Back Pain · Finding the Real Cause · Glastonbury, CT
Most back pain comes from a disc, a pinched nerve, or a stiff or worn joint, and each needs a different plan. Dr. Tortland looks for the actual source of your pain rather than assuming MRI findings explain it, then pairs rehabilitation with targeted injections when appropriate.
Quick answer
Most back pain comes from a disc, a pinched nerve, or a stiff or worn joint, and each needs a different plan. An MRI finding is not always the cause: many people with no pain have disc bulges. Dr. Tortland checks the discs, nerves, facet joints, SI joint and muscles to find the true source. He has treated more than 20,000 patients in his practice.
Most common conditions
Disc, pinched nerve, facet joint and SI joint problems
Diagnosis method
Exam and live ultrasound where it can see the problem
Non-surgical options
Ultrasound-guided PRP, BMA, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
PRP weeks 4 to 10 by area; BMAC or MFAT weeks 6 to 16
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Leg weakness, loss of bladder or bowel control, or severe narrowing that does not settle
Out of network, direct pay
Not covered; but HSA / FSA applicable
Definition
The spine gets treated like a disc-only problem far too often. It usually isn't.
An MRI report that says "bulging disc" or "herniated disc" is often handed over as if it explains the pain, and often it does not. A well-known study of 98 people with no back pain found that 52% had a disc bulge and 27% had a disc protrusion on MRI anyway. The small joints at the back of the spine (facet joints), the sacroiliac (SI) joint, the nerves and the back muscles are often the real source. Dr. Tortland examines you, then uses live ultrasound to look at the muscles, joints and soft tissue before assuming the disc is to blame. Neck pain has its own page.
Indications
Select a condition to explore common causes, symptoms, and non-surgical treatment options.
Treatment options
Back pain treatment depends on the structure causing symptoms. Dr. Tortland evaluates the likely pain generator first, then discusses options suited to the diagnosis rather than treating an MRI finding alone.
When the diagnosis and clinical findings support them, options may include ultrasound-guided PRP for selected spinal structures, prolotherapy for selected ligament or joint-related pain, nerve hydrodissection for suitable nerve entrapment, and image-guided spine injections such as epidurals for indicated nerve-root pain. Intradiscal PRP is a specialized option for carefully selected cases; evidence and uncertainties should be discussed, not assumed.
Physical therapy, progressive exercise, activity modification and a home program are often important parts of care. Depending on the diagnosis, medications or other conventional treatments may also be considered. Surgery can be the better option for selected structural problems or concerning neurologic findings.
No single treatment fits every type of back pain. The potential benefits, limitations, risks and alternatives should be reviewed for your diagnosis and goals.
Step by step
01
Your history and exam focus on finding the real source of the pain (the small joints at the back of the spine, the back muscles, the SI joint, a nerve or a disc) instead of assuming the disc finding on your imaging report explains it.
02
Any MRI, CT and X-ray you already have is compared with what the exam finds, so the treatment matches the true source.
03
Treatment is aimed at the source that was found, with rehab as the base, rather than a generic back pain plan.
04
When PRP, BMA or prolotherapy is the right next step, it is prepared in the on-site laboratory during the same visit and matched to your age, condition and baseline platelet or cell count, not a preset commercial kit. Dr. Tortland's process derives significantly higher concentration than most standard commercial kits produce.
05
The injection is placed under live ultrasound where the target can be seen. Deeper spots in the lower spine can be hard to see with ultrasound alone, so X-ray guidance may be used instead.
06
You leave with a written recovery plan for your spine and the treatment given. Expect soreness for a few days after an injection. Avoid anti-inflammatory medicines such as ibuprofen for two weeks unless you are told otherwise.
07
Follow-up within 6 weeks to 3 months to compare your symptoms against baseline and decide on next steps, with repeat imaging when appropriate.
Candidacy
Want a closer look at what is actually causing your back pain, and how it is treated without surgery?
Back Pain: Finding the Real Cause →Comparison
Frequently asked
Sources
01
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
Candidacy is decided on exam and imaging, not over the phone. Your first visit is a $500 evaluation with live ultrasound. Bring your MRI and get an honest answer in one visit.