Back Pain & Sciatica · Interventional, Non-Surgical Orthopedics · Glastonbury, CT
Most back pain evaluations stop at the MRI. Dr. Paul Tortland, DO, FAOASM, CAQSM, RMSK, an interventional, non-surgical orthopedic physician, looks for the structure actually generating your pain, then walks you through every reasonable option, including surgery when it is the better choice.
Quick answer
Back pain can come from facet joints, the sacroiliac joint, paraspinal muscles and ligaments, discs, or irritated nerve roots. A disc bulge on MRI does not prove the disc is the cause: over half of people with no back pain have one. Sciatica is also frequently misdiagnosed, because leg pain can come from several sources besides a pinched nerve. Dr. Tortland combines your history, a physical exam, a review of your imaging, and a live musculoskeletal ultrasound exam in the same visit. Treatment may include rehabilitation, interventional procedures such as epidural injections and nerve hydrodissection, ultrasound-guided PRP or prolotherapy for selected conditions, or referral to a spine surgeon when that is the right path.
Most common causes seen
Facet joint pain, SI joint pain, sciatica and nerve-root pain
Diagnosis method
History, exam, imaging review and live ultrasound in one visit
Interventional options
Epidurals, nerve hydrodissection, PRP, prolotherapy
First visit
At least an hour, $500, ultrasound included
Physician
Paul Tortland, DO, FAOASM, CAQSM, RMSK
Who treats you
Dr. Tortland personally, every visit
When surgery is right
Significant stenosis, instability, or nerve compression causing progressive weakness
Insurance
Regenerative procedures not covered; HSA / FSA eligible
When to see a doctor
Book an evaluation if your back pain has lasted more than a few weeks, keeps coming back, limits your work, sleep or activity, or has not improved with physical therapy, medication, or injections, or if it comes with pain, numbness, or tingling down a leg. A second opinion before spine surgery is also a good reason to come in.
Seek emergency care right away, not an office visit, if you have new loss of bowel or bladder control, numbness in the groin or inner thighs, rapidly worsening weakness in a leg or foot, back pain after a significant fall or accident, or back pain with fever, unexplained weight loss, or a history of cancer.
For everything else, the most important question is what is actually generating the pain. An MRI report that says "bulging disc" is often handed to patients as if it explains everything, and often it does not: a landmark study of 98 people with no back pain found 52% had a disc bulge and 27% had a disc protrusion anyway. Facet joints, the sacroiliac joint, and paraspinal muscles and ligaments are frequently the real source, and they get overlooked when a clinician goes straight from "disc finding" to "disc is the problem."
Common causes
The back pain and sciatica conditions seen most often in this practice, including sciatica that has been misdiagnosed elsewhere, treated with interventional and non-surgical care whenever the diagnostic workup supports it.
Validate · Investigate · Treat
01
An unrushed first visit of at least an hour focuses on locating the actual pain generator: facet joints, paraspinal muscles, the sacroiliac joint, the disc, or an irritated nerve. Live musculoskeletal ultrasound is performed in the same visit.
02
Your MRI, CT, and X-rays are compared against the exam findings. For leg pain, this step separates true nerve-root sciatica from look-alikes such as sacroiliac or facet-referred pain, a common source of misdiagnosis.
03
Treatment targets the identified pain generator, not a generic "back pain" protocol. You are shown every reasonable option, from rehabilitation and interventional procedures to regenerative treatment or a surgical referral.
04
For sciatica and nerve-root pain, Dr. Tortland performs interlaminar, transforaminal, and caudal epidural injections, including the "sweet caudal" (a caudal epidural using dextrose), as well as ultrasound-guided nerve hydrodissection.
05
For selected facet, ligament, and paraspinal pain generators, PRP is custom-prepared on site to 12 to 15 times baseline platelet concentration (commercial bedside kits typically reach 2 to 7 times) and placed under live ultrasound, often reaching the facet capsule, medial branch nerve, and paraspinal muscle through a single skin entry point. Prolotherapy may be used for sacroiliac or facet-region ligament laxity.
06
You leave with written instructions specific to your spine and the procedure performed. After a regenerative injection, expect two to five days of soreness and avoid 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
Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.
03
Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007;(2):CD004059.
05
Maniquis-Smigel L, Reeves KD, et al. Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial. Anesth Pain Med. 2016;7(1):e42550.
**Medical Disclaimer:** Information on this page is provided for educational purposes and does not constitute medical advice, diagnosis, or treatment, guarantee a particular outcome, or establish a physician-patient relationship. Treatment suitability and expected results vary by patient and depend on individual clinical circumstances and the available scientific evidence. The inclusion of a procedure, treatment, or therapy on this website does not mean that it is appropriate for every patient, effective for every condition, superior to other treatment options, or guaranteed to produce a particular result. Orthobiologic procedures discussed on this website are medical procedures performed under the practice of medicine. The FDA regulatory status of any particular product, device, or use may vary, and FDA approval or clearance should not be inferred unless specifically stated. Dr. Tortland reports no financial interest in the products or devices described on this page. Individual results vary, and treatment decisions require an appropriate clinical evaluation, including an in-person examination when indicated.
Candidacy is determined on exam and imaging, not over the phone. Bring your MRI and get an honest answer in one visit.