A good diagnosis is the cornerstone.

We look at you. The MRI confirms.

Most pain physicians are not diagnosticians, as one would think. We believe a good diagnosis is the cornerstone for successful healing, but we do not always rely on expensive imaging to get it. Without a proper physical exam, the MRI is not a reliable diagnostic tool. At this clinic, we put the focus back on the patient, give a clear diagnosis, and look to an MRI for confirmation.

Few pain doctors are skilled at the physical exam. Fewer still read their own films, instead relying on the radiologist’s report. Especially in the back, where causes are often multiple and interconnected, you need to ask a lot of questions. Empower yourself with the possible causes. Do not accept a rubber-stamp diagnosis from someone who has not examined you.

What happens on the first visit

Before you come in, you fill out a questionnaire about your pain and your medical, social, and family history. We interview you about your pain and perform a detailed physical exam. If additional exams or films are needed, we go over those with you. Then we go over your diagnosis and explain the treatment plan— injections, medications, further imaging, referrals. Due to insurance, staffing, and scheduling, it is rare that we do injections on the same day we examine you.

What the plan is actually for

Treatment is non-narcotic and physical-therapy-centered. Procedures are aimed at producing a quieter window so strength and stability can return. If injections are used without the strengthening, they are a bandage. Used well, a steroid shot can create a two-to-three-month window where the little bracing muscles can be trained again. Getting those muscles strong while you still hurt is almost impossible.

Stability muscles have very little to do with being “strong.” A pitcher does not do rotator cuff work to make the shoulder powerful. They do it to pull the arm into the socket. Bracing muscles do not move you. They hold you steady while everything else is moving.

We do not prescribe pain medication on the first visit—only in rare cases when the pain is new and severe. In almost all cases we refer medication management to a physician who does that work every day. Narcotics are not a main component of this practice.

For referring physicians

In over 40 years there have been no significant advances in the understanding of low back pain. Forty. Years. If a patient has such severe pain they cannot make it through the weeks this work takes, consider a surgeon. Bowel or bladder changes belong in the emergency room. Rapid-onset atrophy in a dermatome should be seen immediately by a spine surgeon. A disc bulge without 10/10 pain or atrophy is often still our work. Sciatica is caused by many things that are not disc bulges. Even with an MRI showing a bulge, many to most patients are diagnosed with something else.

If you are unsure, call. We will be happy to discuss the patient or go over the MRI with you.