more likely to be successful than passive treatments. Any kind of back pain treatment should involve active care, where the patient is an active participant in their treatment. Active care encompasses exercise,
Changing thoughts and beliefs about pain, and learning more about your back pain.

By contrast, passive treatments are things that are done to you, such as surgery, massage, electrotherapy, medications and other passive interventions.

Where to Go for Back Pain Treatment

Physical therapists and chiropractors are the most equipped practitioners for dealing with common back pain, so long as they are not relying on passive types of treatments such as spinal manipulation, electrotherapy, heat and laser modalities.

Look for a clinician who takes a multimodal modern approach to treating back pain, whose protocols include remedial exercise, manual medicine, dry needling and home exercise prescription. Also make sure that these providers are certified or knowledgeable in multiple different methods and techniques that can be combined to formulate an effective multi modal treatment plan.

Alternative Treatments for Back Pain

Acupuncture can be a good adjunct to back pain care, however it should also include an active treatment plan that extends beyond remedial physical therapy or chiropractic rehab exercises.

Yoga and Pilates can be beneficial for patients with back pain, but not in the initial stage, as they are generalized approaches for improving flexibility and strength, but do not necessarily fit every patient. Yoga and Pilates should only be used under the prescription or supervision of your physician or therapist. They can help to reinforce the results of your rehab in the later stages, as long as the practitioner is in communication with your therapist and has experience training people with back pain.

Dry needling can be useful for initially decreasing pain that stems from myofascial trigger points. However, dry needling should not be used as the sole method for treating chronic back pain.

When to See a Physician for Back Pain

You should see a back pain physician if numbness, tingling or severe pain persists after three months of physical therapy or chiropractic care. Your best options are to find a pain management specialist or a doctor specializing in sports medicine. See your primary care doctor if fever, rash or pain keeps you awake at night.

Some common medical interventions for chronic persistent back pain include:

  • Steroid epidural injections are usually performed if there is a herniated disc pressing on a nerve root. However, recent research shows that using steroids to decrease inflammation prevents the resorption of disc materials, inhibiting natural healing and having negative long-term consequences.
  • Nerve ablation is sometimes performed by pain management physicians to alleviate pain, so that physical therapy can proceed. However, the procedure has its downsides. It can cause muscle atrophy, which ultimately inhibits healing and recovery.

You should see a back pain physician if numbness, tingling or severe pain persists after three months of physical therapy or chiropractic care. Your best options are to find a pain management specialist or a doctor specializing in sports medicine. See your primary care doctor if fever, rash or pain keeps you awake at night.

When to See a Surgeon for Back Pain

Surgery is considered a last resort for people with back pain. However, there are certain circumstances where surgery may be unavoidable.

Consider surgery if:
  • Pain is severe pain and not manageable with any type of medication
  • You experience loss of muscular strength and your muscles begin to atrophy
  • When there is loss of bladder or stool control

Back Pain Treatment NYC

At NYDNR, we approach back pain with a variety of manual and therapeutic exercise techniques, spinal stability strengthening, gait therapy, ultrasound guided dry needling and remedial exercises to correct locomotor dysfunction and improve neural wiring of the central nervous system.

Back pain therapy at NYDNR may include:
  • Dynamic neuromuscular stabilization (DNS) to restore innate motor patterns
  • Ultrasound guided dry needling
  • Therapeutic massage
  • Acupuncture
  • Gentle spinal manipulation
  • Gait analysis and retraining
  • Deep core stabilization exercises with C.A.R.E.N, our virtual reality feedback environment
  • Postural retraining
  • Redcord Neurac therapy
  • Extracorporeal shock wave therapy
  • Fascial manipulation
  • McKenzie therapy
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3D Chiropractic
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Range of Available Unique Physical Therapy Treatments at Nydnrehab

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.

Back Pain

This page contains novel technological non- invasive approaches for treatment of low back pain and herniated disc disorders.We have been on forefront of rehabilitation of most difficult low back and neck pain disorders with combination of our integrative hands on manual, rehabilitative and technological approaches.

Back pain affects 90% of Americans at some point of their life and is the leading cause of visits to the doctor. Low back pain is the most prevalent cause of disability in people under age 45; $100 billion is spent annually on treatment of low back pain, with more then half of that spent on surgical treatment. Low Back Pain (LBP) has long reached epidemic proportions in the Western world. Acute LBP is one of the leading symptoms that force an individual to seek medical attention. At the same time the chronic back pain is responsible for enormous cost to health care and society.

It has been traditionally, although incorrectly, believed that acute LBP episodes resolve themselves within a relatively short period of time. This mistaken belief has led to the symptomatic management, consisting mostly of the bed rest and pain medication, which is proven to promote chronicity. A scientific consensus gradually emerged over the past ten years that understate the role of the structural findings by MRI and/or X-RAY as being decisive in LBP diagnostics and treatment strategies. By far the most common painful locomotor (musculoskeletal) system conditions are in fact the ones called idiopathic (without an apparent cause) because no structural pathologies can be found.

An alternative had been suggested advising encouraging LBP patients with reassurance that there is no serious life-threatening disease involved and that the only sure road to the complete recovery goes through the measured resumption of normal activities and restoring function. Implementation of this approach resulted in significant decrease in LBP chronicity and consequent disability in part by eliminating the psychological impact of pain on the nervous system.

Restoring function has only recently become the standard in physiotherapy,chiropractic and rehabilitation medicine. However the restoration of function is mostly attempted by the practitioners through the purely mechanical means. They commonly fail to acknowledge that functional pathology is not just altered biomechanics, but rather a response of the Central Nervous System to pain and dysfunction by altering motor control residing in the brain. Therefore, it is motor control of the Central Nervous System and not the biomechanics that should be addressed when formulating the treatment of low back pain.

It must be also realized that by no means can people complaining of back pain with non-identifiable origin be labeled malingerers, nor should their condition be identified as psychogenic. The somatic origin of their symptoms can be easily established. Clinical examination usually reveals the multitude of signs and symptoms of physical origin of pain. And here lies another problem. Because functional aberration can be objectified through the physical examination, it is routinely treated as a mechanical disorder, the approach which, as we stated above, is inadequate and leads to poor treatment outcomes.

When treating the function it is important to realize that the mechanical change is a source of information processed through the Central Nervous System, which in turn makes the locomotor control programs react in a coordinated fashion. Even when mechanical changes are obvious and structural pathology is objectified, it is the disturbed function that should be the primary target of the treatment.

The biggest mistake in medical approach to treatment of back pain has been isolated by science and has become common knowledge today. Since the wide availability of the MRI doctors have been over relying on radiologic findings with such diagnoses as herniated or bulging disc. This has led to many unnecessary spinal surgeries which known to have poor outcome. In fact recent survey of 800 spinal surgeons to choose most appropriate treatment for herniated and bulging disc conditions was physical therapy .

Back Pain Is Multifactorial

Variety of latest studies showed that patients with back pain do not fit in one category. There are multiple subgroups of patients which have low back pain. Very detailed classifications have been created based on very extensive studies of large population suffering from LBP. At Dynamic Neuromuscular Rehabilitation being participants of four World congresses of Low Back and Pelvic Pain we are quite familiar in recognizing which category and subgroup this particular patient belongs to. Our treatment protocols are not based on one modality or one method.We have professed clinical and technological diagnosis which allows us to select most appropriate integrative intervention for successful treatment. When back pain is not initially addressed with the right intervention it could become chronic and lead to serious consequences.

How Functional Treatment Is Conducted

The term Locomotor Dysfunction, as we have stated above, describes an abnormal condition of tissues involved in body mobility, posture and muscle balance, including muscles, joints, discs and, most importantly, neural wiring in the central motor regulation centers of the Central Nervous System. This situation can be reversed by a variety of manual techniques and remedial exercises, which affect the nervous system globally, as a whole. Manual techniques are used to treat local muscle and joint dyfsunction consist of joint and soft tissue manipulation, reflex stimulation, various muscular techniques, which release Trigger points , muscle hypertonicity (spasm) and either inhibit hypertonic muscles or facilitate (strengthen) weak muscles. Exercise program includes spinal stability (core) and postural training, body awareness exercises, sensory integration, breathing and core retraining and therapeutic exercises.Following pain reduction patients is treated with blend of specific techniques from yoga and Pilates based on individual needs.

Rooted in Developmental Kinesiology, our therapeutic program is based on evoking the ideal movement patterns through the reflex stimulation of the motor regulation centers, and then conditioning the patients through exercise to be able to activate these patterns automatically without any conscious effort. All of the soft tissue techniques and gentle non-forceful manipulations are conducted in basic primal positions and follow the rules of Development Kinesiology.

Our therapeutic program puts a special emphasis on the importance of deep spinal stability. Deep muscles of the spine are the first ones to be affected when motor programs become corrupted. They almost never produce pain, but their inability to properly co-contract (contract together) overloads more superficial muscles. This dysfunction overloads the spine .creates trigger points, fascial restrictions, joint subluxations and other abnormalities that ever so often result in excruciating pain so familiar to the LBP sufferers. Therefore, our primary goal in this respect is to teach our patients to feel and control these muscles in order to decrease load on the spine, reduce shearing forces and guide the body to create optimal compensation. We further aim to train our patients in how to activate these muscles (core and etc..) evoking appropriate movement patterns and eventually to condition the brain to activate the associated locomotor programs automatically without the patient voluntary control. In our experience this is the best way to release muscular tension, remove sublaxation, establish proper movement patterns, improve posture and dramatically improve and strengthen spinal stability. This approach not only alleviates suffering but also prevents relapses and recurrences which are so common with the back pain. For patients with increased work demands or athletes whether recreational or professional we progress spinal stability training into a functional training. The functional training is goal-oriented and involves various movements like: lunges, squats, pulling and twisting all of which are performed in challenging positions and are enhanced by different labile surfaces.
Due to majority of jobs today requiring excessive sitting, back and pain today have intimate relationship of how patient gets into seating as well as the work place ergonomics. We have spent significant time understanding and studying seating back pain category. We have devised specific therapeutic intervention based on seating demands.

The optimal goal of our rehabilitation programs is to optimize the function, it does not mean that we reject cooperation with the most accepted and therapeutically proven conventional methods of medical intervention which involve such procedures as epidural injections.

It is commonly believed, even by most conservative health care practitioners, that a patient should consider epidural steroid injections only when all other options are exhausted. This belief unfortunately may backfire and harm the patient if the practitioner is biased or if he is not greatly familiar with pain management guidelines. The blind belief in the holistic approach can bring disability to the patient if the conservative care practitioner rejects the pain management treatment and has poor understanding of when and what type of pain management is best for the patient. We, in our practice, do not overestimate the power of functional approach and never ever deny the qualified patient timely referral to a pain management specialist . The functional approach that we profess is actually the best indicator of when a patient has reached the plateau and the conservative care is in need of pain management support.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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