Treat your pain and live a better life…

best-pain-doctor-nycWelcome to my blog about pain. Unfortunately, many people suffer from chronic pain. As a board certified physician in physical medicine and rehabilitation, my specialty is treating these people with both acute and chronic pain.

A majority of my practice is working with patients that are experiencing back and neck pain.

My goal with this blog is to help patients who are experiencing any type of back or neck pain to understand what is causing their pain and discuss options that are available to end their pain. I hope to be able to provide readers with a portal that they can can use to educate themselves and facilitate treatment.

My specialty is my Interventional Spine Skills including cervical and lumbar epidural steroid injections, facet injections, medial branch blocks, Radiofrequency ablation, sympathetic ganglion blocks, spinal cord stimulator trials, sacroiliac joint injection, piriformis muscle block and musculoskeletal joint injection. I also perform many other procedures to alleviate acute and chronic pain.

I hope you enjoy reading my blog as much as I enjoy writing it and observing people from all over the world reading it.

– Matthew Grimm, M.D.

Category Archives: Causes of low back pain

Dr. Grimm answers the question: What is an EMG test?

What Is an EMG?

Best-EMG-Testing-Doctor-NYC-1Electromyography or EMG is a study of the electrical activity of muscles. If you have numbness or weakness your doctor may request an EMG to determine the cause. In cases of neck or low back pain associated with numbness or weakness of an arm or leg, an EMG can help to identify which nerve root is compressed or irritated. This can help guide treatment decisions.

An EMG test is routinely accompanied by a nerve conduction study in order to definitively identify the level of nerve involvement. In other words, your doctor wants to make sure that your leg numbness or weakness is not caused by a problem of your peripheral nerves.

Procedure: How is an EMG done?

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Under sterile conditions, a very fine electrode is inserted into select muscle groups to measure their electrical activity at rest and during contraction. The electrical activity is visualized on a computer monitor and analyzed by the performing physician.

During the nerve conduction portion of the exam, select peripheral nerves are stimulated electrically and responses of the appropriate muscle groups are recorded. This test determines the integrity and function of your peripheral nerves.

Indications for an EMG

Best-EMG-Testing-Doctor-NYC-3An EMG and nerve conduction study is frequently performed in cases of neck or low back pain specifically for the purpose of identifying cervical or lumbar nerve root irritation. Assuming that nerve root irritation has been present for at least three weeks, the test can aid in localizing the level and severity of nerve root involvement. An EMG is a valuable adjunctive test in the evaluation of neck or low back pain when nerve root irritation is suspected.

If you suffer from neck or back pain, contact the best pain doctor in NYC, Dr. Matthew Grimm to schedule an examination.

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Piriformis Injections

Severe buttock and leg pain.

Leg and buttock pain doctor nyc 01Piriformis injections are indicated for patients who experience severe buttock and posterior leg pain characteristic of Piriformis Syndrome, a chronic condition that involves the lower sacral muscle. Piriformis syndrome may constitute up to 6-8% of low back pain conditions associated with sciatica, which refers to pain, weakness, numbness, or tingling in the leg. Tightness of the piriformis muscle may cause nerve and vessel entrapment because of its proximity to the large sciatic nerve and blood vessels, causing a deep aching sensation in the mid-gluteal region (buttock) that is associated with pain radiating down the back of the leg.

How Piriformis Injections Work

A piriformis injection involves deposition of a mixture of local anesthetic and steroid medication into the muscle, which will helps reduce pain and inflammation around the nerves that pass near the piriformis muscle. This will also reduce other symptoms such as numbness, tingling or swelling. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure Piriformis Injection

buttock and leg pain doctor nyc 02A piriformis injection is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient is asked to lie prone (on their abdomen) on the table. The skin on the affected buttock is sterilized. Next, a small area of skin is injected with numbing medicine (local anesthesia). When ready, the physician directs a small needle into the piriformis muscle, using x-ray guidance. Other imaging techniquesbuttock and leg pain doctor nyc 03 may be used, such as ultrasound, or electromyography to identify the muscle and the sciatic nerve. A small amount of dye is injected to insure proper needle position. The physician asks the patient to move their leg during the procedure. This consists of rotating the leg outward and moving it straight to the side away from the other leg. A mixture of local anesthetic and anti-inflammatory (steroid) is injected into the muscle. The needle is then slowly withdrawn.

Patients are then monitored in the recovery area and discharged on the same day. Numbness or weakness in the leg are temporary and will disappear in a few hours. After discharge, patients are asked to evaluate the relief they experience during the next week and report for follow-up. It may take at least 72 hours before the full effect of the steroid is observed. Repeat injections may be performed up to three times, if needed, every two weeks.

Contact Us

A Piriformis Injection is a minimally invasive, safe, and effective means of treating buttock and leg pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if piriformis injections are a treatment option for you.

Additional Causes of Low Back Pain

Non-Mechanical Causes of Low Back Pain

200177292-001Mechanical injury is the leading cause of low back pain (please see my previous post titled, “Mechanical Causes of Low Back Pain.”) Today, I’m going to focus on other less common causes including neoplasm, inflammatory, metabolic, Paget’s disease, psychosomatic, depression and referred pain. No matter the cause, it is important to seek medical attention to workup low back pain immediately to prevent acute pain from becoming a chronic condition.

Neoplasm – Low Back Pain

The growth of a tumor can lead to chronic back pain. For this reason, it is important to consult with a pain specialist in order to determine the cause of your back pain. Surgery and adjuvant therapy may be necessary in the case of neoplastic back pain. Simple imaging studies such as an XRAY would be the first step in identifying neoplastic disease.

Inflammatory – Low Back Pain

best pain doctor low back pain 3Many cases of back pain are caused by inflammation. When prolonged inflammation occurs, chronic low back pain can result. These include inflammatory arthropathies such as Rheumatoid Arthritis. Rheumatoid Arthritis is an autoimmune disease that can cause primary low back pain, specifically when it affects the sacroiliac joints.

Metabolic Disease– Low Back Pain

Metabolic diseases of the muscle interfere with important chemical reactions that draw energy from food sources. Since muscles use a tremendous amount of energy to work properly, metabolic disease, while rare, can manifest into low back pain symptoms. Metabolic diseases such as myopathies, can be accurately diagnosed using electrodiagnostic studies such as electromyography. A consultation with a pain specialist is an important step in diagnosis.

Paget’s Disease – Low Back Pain

Paget’s disease is a chronic disorder that causes abnormal bone growth in the spine, pelvis, chest, skull, and legs. When people suffer from Paget’s disease, the bone tissue begins to break down faster than it can rebuild. As the body tries to catch up with the rebuilding process, the new bone is usually weak and fractures easily. Paget’s disease should be treated by both a primary care physician and rheumatologist. If pain symptoms cannot be managed, a pain consultation to a specialist is appropriate.

Psychosomatic – Low Back Pain

There are psychosocial factors that can cause ongoing stress to the body eventually leading to chronic low back pain. Examples may include dissatisfaction with work or home life, financial worries, and any number of other problems. In most cases, psychological stresses amplify the perception of the painful condition and often lead patients to seek medical attention.

Depression – Low Back Pain

As demonstrated above, people’s state of mind can greatly affect their perception of pain. Those who are suffering from depression or chronic stress are more likely to experience long-lasting back pain.

Referred Pain – Low Back Pain

Referred pain describes instances where pain is perceived to take place in an area of the body that is actually adjacent to the actual site of injury. When pain arises from other organs in the body, it can be referred to the spine. Intra-abdominal problems such as kidney disease, pelvic diseases involving reproductive organs or pancreatitis can be referred as back pain. These pain symptoms are also commonly referred to as viscero-somatic.

Seeking the Help of a Pain Specialist

best pain doctor low back pain 1If you are experiencing back pain symptoms, it is important to seek the help of a pain specialist such as myself. Getting a proper history and performing a physical examination will be able to determine an appropriate course of treatment. While many cases can be resolved with adequate rest and pain medication, as listed above, it is important to rule out unusual catalysts for back pain.

I offer safe and effective methods for alleviating chronic low back pain and any other ongoing pain issues. Resolve your pain symptoms by making a visit to our office as soon as possible.

Mechanical Causes of Low Back Pain

‘Mechanical low back pain’

 

originates in the vertebrae, soft tissues, cartilage, spinal joints or discs, and supportive structures around the spine. This condition is also known as lumbar syndrome, lumbosacral strain or pain, lumbago, and idiopathic low back pain. Chronic low clip_image001[4]back pain is one of the leading reasons people seek medical help. About four out of five adults will have experienced low back pain during their lifetime. While the most common cause is lumbar strain, symptoms can develop after cumulative repetitive trauma.

Acute and Cumulative Trauma can Cause Chronic Low Back PainLifting back pain

Strains in the muscles, tendons and ligaments around the spine causes 70% of lower back pain incidences. This can arise from a sudden acute injury such as a motor vehicle accident or by ongoing trauma that often occurs in the workplace. Patients may cross a threshold and develop symptoms without significant injury.

There are a number of other conditions that can lead to chronic low back pain. These include sciatica, osteoarthritis, degenerative discs, kyphosis, scoliosis, arthritis, disc herniation, slipped disc, spinal stenosis, spondylolisthesis, fractures, trauma, pelvic anteversion, and pelvic retroversion.

Osteoarthritis, also known as degenerative joint disease, is a progressive condition caused by excessive stress along the discs and the bony structures of the spine responsible for maintaining posture. The other conditions mentioned also cause functional or anatomical abnormalities of the spine. We will address each of these topics in more detail in future blog posts.

In addition to mechanical factors, there are a number of non-mechanical causes of low back pain. Although non-mechanical causes are far less common, it is important to rule out the possibility of any diseases that may be affecting the body. If symptoms persist, then it is time to make an appointment with a pain doctor such as myself, to find out if there are any underlying issues that you may not be aware of.

Symptoms of Low Back Pain

Back Arthritis Back Pain

Symptoms of low back pain can vary quite a bit. Generally, symptoms involve cramping, stiffness, or muscle spasms. Pain in the back or buttocks can come on suddenly or can extend over long periods of time. When performing weight-bearing movements or other movement that add pressure to your spine, symptoms will increase. Often, symptoms are relieved within two or three days, but can persist for several weeks if left untreated. Avoiding triggering mechanisms is the best way to allow symptoms to dissipate initially.

If you experience an injury that causes nerve-root pressure, you may feel pain in your leg in addition to your lower back and/or buttock. Pain may arise gradually or come on quite suddenly. Nerve-related issues may also cause numbness or tingling in your legs.

If you are experiencing low back pain for greater than one week, seek treatment before the problem worsens and becomes a chronic condition. Often patients wait weeks and suffer needlessly when treatment is available. Great relief can be found with proper treatment administered by a professional. In addition, a doctor who specializes in back pain will be able to rule out any underlying conditions that may be aggravating the problem further.

Do not live with back pain any longer. Call our office today at 646-862-5555 to schedule a consultation and take the first step toward ending your back pain.

Low Back Pain

Causes of Low Back Pain

Low back pain affects 80% of people at some time in their lives. Whether it’s due to muscle strain, overuse, or injury to the ligaments, muscles or spinal discs, it can become very painful over time. Chronic low back pain can lead to a compensation that can result in muscle injuries when a person begins to walk or move differently in order to avoid pain. Fortunately, many people have found relief by learning about the proper way to stretch and move. In many cases people come to see me, a pain specialist, in order to start a person on the path to recovery. Low Back Pain

Non Specific Low Back Pain

Over 99% of low back pain problems arise from benign musculoskeletal issues, also referred to as non specific low back pain. This type of low back pain stems from overuse or injury to the muscles, ligaments, or back joints. It is common for people to strain their muscles or other soft tissues during heavy lifting or any time when there is physical loading of the back.

Chronic low back pain can also be caused when there is pressure on the spinal column nerve roots. Such compression can be caused by different factors including osteoarthritis, a herniated disc, fractures of the vertebrae, and by spinal stenosis.

Postmenopausal women who have osteoporosis, or people who have used corticosteroids for long periods of time are more prone to compression fractures. This type of injury can lead to severe back pain.

While mechanical injury is the most common cause, there are many other less common causes of low back pain. These include inflammatory, neoplastic, metabolic, psychosomatic, Pagets disease, referred pain, and depression. We will address each of these types of low back pain in future blog posts.

Low Back Pain Symptoms

Symptoms of low back pain include cramping, muscle spasms, and pain in the back or buttocks. These low back pain symptoms may last between 48-72 hours, but can be easily aggravated in the days or weeks following by weight-bearing or other movements that add pressure to the injured areas. Often, rest helps but many times these pains fail to go away and medical intervention is necessary. (This is where a pain specialist, such as myself, comes in.)

Sciatica painSymptoms may also include leg pain. Typically, pain begins in the buttocks and then moves down (‘radiates down’) the leg. This condition is known as sciatica and varies from mild to severe pain. It usually only affects one leg and pain can be aggravated by such things as certain motions, coughing or sneezing.

Depending on what type of low back pain you are experiencing, symptoms may improve or worsen in different positions. For instance, if symptoms become more severe when you are in an upright position, you may be able to find relief by sitting down. Bending your knees while you are lying down on your back may also relieve symptoms. If the pain is worse when you bend forward or backwards, try movements that act to straighten your spine such as lying down, standing up straight, or walking.

If low back pain symptoms continue even after sufficient rest, it may be time to visit a pain specialist who can better assess the situation. A pain specialist will be able to offer expert advice and provide necessary treatment to relieve chronic low back pain.

I have extensive experience with low back pain of all different causes. Having back pain is not normal in the aging process and most times there are treatments that can alleviate some or all symptoms.

If you are experiencing back pain (or any other chronic pain) please see our contact page or call our office today!