Lower back pain

Unfortunatelly pain in the low back is perceived as something trivial and can be mistakenly dismissed as a self limiting conditions by patients and doctors alike.

LOW BACK PAIN (LBP) is a pain felt in the lower area of the spine. The pain in the lumbar spine can have multiple anatomical location. Pain from hip or pelvis as well is from thoracic spine can project to the area of lumbar vertebrae and is perceived as pain in the low back.

Back Pain Symptoms

Symptoms will be dependent on which structures are irritated. Usually pain in the low back which changes location is functional in origin.

Low back pain with radiation into the leg, burning sensation, numbness and tingling should always be taken very seriously and requires immediate medical attention.


Low back pain can be caused by structural pathology such as: herniated or protruded disc, arthritis of the lumbar joints.
It can also be caused by pinched nerve within or around the structures of spinal canal or spinal foramens. It could also be functional such as muscular or ligsmentous pain.

Chronic Back Pain

Chronic LBP is usual a result of combination of following factors:

Poor, inadequate and untimely treatment, poor beliefs, poor copping strategies, overuse of structural diagnosis as well as emotional stress.


Diagnosis of LBP is almost always clinical with exception of very severe pain with numbness, tingling, radiation and loss of strength.
Rarely low back pain can arise from structures inside the viscera (organs), however dysfunction of motility of visceral organs as well as breathing can be an important causative factor in LBP. Most often differential diagnosis requires the differentiation of anatomical areas below or above the lowback as well as carefully examination of the whole locomotor system.

Treatment of low back pain

Since low back pain is so multifactorial individual approach is paramount.

The successful treatment of low back pain is one that addresses the cause rather then the symptoms. In order to attack the cause two factors must be identified:

1) movement dysfunction

2) pain generator- structure irritated during specific movement (ligament, muscle, joint, nerve,disc and etc…) Since multiple structures can refer pain to low back, primary load transfer failure must be identified. The spinal stability system has to be addressed from perspective of dynamic stability rather then the core strength

At NYDN we provide very individual and comprehensive approach based on our meticulous examination skills and most integrative treatment . We combine most advanced scientifically proven low back treatment methods such as:

DNS (dynamic neuromuscular stabilization), ISM (integrated system model approach), clinical Pilates, structural integration, postural retraining, myofascial release and acupuncture just to name a few.


C.A.R.E.N: Physical Therapy for Lower Back Pain

From research we know that people with Low back pain (lbp) belong to different categories (or groups) and therefore should be treated with individual approach.

C.A.R.E.N can successfully facilitate treatment of people with LBP which belong to following categories:

  1. 1. insufficient dynamic core activation
  2. 2. excessive core activation
  3. 3. Low back pain which results from gait (walking) impairment due to asymmetrical weight bearing such as with adaptation to healing by unweighting the injured extremity as well as many other types of weight bearing asymmetry
  4. 4. Loss of balance
  5. 5. Gravitational / postural disorders where there is an uneven distribution of trunk versus pelvis and feet as well as loss of control of the center of mass (COM) ober base of support (BOS) Lumbar fatigue: (rephrase for explanation) or may be leave it but isnt it to long?

Protection against spinal injury requires proper anticipation of events, appropriate sensation of body position, and reasonable muscular responses. Lumbar fatigue is known to delay lumbar muscle responses to sudden loads. Patients with chronic low back trouble had significantly poorer ability than control subjects on the average to sense a change in lumbar position, which was noticed before and after the fatiguing procedure. This feature was found in patients and control subjects, but patients with low back trouble had poorer ability to sense a change in lumbar position than control subjects even when they were not fatigued.

Lower back pain treatment and pain management


Low Back Pain

Pain in the low back is the most common musculoskeletal complaint of people over age 40, with almost everyone experiencing an episode of low back pain (LBP) at some time in their life. Many people suffer LBP for years on end, after efforts to resolve it medically, including surgery, have proven futile. However, most cases of LBP can be resolved with appropriate conservative treatment.

Anatomy of the Lumbar Spine

Contrary to what many people think, your low back is not fragile. It is designed to twist and bend, bear weight, transfer force loads between your upper and lower body during physical activity, and provide stability when lifting. Your lumbar spine is both flexible and powerful, enabling you to perform physical work and engage is challenging physical activities.

The five vertebrae of your low back that make up your lumbar spine are the largest non-fused vertebrae in your spinal column. The lumbar vertebrae are numbered L-1 to L-5 in descending order, with the lower vertebrae bearing the most weight. The two lower segments where L-4 meets L-5, and where L-5 meets S-1 (the first vertebra of the sacrum) are the most vulnerable to injury because they bear the greatest loads.

Most cases of low back pain occur at the L-4/L-5 and L-5/S-1 junctions, often due to pressure on the nerve roots of the sciatic nerve that exit the spinal column in the lumbar region. Muscle strains associated with lifting are a common cause of low back and sciatic nerve pain.

Symptoms of LBP

Low back pain can be debilitating at times, keeping you from performing even simple daily tasks.

LBP symptoms may include:

  • Dull aching pain in the low back
  • Stinging or burning pain that descends from the low back to the lower extremity
  • Numbness or tingling in the legs or feet
  • Muscle tightness and spasms in the low back
  • Pain when standing or walking

Common Causes of LBP

Low back pain falls under one of two categories:

  • Mechanical pain is the most common source of LBP, and involves injury or overuse of the mechanical structure of the low back, including muscles, tendons, ligaments and bones. Mechanical pain often resolves itself with rest, and abstaining from the activity that caused it.
  • Radicular pain is cause by an impinged or entrapped nerve root in the low back. It may accompany mechanical pain, if inflamed tissues or misaligned bones exert pressure on a nerve. Radicular pain is often described as sharp or burning, and may be accompanied by weakness, tingling or numbness in the buttocks and lower extremities.

Several lifestyle and behavioral factors can contribute to and increase the risk of LBP, including:

  • Sedentary lifestyle with excessive sitting
  • Poor physical conditioning with lax muscle tone
  • Weak core and low back muscles
  • Imbalances in muscle and connective tissue tension that cause joint misalignment
  • Poor postural habits
  • Faulty gait and movement mechanics
  • Poor lifting technique
  • Obesity
  • Overuse and injury from sports and exercise

LBP Diagnosis

As with most musculoskeletal conditions, diagnosis of LBP begins with a detailed patient history and physical exam. The patient may be asked about recent and older injuries, sleep postures, lifestyle behaviors, activity level and athletic participation. A postural assessment may be performed. The physical exam may include palpation of the painful area, tests for range of motion and reflexes, and other motor assessments. A neurological exam may also be performed.

Imaging via MRI, X-ray or CT scan is often prescribed in hopes of revealing abnormalities in the low spine, but in many cases traditional static imaging scans are unable to identify the precise cause of pain, and some consider those diagnostic methods to be obsolete.

Traditional Treatment for LBP

Medical treatment for LBP mainly focuses on eliminating pain to ease the patient’s discomfort. Treatments may include:

  • Narcotic pain medication
  • Muscle relaxants
  • Corticosteroid injections
  • Bracing

However, because most back pain is mechanical in nature, treating pain alone does not resolve the underlying issues that caused it, and back pain often returns once treatment is discontinued.

LBP Diagnosis and Treatment at NYDNR

At NYDNRehab, we use the most advanced technologies and innovative therapies to diagnose and treat your low back pain. Many of our diagnostic and treatment tools are unique to our midtown Manhattan clinic, and cannot be found elsewhere.

Some of the diagnostic and treatment approaches that set NYDNR apart include:

  • Diagnostic Ultrasound: Unlike traditional imaging methods, ultrasound imaging allows both the clinician and patient to see the inner structures of the low back in real time, including muscles, tendons, ligaments, bones and neural bodies. During the diagnostic session, the patient is able participate in the diagnostic process through movement and feedback. Ultrasound also provides important information about the patient’s progress following treatment.
  • 3D Video and Force Plate Technology, with EMG systems: This sophisticated technology enables us to analyze gait and biomechanics, to identify deficient movement patterns that are often at the source of pain.
  • Dynamic Neuromuscular Stabilization (DNS): This unique treatment approach helps patients to activate and coordinate intrinsic spinal stabilizers for optimal control of the lumbar spine and pelvic region.
  • Computer Assisted Rehabilitation Environment (C.A.R.E.N): NYDNR is first among a handful of private clinics to incorporate virtual reality technology into our treatment toolbox. Patients interact with a virtual reality environment while 12 infrared cameras capture their motion and provide real-time feedback to correct faulty movement patterns and improve performance.

Dr. Kalika and his team are dedicated to getting to the sources of low back pain, and devising individualized treatment plans to eliminate them, with the end goal of improving our patients’ quality of life.

130 West 42 Street Suite 1055, New York NY 10036

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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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