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The spine is a bony structure that starts from the base of the skull and ends at the tailbone. Consists of the cervical spine (neck), thoracic spine (mid-back), lumbar spine (lower back), tailbone (sacrum and coccyx). This bony structure is interconnected via joints, discs, ligaments, nerves, tendons, muscles, and vascular network that work together to provide support, flexibility, and strength. Any of the components of the spine and its surrounding structures are susceptible to injury and can become pain generators.

A condition in which the annulus fibrosis/outer part of vertebral disc has a defect. This causes the nucleus/inner portion of disc to herniate or slip through the defect. The herniated material can compress or pinch the surrounding nerves. This can cause pain to radiate into the upper extremities if its from the neck/cervical spine or into the lower extremities if from the lower back/lumbar spine. Symptoms can be treated with non-surgically with medication, therapy, and epidural steroid injections to name a few. In some cases, surgery may be an option.

Refers to abnormal narrowing of the bony canal that houses the spinal nerves or the spinal cord. Can occur from birth or can be acquired as the body ages. At times asymptomatic but noticeable symptoms such as radiating extremity pain from the neck or lower back, weakness, numbness or tingling occur when there is significant narrowing. Symptoms can be treated with non-surgically with medication, therapy, and epidural steroid injections to name a few. In some cases, surgery may be an option.

Degeneration of the spine and its structures occurs with normal aging. When the spinal disc ages or degenerates, it doesn’t functional role as part of the spine unit is not as efficient and effective as it used to be. This can lead to symptoms of neck or back pain with or without associated radiation into the extremities. Symptoms can be treated with non-surgically with medication, therapy, and epidural steroid injections to name a few. In some cases, surgery may be an option.

Facet joints are small joints found at almost each spinal level (cervical, thoracic, lumbar). These joints aide in twisting motion and associated stability in the spine. The angles of the facet joints vary at each spinal level to provide limitations to excessive rotational forces that can lead to instability and injury. Symptoms can include back pain that may/may not radiate into posterior aspect of lower extremities or neck pain that may/may not radiate to the head and shoulders. Symptoms can be treated with non-surgically with medication, therapy, and facet joint injections, facet blocks, radio frequency ablation to name a few. In some cases of destabilizing spine injury, surgery may be an option.

Nerve damage, usually in the hands and feet with symptoms of weakness, numbness, and pain. Peripheral neuropathy can occur from disease such as diabetes mellitus. Can also result from injuries, toxins, and or infections. It is important to seek out the underlying cause of the neuropathy. Treatment is inclusive of medications, supportive care and treating the underlying condition.

Sacroiliac joint is formed from the connection of sacrum with the pelvis on either side. Sources of pain or inflammation can result from degenerative joint changes, decreased or increased range of motion, injury, dysfunction of surrounding soft tissue structures. This can cause pain on either side of buttocks just below the lumbar spine. Symptoms can be treated with non-surgically with medication, therapy, and sacroiliac joint injection, sacroiliac nerve blocks, radio frequency ablation to name a few.

The coccyx is the true tailbone, at the very bottom portion of the spine. Persistent tailbone pain is known as coccydynia. Pain can be worsened by sitting or putting pressure on bottom of the spine. Symptoms can be treated with non-surgically with supportive care, medication, therapy, ganglion impar block, to name a few.

The piriformis muscle is located in the buttock region on each side. The sciatic nerve is in close proximity to the muscle. Piriformis syndrome is causes by irritation of the muscle which in turn leads to buttock pain. If the close by sciatic nerve is irritated as well, symptoms can include tingling, numbness sensations in the affected lower extremity in the distribution of the sciatic nerve. Symptoms can be treated with non-surgically with supportive care, medication, therapy, piriformis injection, and botulinum toxin to name a few.

A breakdown of the cartilage in a joint can often lead to dysfunction and limitation of motion in the affected area. At times asymptomatic but the inflammation of surrounding structures can lead to aches and pains that cause a decline in daily functioning with repeated use.

Inflammation in the bursal sac. A bursa is a thin sac around a joints that serves as a shock absorber between bone and surrounding soft tissue. The bursal sac is made up of a membrane that contains fluid. Trauma, friction, repetitive use can result in swelling that is localized, tenderness, pain in the affected area. Examples are bursas in the hip, knee, shoulder, or elbow areas,

Can be treated with supportive care, rest, ice, medications, and injections just to name a few.

The carpal tunnel located in the wrist. It is a structure that contains the median nerve and tendons that are associated with the tendons of the fingers and hand. When the carpal tunnel is too small or if there is inflammation of the structures, the median nerve becomes compressed which results in symptoms of numbness, tingling in the wrist, palm, and first 3 ½ digits. Symptoms are usually worse during the night or the morning. If severe weakness of the hand can occur as well as atrophy of musculature that the median nerve feeds. Nonsurgical treatments include but not limited to bracing/splinting, rest, ice, medication, and injections. Severe cases may require surgical carpal tunnel release.

Osteoarthritis is the most common form of arthritis and it is caused by the wear/tear of the cartilage that surrounds the joint. This can cause the bones of the joint to rub together, depending on the severity of the degeneration. This in turn causes an inflammatory response and pain. Osteoarthritis is also known as degenerative joint disease.

A type of headache that can vary in intensity. It can be associated with nausea and sensitivity to light as well as sound. Some times migraines are preceded by warning symptoms, known as an “aura”. Some triggers include certain foods or drinks, stress, exercise, and hormonal changes. It is important to rule out other causes of headaches.

A chronic myofascial pain syndrome that causes generalized musculoskeletal pain in specific area of the body to become tender to the touch. Associated with but not limited to fatigue, sleep disturbances, joint stiffness, depression, and headaches. This form of pain is still being widely studied as it has no known or understood cause.

Pressure on sensitive points in the muscle results in pain. Myofascial pain syndrome can occur after repeated injury or overuse of muscles. Sometimes it manifests a tender muscle knot and pain can be persistent. Treatments include therapy, medication, trigger point injections, relaxation techniques.

Strains or a “muscle pull” occur when the muscle is over-stretched or torn, resulting in damage to the muscle fibers.

Ligaments are fibrous material that connects bones together. Sprains occur when ligaments are stretched too far or are torn. Repetitive stress to the body such as with sports can result in the above. A cascade of inflammation can occur resulting in pain in the affected area.

Pain that persists after adequate healing of spine surgical site. Despite the surgery being successful, one may experience unchanged or worse pain. Also there may have been post procedure complications such as infection, nerve damage, or failure for the surgery to achieve the intended anatomical goal. This condition is referred to as post-laminectomy syndrome. With cervical post laminectomy syndrome, the symptoms can involve the neck and upper extremities. With lumbar post laminectomy syndrome, symptoms can involve the lower back and lower extremities. Treatments are inclusive but not limited to medication, therapy, biofeedback, injections, and spinal cord stimulation.

Pain in the upper or lower extremities that may or may not develop after an injury.

The exact cause of complex regional pain syndrome isn’t well understood but may involve abnormal inflammation or nerve dysfunction. Complex regional pain is characterized by pain that is greater than would be expected from the injury that causes it. Treatments include but are not limited to medications, heat or cold therapy, physical therapy, biofeedback, sympathetic blocks, and spinal cord stimulation.

Chronic pain describes pain that lasts more than three to six months or pain beyond the point of tissue healing.  Chronic pain can be a lifelong struggle for many. There are some identifiable causes like normal aging/degeneration, joint pain or spine related pain. Others like fibromyalgia are not well understood. Treatment works best if the source is identified, inclusive of but not limited to medication, therapy, psychological counseling, biofeedback, supportive care, and injections. In some cases, surgery may be an option.