Conditions We Treat

Pain has a cause, and naming it is the whole job. These are the conditions we see most. Each page says what the condition really is and how we find out which one you have.

Pain is a symptom. The useful question is which structure is producing it

Almost everyone comes in with a place and a length of time: low back, eighteen months. Almost nobody comes in with a structure. That gap is why so much pain treatment falls short. If a treatment aims at a structure picked by habit, not found by testing, it helps some people by luck and fails the rest.

In the lumbar spine (the low back) there are four real suspects. They cause the large majority of lasting low back pain: the discs, the facet joints, the sacroiliac joint, and the muscles and fascia (the tissue wrapping the muscles). The neck has three: discs, facet joints, and nerve roots. Naming which one is the whole first visit.

Why the scan usually does not answer it

Scans are key for ruling out dangerous causes of pain and for planning surgery. They are a poor tool for telling which of several common findings is the one that hurts.

The reason is how common they are. Disc degeneration, bulges, facet arthritis and foraminal narrowing (a tight opening where a nerve exits the spine) show up all the time in people with no pain at all. They grow much more common with age. Finding them on a scan shows you have an adult spine. It does not show they cause your pain.

The sacroiliac joint makes the point best. It can cause all of someone’s pain and look totally normal on MRI. There is nothing on the scan to see. That is why it is one of the most often missed sources of low back pain.

How the diagnosis is actually made

The history narrows it more than anything else. The most telling question is not what makes the pain worse. It is what makes it better. Pain eased by sitting or leaning forward points toward stenosis (a narrowed spinal canal). Pain eased by standing and made worse by sitting points toward a disc. Pain eased by lying on the other side points toward the sacroiliac joint.

The examination tests those hypotheses. Where the numbness sits. Which moves set it off. Whether one muscle is weak. Whether a reflex is gone. Each one narrows the field, often to one or two suspects.

A targeted block settles what remains. Placing local anesthetic (numbing medicine) right onto one structure shows whether the pain goes away. It is the only test that answers the question directly. It is how facet pain and sacroiliac pain are confirmed. It is also the step most often skipped.

Referred pain is why the problem is so often treated in the wrong place

Body parts send pain to other places, in patterns that do not match how most people picture the body. Cervical facet joints (small joints in the neck) send pain into the shoulder blade. That is why people get shoulder scans, and now and then shoulder surgery, for a neck problem. The hip joint sends pain to the groin and the knee. The L3 nerve root sends pain to the knee. Trigger points send pain across whole regions.

Here is a simple rule that catches most of this. If someone else can move a joint through its full range with no pain, the pain is unlikely to come from that joint.

Pain that has lasted a long time is a different problem from pain that is new

After several months, the first structure is often not the only thing causing pain. The nervous system gets better at sending the pain signal. Sleep gets worse. Activity drops. Muscle is lost. Each of those, on its own, makes the pain worse.

That is why we ask about sleep, blood sugar and activity when someone comes in about their back. It is not a detour. In long-term pain, those factors often decide whether the treatment of the structure works at all.

How to use this section

Each page covers what the condition really is, how it usually shows up, what it often gets mixed up with, and how we diagnose and treat it here. The focus on mix-ups is on purpose. A large share of lasting pain gets treated as the wrong problem for months before anyone tests the guess.

Two themes come up on almost every page. Scan findings are very common in people with no symptoms at all. So a report that describes degenerative change (tissue breaking down) rarely settles which structure hurts. And partial or short-lived relief from a past treatment is very telling, because it points at a target even when the relief did not last.

Neck and upper back

Low back, hip and leg

Nerve pain

Inflammatory and joint

Head and whole-body

Sources

• Qaseem A et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 2017. PubMed 28192789
• Blanpied PR et al. Neck Pain: Revision 2017. The Journal of orthopaedic and sports physical therapy, 2017. PubMed 28666405
• GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. Neurology, 2018. PubMed 30353868
• McKenzie BJ et al. Agreement between high-quality clinical practice guidelines in their treatment recommendations for low back pain: a systematic review. The spine journal : official journal of the North American Spine Society, 2025. PubMed 40639620