Epidural Steroid Injections (ESIs) are used in the treatment of acute or chronic pain in the back, neck, arms, or legs. The injections are often used in the first line of attack against pain. Typically, patients who are candidates for an ESI are suffering from spinal stenosis, spondylolysis, a herniated disc, degenerative disc disease, or sciatica. The ESI is a minimally invasive procedure in which the physician delivers medicine – a long-lasting corticosteroid -- to the spinal nerve. This is accomplished by guiding a needle into the epidural space, the area between the protective covering of the spinal cord and the vertebrae, with the help of an imaging technology called fluoroscopy. The benefits of an ESI can last from days to years. The treatment is helpful in halting pain and reducing inflammation, thereby enabling the patient to resume normal activities and pursue a physical therapy program.

Facet Injections and Rhizotomy are used in the treatment of neck or back pain caused by inflamed facet joints. Arthritis, injury, and disc degeneration can cause pain in the facet joints, which connect vertebrae to each other and allow motion of the spine. A facet injection is a minimally invasive procedure in which the physician injects a long-lasting corticosteroid and numbing agent into the painful facet joint with the help of an imaging technology called fluoroscopy. A facet injection, which can bring relief for several days to years, also can be used to determine whether the facet joints are the true source of the patient’s pain. If the injection does provide relief, the patient might benefit from a facet rhizotomy. In this minimally invasive procedure, the physician directs a radiofrequency current at nerves surrounding the painful facet joint in an attempt to deaden them and prevent pain signals from reaching the brain. Both treatments are helpful in halting pain and enabling the patient to resume normal activities and pursue a physical therapy program.

Sacroiliac Joint Injections are used in the treatment of pain in a large joint in the area of the lower back (lumbar spine) and buttocks. Arthritis, injury, and disc degeneration can cause pain in the sacroiliac or referred pain in the groin, abdomen, hip, buttock, or leg. A sacroiliac joint injection is a minimally invasive procedure in which the physician injects a long-lasting corticosteroid and numbing agent into the joint. This is accomplished by guiding a needle into the joint with the help of an imaging technology called fluoroscopy. The injection also can help determine whether the sacroiliac joint is causing the patient’s pain or whether the pain is originating from another location.

Trigger Point Injections are used in the treatment of painful knots of muscle, called trigger points, which fail to relax. Trigger points can be painful and, by irritating surrounding nerves, can cause pain to radiate into other areas of the body. A trigger point injection is a minimally invasive procedure in which the physician injects a corticosteroid and numbing agent into the knotted area, usually in the lower back, neck, arms, or legs. The injection is usually effective in treating the problem.

Radiofrequency Ablation (Rhizotomy) is used in the treatment of neck or back pain caused by inflamed facet joints. Arthritis, injury, and disc degeneration can cause pain in the facet joints, which connect vertebrae to each other and allow motion of the spine. Radiofrequency ablation is a minimally invasive procedure in which the physician directs a radiofrequency current at nerves surrounding a painful facet joint in an attempt to deaden them and prevent pain signals from reaching the brain. The physician can confirm that the facet joint is causing pain by first performing a facet joint injection. During a radiofrequency ablation procedure, the physician injects a needle and numbing agent into the painful facet joint with the help of an imaging technology called fluoroscopy. The physician then inserts a microelectrode inside the needle and delivers a small radiofrequency current to the nerves.

Spinal Bracing can play a role in treatment following injury or surgery. Braces, called orthotics, can immobilize the neck or back during healing, can stabilize injured areas, and can control pain by restricting movement. Braces can be custom-molded and adjusted to the size and needs of individual patients. Braces should be worn at all times, even during sleep, unless the surgeon instructs otherwise.

Exercise Programs play a critical role in a patient’s recovery from injury or surgery and in the maintenance of a normal, healthy back. Regular exercise also can help prevent injury from occurring. Exercises for a healthy back are divided into three groups: those that strengthen the back through repeated muscle contractions; those that promote flexibility by stretching and lengthening muscles; and those that promote fitness through the steady use of large muscle groups. Exercises should be performed slowly and comfortably to avoid injury.

Physical Therapy is an important part of a nonsurgical approach to restoring, maintaining, and promoting overall health. In collaboration with a physician, a physical therapist helps patients who are recovering from surgery, injury, or disease. A physical therapist will evaluate a patient’s movement and body type and then design a personalized regimen to help restore function, relieve pain, and improve mobility and strength.

Pilates is an exercise program that seeks to strengthen the body’s core muscles, or torso, and to improve postural alignment. The core muscles lie within the abdomen and around the spine. The program was developed from techniques first described by the German-born Joseph Pilates, who sought to help rehabilitate soldiers returning from World War I. Because the core muscles help support and protect the spine, pilates can play a role in the holistic treatment of back pain or injury as well as in the prevention of injury. Pilates, usually performed on a floor mat, focuses on stretching, strengthening, postural alignment, stability, and breathing techniques.

Yoga is an exercise program that embraces poses, postures, and controlled breathing. It seeks to strengthen and stretch muscles, create balance through flexibility, and alleviate stress. Yoga originated in ancient India, and the word yoga means “union” in the ancient Indian language of Sanskrit. Individuals who are dedicated to yoga strive for a union of body, mind, and spirit. Among other things, yoga strengthens the core muscles of the abdomen and back, which help support and protect the spine. As such, yoga can play a role in the holistic treatment of back pain or injury as well as in the prevention of injury.

Chiropractic Care can play a role in the restoration of structure and function of the spine. Spinal vertebrae (bones) can undergo minor displacement (subluxation) because of stress, accidents, injury, or overexertion. A displaced vertebra can result in muscle tension or irritation to the spinal nerves, which in turn can cause pain and impairment to overall health. In the event of a minor displacement, a chiropractor can help restore systems to their proper function through an “adjustment” technique.  While giving an adjustment, the chiropractor quickly applies firm pressure with the hand to reduce subluxation and restore movement.

Spinal Rehabilitation is supervised by a physician who specializes in physiatry, also known as physical medicine and rehabilitation. The physiatrist specializes in the diagnosis and treatment of patients with acute and/or chronic illness or pain, including back pain. The physiatrist seeks to help the patient achieve optimal function and quality of life through the reduction of pain and the adaptation to assistive devices, including braces and wheelchairs. Depending on the patient’s needs, the rehabilitation team may also include physical and occupational therapists, speech pathologists, and social workers.

Self Care and Braces- Patients can protect their back and further the healing process by using correct posture, by keeping the spine in alignment, by wearing a brace if recommended, and by following through with physical therapy or a regular exercise program. The lower back bears most of a person’s weight, so proper alignment can prevent further slippage and injury to the spinal nerves and discs. Proper lifting habits – keeping the back perpendicular and bending at the knees -- can also protect against injury. Wearing a back brace may be advisable while the abdominal and lower back muscles are being strengthened following surgery or an injury. The brace can decrease muscle spasm and pain as well as help immobilize the spine during the healing process.

Holistic Medicine, also known as alternative or complementary medicine, focuses on the whole person rather than the person’s physical ailment alone. As such, holistic medicine considers the patient’s physical, mental, emotional, and spiritual health during treatment. Holistic health presumes that a person must be healthy in body, mind, and soul if true wellness is to be achieved. Physicians often integrate principals of holistic medicine – including exercise, diet, smoking cessation, and reduction of anxiety -- with scientifically proven medical or surgical treatments. Holistic medicine can be a beneficial and complementary component to spinal rehabilitation and prevention of illness or injury.

Acupuncture is an ancient medical art that originated in China thousands of years ago and has gained advocates in the United States. It is a form of alternative or complementary medicine involving the stimulation of specific points on the body through the insertion of thin metal needles. Underlying the concept of acupuncture is the Chinese medical philosophy that the body contains two opposing forces: yin (cold and slow) and yang (hot and active). When yin and yang are unbalanced, the body is unhealthy. The Chinese, drawing on a matrix of 2,000 acupuncture points, used acupuncture to restore that balance and to block pain.

Medical Pain Management involves the management and control of acute or chronic pain with medications. Acute pain is directly related to tissue damage and has an obvious source. Chronic pain, whose origin can be difficult to pinpoint, is persistent and can last months. In some cases the brain will continue to receive pain signals even after an injury has healed. Amputees are known to experience pain, known as phantom pain, in a limb that is no longer there. Chronic pain also is frequently present in ongoing conditions, such as arthritis or cancer. The Mayfield Clinic provides only surgical treatment for pain, but numerous organizations offer medical options that also can include holistic treatment.

Interventional Pain Management involves the diagnosis, management, and control of acute or chronic pain with minimally invasive techniques. It is an option for patients whose pain is not adequately relieved by standard medical pain management. A team of specialists provides interventional pain management, which can include epidural injections, facet injections, discography, and radiofrequency ablation (rhizotomy). Acute pain is directly related to tissue damage and has an obvious source. Chronic pain, whose origin can be difficult to pinpoint, is persistent and can last months. In some cases the brain will continue to receive pain signals even after an injury has healed. Amputees are known to experience pain, known as phantom pain, in a limb that is no longer there. Chronic pain also is frequently present in ongoing conditions, such as arthritis or cancer.

Spinal Cord Injury Rehabilitation is a highly specialized and continuing process. It brings together a multidisciplinary team that includes rehabilitation specialists, psychologists, social workers, and physical, speech, and occupational therapists. The rehabilitation process includes inpatient and outpatient care and is determined by the type and severity of the patient’s injury. The goal is to help each patient regain as much independence as possible while furthering his or her re-entry into the community. Spinal cord injury rehabilitation includes an educational component for both patient and family members.

Physical Medicine and Rehabilitation (PM& R) is a specialty whose physicians – known as physiatrists—diagnose and treat injuries and illness that involve movement. Physiatrists treat the whole person, not just the physical problem. They are experts at diagnosing and treating acute and/or chronic pain. The physiatrist seeks to help the patient achieve optimal function and quality of life through the reduction of pain and the adaptation to assistive devices, including braces and wheelchairs. Depending on the patient’s needs, the physiatrist’s rehabilitation team may also include physical and occupational therapists, speech-language pathologists, and social workers.

Discography is a minimally invasive procedure that produces an x-ray of intervertebral discs. A discogram can identify discs that cause pain and helps the surgeon plan neurosurgical treatment. The surgeon uses fluoroscopy to guide a needle into the disc space, then injects a dye and antibiotics. X-rays and CT scans are taken after the needle has been removed.

EMG (electromyography), often done in conjunction with a nerve conduction velocity (NVC) study, is a diagnostic test that measures muscle strength and the electrical activity of nerves. The EMG test helps determine whether muscle weakness is resulting from nerve damage, another muscular condition, or the patient’s reluctance to use the muscle because of pain. During an EMG, the physician inserts very thin needles into the affected muscles. An electrode attached to each needle sends signals to a machine, allowing the physician to analyze the muscle and detect peripheral nerve damage.