Golf provides some of us with moments of joy when hitting a great drive, sinking a long putt, or chipping in for a birdie. These emotional highs are mixed with crushing moments of frustration when other shots don’t meet our expectations.

We can even find great satisfaction from one great shot. Regardless of our scores, we push forward and embrace a lifetime of practice and fine-tuning that the game requires.

That is, until we suffer a golf injury.

Golf seems, on the surface, to be a gentle sport. But it can be easy to get hurt without good flexibility, strength, and proper technique.

We’ll look at common golf injuries and how to avoid them.

A man finishes his golf swing while his playing companion watches

Common Golf Injuries

Many golf injuries can be traced back to an aspect of the swing, which involves balancing an explosive forward motion, violent muscle contractions, and the long lever arm effect created by the force of the golf club. Most golf injuries happen repetitively, over time, from taking many swings with incorrect form.

Common golf injuries include:

We’ll look at each of these injuries in turn.

Back Injuries and Strains

During a round, a golfer spends shot after shot in a bent position while applying pressure to the spine and back muscles. This can strain muscles and result in pain. Lower lumbar spine injuries and disc herniation can also occur – or if these injuries pre-exist, they can be aggravated by golf swings.

Golfer’s Elbow

Golfer’s Elbow is caused by the excessive force used to bend the wrist toward the palm when swinging a golf club. It results in pain, soreness, and inflammation on the inner part of the elbow. The pain is caused by damage to the tendons that bend the wrist toward the palm. Tendons are tough cords of tissue that connect muscles to bones.

Tennis Elbow

While golfers don’t carry a tennis racket in their golf bags, they can also be susceptible to tennis elbow. Tennis elbow involves inflammation in the outer tendons of the elbow. Golfers will feel pain from this condition along the outside of the elbow when extending their arms during a golf swing.

Rotator Cuff Injuries or Shoulder Pain

Have you ever taken a shot off the fairway and hit a rock or a root during your swing? The force of that unexpected impact can cause a rotator cuff injury or pain in the shoulder. Improper swing technique can also lead to tendinitis, bursitis, shoulder separation, and shoulder impingement syndrome from repetitive swinging movements.

Hip Injuries

Most of the power in a golf swing comes from movement and rotation in the hips. Lack of hip flexibility can cause hip problems and lower back issues. One common hip injury and pain source for golfers is trochanteric bursitis, where the bursa on the outer part of the hip joint inflames and swells.

Knee Injuries

If a knee has weak muscles, the strain on it to stabilize the hip rotation at the beginning of the swing can cause severe knee pain. Extreme force applied to the knee can cause torn or sprained ligaments and kneecap injuries.

Partial meniscus tears in the knee can also be present without symptoms. A golf swing can further aggravate that existing tear to the point where pain and inflammation suddenly become apparent.

General Golf Injury Prevention

Maintaining fitness is an integral part of a healthy and competitive golf game. Those golfers who tend to stay healthy follow structured fitness and exercise programs outside of their time on the course.

If you live a sedentary lifestyle between your golf rounds, you are more likely to suffer injury when you do play.

Beyond being fit, the following recommendations are a good starting point for general golf injury prevention:

  • Work with a golf professional to learn proper swing techniques. Good form and proper mechanics will reduce stress on the body and help improve flexibility and agility.
  • Warm up and take practice swings before a round. Stretch and hit a few balls on the range to prepare your joints and muscles for play.
  • Build up your tolerance for golf movements. Don’t overdo it with too many shots in a day or over a period of days without preparing your body for it.

If You Do Get Injured

If you do experience musculoskeletal pain during golf that continues after the round, see a doctor before getting out on the course again. You may be surprised by what can be done with proper diagnosis to get you back out again playing golf pain-free.

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Sports medicine isn’t solely limited to procedures and treatments for athletes.

It does focus on preventing, diagnosing, treating, and rehabilitating sports-related injuries. But you don’t have to be a weekend, school, or professional athlete to take advantage of all it offers.

Sports medicine is also appropriate for those injured during physically demanding work activities, such as pulling a muscle while on a construction site. It has a place for those hurt while pursuing active lifestyles, such as throwing out your back while doing yard work. It provides services to those who injure themselves while doing recreational exercises, too.

In this article, we’ll help you better understand what sports medicine involves and determine if it might be a good treatment path for you.

A woman kicks a soccer ball into play

Who Practices Sports Medicine?

Most sports medicine practitioners have a variety of backgrounds, ranging from physical medicine and rehabilitation to orthopedics, family medicine to internal medicine, pediatrics to emergency medicine, and other specialties. They all share one common goal: to get you back into the game and function at peak performance.

Sports medicine is also practiced with a team of supporting medical professionals. These may include:

  • Physical Therapists
  • Certified Athletic Trainers
  • Exercise Physiologists
  • Occupational Therapists
  • Chiropractic Practitioners

Each of these professionals may play a role in your recovery, helping you return to full function sooner.

What Kinds of Injuries Does Sports Medicine Treat?

Sports Medicine covers various musculoskeletal conditions involving the bones, muscles, tendons, ligaments, and joints. These include:

There are two general categories within sports medicine care.

The first involves acute injuries. These kinds of conditions develop suddenly and usually last only a short period. Examples may range from a sprained ankle or an accidental fall to bone fractures, dislocated shoulders, or torn tendons.

The second category involves wear-and-tear disorders like arthritis that develop over time. These disorders can occur or get worse with sports or exercise, but they are more often a result of repetitive movement in our work or simple daily routines. This can lead to a loss in mobility, along with mild to severe pain from strain or stress on affected body parts.

How Are Sports Medicine Injuries Evaluated?

An initial sports medicine appointment will involve a full evaluation to fully understand a patient’s symptoms, medical history, daily activities, and goals. Most frequently, common musculoskeletal conditions can be successfully treated non-operatively.

Magnetic resonance imaging (MRI), X-rays, or ultrasound will be prescribed in appropriate cases to visualize and assess sports injuries.

X-rays provide valuable insights into fractures and bony abnormalities, while MRI and ultrasound offer detailed information about soft tissue structures, including muscles, tendons, ligaments, and cartilage. These imaging techniques help confirm diagnoses, assess the extent of injuries, and guide treatment decisions.

How Are Sports Medicine Injuries Treated?

Although a sports medicine doctor will take the lead in evaluating your injury, treatment plans often involve a team of supporting medical professionals.

Physical therapy and other types of rehabilitation are often integral components of sports medicine injury treatment.

Sports medicine professionals work closely with physical therapists to design individualized rehabilitation programs that focus on restoring strength, range of motion, and function. Rehabilitation may include exercises, manual therapy, specialized therapies, and functional training to aid recovery and prevent future injuries.

Medications and injections may be prescribed to manage pain, reduce inflammation, and facilitate healing. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate pain and inflammation associated with sports injuries.

In some cases, corticosteroid injections may be administered to target specific areas of inflammation and provide localized relief. These injections also reduce pain, allowing more effective physical therapy treatments.

When a sports injury is severe and non-surgical alternatives have been exhausted, a sports medicine doctor may suggest that surgical intervention be considered. Surgical treatments can involve fracture fixation, ligament reconstructions, cartilage repair, and other procedures to restore function and promote recovery.

How Can Sports Injuries Be Prevented?

There are ways that you can minimize the likelihood of sustaining sports injuries:

  • Stretch and Cool Down: Warming up before a workout with an easy walk or jog will lessen muscle strain. After warming up, stretch to increase flexibility, and be sure to cool down afterward. This advice applies to preparing to participate in a sport, begin an exercise workout, or engage in any intense physical activity, such as construction or yard work.
  • Learn and Use Proper Technique: Proper technique in your sport is vital for injury prevention. Seek guidance from experienced coaches or trainers to use the correct form and body mechanics during training and competition. This also includes using proper techniques in general activities, such as lifting heavy items.
  • Develop Strength and Conditioning: Follow a fitness plan incorporating resistance training to target core stability and flexibility to support your body during sports and physical activities.
  • Wear Protective Gear: Wearing appropriate protective gear, such as helmets, pads, and mouthguards, can significantly reduce the risk of severe injuries in contact sports. Wearing a helmet when biking, skiing, or participating in similar activities is essential. Use specialized equipment that is designed to protect you in everyday work situations.
  • Wear the Right Shoes: Improperly fitting or inappropriate shoes can lead to conditions such as stress fractures, plantar fasciitis, Achilles tendonitis, and ankle sprains. Ensure you are using the right shoes for the activity you are participating in and that they are not worn beyond their useful life.
  • Stay Hydrated: Drinking plenty of water before, during, and after exercise can help prevent muscle damage, fatigue, and other complications that can lead to injury.
  • Pay attention to your body: Look for signs of fatigue, pain, or discomfort. If you experience pain while playing, exercising, or working, stop the activity. Pushing through injuries can worsen them and lead to longer recovery times.
  • Adjust Your Routine in Hot Weather: Take extra precautions to prevent heat-related illnesses during hot weather. Wear lightweight, breathable clothing and schedule activities during cooler parts of the day.

When Should You See a Sports Medicine Practitioner?

When an injury still hurts after resting, or it feels better until you start to exercise again, you should make an appointment with a sports medicine physician or a specialist in musculoskeletal medicine, such as a physical medicine and rehabilitation doctor.

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Those who periodically suffer from lower back pain know the reality. Staying active and using over-the-counter pain relievers may often be sufficient to restore the quality of your life. With this approach, lower back pain usually fades away with time.

However, for some, home remedies fail to relieve the angry pain that confronts them each day. At that point, it becomes time to work with a doctor to figure out an individualized path for pain relief. 

Lumbar epidural steroid injections are one of the standard treatment options doctors consider for many forms of lower back and leg pain. They have been used since the 1950s. For doctors who are Physical Medicine and Rehabilitation specialists, they are considered an integral part of the non-surgical management of lower back pain and sciatica.

Illustration of the target area for epidural injection for back pain.

What Is a Lumbar Epidural Steroid Injection?

An epidural steroid injection of an anti-inflammatory medication (also called corticosteroid) into the lower back to relieve pain in the legs or lower back. The medication is injected using fluoroscopic (X-ray) guidance into the epidural space, an area of fatty tissue surrounding the spinal nerves.

A lumbar epidural steroid injection can help reduce nerve inflammation and stabilize membranes. It can reduce swelling and pressure on irritated nerves in the lower back. Corticosteroids decrease the production of inflammatory chemicals and reduce nerve fibers’ sensitivity to pain.

What Are Corticosteroids?

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone our body’s adrenal glands and brain produce naturally. Corticosteroids are often referred to as “steroids,” but it is different from the anabolic steroid compounds that some athletes use to build muscles.

Corticosteroids are used to help reduce pain and inflammation as well as treat a variety of painful conditions, including lumbar disc herniation.

The Goals of a Lumbar Epidural Steroid Injection

The goals of a lumbar epidural steroid injection are to:

  • Relieve pain by reducing inflammation in and around nerve roots.
  • Help a patient improve their mobility and lower back function.
  • Improve leg mobility and function for sciatica sufferers.
  • Enable a patient to participate and progress in a comprehensive physical therapy program.

Commonly, lumbar epidural steroid injections are only recommended when a series of other more conservative treatments have been tried without adequate results.

What to Expect from a Lumbar Epidural Steroid Injection

For many patients, a lumbar epidural steroid injection can provide relief for intense episodes of back and/or leg pain. 

These injections are normally administered in an outpatient setting, usually under twilight sedation. A local anesthetic is used at the injection site, and fluoroscopic (X-ray) guidance precisely targets the medication to nerve roots in the epidural space of the back. 

It generally takes a few days after an injection before the medication begins to take effect and lower back pain improves. Pain relief often lasts at least three months and may extend for years. 

For some patients, one lumbar epidural steroid injection is all they need to resolve their back pain issues. If more than one injection is required, there usually is a limit of three or four a year.

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If back pain is present for over three months, it is considered chronic. It can come and go and vary in intensity.

If you suffer from it, you are not alone. Surveys estimate that more than 8 percent of U.S. adults are currently experiencing chronic back pain. It limits everyday activities as a result.

While spinal back surgery can benefit some causes of back pain, it’s important to note that it’s rarely necessary. Back pain often resolves itself over a few months, especially with the help of effective non-surgical treatments. 

We’ll take a look at nine options to try to relieve back pain without surgery.

1. Follow an Anti-Inflammatory Diet

Inflammation is a natural response of the body in response to illness or injury. It follows that when you are experiencing back pain, you may have some accompanying inflammation. Recent University of Pittsburgh Medical School research suggests that anti-inflammatory diets are better for back pain.

Anti-inflammatory diets include a variety of whole grains, fruits, and vegetables, a mix like the Mediterranean diet. Conversely, processed foods and foods high in sugar tend to increase inflammation. 

Omega-3 fatty acids, found naturally in fish, seafood, nuts, and seeds, are also beneficial for anti-inflammation.

Woman with back pain sits at her work desk and clutches back

2. Achieve a Healthy Weight

According to multiple studies, excess weight contributes to lower back pain and degenerative disk disease. Every extra pound of weight significantly increases the strain on the muscles and ligaments of the back. 

Excessive weight can pull the natural curves of the spine out of alignment. It can overload the shock-absorbing disks of the spine. And fat can secrete chemicals that contribute to chronic whole-body inflammation and pain disorders.

Achieving a healthy weight can reduce some of the continuing damage to your back, but it can’t reverse existing damage.

3. Regular Exercise

A sedentary lifestyle can result in weak core muscles, poor posture, and increased low back pain. Lifestyle changes are required to reverse that trend.

There are no guarantees that an exercise program will completely alleviate back pain. However, research shows it often relieves pain and improves overall fitness and mobility. Studies have also found that doing regular exercise can reduce the occurrences of back pain by almost half.

Even ramping up daily activity by a small amount can significantly improve back pain levels.

However, if you last exercised regularly a while ago, you should consult your doctor before starting a fitness program.

4. Physical Therapy

Doctors often refer patients to a physical therapist as one of the first treatment options for low back pain. Their recommendations usually include that a physical therapist provide guided therapeutic exercises to strengthen lower back muscles and condition spinal tissues and joints.

These physical therapy programs aim to decrease painful symptoms, improve low back function, increase spine flexibility, and set up a long-term program to prevent back pain recurrence.

5. Alternative Treatments

Some patients may benefit from alternative treatments for chronic low back pain. Acupuncture, massage, and biofeedback therapy are options worth exploring. The potential benefits of these therapies outweigh their risks.

6. Injection-Based Treatments

Doctors may use injection-based treatments, including lumbar epidural steroid injections, for specific causes of chronic lower back pain. Lumbar epidural steroid injections are often effective for relieving pain from herniated disks and spinal stenosis. They are usually precisely targeted using fluoroscopic (X-ray) guidance.

These injected steroids can reduce swelling and pressure on the nerves that are causing back pain. This procedure often leads to temporary pain relief lasting three months or longer.

7. Ablation Procedures

When other back pain relief methods have been unsuccessful, ablation procedures may be an appropriate alternative. 

One such procedure is radiofrequency ablation (RFA), also known as a radiofrequency neurotomy. Radiofrequency ablation uses radio waves to heat a small area of nerve tissue in the spine identified as a source of back pain. The heat destroys that nerve area, stopping it from sending pain signals to the brain. 

Another ablation procedure, called Intracept, targets the basivertebral nerve that causes chronic vertebrogenic low back pain. Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates from disc degeneration or simply wear and tear from everyday life.

8. Orthobiologic Therapies

Orthobiologic therapies use blood, tissue, or cells to boost the body’s natural healing processes. 

The VIA Disc procedure falls into this category. This minimally invasive therapy rehydrates and supports the cushioning function of degenerated discs, which can relieve back pain. VIA Disc is one of the first orthobiologic therapies covered under Medicare.

Platelet-rich plasma Injections (PRP) are another therapy in this category. It uses a patient’s blood to isolate and concentrate platelets injected into an injured back area. Although clinical results for this procedure seem promising, it is still considered an experimental treatment. The use of PRP for chronic back pain is generally not covered by medical insurance.

9. Neuromodulation Therapies

Spinal Cord Stimulation (SCS), Dorsal Root Ganglion Stimulation (DRG), and Peripheral Nerve Stimulation (PNS) are three neuromodulation therapies used to relieve back pain. These therapies use mild electrical stimulation targeted to specific neurological sites in the body to interrupt pain signals before they reach the brain.

These minimally invasive procedures may be appropriate when multiple other treatments have failed to provide adequate relief. They each have the significant potential to restore patients’ quality of life.

Summing It Up

Spine surgery may be ultimately appropriate for some patients for pain relief. However, it should only be considered after all other alternatives have been exhausted. 

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Sciatica is a symptom of a medical problem that causes pain, numbness, tingling, or weakness in the leg. It is most commonly associated with two different conditions: a herniated disk or lumbar spinal stenosis

Sciatica pain occurs along the path of the sciatic nerve, which runs down the lower back and into the legs. This symptom can result from a herniated disk, where the disk ruptures and its gel center pressures the lumbar nerve roots.

Lumbar spinal stenosis can also cause sciatica pain or cramping in one or both legs. Lumbar (lower back) spinal stenosis is usually caused by osteoarthritis. This is a “wear and tear” condition resulting in bone overgrowth. This overgrowth can extend into the spinal canal, narrowing the space, which pinches and puts pressure on nerves within the spine.

The potential for misdiagnosis is understandable, given the similarities in the leg pain and sciatica symptoms between these two conditions. However, getting the diagnosis correct is critical, as the treatments for each differ.

In this article, we’ll take a deeper look at the causes and symptoms of each.

Older man with sciatica clutches back

Herniated Disks and Sciatica

Disks sit between vertebrae bones that stack to make the spine. These disks act as rubbery cushions that allow you to bend and move easily.

Each spinal disk has a soft, gel-like center called a nucleus and a firmer outer layer known as the annulus. A herniated disk occurs when the annulus tears and some of the nucleus’s gel center pushes through the opening. It is also known as a ruptured disk or slipped disk.

Herniated disks usually occur in the lower back or neck. Since our discussion is on sciatica symptoms, this review is specifically on ruptured lower spine disks. Aging, excessive weight, repetitive motions, and sudden strain from improper lifting or twisting can all contribute to a disk rupture.

Often, people experience no symptoms from a herniated disk. But for some, the rupture creates pressure on one of the sciatic nerve’s nerve roots. With sciatica symptoms, this usually occurs in the last lumber nerve root (L5) or the first sacral nerve root (S1) as they exit the lower spinal column. 

Sciatica from a Herniated Disk Symptoms

Sciatica pain may be experienced anywhere along its nerve pathway. Frequently, it follows a path that radiates from the lower back down one side of the buttocks into the leg and sometimes the foot. The pain can vary from a mild ache to a sharp burning. 

Other symptoms may include:

  • Lower back pain.
  • Tingling or numbness in the legs and/or feet.
  • Muscle weakness.
  • Pain while sitting and rising from a sitting position.
  • Worsening pain from prolonged standing.
  • Pain when bending forward.
  • Pain that improves throughout the day after rising.

Treating Sciatica from a Herniated Disk

In most cases, pain from a herniated disk can be treated at home. If the pain is severe, it is recommended that sciatica sufferers rest for one to three days but avoid long periods of laying down to prevent stiffness. You can also take an over-the-counter pain reliever, such as ibuprofen or acetaminophen, and apply heat or ice to the affected area.

However, you should see a doctor if the symptoms don’t improve after four to six weeks or get worse. You should also see your doctor if the pain interferes with your everyday life, you develop loss of bladder or bowel control, or you have trouble standing or walking.

Lumbar Spinal Stenosis and Sciatica

By age 50, degenerative changes begin to affect 95% of people. One of those changes is spinal stenosis, the narrowing of one or more spaces within the spinal canal. The spinal canal is the tunnel that runs through the vertebrae bones of the spine. It contains the spinal cord, which connects the brain to the lower back.

As the spinal canal narrows due to bone overgrowth from spinal stenosis, it can cramp the spinal cord and the nerve roots that branch off it. The tightened space can irritate, compress, or pinch the spinal cord and nerves, leading to back pain and other nerve issues like sciatica. 

Spinal stenosis usually develops slowly over time. Lumbar spinal stenosis is less commonly known as lower back spinal stenosis.

Sciatica from Lumbar Spinal Stenosis Symptoms

Sciatica pain from lumbar spinal stenosis begins in the buttocks, runs down the leg, and may continue into the foot. It may involve one or both legs. 

Other symptoms involve neurogenic claudication, including:

  • Lower back pain.
  • A heavy feeling in your legs, which may lead to cramping.
  • Numbness or “pins and needles” tingling in the buttocks, legs, or feet.
  • Pain worsens when standing for long periods, walking downhill, or bending backward.
  • Pain that lessens when you lean forward, walk uphill, or sit.

Treating Sciatica from Lumbar Spinal Stenosis

The treatment for lumbar spinal stenosis varies depending on the severity of the symptoms.

For mild symptoms, at-home care may be appropriate. This may include:

  • Over-the-counter pain relievers.
  • Head and cold applied to the aching joints.

If at-home care is insufficient, your doctor may recommend nonsurgical treatment options, including:

  • Physical therapy to strengthen spine-supporting muscles and improve flexibility and balance.
  • Corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain, and irritation.

Surgery for spinal stenosis is only considered in rare cases where all other treatment options have failed to provide adequate relief.

Wrapping It Up

Sciatica may result from two different conditions: a Herniated Disk or Lumbar Spinal Stenosis. Knowing which condition is causing sciatica pain is essential to establish the appropriate course of treatment.

You should usually see your doctor to get an accurate diagnosis.

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There is no single magic treatment that works for all forms of chronic low back pain. The first key in successfully treating it is to determine the source and cause. Then with a diagnosis, your medical professional can evaluate appropriate alternatives to relieve the symptoms.

Until about 20 years ago, the medical community believed there were only three primary sources for low back pain. Today, doctors recognize a fourth source of low back pain that involves damaged vertebral endplates.

We’ll bring you up to speed on what you should know about this pain source and a treatment option to consider if you are suffering from it.

What are three of the sources of low back pain?

For years, medical specialists believed the sources of low back pain were rooted in three spine structural components:

  1. The zygapophyseal joints. These both allow and limit rotation and bending movements in the spine. Degenerative changes in the facet joints can lead to low back pain.
  2. The sacroiliac joints. These joints link the hip and the lower spine. Low back pain can result from joint damage or injury.
  3. The intervertebral discs. These provide cushioning and flexibility for the spinal column during everyday activities. Disc degeneration can pinch spinal nerves, leading to low back pain that may radiate into the legs.

There are many different conditions across these three sources that can cause problems for patients. The complexity of diagnosing them usually requires an in-depth examination by a medical professional.

What is a fourth source of low back pain?

The more recenlty discovered fourth source of low back pain can arise from a damaged vertebral endplate.

What are vertebral endplates?

The spine has a series of stacked small bones called vertebrae that form the spinal canal. Between adjacent vertebrae are intervertebral discs that provide cushioning and flexibility.

At the top and bottom of each vertebra are vertebral endplates. These endplates serve as the interface between each vertebra and the adjacent disc. (In the image below, the vertebral endplates are illustratated by the lighter yellow rings).

Illustration of vertebral endplates
Illustration of vertebral endplates.

What is vertebrogenic pain?

As intervertebral discs deteriorate with wear and tear with age, stress occurs on the vertebral endplates. With this stress, the endplates may become damaged.

Damaged vertebral endplates can become inflamed, leading to vertebrogenic pain. The basivertebral nerve (BSN) transmits pain signals to the brain from the endplates.

What are the symptoms of a damaged vertebral endplate?

The symptoms of a damaged vertebral endplate are similar to that of a damaged intervertebral disc.

In both cases, patients describe:

  • The source of the pain is in the middle of the low back.
  • Pain that worsens with physical activity, prolonged sitting, bending, and lifting.

This similarity presents a challenge when identifying the difference between the two. A damaged vertebral endplate requires distinctly different treatments than a damaged intervertebral disc.

How do doctors determine if a patient has vertebrogenic pain?

To confirm that a patient has vertebrogenic pain, doctors use an MRI to look for specific changes that occur with endplate inflammation. These are called Modic changes.

They look for two of the three types of bone marrow changes: type 1, inflammation and edema, and type 2, fatty infiltration, which each indicate vertebrogenic pain.

Modic Changes Illustrated by Type
Illustrations of Healthy Endplate Alongside Those With Modic changes: Healthy endplate, Type 1, Type 2, and Type 3 changes.

What indicates if someone might be a good candidate for the Intracept Procedure to relieve vertebrogenic lower back pain?

A patient may be a good candidate for the Intracept Procedure if:

  • They have had chronic back pain for at least 6 months; and
  • They have failed to respond to conservative care for a period of at least 6 months; and
  • An MRI has shown that they have Type 1 or Type 2 Modic changes in at least one vertebrae from L3 to S1.

The Intracept Procedure

The Intracept Procedure is a minimally-invasive outpatient procedure for patients with vertebrogenic pain. The procedure targets the basivertebral nerve to relieve this chronic pain. It may be considered after other conservative options fail to relieve pain.

  • A doctor uses fluoroscopic guidance to target a radiofrequency probe. The probe heats the basivertebral nerve, stopping it from sending pain signals to the brain.
  • The Intracept procedure typically lasts an hour and takes place in an outpatient surgery center using local anesthetic and light sedation.
  • The Intracept back procedure is minimally invasive and preserves the overall structure of the spine.
  • The Intracept procedure recovery time, when most patients feel pain relief, is within two weeks after the procedure.
Vertebrogenic pain is a distinct type of chronic low back pain caused by damage to vertebral endplates, the interface between the disc and the vertebral body. The basivertebral nerve (BSN) transmits pain signals to the brain from the endplates.

What’s the Intracept Procedure success rate? A recent study on Intracept showed function and pain relief improvements that lasted more than five years¹.

Wrapping it up, there are two key takeways if you have lower back pain:

  1. Vertebral endplate damage should always be considered as a possible alternate pain source in addition to spinal disc degeneration.
  2. For appropriate patients with vertebrogenic low back pain, the Intracept Procedure can be an effective option.


  1. Fischgrund J. Ryne A. Macadaeg K. et al. Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized, double-blind sham-controlled multi-center study. Eur Spine J. 2020 Aug;29(8):1925-1934. doi: 10.1007/s00586-020-06448-x [PubMed]
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It’s normal to experience aches and pains in our back, particularly as we get older. Roughly 75 to 85% of adults in the U.S. experience back pain sometime in their lifetime.

Our back pain may be a simple sign of an aging spine. Or sometimes, it may indicate we have a disease or injury. A visit to our doctor can help sort through what is normal from what may be a problem.

One common back pain progression begins with age-related degeneration of the spine. Spondylosis is a broad term that encompasses different types of spine degeneration.

“Over time, spondylosis in the lower back can cause lumbar spinal stenosis,” says Farzad Karkvandeian, DO. Dr. Karkvandeian is a doctor at the Philadelphia region’s Main Line Spine medical practice.

He continued, “The mild procedure can relieve lumbar spinal stenosis back pain for some patients who don’t respond to traditional conservative treatments.”

What Is Spondylosis?

Spondylosis results from normal “wear and tear” degeneration of soft structures and bones in our spine. It can appear in any part of the spine. However, it is most commonly observed in the neck (cervical) and lower back (lumbar) regions.

“Osteoarthritis of the spine” is an alternative name for spondylosis.

Patients with this degenerative condition may or may not experience symptoms. Most people don’t experience significant pain or other issues related to these arthritic changes, Dr. Karkvandeian noted. Spondylosis frequently evades detection until a patient undergoes an imaging scan triggered by a different condition.

“Nevertheless, some individuals experience a decline that ultimately results in discogenic pain,” he added. “This can limit a patient’s range of motion. In the lower back, it also indicates a patient may have lumber spinal stenosis.”

Research indicates that spondylosis affects approximately 90% of individuals aged 60 and above. Lumbar spinal stenosis is present in about 20% of this same population in the United States.

What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis (LSS) usually occurs from an injury or changes in the spine as we age. It can cause the spinal canal in the lower part of the back to narrow.

This narrowing can create pressure on nerves running through the hollow space in the center of the spine’s vertebrae. The pressure may lead to a set of lumbar spinal stenosis symptoms called pseudoclaudication, also called neurogenic claudication.

“When lumbar spinal stenosis occurs, it typically impacts the lower L3 to L5 levels of the spine,” Dr. Karkvandeian noted. “When patients have lumbar spinal stenosis, their legs will often feel heavy. Some describe it as if they were walking in cement.”

Other early symptoms may include cramping or discomfort in the leg(s) after a long walk. Those with the condition may also feel leg numbness or achiness after prolonged standing. In the later stages, pseudoclaudication may progress into even more severe leg pain that worsens when walking.

Illustration of lower spine S1 and L5 to L1 and spinal canal
Illustration of the lower portion of the spine from S1, L5 to L1, and illustration of the spinal canal.

Back Pain Relief with the mild Spine Procedure

According to Dr. Karkvandeian, one of the major causes of lumbar spinal stenosis is the presence of excess ligament tissue. This usually develops on the spine with spondylosis.

Over time, the strong ligament cords that help hold the spine’s bones together can become thick and stiff. As this happens, these thick ligaments can push into the spinal canal.

Spondylosis and lumbar spinal stenosis are not one in the same and shouldn’t be confused for each other. But Dr. Karkvandeian emphasized that it would be uncommon to find thickened ligaments and LSS without the presense of spondylosis.

“The mild procedure provides us with a minimally invasive way to remove that excess ligament tissue,” Dr. Karkvandeian says. “By doing that, we can restore space in the spinal canal. This relieves pressure on spinal nerves and the associated low back pain.”

Mild stands for minimally invasive lumbar decompression.

The mild back surgery procedure typically takes less than an hour. It is performed with specialized instruments through a single, tiny incision that measures less than the diameter of a baby aspirin (5.1 mm). mild® is normally completed in an outpatient surgery center using local anesthetic and light sedation.

“It’s important to remove the excess ligament tissue from both sides of the spinal segment during the procedure,” Dr. Karkvandeian emphasized. “There are no half-measures that are adequate when you want to maximize the long-term outcome for a patient.”

mild Procedure Durability

“Every patient is different, and the outcomes have varied,” says Dr. Karkvandeian. “We have witnessed individuals transition from experiencing extreme pain levels of 10 out of 10 to complete pain relief. When the procedure works well, it is an extremely gratifying experience for our patients and medical team.”

“Like with all procedures of this kind,” Dr. Karkvandeian added with caution, “it doesn’t work for everyone.” “However, a study of the five-year follow-up of Cleveland Clinic mild procedures shows encouraging results.”

Seventy-five individuals received mild® treatment at the Cleveland Clinic between 2010 and 2015. Of that group, only 9 needed additional lumbar surgical decompression during a 5-year follow-up afterwards¹.

“We will continue to learn more from clinical studies that will follow this one,” Dr. Karkvandeian said. “But for now, Cleveland Clinic’s experience provides an objective record of long-term success with mild. Our own direct experience with mild procedure outcomes with our patients remains positive.”


  1. Mekhail N, Costandi S, Nageeb G, Ekladios C, Saied O. The durability of minimally invasive lumbar decompression procedure in patients with symptomatic lumbar spinal stenosis: Long-term follow-up. Pain Pract. 2021 Nov; 21(8): 826-835 [PubMed]
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Complex regional pain syndrome (CRPS) is a chronic and painful condition usually affecting the arms or lower extremities. The impacted extremity may involve the pelvis, groin, hip, knee, ankle, or foot. It can develop due to an injury, surgery, stroke, or heart attack. In some cases, it can occur without an apparent cause.

Those suffering from CRPS often have pain far out of proportion to whatever caused it. In addition to burning or throbbing pain, symptoms may include swelling, joint stiffness, muscle spasms, temperature sensitivity, and skin changes.

It is important to begin treatment of CRPS early. When it first appears, it presents the easiest opportunity to improve symptoms. But this condition can be a challenge to treat.

Some conservative treatments, including physical therapy, medications, and sympathetic nerve blocks, can be effective. But these options may fail to provide adequate results. Patients will often then consider neurostimulation to avoid more aggressive surgical alternatives.

Spinal Cord Stimulation (SCS) Therapy as an Alternative for Chronic Regional Pain Syndrome

Traditional spinal cord stimulation (SCS) is a neurostimulation therapy used to manage chronic, severe pain. It has been in use for over 40 years.

Around the world, tens of thousands of patients undergo spinal cord stimulator implants each year. Spinal cord stimulation delivers mild electrical stimulation to nerves along the spinal column. This modifies nerve activity to minimize the sensation of pain signals reaching the brain.

SCS therapy is now significantly improved and refined since its first routine use. Advances have continued to enable better personalization and effectiveness for each patient’s needs.

However, chronic regional pain syndrome usually involves specific extremities such as the pelvis, groin, hip, knee, ankle, or foot. For some CRPS pain sufferers, spinal cord stimulation doesn’t provide the kind of specific extremity targeting needed for pain relief.

Dorsal Root Ganglion (DRG) Stimulation as an Alternative Chronic Regional Pain Syndrome Therapy

Dorsal root ganglion (DRG) stimulation provides targeted neurostimulation pain relief to the lower extremities. The FDA has approved it for patients with complex regional pain syndrome (CRPS I and II). DRG stimulation has shown to be effective for CRPS when SCS isn’t a viable option.

It works by targeting neurostimulation at the dorsal root ganglion.

What Is a Dorsal Root Ganglion?

The nervous system in our bodies has two components: the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists primarily of the brain and spinal cord. The peripheral nervous system consists of nerves and ganglia outside the brain and spinal cord.

For clarity, the definition of “ganglia” is the plural form of “ganglion.”

The peripheral nervous system’s job is to connect the central nervous system to the limbs and organs. It serves as a relay between the brain, spinal cord, and the rest of the body.

The dorsal root ganglia are clusters of neurons on the back root of spinal nerves. They act as peripheral nervous system “gates” controlling our perception. Everything we sense must pass through a dorsal root ganglion before entering the spinal cord. Those sensory signals then pass from spinal cord nerves to the brain.

Spinal cord cross-section illustration showing dorsal root ganglion
An illustration of a cross-section of the spinal cord showing the dorsal root ganglion.

How Does Dorsal Root Ganglion Stimulation Work?

Dorsal root ganglion stimulation is similar to traditional spinal cord stimulation. Both systems use a small neurostimulator implant pulse generator. And both use small, insulated wires called leads to direct stimulation to their targets.

The major difference between the two is the target. In spinal cord stimulation, the leads directly target spinal nerves. However, with dorsal root ganglion stimulation, the leads target dorsal root ganglia on the posterior root of spinal nerves.

When active, DRG stimulation delivers tiny electrical pulses to the dorsal root ganglia. These impulses mask the feeling of pain traveling to the brain.

The stimulator does not eliminate a patient’s pain but changes how their brain perceives it.

Why Is DRG Stimulation More Effective than Spinal Cord Stimulation for Treating CRPS?

Spinal cord stimulation blocks pain signals from broad areas of the body.

In comparison, dorsal root ganglion stimulation is tightly focused on the nerves associated with a specific area of pain. This makes it more effective in masking pain from one particular extremity.

In addition, DRG requires only about 10% of the energy used by SCS, which minimizes the paresthesia-tingling sensation during use. It also means that the batteries of the system last far longer.

A Physician’s First-Hand Perspective on DRG Stimulation

Dr. Jeffery Rowe is a physician at Main Line Spine, a physiatry specialized medical practice, who is an expert in the DRG procedure. Abbott notes that he has implanted more dorsal root ganglion stimulators than any other doctor in the United States. He is also one of the country’s top spinal cord stimulation physicians.

“I continue to see very encouraging results from DRG stimulation procedures,” says Dr. Rowe. “It has been a game-changer for treating chronic regional pain syndrome and other challenging conditions.”

Dr. Rowe has helped to train more than 2,000 doctors in the procedure at Abbott’s Texas facility. He was part of the Neuromodulation Appropriateness Consensus Committee (NACC) that developed the best practices consensus document on DRG stimulation.

“We see individuals who’ve had chronic pain for 20 years, and they think they’ve tried everything,’ says Dr. Rowe. “Or they may have had a spinal cord stimulation trial ten years ago. They’ll tell us that it didn’t help them much.”

“However, DRG stimulation provides a truly unique alternative. And neurostimulation has evolved significantly over the years,” he continued, “the technology is vastly different today. The differences over time are like comparing apples to oranges.”

Dr. Rowe reflected on what he believes is one of the major keys to success with the procedure. “It’s vital to devote enough time to place and anchor the leads properly,” he says. “It’s important to follow rigorous protocols to optimize lead placement.”

He encourages patients with CRPS who haven’t had success with conservative treatments to consider the procedure. Dr. Rowe says, “A DRG stimulation trial could be a first step to life with chronic pain in control.”

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Chronic knee pain affects one in four people aged 55 and older. For many, the symptoms are mild to moderate. However, when it is severe, it can be debilitating.

Ongoing knee pain can also occur after knee replacement or ACL surgery. The triggers and causes of this kind of knee pain are complex and can be related to many different factors.

If you suffer from severe knee pain, it can make the simplest tasks seem almost impossible. Everything from walking to sitting down can be painful. Coping with chronic knee pain without seeking treatment can make the situation even worse.

We’ll look at the major possible causes of severe chronic knee pain along with leading options to treat it.

The Knee Is a Highly Vulnerable Joint

The knee is the joint that connects your thigh to your lower leg. It’s the biggest joint in your body. Like all joints, your knees are part of the bones in your skeletal system. Your knees also contain cartilage, muscles, ligaments, and nerves – all of which are vulnerable to damage.


The knee bears a great deal of stress from everyday activities, such as walking, lifting, and kneeling, and from high-impact activities, such as running, jumping sports, and aerobics. Pain and damage from traumatic injuries and overuse are common


Knee pain can also result from different types of arthritis including osteoarthritis, rheumatoid arthritis, gout, pseudogout, and septic arthritis. Osteoarthritis of the knee is very common, with 46% of people developing it at some point in their lifetimes.

Post-Knee Replacement Pain

Although uncommon, a small percentage of knee replacement patients continue to have chronic pain on the outer sides of the knee after surgery. This is where the surviving knee ligaments and tendons are located. Most often these connective tissues are damaged either by the surgery or new stresses placed on them by the implant.

A number of other knee replacement patients have nerve irritations. This nerve irritation can be below or above the knee or within the kneecap. Other people become hypersensitive to pain after surgery, experiencing more pain than they should.

Individual clutching painful knee

Preventing Knee Pain

Although it’s not always possible to prevent knee pain, there are some things you can do to ward off injuries and slow joint deterioration.

Maintain a Healthy Weight and Keep Extra Pounds Off

It’s one of the best things you can do for your knees. Every extra pound puts additional strain on your joints, increasing the risk of injuries and osteoarthritis.

Regularly Exercise to Be Strong and Flexible

Strong muscles will help stabilize and protect your knee joints and muscle flexibility can help you achieve a full range of motion. Prepare for the jumps and pivots of sports like basketball with good hip control by building glute strength. Work on normal ankle mobility to decrease unnecessary stress on the knee.

Use good cushioning shoes and focus on form when running or jogging to minimize pounding on the knees. And approach repetitive work knee stress in jobs such as construction or farming by preparing with exercises to strengthen impacted muscles.

Seeking Medical Help for Chronic Knee Pain

If knee pain persists and impacts the quality of your life, you should see a qualified medical professional to evaluate your condition. Putting off an appointment to address your chronic knee pain issues when they become critical will often allow things to further deteriorate and get worse.

There are a variety of treatments that may be appropriate for each individual situation. They include:

  • Physical therapy can help strengthen the muscles around your knee and make it more stable.
  • Medications can be prescribed to relieve pain and address the symptoms causing it.
  • Corticosteroids can be injected into your knee joint and may help reduce the symptoms of an arthritis flare and provide pain relief that may last a few weeks to a few months.
  • Hyaluronic acid is a natural substance found in joints. It is a viscous, gel-like substance. A treatment called viscosupplementation injects it to augment the fluid that naturally lubricates your knee joints. This may reduce friction within the joint, thereby reducing pain and stiffness, and preventing the loss of cartilage and bone.
  • Platelet-rich plasma (PRP) injections may benefit certain people with osteoarthritis with a PRP concentration of many different growth factors that appear to reduce inflammation and promote healing.

But what if these options aren’t sufficiently effective? Or if you want to avoid prolonged use of pain medications? What additional options are there short of surgery?

Peripheral nerve stimulation may be an answer for some patients. Itpresents a drug-free alternative that has proven to be highly effective to control chronic knee pain in appropriate cases.

Peripheral Nerve Stimulation

Neurostimulation has been used successfully to manage intractable chronic pain for over 40 years.

You may have heard of spinal cord stimulation (SMS) which was the first therapeutic approach that used neurostimulation. This therapy uses gentle electrical impulses to interrupt pain signals before they reach your brain. SMS offers a drug-free approach that does not require drugs or physical therapy to work.

Peripheral Nerve Stimulation (PNS) describes a localized and miniaturized approach to using neurostimulation. Peripheral nerve stimulation is different from spinal cord stimulation because it places the stimulating device directly over the nerve at the targeted pain area, not on the spinal cord where the nerve originates.

There are several medical device manufacturers that offer variations of peripheral nerve stimulation devices. Some of these devices are designed for a course of treatment that is 60 days or less. Others are designed for longer term use. Doctors will select specific devices based on each individual patient’s situation.

These PNS devices are small in size, minimally invasive, discreet, and upgradeable. The diameter of the leads implanted to provide stimulation is smaller than the size of a thin strand of spaghetti. There are both temporary and permanent PNS therapy options. They can be removed by your doctor if you decide to discontinue the therapy.

Peripheral Nerve Stimulation and Knee Pain

Peripheral nerve stimulation devices are increasingly used to help patients control their chronic knee pain. Very small electrodes are implanted next to the nerves involved, which can then be stimulated with the goal of relieving knee pain. Control of applying that stimulation is in the hands of the patient when they need it.

Appropriate candidates for peripheral nerve stimulation should have exhausted more conservative treatments without adequate improvement.

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When you are in pain – particularly if it’s low back pain – your initial reaction may be to stop all activity and rest. In fact, however, the opposite is often true.

Let’s stop for a moment and not get ahead of ourselves. If you have back problems, you should first see a medical professional for diagnosis and guidance before following any treatment protocols. But after you do, your doctor will often recommend that you work to move and stay active, despite the pain.

a woman participates in gentle exercise with others
A woman participates with others in gentle exercise to increase flexibility and strength and improve cardiovascular fitness

Lower Back Pain Is Often Persistent

When you have an acute musculoskeletal injury, it’s important to get pain, swelling, and inflammation under control as soon as possible. One recommended treatment approach to do so is RICE:

  • Rest
  • Ice
  • Compression
  • Elevation

However, this kind of “take it easy” approach is normally only recommended for a period of 48 to 72 hours. If your pain persists after that, you should be seeing a doctor to find out why.

Low back pain is often chronic. However, it can come and go on an ongoing basis at different levels of severity. ICE, heat and taking over-the-counter anti-inflammatories may help – but you need to do more to help yourself for the long term. You need to move.

Mechanical Pain

80% of all back problems are mechanical in nature. This means that these problems will respond best if you keep moving – even if your pain is persistent.

Your spine is made up of a series of joints. Mechanical pain occurs when anything happens that restricts the movement of one or more of those joints. This is why back pain is also accompanied by stiffness. A bulging disk, ligament issue, or forms of arthritis can create obstructions within the structure of your spine.

If you move the right way as your medical professional has recommended to you, you can release those obstructions. And as they are released, stiffness is reduced, and you usually will experience less pain.

Sitting Too Long and the Pain-Spasm-Pain Cycle

Most of us know that sitting too long can be bad for our health. However, it also can be a cause of back pain. When you sit too long, your joints aren’t being used. The area of your low back is a nerve-dense location, and with the immobility of sitting too much, it can start what’s known as the pain-spasm-pain cycle – where a skeletal muscle spasm causes pain in your spine.

The pain-spasm-pain cycle can first be triggered from an underlying condition such as a herniated disc, arthritic joint or bulging disc. When that happens, usually without warning, one of these conditions suddenly triggers a muscle spasm in your spine.

In turn, the triggered muscle spasm causes ischemia, which is a lack of blood flow in and around the muscle.  The ischemia then causes pain. The muscle sees that pain as a threat to the spine – and reacts in an effort to protect it with another new spasm.

As a result, you can get locked into a never-ending back pain-spasm-pain cycle.

The good news is that your medical professional can help you break this cycle with therapies that will release and reset the affected muscle.

Diagram illustration of how a trigger can start an ongoing pain-spasm-pain cycle
A muscle spasm triggered by an underlying back condition can start a never-ending pain-spasm-pain cycle.

Get Moving!

One of the most important things that people with low back pain can do is to stay as physically active as possible in daily life and exercise regularly. Not moving enough can weaken your core muscles, make the pain worse over the long term, and lead to other health problems. It’s a fact that regular physical exercise has been shown to reduce pain – but do it after reviewing your plans with your doctor.

If you have low back pain, it’s a good idea to go about your daily life as normally as possible, and not to let the pain limit your activities too much. Don’t isolate yourself but get out and do the things you enjoy. This will make it easier for you to cope with your back pain.

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