Back pain is one of the most common presenting problems that I see. Despite MRI findings and disc abnormalities, in my experience Pelvic strain/sprain is by far the most common root-cause of backpain. The wonderful news is that for a Regenerative Orthopedic specialist, this type of back pain should be quite straight forward to fix.
The large gluteal muscles that stabilize and work the hips are very commonly strained. If a patient presents with backpain the essential part of the exam is a thorough palpation of the whole low back region including the lumbar spine, sacroiliac, gluteal insertions and the hips, as well as the IT bands (down the lateral part of the femur). Quite commonly the gluteal insertions will often light up with the “jump sign” and the patient will report that palpating reproduces their pain. Unfortunately, these stretched insertions don’t show upon MRI’s.
These gluteal insertions are one of the simplest and safest areas in the body to inject with either concentrated dextrose or PRP. Our success rate is upwards of 85% for patients who have a positive jump sign.
As I have mentioned, it is not uncommon for patients to present with positive MRI findings and show a disc issue. In my view these are imaging abnormalities that are clinically irrelevant. In other words, these discopathies are there but are not the root-cause of the pain. This is, of course, crucial to understand. Otherwise one ends up with the wrong diagnosis and inappropriate treatment (such as epidurals and possibly surgery) that are unlikely to solve the pain problem and may even aggravate the situation.
Some of you may be aware that back surgery has a pretty poor track record of improving backpain. The reason for this in not that the surgeon is lacking etc. but that the diagnosis is wrong. Part of the issue is modern medicine is we are overly reliant on MRI to make the diagnosis. When I went to medical school many years ago we were taught that there is no substitute for a good history and physical exam. I think this dictum is still relevant today. A simple yet detailed palpation exam remains a very elegant way to identify the structures that are the root-cause of the pain. We call these palpation exams “advanced digital guidance systems”. When we identify the “jump sign” we have made the diagnosis of where the pain is originating with a high degree of certainty.
If one uses PRP injections alone, resolution of back pain usually takes three or four sessions over a two month period. If one elects to use stem cells, results may be considerably faster. We like to recommend an active rehab with swimming and cycling. I also find that using a foam roller on a carpeted floor helps patients roll out the kinks in their pelvis and speeds the healing process.
As usual, we ask patients to avoid anti-inflammatory pharmaceuticals for pain. They may use Tylenol or mild painkillers such as codeine or tramadol to make themselves more comfortable while they heal. At our center we have an overall success rate exceeding 85%. Results tend to be long-lasting.
A word about Sciatica
Sciatica refers to radiating pain down the leg and is often taken by conventional docs to imply nerve impingment. In reality, a sciatica type syndrome is actually very rarely due to sciatic nerve impingement. The pain from Gluteal muscle strain (known as enthesopathy) radiates in a manner indistinguishable from nerve pain. So called “sciatica” type syndrome is far more likely to be due to damaged gluteal attachments (i.e. strain) with radiating pain down the leg.
Every now and then I see a patient who comes in and tells me they were told that their sacroiliac joints were dysfunctional. In connective tissue terms, we would say that the problem is loose SI joints. This is a perfect case for Regenerative Medicine. In fact, I believe that Regen. Ortho. is the only sensible way to fix the problem (to “tighten” the joints). Steroids, as usually is the case, are contraindicated because they can further weaken the joint. In my view there is no reasonable surgical option.