Back & Neck Pain · Finding the Real Cause · Glastonbury, CT
Most spine evaluations stop at the MRI. This one doesn't. Dr. Tortland's approach is built around identifying the actual pain generator — not just the disc findings on your report and, for the neck, testing for instability that static imaging cannot show.
Quick answer
An MRI showing a bulging or herniated disc does not automatically mean the disc is what's causing your pain. A landmark study found that over half of people with zero back pain have a disc bulge on MRI, and 27% have a disc protrusion — meaning these findings are often coincidental. Dr. Tortland's evaluation looks past the disc to paraspinal muscle, facet joints, and other extradiscal structures that are frequently the actual pain generator. For chronic neck pain, especially after an injury, when standard imaging is negative he may recommend digital motion X-ray (DMX) to evaluate for ligamentous cervical instability — a diagnosis static MRI and CT often miss entirely.
Most common conditions
Facet arthropathy, paraspinal pain, cervical instability
Diagnosis method
Live ultrasound, exam, and DMX when indicated
Non-surgical options
Ultrasound-guided PRP, BMA, prolotherapy
Return to activity
Usually within days; depends on treatment
First results
Weeks 4 to 16, depending on treatment
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Stenosis, instability, or radiculopathy needing decompression
Insurance
Not covered; but HSA / FSA applicable
Definition
The spine gets treated like a disc-only problem far too often. It usually isn't.
For the back: an MRI report that says "bulging disc" or "herniated disc" gets handed to patients constantly as if it explains the pain — and often it doesn't. A landmark study of 98 people with zero back pain found 52% had a disc bulge and 27% had a disc protrusion on MRI anyway. Facet arthropathy, paraspinal muscle dysfunction, and other extradiscal structures are frequently the real pain generator, and they get overlooked when a clinician goes straight from "disc finding" to "disc is the problem." Dr. Tortland's evaluation examines the paraspinal muscles, facet joints, and surrounding soft tissue on live ultrasound before assuming the disc is guilty.
For the neck: when chronic neck pain follows an injury and standard MRI or CT comes back negative, that doesn't mean nothing is wrong — it may mean the wrong test was ordered. Static imaging cannot show ligamentous instability, because the ligaments that hold the cervical vertebrae in proper alignment often only fail to do their job when the neck is actually moving. Digital motion X-ray (DMX) captures the cervical spine in real time through flexion, extension, and lateral bending, and can identify instability that a motionless MRI or CT will miss entirely — a diagnosis many other doctors don't test for and therefore don't find.
Indications
The back and neck conditions seen most often in this practice, treated without surgery whenever the evidence and the diagnostic workup support it.
Step by step
01
The exam and history focus on locating the actual pain generator — facet joints, paraspinal muscle, sacroiliac joint, or disc — rather than assuming the disc finding on your imaging report explains your pain.
02
Existing MRI, CT, and X-ray are reviewed against the exam findings. For chronic neck pain after an injury with negative standard imaging, digital motion X-ray may be ordered to evaluate for ligamentous cervical instability that static imaging cannot detect.
03
Based on the diagnosis, treatment targets the actual pain generator — facet joint, paraspinal structure, or, for select cases, the lumbar spine's deeper anatomy — rather than a generic "back pain" protocol.
04
When PRP, BMA, or prolotherapy is the right next step, it's prepared in an on-site laboratory the same visit and customized to the patient's age, injury, and baseline platelet or cell count never a preset commercial kit. Dr. Tortland's process derivessignificantly higher concentration than most standard commercial kits produce.
05
The injection is placed under live ultrasound guidance — for the spine, an experienced practitioner can reach the transverse process, facet capsule, medial branch nerve, and paraspinal muscle through a single skin entry point.
06
You leave with a written loading schedule specific to your spine and the treatment given. Expect two to five days of soreness after an injection — that response is part of the treatment working. No anti-inflammatories for two weeks.
07
Follow-up at six to ten weeks to compare your symptoms against baseline and decide on next steps, with repeat imaging when appropriate.
Candidacy
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.
02
Dai WL, et al. Efficacy of platelet-rich plasma versus hyaluronic acid in knee osteoarthritis: meta-analysis of randomized controlled trials.
03
Filardo G, et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: evidence and indications.
05
Bennell KL, et al. Effect of intra-articular platelet-rich plasma on knee pain and cartilage volume: randomized clinical trial.
This page is written for patient education and does not constitute medical advice or establish a physician-patient relationship. Treatment decisions require an in-person examination. Orthobiologic procedures are not FDA-approved drug therapies; they are performed as autologous same-day procedures under the practice of medicine. Dr. Tortland reports no financial interest in the products or devices described on this page.
Candidacy is determined on exam and imaging, not over the phone. Bring your MRI and get an honest answer in one visit.