My Jaw Clicks and Hurts – All About Temporomandibular Joint (TMJ) Problems

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The mandible of the jaw is a modified hinge joint that is supported by muscles and allows you to chew your food.  The joint that allows this movement is the jaw joint, called the temporomandiublar joint or TMJ.  It is located just in front of your ear.  You can feel the joint by putting your finger on your cheek in front of your ear and open/close your mouth.

Inflammation of this joint can cause pain and that can sometimes be confusing because the average person often does not think about this area as a source of pain.

Symptoms of TMJ inflammation can be:

1)   A dull pain in the jaw muscles on one side

2)   Pain around the ear that can be confused for an ear infection

3)   Jaw pain that can sometimes make you think you have a tooth infection

4)   Neck pain or tenderness

5)   Pain when chewing food

6)   Popping when opening your mouth

7)   Difficulty opening your mouth widely because of pain

8)  Headache

Causes:  Because the jaw is a hinge joint, it can become inflamed with arthritis.  Other possible causes are:

1)   Stress that causes jaw clenching

2)   Teeth grinding – especially at night when you are asleep

3)   If your teeth/bite is not quite right, sometimes a dentist can help adjust this

Treatment: For many people the symptoms occur only occasionally and do not last very long. There is not a “usual” treatment for TMJ.  Treating the cause of the problem is the goal, and that might be fixing your teeth/bite or decreasing stress that might lead to jaw clenching or teeth grinding.  Dentists will sometimes fit patients with a dental appliance that helps protect the teeth and also decreases grinding.  For some people this has been very helpful in reducing the pain from TMJ.   Other possible treatments include:

1)   Medications to reduce inflammation and relieve pain such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, etc.) or muscle relaxants

2)   Jaw exercises that stretching of the muscles around the TMJ

3)   Stress reduction and biofeedback to decrease teeth griding/clenching

4)   Appropriate dental care

5)  Avoiding actions that cause your symptoms such as yawning, singing or chewing gun

To find a dentist in your area, the American Dental Association has a useful Dentist locator:

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO



A Healthy Poke: Demystifying the Science Behind Acupuncture

SEP 29 2011, 10:07 AM ET 442

ALICE G. WALTON – Alice G. Walton is a health-and-science journalist who writes on medical issues, particularly those related to the brain and behavior. She holds a Ph.D. in biopsychology and is an editor at

Many of us have started to embrace the use of alternative medicine, but acupuncture, with its qi, yin, and meridians, still raises eyebrows

While many practices in alternative medicine are slowly but surely making their way into the mainstream, acupuncture is one that still produces skeptical eyebrow raises. This phenomenon is partly due to linguistics. Scientists have worked to elucidate the mechanisms by which yoga, meditation, and various dietary interventions may work on the cells of the body, but there is something fundamentally more ancient-feeling about the language of acupuncture. Go to the NIH’s website on complementary and alternative medicine (NCCAM), and even here you’ll find a discussion that involves qi, yin, yang, and meridians.

Is it possible to discuss acupuncture in a way that makes sense to even the most Westernized brains? The short answer is yes — but with the caveat there there is no single unifying explanation for how it works. While acupuncture has been demonstrated to be useful in pain management and in treating the nausea and vomiting associated with chemotherapy, other uses have had more mixed results when studied scientifically.

Dr. Leena Mathew is an attending physician in Anesthesiology and Pain Medicine at New York Presbyterian Hospital/Columbia University Medical Center. She uses acupuncture as an “adjunct analgesic modality,” meaning that she uses it as a complementary treatment for pain in her patients should they require or prefer it. She and Dr. Josephine Briggs, director of NCCAM, discussed with us the most likely theories of the mechanisms behind acupuncture.

For pain management, one idea is that acupuncture may be working via the gate control theory, first outlined by Melzack and Wall in the 1960s. This theory suggests that pain is transmitted through small nerve fibers from the skin through the spinal cord and on up to the brain. Also present are larger fibers which normally send inhibitory signals to the small pain fibers, which essentially “gates” or prevents a pain signal from being set off. When a painful stimulus comes in, however, the activity in the small nerve fibers overwhelms the large ones, so inhibition is released and the gates of pain opened. Where does acupuncture come in? Theoretically, the needles are placed in positions to stimulate the large nerve fibers, so that the small — painful — ones are inhibited. Mathew says that the same logic theoretically underlies why rubbing your elbow after you bang it helps alleviate the pain: you’re stimulating the inhibition that quiets the pain.

Another possibility is that endorphins, the body’s famed “feel good” chemicals, are behind the effect of acupuncture on quelling pain. Mathew says that the happy little chemicals are released in response to a range of phenomena — distress, injury, running long distances, chocolate — and have the knack for acting like morphine on the body and brain. Studies have tracked levels of these molecules in the blood, and shown that acupuncture is linked to higher levels of beta-endorphin at the same time that patients are reporting decreases in their pain levels. Even more, when you inject people with the anti-morphine drug naloxone, the effects of acupuncture are reduced.

But other theories better explain why acupuncture has been shown to work well on the nausea and vomiting (PDF) associated with chemotherapy. In the 1950s, the nerve reflex theory was proposed, suggesting that the body’s periphery (the skin) is connected to the internal organs through a reflex called the viscero-cutaneous reflex. “If you stimulate the periphery with acupuncture needles,” explains Mathew, “you can change the blood flow pattern to the stomach and abdomen, which could explain the effect on nausea and vomiting.”

Acupuncture may also have an effect on the body’s stress response system, otherwise known as the hypothalamus-pituitary-adrenal (HPA) axis, which could be why acupuncture patients report lower stress levels and anxiety after treatment, at least in the short term.

If you were wondering when the word “placebo” was going to enter the discussion, here it is — but it’s not what you think. What researchers now know about the placebo effect is that it isn’t some hokey “mind over matter” thing. The response is a robust, demonstrable physiological phenomenon, according to Mathew. When people are being “treated” with placebo, you can actually see the change in blood flow patterns in the cortices of their brains in fMRI. Some people are more responsive to the placebo effect than others, and there is no doubt that some of this effect is going on with acupuncture, and particularly heightened in placebo-sensitive individuals.

Which leads to the final theory about why acupuncture may work on certain conditions. The very presence of human touch may have a lot to do with acupuncture’s healing power, Mathew suggests. “This is therapeutic touch,” she says. “As Westerners, we’re disconnected from this. We don’t want to touch patients.” But just as a mother calms a child simply through her physical/emotional presence, having another human being exert a well-intentioned touch may, in its simplicity, also do a lot to alleviate pain. This effect may have to do with the alleviation of fear and anxiety, things we know account for a huge portion of our perception of pain.

Briggs adds to this idea by mentioning that some of the effects of acupuncture can also be seen when “sham” treatments like toothpicks are used, which can sometimes have an effect similar to acupuncture. This, she says, “tells us that a very important part of acupuncture’s effect is the ritual involved, which includes pressure, reassuring practitioners, and the patient’s expectation.” In other words, the act of acupuncture itself is at least partially what accounts for its effect.

She adds that we need to start asking different questions about acupuncture, and using different language to discuss is. For example, she says that “meridians were developed by a tradition of people who didn’t dissect human body — meridians are not good a scientific question. But, ‘How does the practice change our perception of pain?’ is a good question. It’s quite plausible that pain pathways are modulated by emotion, pill placebo, etc., so it’s not surprising that reassurance of ritual or expectation is at play here. ”

As Mathews points out, acupuncture is a “retrospective science, going on for 3,000 years. We know it works, we just don’t know why. It’s very hard to translate into Western language.” Still, it should be possible to do so, and we seem to have made some progress. Hopefully more researchers asking the right questions, and coming up with clever new techniques to address them, will help elucidate the mechanisms and unify the theories.

Image: REUTERS/Mike Cassese.



If you would like to locator an Acupuncturist/Oriental Medicine Provider in your area, one resource that I found helpful is the American Association of Acupuncture and Oriental Medicine Website:

Scott Rennie, DO

Plantar Fasciitis – What a Pain in the Foot!

shutterstock_90181162One of the more common reasons that I see patients in the urgent care for is plantar fasciitis.  It causes foot pain, mostly in adults.  Patients are more prone to this kind of foot problem if they jump or stand for prolonged periods of time.  These motions stretch the plantar fascia.  Most people who have an episode of plantar fasciitis have no pain within one year.

Causes:  A strain in the ligaments in the fascia which is a thick, white pearly tissue with long fibers that starts at the heal bone and fans out along the under surface of the foot and extends to the toes.  The plantar fascia provides support as the toes bear the weight of the body when the heal rises while walking.

Symptoms:  pain beneath the heel and sole of the foot.  The pain is often worst when stepping out of bed early in the morning or getting up after being seated for a period of time.

Risk factors:

1)   Long distance running

2)   Standing for long periods of time (grocery store cashiers for example)

3)   Dancing

4)   Repeated squatting or standing on the toes

5)   Poor fitting shoes

6)   Obesity

Diagnosis:  The diagnosis is usually made by a healthcare provider who takes the history of the patient and performs a physical examination.

Treatment:  Several treatment options are used to help with plantar fasciitis.  They may include:

1)   Rest – Limit jumping or standing for extended periods of time.  A complete lack of physical activity is not recommended however

2)   Ice – Putting ice on the area 4x/day for 20 minutes at a time may reduce pain

3)   Exercise – Home exercises including calf-plantar stretches, foot and ankle circles, toe curls, and toe towels often help reduce pain.  Careful attention not to overdo the stretches is important

4)   Pain medication – Ibuprofen or Naproxen may be helpful to reduce the swelling and pain

5)   Shoes with good arch support or metal shanks take the pressure off the plantar fascia and are one of the most important parts of treatment.

6)   Steroid Injection – a steroid shot may be given in the foot to relieve pain but usually the effect wears off after a few weeks.  There is also a risk of worsening the foot pain due to small crystals of the steroid forming in the plantar fascia

7)   Casting – a short walking cast that has a rocker-shaped bottom decreases the flexibility of the sole of the foot and can provide relief from pain.

8)   Surgery  – this is rarely recommended for plantar fasciitis.  If symptoms persist for at least 6-12 months and all other treatments have failed, it may be an option for some people

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Cervicalgia – A Pain in the Neck

shutterstock_142402684Patients frequently come into the Urgent Care clinic for problems related to neck pain.  It can be caused by a number of different factors including ligament or muscle strain, arthritis or a “pinched nerve.”

It is quite common, and in fact 10% of adults have neck pain at any one time.  Most patients recover with conservative therapy regardless of the cause of the pain.  Understanding neck pain is much easier if you have a good knowledge of the structural anatomy of the neck.

Brief description of the anatomy is outlined below:

1)   Cervical vertebrae:  Seven small bones the make up the cervical spine of the neck

2)   Spinal canal:  The structure through which the spinal cord (nerves) flow which is made from the cervical vertebrae as well as the supporting ligaments and overlying neck muscles.

3)   Cervical discs:  Between the neck bones, these tiny shock absorbers cushion one bone from another.  The inner part of the disc contains a gelatin-like material and when excessive pressure on the disc occurs, this gelatin-like material can protrude and cause what we call a “herniated disc.”

Causes:  There are several causes for neck pain, some of which are mentioned here:

1)   Whiplash injury:  A traumatic event that causes sudden forward/backward movement of the cervical spine.  A motor vehicle accident is the most common cause.

2)   Cervical strain:  Injury to muscles of the neck that cause spasm of the neck and upper back muscles causes this type of pain.  It can be a result of physical stresses of everyday life including poor sleep habits, muscle tension from psychological stress, or poor posture.

3)    Diffuse skeletal hyperostosis:  Also called (DISH) is when there are abnormal calcifications in the ligaments and tendons along the cervical spine.

4)   Cervical spondylosis:  Abnormal wear and tear causes gradual narrowing of the disk space and loss of normal bone structure which often leads to bone spurs.  These spurs can increase the pressure on surroundings areas.

5)   Cervical discogenic pain:  The intervertebral discs of the neck function as shock absorbers that cushion the neck bones from one another.  If there are structural changes in these discs, it can cause pain.

6)   Cervical facet syndrome:  Pain involving the facet joints is common in people who repeatedly extend the neck (tilt the head backwards).  The facet joints are on the left and right of the vertebrae.

7)   Cervical radiculopathy:  When disk or neck pass pushes on or irritates a nerve root, this can cause pain, weakness or numbness/tingling of the neck and/or arm.

8)   Cervical spondylotic myelopathy:  This is narrowing of the spinal canal inside the bones of the neck, and is usually caused by either damage to the disks or degeneration from arthritis.

Testing:  In order to determine the cause of the pain, your healthcare provider will examine your neck and look at the movement or range of motion to the neck and observe posture of the neck and shoulders.  In some cases there may be a radiological study such as an x-ray, MRI (magnetic resonance imaging) or CT scan (computed tomography) ordered.  The need for on of these tests depends on the patient’s history and physical examination.

Treatment:  The individual treatment is tailored to the patient to help treat the underlying cause of pain.  Some possible treatments may include:

1)   Medications:  Ibuprofen, naproxen or Tylenol may be prescribed.  Other medications such as muscle relaxants or narcotics may also be prescribed depending on the circumstances.

2)   Heat:  Can be helpful for decreasing the muscle spasm in the neck.  Moist heat (from a shower, hot tub, or moist towel warmed in a microwave or with warm water) seams to work best

3)   Ice:  Can reduce the pain in many people.  Ice is applied directly to the painful area.  A bag of ice, frozen peas or a ice cubes in a plastic bag is often used, but avoid applying the blue ice that is used for coolers/camping to the skin as this can cause freezer burn.

4)   Massage:  By applying pressure on both sides of the neck and upper back, the neck muscles may be relaxed.  This is usually most helpful if done by a professional massage therapist.

5)   Stretching exercises:  Do not attempt exercises without being evaluated by a healthcare provider as they can actually make the problem worse if performed incorrectly.  Exercises can be performed to relieve stiffness and improve range of function.

6)   Stress reduction:  Neck tension can be increased due to emotional stress and can delay the recovery process.  To help with stress reduction, breathing exercises, meditation, progressive muscle relaxation, biofeedback, prayer or self-hypnosis are helpful for some patients.

7)   Posture:  It’s important to avoid extreme ranges of motion or positions that cause constant tension.  Avoid sitting in the same position for extended periods of time.  Also avoid placing backpacks, over-the-shoulder purses, or children on the shoulders.  Do not perform overhead work for prolonged periods of time.  Hold your head up and keep shoulders back and down to maintain a good posture.  Sleep with your neck in a neutral position by sleeping with a small pillow under the nape of your neck (while laying on your back).  Carry heavy objects close to your body rather than with outstretched arms.

Other treatments:

1)   Osteopathic manipulative therapy (OMT)– physically manipulating the muscles, soft tissues and joints can help with neck pain

2)   Trigger Point Injection:  A local anesthetic such as lidocaine can be injected into an area of muscle spasm

3)   Accupuncture:  A needle placed into the proper body area by a healthcare professional who is trained in accupunture therapy can be helpful

4)   Electrical stimulation:  Transcutaneous electrical nerve stimulation (TENS) is a treatment that uses a mild electric current that is applied to the skin to decrease pain and increase mobility and strength.  Some people have found TENS helpful.

5)   Cervical traction:  The use of weights to pull the spinal column into alignment have been helpful for some people in the short term, however clinical studies have shown no long term benefits.

6)   Surgery:  Surgery has a role in relieving symptoms related to a pinched nerve in some cases.  Usually these patients have tried all prior treatment options before proceeding with surgery.

To find an Osteopathic physician in your area, the American Osteopathic Association has a useful website:

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


All About Knee Pain

shutterstock_94626553I often have people come to the Urgent Care who have problems due to knee pain. Pain that originates in the knee can be complex because there are quite a few areas within the knee that can cause pain. The knee is a “hinge” type joint that is at the greatest risk of injury, age-related wear and tear, arthritis as well as infection related arthritis.

Causes: As I mentioned above, there are many causes of knee pain. Several are listed below:

1) Patellofemoral pain syndrome – Group of symptoms that is sometimes caused from overuse of the knee. It can affect running athletes, and is more common in women. The pain is usually in the front of the knee and is made worse with squatting, running, prolonged sitting or when climbing or going down stairs. We also call this Patellar tracking syndrome because it is related to the knee cap (patella) sliding out of the groove that it normally sits in.

2) Meniscal tears – The meniscus is a specialized shock absorber that provides cushion on both sides of the knee. They can become damaged or torn from an acute knee injury or from overuse that comes with age. They have a very poor blood supply, so they don’t heal very quickly

3) Bursitis – The knee is lubricated by joint fluid that is produced by a lubricating bursa (or sac). These bursa sacs can become irritated as a result of injury or even overuse. Inflammation of the bursa is called bursitis

4) Arthritis – This refers to inflammation of the cartilage covering the ends of the bones and undersurface of the knee cap. When it gets worn down, irritated or irregular, it can become painful and is known as arthritis.

5) Tearing of a ligament – The knee is held together by a combination of ligaments including the anterior and posterior cruciate ligaments as well as the medial and collateral lateral ligaments. These ligaments function to hold the bones together and prevent side-to-side or back and forth motion.

6) Muscle strain – If the muscles on the front or back of the knee area become injured, or in spasm they can cause pain around the knee joint. These muscle groups are the quadriceps (located on the front of the top of the knee) and the hamstrings (located on the back part of the leg). These muscle groups work to give support to and move the knee joint

7) Fractures – Broken bones around the knee can obviously cause pain

8) Infection – If bacteria get into the knee joint, this can cause pain, swelling and decreased range of motion

9) Gout – This is caused by the formation of uric acid crystals that build up within the knee joint and is less common in the knee than some other joints

10) Baker’s Cyst – a cyst in the back of the knee can cause pain

Diagnosis: Since there are so many different possible causes of knee pain, it is important to make an accurate diagnosis to treat the underlying problem. In addition to getting a good history from the patient about their pain, a physical evaluation will be performed and sometimes knee x-rays, an ultrasound, or an MRI will be ordered. Additionally, a small sample of synovial fluid is sometimes removed from the knee using a needle. This fluid can be examined under a microscope and/or sent for culture to look for bacteria, crystals or signs of inflammation.

Treatment: The individual patients injury will dictate the kind of treatment that they need to recover the fastest. Physical therapy is often used because it speeds recovery and regain motion. We also often recommend ice, elevation of the leg and muscle-toning exercises when appropriate. Sometimes a knee brace or immobilizer may be appropriate. Medications such as ibuprofen, Aleve or Tylenol may be appropriate for knee injuries. If infection is present, antibiotics may also be prescribed. If injury to the bone or ligaments is the cause, surgery can be helpful in some patients.

Limiting certain activities: Speeding the recovery and helping prevent further injury sometimes involve limiting activities temporarily. Excessive pressure on the knee joint by the following activities should be avoided to help recovery:

1) Kneeling
2) Jogging
3) Squatting
4) Twisting and pivoting
5) Aerobics/Dancing
6) Playing stop and go sports such as basketball or racquet sports
7) Swimming with frog leg or whip kick techniques
8) Rowing machine
9) Stationary bike
10) Stair stepper
11) Leg extensions with weights

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


So I have gout, what does that mean? How to prevent the gout flare

shutterstock_114066385At least once a week, I have patient who presents to the clinic due to pain from gout.  It is a painful condition that develops in some patients who have elevated levels of uric acid in their blood (hyperuricemia).  Up to 66% of patients who have elevated uric acid levels never develop symptoms.  We’re not sure why some people develop symptoms and others don’t have symptoms at all.

Uric acid crystals most commonly affect one or multiple joints in the body, but may also cause uric acid crystals to develop within the kidney or urinary tract.  A stone within the kidney may cause impaired kidney function or pain.  Only 15% of people with gout develop kidney stones due to uric acid.

Gout risk factors:  Gout is estimated to affect about 2% of the population in the USA.  It is most common in men between 30-45 and women between 55-70.  There is an increased risk of gout with the following:

1)   Taking medications that affect uric acid levels, such as diuretics

2)   Obesity

3)   Ingesting large amounts of meat or seafood

4)   High blood pressure

5)   Consuming high quantities of alcohol

6)   Overeating

7)   Recent surgery or injury


1)   Sudden severe joint pain (usually one joint), sometimes with redness and swelling

2)   Pain and inflammation are worst within several hours and improve over a few days to weeks completely even if untreated

Gout phases:

1)   Acute gouty arthritis:  attacks usually involve the big toe or knee which become painful and inflamed

2)   Intercritical period:  The time between attacks.  Usually a second attack occurs within 2 years.  If uric acid levels are uncreated over several years the time between attacks may shorten or the symptoms may become more severe when attacks occur.

3)   Chronic tophaceous gout:  Large numbers of uric acid crystals may collect in joints, bones or cartilage and cause a nodule called a tophus to form.  This tophus is not usually tender, but cause erosion of bone and permanent deformity.  The tophi when the occur on the knuckles can cause an unfortunate cosmetic problem.

Diagnosis:  Gout may be suspected if the person has the sudden onset of joint pain in the commonly affected joints such as the big toe.  If the patient has a period when there are no symptoms, and then symptoms return this is very typical of the disease.  The best way to diagnose gout is to examine fluid from the affected joint to look for uric acid crystals.  A medical provider uses a needle and syringe to withdraw a small sample of synovial fluid from the joint and this fluid is sent to the lab for microscopic analysis.  Other criteria for diagnosis gout may be:

1)   Blood testing showing high uric acid levels

2)   Rapid improvement of symptoms after the patient is treated with colchicine

3)   History of pain and inflammation involving one joint at a time, especially at the base of the large toe

4)   The symptoms totally go away between attacks

Treatment:  The goals of gout treatment are to decrease the pain of a gout attack and also to reduce the frequency of their attacks.  Some of the treatment options are listed below:

1)   Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the swelling in the joint.  Examples of these are Ibuprofen or indomethacin.  They are most effective if started as soon as possible after the gout attack starts.

2)   Colchicine is a medication that may decrease the pain of a gout attack very rapidly.

3)   Steroids such as prednisone may be used if an NSAID is not used.  This type of medication can be injected directly into the affected joint or can be given as pills or intramuscular injection.  There is a risk of “rebound gout attack” as the steroids are stopped however, so usually steroids are slowly tapered over 7-10 days.

Prevention therapy:  Some medications as well as dietary changes can be helpful to reduce the frequency of gout attacks.

1)   Uric acid lowering medications are used indefinitely because there is not a benefit from taking a break from the medications.  Examples of this are Probenacid, Losartan, and Allopurinol.  Rapid lowering of uric acid can cause a gout flare .

2)   Increased water intake – at least 2 liters/day are recommended

Dietary changes:  Obesity is a major risk factor for gout so changing diet may decrease the frequency of gout attacks.  Current recommendations also include eating less of the following:

1)   Red meat

2)   Seafood

3)   Beer and hard alcohol (gin, vodka, etc.)

4)   Foods and drinks that contain high-fructose corn syrup (fond in some non-diet sodas for example)

Some foods that may be good to eat or drink if you have gout may include:

1)   Low fat dairy

2)   Foods with complex carbohydrates such as whole grains, brown rice, oats and beans

3)   Vitamin C (500mg/day has been found to have a mild uric acid lowering affect).

4)   Coffee in moderation

5)   Wine in moderation – (1-2 5oz servings/day me be helpful)

6)   Pineapples – see my blog article about preventing gout by eating pineapples

7)   Drink plenty of water – twelve 8oz glasses of water during every day.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO


Help with low back pain

shutterstock_115219366Low back pain is very common, in fact about 80% of people have at least one episode of low back pain during their lifetime.

Symptoms:  Pain in the lower spine along the lumbar spine.  It may be worse with bending, twisting or getting into a seated position.  Sometimes patients with low back pain have irritation of the nerve root due to arthritis or a disk protrusion, but most of the time the muscles that support the back are the cause of the pain.  Radiation of pain, numbness or tingling or muscle weakness in specific areas can be due to radiculopathy or a “pinched nerve.”

Sciatica:  Pain that occurs when one of the 5 nerve roots branches of the sciatic nerve are irritated. This causes sharp burning pain that extends down the back or side of the thigh, usually down to the foot or ankle.  You may also feel numbness or tingling.

When to seek help:  Most patients who have low back pain can be seen and treated by their primary care provider.  If the pain is caused from a serious condition, a surgeon may be recommended.  Please contact your primary care physician if you have any of the following:

1)   Age 70 or older with new onset of back pain

2)   Pain that does not improve even when laying down at night

3)   Weakness in one or both legs

4)   Loss of control of bowls or bladder

5)   Back pain accompanied by unexplained fever or weight loss

6)   History of cancer or weak immune system

7)   History of osteoporosis

8)   Back pain as a result of falling or an accident, especially if older than age 50

9)   If pain does not improve within 4 weeks.

Diagnosis:  In addition to a physical exam and taking a history, your doctor may order tests to help determine the cause of your low back pain if it is not improving.  Some possible tests include x-rays, CT (Cat scan), or MRI.  Xrays can be helpful to look for vertebral compression fractures or alignment problems.  MRI or CT scans give more detailed images  of the soft tissues and bony structures of the back.

Bulging disk:  With time, the body breaks down bulging disks, taking pressure off the nerve.  A bulging disk is usually not an indication for surgery.

Treatment:  Remaining active is one of the best things you can do to help the pain.  Prolonged bed rest may actually make the pain worse.  Studies have shown that people with low back pain recover faster when they remain active.

Using a heating pad can help low back pain during the first few weeks.  Sometimes alternating between ice and heat is helpful.  Most physicians will recommend that patients with low back pain continue working if it is possible to avoid prolonged standing, sitting, heavy lifting or twisting.

Medications:  Pain medications such as aspirin, Tylenol, ibuprofen, or Aleve may be helpful.  In addition, we often use muscle relaxants such as baclofen or Flexeril for pain but they can cause drowsiness.  You should be careful if you need to drive and are taking a muscle relaxant or narcotic pain medication that can interfere with your ability to drive or operate heavy machinery.

Exercises:  We usually don’t recommend stretching routines or back exercises right after a new episode of back pain because sometimes this can make the pain worse.  As symptoms are improving, a program of exercises can help increase flexibility.

Physical therapy:  A healthcare provider may recommend physical therapy if the pain persists for more than 4-6 weeks.  They will work to help strengthen muscles of the back and stretch out other muscles that could be contributing to the back pain.

Osteopathic manipulation:  An osteopathic physician (Doctor of Osteopathic Medicine) may use manual techniques to treat acute or chronic back pain.  The theory is that reduction in range of motion to one part of the body can contribute to low back pain and low back pain may contribute to reduced range of motion.  Improving range of motion of the body may reduce the pain and break the cycle of pain.

Massage/Yoga:  Relief of pain can also be achieved with massage or yoga with the goal of improving range of motion and thereby allowing the body to heal itself.

Acupuncture, injections, manual traction, and braces may all be useful in some patients.

Sometimes surgery is recommended for the treatment of low back pain.

Prevention:  Staying active and flexible can help prevent low back pain.  Regular exercise can help strengthen the muscles of the hips/torso and abdominal muscles.  Avoiding activities that involve repetitive bending, twisting or high impact activities that increase stress on the spine can also be helpful.  Bend and lift correctly – at the knees rather than back.  Stretch out the hamstrings, quadriceps, piriformis and glute. muscles regularly.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.


I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO