Neurological Pain Management & Rehabilitation

What is Stenosis?
Throughout the spine, the center portion, called the spinal canal, is a space which contains the spinal cord and nerves. This spinal canal can become narrow as it suffers from wear and tear, degenerative changes in discs and joints, disc herniations, and thickening of the ligaments. This is called spinal stenosis, which means “narrowing.” It can range from mild to severe in terms of the symptoms (pain, numbness, tingling, and weakness) and neurological effects it can cause.

How experienced is the team in treating stenosis?
The rehabilitation and pain management team is highly experienced in properly diagnosing and managing spinal stenosis. It’s one of the most common conditions we treat.

What are the most common types of treatments for stenosis?
In most cases, stenosis is initially treated with physical therapy, fitness, nutrition, and weight loss. A small percentage of patients will need to undergo a surgical procedure.

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What is a degenerative disease?
Degenerative disease can affect any part of the spine, especially the cervical and lumbar spine, and it is the most common cause of neck and back pain. It will gradually progress if not treated properly. The discs will degenerate over time, leaving less space between the vertebrae, disabling their ability to protect the nerves.

How experienced is the Barrow team in treating degenerative disease?
A team of dedicated physiatrists (physicians trained in physical medicine and rehabilitation) are the most skilled in treating these conditions because of their comprehensive approach, and long-term favorable outcomes. It’s not about finding a quick fix, but a lasting solution.

What are the most common types of treatments for degenerative disease?
The most common approach is physical therapy, improving flexibility and strength of the muscles and joints, and proper fitness such as core strengthening. In severe cases, pain management procedures such facet blocks or stem cell injections can be effective in helping to relieve pain. Our team is also passionate about the use of natural anti-inflammatory supplements to augment pain relief and mitigating inflammation.

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What is disc herniation?
Disc or intervertebral disc, is a structure present throughout the spine in between the vertebrae. It consists of an outer hard shell made of collagen, an inner shell consisting of a gel-like material called nucleus. Small tears or cracks can occur in the outer shell, and the gel can leak or protrude, impinging the spinal nerves, causing pain. The protruding portion of the gel is called “herniated disc.”

How experienced is the Barrow team in treating disc herniation?
Our team is highly experienced in providing nonsurgical as well as surgical management of this condition. We commonly see and successfully treat this often debilitating condition.

What are the most common types of treatments for disc herniation?
Patients can be initially treated with physical therapy and anti-inflammatory medication. If the nerve pain is significant, patients may receive epidural injections, which is an injection of steroid near the spinal nerve where the disc herniation has occurred. If improvement does not occur over time, patients may need surgery to remove the herniated disc.

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What is scoliosis?

Scoliosis is a condition where the spine has an abnormal, sideways curve. It is generally developmental, and hereditary, but can also occur with significant disc degeneration. It affects all parts of the spine, but most prominently the thoracic and lumbar spine.

What is Kyphosis?
Kyphosis occurs when the spine curves outward, causing abnormal spine posture and increased stress on the discs and joints.

How experienced is the Barrow team in treating these conditions?
We have a team consisting of experienced physiatrists, pain management specialists and neurosurgeons to manage these conditions in the most effective manner. This approach results in very effective and long-lasting benefits, which is especially important during key stages of development.

What are the most common types of treatments for scoliosis & kyphosis?
Initial assessment of these patients includes spine X-ray, and a neurological and physical examination. Depending on that evaluation, patients may participate in physical therapy, and in many cases, bracing to correct the curve. However, in severe cases, surgical intervention is the best option.

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What are entrapment neuropathies?
Entrapment neuropathies are often referred to as pinched nerves. Most common of these conditions is carpal tunnel syndrome, causing significant pain, tingling and weakness of the hands. Other entrapment neuropathies are thoracic outlet syndrome, which occurs in the shoulder area, and ulnar neuropathy, which mostly occurs in the region of the elbow.

Some of the common entrapment neuropathies in the lower extremities consist of pyriformis syndrome (pinched sciatic nerve in the gluteal or buttock area), tarsal tunnel syndrome (compressed tibial nerve in the area of the ankle), and peroneal entrapment of the knee (can occur just below the knee as it enters the area of the leg).

How experienced is the team in treating these conditions?
Our team is well-trained and experienced in diagnosing and providing both nonsurgical and surgical management of these conditions. All treatments can be handled here at Barrow because of our collaborative approach to care.

What are some of the most common treatments for these conditions?
The most common types of treatments consist of physical therapy, splints and braces, nerve blocks, and surgery if the condition doesn’t improve first with nonsurgical approaches.

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What are joint (or musculoskeletal) problems?
Musculoskeletal and joint pain are common problems, and are the result of a variety of conditions that affect the mechanics and function of that particular joint. These issues can potentially lead to joint and soft tissue dysfunction.

Acute and chronic conditions, such as ligament sprains, muscle strains, tendonitis, bursitis, and arthritis, can all have an effect on how a person uses that joint, which can lead to chronic mechanical dysfunction, and chronic pain.

How experienced is the team in treating these conditions?
Our nonsurgical team, consisting of physical medicine and rehabilitation specialists (physiatrist) and physical therapists, have extensive experience in the evaluation and treatment of these conditions. These conditions can affect any individual, however, many professional athletes have entrusted us with their care, based on our ability to address the condition in such a comprehensive manner.

What are some of the most common treatments for these conditions?
We’ll first perform a detailed history and physical examination to identify specific areas that may be causing your symptoms. We may also order specific tests, such as x-rays, MRIs, blood work, and electrodiagnostic testing to obtain even more detail about your diagnosis.

Once the appropriate diagnosis is made, treatment can begin, which consists of a detailed and comprehensive supervised physical therapy program. This will aid us in re-establishing proper alignment of the soft tissue area or joint in question, as well as improve range of motion, strength, and joint mechanics, to maximize function of the joint.

Additionally, the use of bracing, and other modalities, such as TENS (transcutaneous electrical nerve stimulation), electrical stimulation, therapeutic ultrasound, soft tissue laser, and ASTYM treatment (which helps to remove unwanted scar tissue that may cause pain or restrict motion)  may be used to decrease muscle spasm, improve flexibility, and decrease pain.

Because therapy can be strenuous, and even painful, we incorporate pain management strategies, such as image-guided soft tissue, nerve, and joint injections. We may also look to medication to decrease pain and help you tolerate your therapy. If we’re unable to achieve relief from your symptoms through nonsurgical care, then we’ll refer you to the most appropriate specialist.

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What’s included in a spine assessment?
Patients with any spinal problems or symptoms will be seen by one of our physiatrists or pain physicians. Following the initial assessment, diagnostic studies such as MRI, X-Ray, CT scan and EMG (electromyography) will be arranged. Depending on the results of these studies, we’ll review your treatment plan with you.

Why is an assessment necessary?
This type of assessment will allow us to diagnose and treat the spine comprehensively. We’re dedicated to treating the entire spectrum of a patient’s problems, not just the presenting symptoms.

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What is pain management?
Acute and chronic pain can greatly impact quality of life, ability to work, and interpersonal relationships. Our number one goal is to help patients regain their quality of life by implementing a comprehensive treatment plan in a compassionate, empathic manner. The utmost importance is placed on accurately diagnosing the source of pain, and then educating each patient on their pain condition and their treatment options in order to ease suffering and to maximize functioning. Potential treatment options may include physical therapy, injection therapy and/or medication management.

Why pain management over other approaches?
Noninvasive treatment options such as physical therapy, injection therapy, and medication management are very effective in treating pain symptoms. Noninvasive treatments minimize recovery time and allow the patients to return their life activities quickly.

How effective is pain management?
Pain management is effective in not only treating pain, but also in increasing quality of life and allowing patients to return their optimal functional status.

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What types of physical therapy are offered?
The goal of our rehabilitation program is to improve your mobility and function as quickly as possible, and physical therapy is a critical part of your treatment. You’ll have a dedicated therapist who will develop an extensive rehabilitation program based on manual interventions, modalities and exercise prescription. This will be based on your personal recovery goals.

We treat all aspects of the body with an emphasis on spinal rehabilitation, using a variety of techniques. Our rehabilitation programs are built on a foundation of intervention-based therapies, all directed at returning you to the level of function you desire. Treatment may include muscle strengthening, flexibility and general conditioning, joint and soft tissue mobilization, and spinal decompression. Your physical therapy team may also employ a host of complementary strategies, such as injury prevention/education and pain management.

In addition, we strengthen your overarching care plan by working seamlessly with the Barrow Brain and Spine neurosurgical and pain physician team. Our access to medical records and diagnostic findings provides you the continuum of care you deserve.

How experienced is the team with this approach?
Your physical therapy team is comprised of specially trained physical therapists, physical therapy assistants and technicians, with a collective of more than 60 years of experience. Our team is specially equipped to handle complex neck and back pain conditions in addition to a variety of other ailments. We’re proud of the level of care we’re able to offer patients, due to our high standard of training in manual medicine, backed by a diverse understanding of approaches to physical therapy.

How long will it take to see results?
The goal of rehabilitation is to provide relief through a variety of techniques, starting with your first treatment. Often times, patients feel improvements in their symptoms after two to three visits. Our team is committed to building foundations that create sustainable improved function, leading to long-term results. We do so by rebuilding the body, finding the root cause of the primary symptoms, and leveraging those discoveries for continued results.

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What is bracing?
Bracing is a form of support and movement restriction that can significantly reduce pain, pressure, and protect the injured area.

Why is this offered?
Your doctor may feel that you are not a surgical candidate at this time and recommend other forms of treatment which may include a brace. You may be prescribed some sort of bracing post injury or procedure to aid in the healing process. We often see patients get back to their lives sooner with the assistance of a brace.

What are the benefits of this treatment?
Often times, patients are assigned a brace to evaluate if a surgery will be beneficial. You’ll be asked to wear the brace as directed for a specific time frame, and report back the changes, if any. This can be a leading factor in deciding how to proceed with your treatment plan. In addition, bracing can help expedite healing as it allows the injured area to heal without risk of unwanted force or movement.

Lastly, we pride ourselves on our ability to make bracing as easy and convenient as possible for our patients, enabling them to leave with their custom-fitted brace on the same day as their initial appointment.

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What is injection therapy?
Injection therapies are procedures that provide a more specific, directed intervention in the treatment of pain conditions. These procedures include joint injections, injections into the muscle, and spinal injections.

What types of injections do you offer and how might they benefit me?
There are many types of injections that are utilized to treat pain conditions. Some examples of injection therapy include epidural steroid injections, selective nerve root blocks, radiofrequency ablation, trigger points injections, sacroiliac joint injections, and peripheral joint injections. Injection therapy can be very successful in alleviating pain and allowing patients regain their quality of life.

How soon will I see results?
The timing of results depends on the type of injection that is performed. There are many procedures that lead to immediate relief. Other injections may take days or weeks to achieve maximum pain relief.

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Through our Barrow NeuroSpine and Rehabilitation Medical Director, Dr. Raj Singh, patients have access to the Healthy Living program. The concept of the program is simple but important: Americans are living longer but not necessarily healthier. This program consists of a triphasic approach to wellness, which involves proper and healthy nutrition, sensible weight loss, individualized exercises and a tailored fitness program.

Patients also have access to metabolic and hormonal evaluation, which consists of several blood tests. Depending on the results, metabolic disorders such as abnormal thyroid function, diabetes, abnormal blood lipids, and abnormal hormones can be corrected and optimized. Correction of these metabolic disorders improves health, helps with weight loss, and improve energy, vitality and sleep.

In motivated individuals, results can often be surprising in ways patients hadn’t imagined. A healthy and enjoyable lifestyle can be achieved along with disease and injury prevention.

These complementary techniques can be extremely helpful in expediting your recovery, especially when used in tandem with traditional approaches. Proper nutrition, health, and exercise is becoming one of the primary indicators of whether other traditional treatments will work.

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