Our spine program is the backbone of our practice. Lower back pain, sciatica, neck pain, and cervical radiculopathy or “pinched nerves” make up the majority of what we treat. We’ve had tremendous success in managing such conditions irrespective of prior diagnosis, imaging abnormalities, or failure of traditional treatments. We have advanced training in Mechanical Diagnosis and Therapy® (McKenzie Method) that has been proven to be amongst the most effective assessment and treatment methods for managing spinal pain.
Magnitude of problem
Back pain is the most common physical condition for which patients see a physician. At any given time, almost one in three people over the age of 18 years suffer from back pain.
Although extremely common and debilitating, back pain is rarely serious. Most people with new episodes of back pain recover substantially within six weeks. However, recurrence is common in the absence of adequate prevention strategies, and for a select few it remains persistent and disabling.
Diagnosis problem
Low back pain and neck pain is a symptom, not a diagnosis. Unlike other fields of traditional medicine, for a vast majority of people with low back pain (or neck pain), the specific cause of pain can rarely be identified. Such identifiable causes are mostly serious and require immediate medical attention.
Red Flag Conditions
Fractures
Malignancy (cancer/tumor)
Inflammatory disorders like spondyloarthritis
Infections
Intra-abdominal causes
Cauda equina syndrome
In the absence of serious pathology, most cases of low back or neck pain are customarily labeled ‘non-specific'.
Common Spinal Diagnoses
Sciatica
Radiculopathy
Degenerative disc disease
SI joint pain
Muscle strain or spasm
Stenosis
Bulging disc or herniated disc
Nerve impingement (“pinched nerve”)
Osteoarthritis
Facet joint syndrome
Spondylolisthesis
Whiplash
Imaging problem
World’s leading medical associations and reserachers have all strongly advised against the use of imaging like X-rays, CT scans or MRIs in the first 6-8 weeks of back or neck pain unless there is progressive neurological deficit or suspicion one of the above-mentioned serious medical conditions.
Yet it remains a common practice for physicians and surgeons to routinely utilize such unreliable tests either for medicolegal reasons or due to patients’ demand. No wonder the rate of spinal surgeries has skyrocketed in the past two decades without much improvement in the outcomes after such surgeries.
Training problem
While family physicians and internal medicine practitioners have excellent training in the identification and management of medical conditions, their ability to diagnose and treat spine, joint, and muscle problems remains extremely limited. When medications and general advice is not helpful, they usually give in to patient demands and prescribe advanced imaging in the hopes to identify the source of pain or escalate care to orthopedic surgeons or neurologists.
Research has clearly shown that early physical therapy for low back pain and sciatica results in improved disability levels, decreased pain intensity, lower prescription of opioid medications, and decreased need for other interventions. Yet only 7% of all patients who see their primary care physician for such complaints ever receive a referral for physical therapy!
Simplifying the problem
Regardless of the medical diagnosis, most back pain (or neck pain) is mechanical, that is, affected by movement or positions. While it can present in many different ways, for the sake of simplicity, two broad patterns of spine-associated pain are commonly seen:
Back-dominant pain
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pain in back and/or buttock(s) or around the hip(s)
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typically comes and goes, or associated with bouts of “spasms”​
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usually worse with bending, sitting, rising from sitting, and temporarily better with walking or changing positions frequently
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regardless of severity, it is usually not serious as there is no damage to nerves or spinal cord
Leg-dominant pain
Sciatica/radiculopathy
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pressure or compression of nerves in the back causing pain down the leg anywhere from the thigh to the foot
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often constant
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usually worse with bending and sitting, and temporarily better with lying on the side
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Stenosis/neurogenic claudication
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leg pain comes on only when standing or walking, and relieved by sitting or bending forwards
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feeling of cramping or heaviness in legs when walking
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usually in older adults
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caused by narrowing of spinal tunnel containing the nerves
Our method
The Spine and Extremity Validity Algorithm (SEVA), based on the principles of Mechanical Diagnosis and Therapy®, guides us in classifying your presentation into distinct sub-categories.
Treatment then involves repeating very specific movements and/or postures several times a day to decrease the sensitivity of painful tissues while helping you move better.
Results
Over 90% of above mechanical conditions respond rapidly and favorably to our unique treatment approach without the need for additional tests or investigations. Recurrence rates are much less compared to traditional stretching and strengthening. Need to undergo invasive procedures is significantly reduced.
We guide you with the right advice to take ownership of your treatment with highly effective self-care strategies and decrease your dependency on passive treatments like massage, modalities or joint manipulation.
A prompt referral to another medical professional is made if there is a suspicion of a rare but serious condition such as spinal infection, tumor/cancer, fracture, caudal equina syndrome, aneurysm or other systemic inflammatory problem.
We strive to provide you with a clear understanding of your condition in order to minimize negative beliefs and attitudes such as fear and avoidance of activity because of your back pain, sciatica or neck pain while promoting positive coping strategies to minimize the risk of low self-efficacy and prolonged disability.
Frequently asked questions
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