Call Today: (877) 966-7846 | (512) 439-1000
Texas Orthopedics, Sports & Rehabilitation Associates

Tuesday, March 22, 2011

Specialists Who Treat Back & Neck Pain

There are many types of health practitioners that care for patients with spinal conditions, and each has a slightly different role. Selection of the most appropriate type of health professional—or team of health professionals—largely depends on the patient’s symptoms and the length of time the symptoms have been present.

There are three broad groups of health providers who treat back pain:

Primary care providers are often the first port of call for patients when back pain strikes:
Primary care physicians (Family practice doctors, Internists, Pediatricians)
Doctors of osteopathy

Spine specialists have a specific area of expertise in diagnoses and/or treatments for back pain:
Surgeons (Orthopedic surgeons and Neurosurgeons)

Therapists for back pain or psychological help for chronic pain:
Physical therapists
Clinical psychologists

A Physiatrist is a Medical Doctor who specializes in Physical Medicine and Rehabilitation (PM&R). Essentially, physiatrists are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move.

Physiatrists diagnose and treat both acute and chronic pain and musculoskeletal disorders. They can order and interpret all types of spine imaging (x-ray, CT myelogram, MRI, bone scan) and perform specialized nerve tests (EMG and NCS) to help assess the location and severity of nerve damage. Typical treatments may include:

o Referral to Physical Therapy (e.g. exercise, stretching, heat/ice, TENS units)
o Prescription medications
o Electromyographic studies
o Interventional procedures (e.g. epidurals, joint injections)

Physiatrists treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Physiatrists take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of a team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, physiatrists help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

Texas Orthopedics has two physiatrist, Dr. Kenneth Bunch and Dr. Ai Mukai, that work closely with our orthopedic surgeons to provide comprehensive musculoskeletal care.

Tuesday, March 8, 2011

Back Pain

Post provided by Ai Mukai, MD

What can cause back pain?

There are many structures in the back area that can cause pain. Some of those structures are:
• Muscle – muscle strain and sprain – usually achy, may have spasms
• Disc – usually sudden pain, can pinch nerve, twisting and bending makes it worse
• Bone – fracture of the back bone or smaller bony structure in back – usually constant, may be sharp or achy
• Ligament – strain or sprain, usually worse with movement
• Nerve – pinched nerve – can shoot pain to one side or another, feels like burning, shooting, tingling pain
• Joint – sacroiliac joint – near the base of spine and buttock area, worse with transitional movements like sit to stand
• Joint – facet joints – “knuckles” of the back, pain with bending backward or twisting.
• Coccyx – tailbone pain- worse with prolonged sitting, feels achy and inflamed

How do you figure out what is causing the pain?

X-rays can show broken bones or alignment issues. MRI is usually needed if soft tissue injury or cause is suspected like disks, pinched nerves, and ligaments. Information about how the symptom started, what it feels like, what makes it better or worse and physical examination can help narrow down the possibilities. Sometimes, there are multiple causes for the pain and one pain can cause another. Lab work can diagnose issues that may be preventing you from healing or causing more widespread pain and inflammation.

What are some possible treatment options?

Physical therapy is the key to improving alignment, taking pressure off areas of pain, and preventing future injuries. For the spine, McKenzie method and looking at the stabilizing the pelvis seems to give the best long term results. To help with the symptom relief of pain, different types of medications aimed at the different causes of pain (nerve pain medicine, muscle relaxers, anti-inflammatories) can be taken short term while undergoing physical therapy. For more severe pain or long term issues, non-surgical procedures such as injections into joints, epidural space (space where discs and nerves live), and muscles may help. There are more specialized procedures geared towards specific structures like radiofrequency ablation (burn the small nerves that supply joints) and spinal cord stimulators. Sometimes, the procedure can help diagnose the cause of the pain. Lastly, if all options fail, or there is something that needs to be addressed surgically, spine surgery is an option.