Despite MRI findings, Pelvic strain/sprain is by far the most common cause of back pain!
Backpain is one of the most common presenting problems that I see. In my experience, by far the most common cause of the backpain is pelvic strain. 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 fails too.
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.
Now it is true that many patients will present with positive MRI findings showing 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 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 highly likely to not solve the pain problem and may even add another source of pain, thus aggravating the situation.
Some of you may be aware that back surgery has a pretty poor track record of curing 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 a little 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 palpation exam can often reveal all that you need to know.
Of course if a patient has six or seven treatments of Prolo (or four of PRP) and fails to have any effect/benefit after say two months of Regenerative Medicine treatments, one can always proceed with other options including MRI and possible epidural. For me surgery should be the last resort and reserved for patients who have real signs of motor weakness and fail to respond to optimal non-surgical treatment with Prolo and PRP.
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 Prolo/PRP 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.