Conditions Treated

Degenerative Disc Disease
Degenerative disc disease is a condition that is commonly misunderstood. A degenerated disc is not actually a disease—it is part of the normal aging of the spine. When a spinal disc wears out, it loses its ability to function efficiently as part of the spinal joint, which in turn can lead to back pain and possibly pain that radiates through the lower extremities.

Herniated Disc
For normal or degenerated disc, the soft inner gel in the disc can leak back into the spinal canal. This is known as disc herniation or herniated disc. Once inside the spinal canal, the herniated disc material then puts pressure and/or inflammation around the nerve, causing pain to radiate down the nerve leading to sciatica or leg pain (from a lumbar herniated disc) or arm pain (from a cervical herniated disc).

Myelopathy
Loss of spinal cord activity as the result of sudden injury or the natural degeneration of the spine. It is necessary to treat myelopathy proactively to maintain your quality of life and prevent the dangerous deterioration of the spinal cord. If you believe you or a loved one may be experiencing myelopathy, schedule a consultation with one of our highly experienced spine surgeons today to prevent this serious condition from progressing.

Neuropathic Pain
The distinct nature of neuropathic pain is numbness, burning, and pins, and needles—caused by pressure or injury to the spinal cord or peripheral nerves, rather than pain elsewhere being relayed by the nerves.

Osteoarthritis
Osteoarthritis occurs when the protective cartilage in a joint begins to break down and no longer facilitates smooth movement between bones, which can eventually result in the joint becoming swollen, stiff, grinding and painful.

Piriformis Syndrome
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).

Sacroiliac Joint Dysfunction
Often hard to diagnose, sacroiliac joint dysfunction is commonly thought of as a source of lower back pain and/or leg pain. Connecting the triangular bone at the bottom of the spine (the sacrum) with the pelvis, the sacroiliac joint may be a source of pain if its normal motion is disturbed. More specifically, sacroiliac joint pain may be caused by too much or too little movement.

Coccydynia
Coccydynia refers to any type of persistent tailbone pain. The tailbone, located at the very bottom of the spine, is medically known as the coccyx. Coccydynia is typically felt as a localized pain that usually worsens when sitting or with any activity that puts pressure on the bottom of the spine.

Scoliosis
Scoliosis is abnormal side-to-side curvature of the spine. The spinal curve may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S). In children and teens, scoliosis often does not have any noticeable symptoms and may not be noticeable until it has progressed significantly. The two most common forms are degenerative scoliosis and idiopathic scoliosis (adolescent). Three orthopedically approved options exist for combating scoliosis: observation, bracing, or surgery.

Spinal Stenosis
Spinal stenosis occurs when the spinal cord in the neck (cervical spine) or the spinal nerve roots in the lower back (lumbar spine) are compressed. Symptoms of lumbar stenosis often include leg pain (sciatica) and leg tingling, weakness, or numbness. Arm pain is a typical symptom of cervical spinal stenosis. For cervical spinal stenosis with myelopathy, difficulty with coordination often occurs. Stenosis treatment may include non-surgical options (exercise, anti-inflammatory medication, epidural injections, and activity modification) or spine decompression surgery.

Muscle Strain
Muscle strain, muscle pull, or even a muscle tear refers to damage to a muscle or its attaching tendons. You can put undue pressure on muscles during the course of normal daily activities, with sudden heavy lifting, during sports, or while performing work tasks.

Whiplash
Whiplash occurs when the neck and head are suddenly forced backward and then forward, putting the cervical spine through lightning-quick motions and extreme stresses. Most cases of whiplash are caused by car accidents where the person has been rear-ended. Other potential whiplash causes, while comparatively rare, can include assault, bungee jumping, rollercoaster, football, falls while skiing or during equestrian events, and other high-impact activities where extreme acceleration-deceleration forces might be applied to the cervical spine.

Model of the spine and ribs

Conservative Treatments

Epidural Steroid Injection
Epidural steroid injections (ESIs) are a common treatment option for many forms of low back pain and leg pain. They have been used for low back problems since 1952 and are still an integral part of the non-surgical management of sciatica and low back pain. The goal of the injection is pain relief; at times the injection alone is sufficient to provide relief, but commonly an epidural steroid injection is used in combination with a comprehensive rehabilitation program to provide additional benefit.

Facet Joint Block
A facet joint block is an injection of local anesthetic (numbing medicine) into one or more of the small joints located along the side of each vertebra on both sides of the spine in the lower part of the back. Multiple injections may be performed, depending upon how many joints are involved. Facet joint blocks are typically requested for patients who have pain primarily in their back as a result of arthritic changes in the facet joints or for patients who have mechanical low back pain. A facet joint block may be diagnostic (a test to see if your pain is coming from this area) and/or therapeutic (to relieve your pain).

Sacroiliac Joint Block
A sacroiliac (SI) joint injection—also called a sacroiliac joint block—is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction. The sacroiliac joints lie next to the spine and connect the sacrum with the hip on both sides. There are two sacroiliac joints, one on the right and one on the left. Joint inflammation and/or dysfunction in this area can cause pain.

Selective Nerve Root Block
Another common injection, a selective nerve root block (SNRB), is primarily used to diagnose the specific source of nerve root pain and, secondarily, for therapeutic relief of low back pain and/or leg pain. In an SNRB, the nerve is approached at the level where it exits the foramen (the hole between the vertebral bodies). The injection is done both with a steroid (an anti-inflammatory medication) and lidocaine (a numbing agent). Fluoroscopy (live X-ray) is used to ensure the medication is delivered to the correct location. If the patient’s pain goes away after the injection, it can be inferred that the back-pain generator is the specific nerve root that has just been injected. Following the injection, the steroid also helps reduce inflammation around the nerve root.

NSAIDs
Every day, an estimated 30 million people worldwide take a non-steroidal anti-inflammatory medication or NSAID. These versatile medications, available in over-the-counter and prescription strength, treat both pain and inflammation. Inflammation is a contributing factor in most back pain conditions, so reducing inflammation is important to alleviate the pain. NSAIDs are used to address acute (short-term) as well as chronic back, neck, and muscle pain.

Antidepressant Medication
An antidepressant is a drug used that is primarily used in the treatment of clinical depression. Antidepressants are said to stimulate the mood of patients through the chemical manipulation of neurotransmitters in the brain. Aside from the treatment of depression, these drugs are also sometimes used to treat anxiety disorders, chronic pain, sleep disorders, and certain other disorders. Antidepressants are often accompanied by a range of undesirable side effects, and the efficacy of each type of antidepressant varies from patient to patient. Antidepressants may have serious (potentially fatal) drug interactions with certain other types of medication.

Narcotic Medication
Narcotic pain medications are strong pain relievers widely used to treat back pain. These medications change the perception of pain by weakening pain signals to the brain. Emotions are also affected, leading to a feeling of enhanced well-being and sleepiness in many patients. Narcotic pain medications are medically termed opioids and may be referred to as painkillers. They are derived from opium or made synthetically. Some narcotic pain medications contain both opium-derived and synthetic material.

Bracing
The optimal time to treat a progressing idiopathic scoliosis curve is typically before the adolescent growth spurt when the curve might rapidly worsen. Current medical literature tends to favor wearing a rigid back brace during this crucial period to lower the chance of developing a severe spinal deformity.

McKenzie Exercises
The McKenzie Method was developed in the 1960s by Robin McKenzie, a physical therapist in New Zealand. In his practice, he noted that extending the spine could provide significant pain relief to certain patients and allow them to return to their normal daily activities. With the McKenzie approach, physical therapy and exercise used to extend the spine can help “centralize” the patient’s pain by moving it away from the extremities (leg or arm) to the back. Back pain is usually better tolerated than leg pain or arm pain, and the theory of the approach is that centralizing the pain allows the source of the pain to be treated rather than the symptoms.

Physical Therapy
Patients suffering from most types of low back and neck pain are often referred for physical therapy for 6-8 weeks as an initial conservative (nonsurgical) treatment option before considering other more aggressive treatments, including back surgery. The goals of physical therapy are to decrease back pain, increase mobility, function, and teach the patient a maintenance program to prevent future back problems.

Physical Medicine Rehab Clinics
Address:
7125 N Chestnut Avenue Suite 103
Fresno, CA 93720

Phone:
559-765-4868
Fax:
559-797-4674

Hours: Monday - Friday
9 AM - 12:30 PM, 1:30 PM - 5 PM

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