Low Back Pain


 

LOW BACK PAIN

The lower back provides flexibility and support to your body. It is not surprising that this interconnected mechanism made up of the spine, muscles, tendons and ligaments can be vulnerable to injury and pain.

At the Center for Integrated Pain Management  we will devise a customized treatment plan to relieve your aching back. Below is a list of low back and spine conditions that the Center treats.


  • Coccydynia
  • Degenerative Disc Disease
  • Lower Back Spinal Stenosis
  • Facet Joint Syndrome
  • Lower Back Spondylolisthesis
  • Failed Back Surgery Syndrome
  • Muscle Spasms
  • Sacroiliac Joint Dysfunction
  • Nerve Entrapment/Radiculopathy
  • Lower Back Spinal Osteoarthritis

 

A diagnosis will be made once Dr. Kulick reviews your family history, completes a thorough physical examination and conducts an in-office ultrasound. If necessary, Dr. Kulick may request that you obtain an MRI, CT Scan or additional X-rays in order to precisely determine your diagnosis and treatment plan.

To learn more about the treatment and relief of low back conditions please contact our office at 212-867-1777.

 

Coccydynia

 

What is Coccydynia?

The coccyx or tailbone is located at the base of the spine.  Coccydynia is a condition characterized by pain and tenderness in the tailbone area.  It may become worse when sitting or standing for long periods of time. It may also be accompanied by sciatica or back pain. It occurs more often among women than men. It may result from a trauma caused by a fall, poor posture, stress placed on the region during childbirth or repetitive pressure on the area because of a sport such as horseback riding or biking.

 

Seek Treatment for these Symptoms:

  • Pain in tailbone area does not dissipate in a few weeks
  • Pain is severe

 

Next Steps

Consult the Center for a diagnosis and for treatment options.  Depending upon the cause of the pain, treatment options may include ultrasound guided corticosteroid injections, trigger point therapy, anti-inflammatory medication or physical therapy.

To learn more about the treatment and relief of Coccydynia please call us at 212-867-1777.



Low Back Degenerative Disc Disease

 

What is Degenerative Disc Disease?

The spinal column allows you to twist and bend. It is made up of bones (vertebrae) between which are jelly-like cushions called discs that act as shock absorbers between the vertebrae. These discs may degenerate as a result of aging, back injuries and daily wear and tear. In addition, the outer wall of the disc may sustain minute tears that are replaced with scar tissue. The disc wall can become progressively weaker and the jelly-like center of the disc containing water and proteins may begin to dry out.  If the disc completely ruptures or cracks it is called a herniated disc. As the disc loses water it compresses and the joints in the vertebrae begin to rub against each other causing osteoarthritis pain and stiffness. The compressed disc may also put pressure on nerves as they exit the spine through its openings and cause further pain, numbness or tingling. You may endure pain in the lower extremities or buttocks while others may experience no pain.

 

Seek Treatment for these Lower Back Symptoms:

  • Pain in the lower back, buttocks, and thighs
  • Pain that is worse when sitting or bending
  • Pain may lessen when walking or lying down
  • Numbness and tingling in the legs
  • Weakness in the leg muscles

 

Next Steps

Consult the Center for a diagnosis and for treatment options.  Depending upon the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound guided injections of platelet rich plasma (PRP), ultrasound guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections may be recommended.

To learn more about the treatment and relief of Degenerative Disc Disease please call our office at 212-867-1777.



Facet Joint Syndrome

 

What Is Facet Joint Syndrome?

Facet Joint Syndrome is pain in the joints of the vertebrae, the bones that comprise the spine. Each vertebra has 2 facet joints that connect it to the next vertebra. The joints both stabilize the spine so that it does not move too far forwards or backwards and they allow you to bend and twist.  Soft tissue called cartilage, as well as a lubricating fluid, cushion the joints. An injury to the back or neck, daily wear and tear or osteoarthritis can cause the cartilage to deteriorate and the joints to rub against each other causing stiffness and pain. This may in turn cause bone spurs or an overgrowth of bone, that result in increased inflammation. If the joints swell too much then the openings in the spine through which nerves travel may narrow and cause nerve compression and even greater discomfort.

 

Seek Treatment for these Symptoms:

  • Need to turn entire body to look left or right
  • Unable to bend or twist body
  • Trouble standing up straight or getting out of a chair
  • Back or neck pain
  • Pain that extends into your buttocks and upper thighs
  • Muscle weakness in the arm, shoulder, or leg

 

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending upon the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, physical therapy, ultrasound guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections may be recommended.

To learn more about the treatment and relief of Facet Joint Syndrome please call our office at 212-867-1777.

 

Failed Back Surgery Syndrome

 

What is Failed Back Surgery Syndrome?

Failed back surgery syndrome is a general term for chronic pain that does not dissipate following spine surgery.  The surgery may not have been effective or may have resulted in scar tissue that compressed a nerve. The cause of the initial back pain may have been misdiagnosed so that the procedure did not address the correct root of the back pain. Regardless, the result is continued pain, stiffness and discomfort.

 

Seek Treatment for these Symptoms:

  • Dull aching pain in the back or neck
  • Pain radiating to the legs or arms
  • Sharp or burning pain in the legs or arms
  • Limited ability to walk and move

 

Next Steps

Depending upon the reason for the pain, treatment options will vary. These may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended, or under ultrasound breaking up scar tissue with a needle if needed.

To learn more about the treatment and relief of Failed Back Surgery Syndrome please call our office at 212-867-1777.

 

Sacroiliac (SI) Joint Dysfunction

 

What Is Sacroiliac (SI) Joint Dysfunction?

The SI joint links the sacrum, the triangular bone at the bottom of the spine, to the pelvis or hip bones, via strong taut ligaments. Unlike other joints that are designed for big movements, the sacroiliac joint should only move slightly to allow for actions such as walking. This joint stabilizes the pelvis and acts as a shock absorber for the spine.

Too much or too little movement in the SI joint can cause the joint to become inflamed, unstable, and affect its ability to properly function. Excess movement in the joint may be caused by loose or injured ligaments in the SI, pregnancy, arthritis, or a traumatic injury.  Too little movement may be caused by degenerative joint diseases such as arthritis.

 

Seek Treatment for these Symptoms:

  • Pain in the lower back, buttocks, groin, hip/pelvis, or back of the leg.
  • Muscle spasms near the SI joint
  • Difficulty standing or sitting for long periods of time
  • Pain disrupts sleep

 

Next Steps

Consult the Center for a diagnosis and for treatment options.  Depending on the underlying conditions, these may include ultrasound-guided corticosteroid injections, ultrasound guided injections of platelet rich plasma (PRP), ultrasound guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about SI Joint Dysfunction and its treatment please call our office at 212-867-1777.

 

Low Back Spinal Osteoarthritis

 

What is Osteoarthritis?

Osteoarthritis can affect any joint in the body, including joints in the spine. It causes the gradual weakening of the cartilage. Cartilage is connective tissue that protects the ends of the bones and allows the bones to glide smoothly in the joint. In the spine, the facet joints of the vertebrae are lined with cartilage. These joints allow the spine to bend forward, extend backwards and to twist. When the cartilage deteriorates, bones rub against one another creating inflammation, stiffness and pain. Bone spurs, an overgrowth of the bone, often develop and may place pressure on the nerves further intensifying the pain. Aging and daily wear and tear increase the degeneration of the joint.  Other risk factors include excess weight, family history and gender. Osteoarthritis is more common in postmenopausal women than in men in the same age range.

 

Seek Treatment for these Symptoms:

  • Back stiffness when awake in the morning or after periods of inactivity
  • Intermittent back pain
  • Back pain that radiates into the buttocks, thighs, pelvis, or down the back of the leg
  • Grinding or popping noise when you turn your neck
  • Weakness or numbness in the legs or arms
  • Neck pain, tenderness, or numbness
  • Loss of bladder or bowel function

 

Next Steps

Seek a diagnosis and treatment options. Dr. Kulick will design a customized treatment plan designed to alleviate the symptoms suffered.  Options include anti-inflammatory medication, ultrasound-guided corticosteroid injections, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc or Supartz to help cushion the joints, ultrasound-guided prolotherapy injections and physical therapy.  Cutting edge therapy such as ultrasound guided injections of platelet rich plasma (PRP) or ultrasound-guided stem cell injections that may stimulate the growth of new cartilage are other options..  

To learn more about the treatment of Osteoarthritis please contact our office at 212-867-1777.

Low Back Spinal Stenosis

 

What is Spinal Stenosis?

The vertebrae of the spine encase the spinal cord which is made up of nerves and bundles of nerves in an open space called the spinal canal. These nerves branch out from the spinal cord through openings in the vertebrae in order to allow the brain to send nerve signals throughout the body. When the canal narrows, it places pressure on the nerves, causing numbness, pain and/or tingling.  This typically occurs in the cervical spine (neck), and the lumbar spine (lower back). It is a degenerative process and is often associated with aging. Ligaments surrounding the spine may thicken and bulge into the open spaces of the vertebrae, osteoarthritis may cause bone spurs to jut into the spinal canal, herniated discs or tumors can narrow the canal and spinal injuries or post spinal surgery swelling can cause stenosis. These conditions all result in compression of the nerve root.

 

Seek Treatment for these Symptoms:

  • Persistent stiffness, numbness or pain in back, legs, neck or arms
  • Sciatica with pain radiating down the leg
  • Difficulty walking
  • Cramps in legs or arms

 

Next Steps

Consult the Center for a diagnosis and for treatment options.  A steroid-free hydrodissection will release the nerve and ultrasound-guided nerve block injections will provide relief.  Depending upon the cause of the stenosis, additional treatment options may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound- guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication. To learn more about the treatment and relief of Spinal Stenosis please call our office at 212-867-1777.

 

Lower Back Spondylolisthesis

 

What is Spondylolisthesis?

Spondylolisthesis is a condition in which one of the vertebra of the lumbar spine (lower back), slips forward over another vertebra, pushing the spine out of alignment. This can place pressure on the spinal cord or one of the nerve roots inducing severe pain. Spondylolisthesis may be caused by a traumatic injury, a fracture or the degeneration of bones, ligaments or discs due to aging. Some people have no symptoms as a result of Spondylolisthesis while others suffer pain from nerve compression.

 

Seek Treatment for these Symptoms:

  • Lower back or leg pain
  • Muscle weakness in the legs
  • Sciatica

 

Next Steps

Consult the Center for a diagnosis and for treatment options.  A steroid-free hydrodissection will release the nerve and ultrasound-guided nerve block injections will provide relief if there is nerve compression.  Depending upon the cause of the spondylolisthesis, additional treatment options may include ultrasound-guided corticosteroid injections, ultrasound-guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, stem cell therapy, physical therapy and anti-inflammatory medication.

 

Muscle Spasms

 

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you pick up a heavy box, reach for an item or even sleep in an awkward position. This suddenly triggers a muscle spasm in your lower back that makes you incapable of movement or straightening. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They commonly occur in the neck, upper or lower back,  and legs. Muscle spasms may be caused by heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease or a herniated disc, and many sports injuries. Some sports including golf, football, weightlifting and basketball that require the constant twisting of the spine may lead to back spasms. Spasms may seem to appear out of nowhere, however, typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn sparks a muscle spasm that can cause pain, cramping or twitching.

 

Seek Treatment for these Symptoms:

  • Muscle pain that does not dissipate on its own
  • Constant muscle cramps
  • Difficulty walking or moving
  • Muscle feels hard or distorted

 

Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.

Radiculopathy/Nerve Entrapment

 

What Is Radiculopathy?

Radiculopathy is a group of conditions affecting one or more nerves in the spine. These nerves may become pinched or compressed, causing pain, numbness or tingling in the arms or legs. The sciatic nerve, the large nerve that runs down the lower back, hip, buttocks, and back of leg to the foot may be compressed in the lower back as a result of a herniated disc or other spinal damage.

Radiculopathy commonly occurs in the cervical spine (neck), the thoracic spine (mid back)or the lumbar spine (lower back).

Cervical, thoracic, and lumbar radiculopathy are often caused by herniated discs in the vertebrae (bones of the spine) and spinal stenosis, a narrowing of the hole in the vertebrae through which spinal nerves exit.  This places pressure on the nerves as they branch out from the spine. The compression may also be caused by an injury, overuse of muscles and tendons, poor posture, bone spurs, and arthritis.

 

Seek Treatment for these Symptoms:

  • Pain that radiates outward from the injured nerve
  • Numbness, tingling, burning sensation
  • Muscle weakness
  • Cervical radiculopathy affects the neck, upper back, shoulder, chest, arm, or hand.
  • Thoracic radiculopathy affects the chest, ribs, shoulders, mid back or stomach area
  • Lumbar radiculopathy causes sciatica which is an irritation of the large sciatic nerve located in the lower back.  This causes pain to radiate down the back of the leg to the calf or foot called sciatica
  • Pain may be aggravated by activities such as walking, climbing stairs or sitting

 

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending on the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound -guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve and ultrasound-guided nerve block injections will be recommended.

To learn more about cervical radiculopathy and its treatment please call our office at 212-867-1777.

Location
Alexander Kulick, MD
112 East 61st Street
Upper East Side

New York, NY 10065
Phone: 917-810-4139
Fax: (646) 585-0042
Office Hours

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917-810-4139