Back Pain
Chronic low back pain is pain lasting longer than three months, most often coming from the discs, the facet joints, the sacroiliac joint or an irritated nerve root. Identifying which structure is responsible is what makes treatment work. Most patients improve without surgery once the source is correctly identified.
Medically reviewed by Ramya Rangaraj, MD — ABPMR, ABPM
Back pain is a symptom, not a diagnosis
Almost everyone with chronic back pain has been told they have "degenerative changes" or "arthritis" on an MRI. That is rarely useful on its own, because most adults over 40 have findings on imaging that cause them no pain at all.
The question that matters is which structure is generating your pain right now. In the low back there are only a few real candidates: the intervertebral disc, the facet joints at the back of the spine, the sacroiliac joint where the spine meets the pelvis, a compressed nerve root, or muscle and myofascial tissue. Each one has a recognizable pattern, and each one has different treatment.
That is what a first visit here is for. History, examination, review of your imaging, and — when the picture is unclear — a diagnostic block that answers the question directly.
Common sources and what they feel like
- Facet joint arthritis: one-sided aching, worse standing or leaning back, better sitting or bending forward.
- Sacroiliac joint: pain below the belt line on one side, worse rising from a chair or rolling in bed.
- Disc: central pain worse with sitting, bending forward and coughing.
- Nerve root compression: back pain plus burning, numbness or weakness down a leg.
- Spinal stenosis: leg heaviness and cramping when walking, relieved by sitting or leaning forward.
- Myofascial pain: tight, tender bands of muscle that refer pain in a predictable pattern.
How we treat it
Treatment follows the diagnosis, not the other way around. Facet-driven pain responds to medial branch blocks and, when those confirm the source, radiofrequency ablation. Nerve root pain responds to epidural steroid injections. SI joint pain responds to a targeted joint injection. Muscle pain responds to trigger point injections plus a stretching program.
None of these are stand-alone answers. Injections open a window; physical therapy, weight management, sleep and activity are what keep the pain from coming back. We are direct about that at the first visit.
When to be seen promptly
- New weakness in a leg or foot drop
- Loss of bladder or bowel control — go to an emergency room
- Numbness in the groin or inner thighs — go to an emergency room
- Back pain with fever, unexplained weight loss, or a history of cancer
- Severe pain after a fall or car accident