Information for Doctors
Dear Doctor,
A common PCP dilemma is deciding what to do with a spine patient whose MRI report says “HNP” or “disc herniation”: Is this a surgical candidate or not? Who will interpret the films in light of the patient presentation? The most important services we provide in this and similar scenarios are to view and correlate a patient’s imaging studies with a comprehensive spine history and functional exam.
Statistically, because there is a 30% prevalence of a herniated disc on MRIs of asymptomatic 40 year-olds, and, because 90% of herniated discs heal without surgery, there is a good chance that a patient with an abnormal study can be managed non-invasively—or at least should try.
All films are personally reviewed with each patient to teach and reassure, provide a realistic prognosis, and involve him/her in the therapeutic plan. We maintain our own radiology PACS system to permanently archive all patient studies for instant retrieval.
If your patient needs to be seen immediately (within 24 hours), please phone the office to bypass the regular scheduling queue.
If your patient's condition is already well-defined, he/she can be referred directly for physical therapy with a PT order. If your patient needs more workup and/or imaging, please refer to us for a physical medicine consult where we are happy to complete the evaluation and further manage the case.
We strive to keep you in the loop about your patient, to clearly communicate our impression and plan of care.
Although spine care is typically episodic, any patient that has seen us in the past may easily re-enter our care should there be future issues.
Because we enjoy a politically neutral and friendly standing in the medical community, your patients retain the full breadth of future options should their condition require input of other consultants.
We embrace the consensus evidence-based spine care algorithm (similar to that for cardiac care) whereby evaluation and treatment is stepped and proportionate to symptoms and diagnosis. We look for “worst things first” in screening for red flag conditions prior to any other treatment.
If/when patients need consultation or treatment by a pain specialist or spine/neurosurgeon, we always “package” the patient, and in most cases speak directly to the consultant to assure seamless care.
Partial list of conditions with which we have extensive experience evaluating and/or treating:
- degenerative disc disease
- protrusions and disc herniations
- facet syndrome and facet disease
- SI dysfunction
- spondylolisthesis (degenerative or spondylolytic etiology)
- scoliosis
- central and neuroforaminal spinal stenosis
- compression fractures
- radiculopathies
- referred pain
- thoracic outlet syndrome
- abnormal posture and its consequences
- muscle spasm and muscle-contraction headaches
- macromastia
Other problem areas (e.g., shoulder, hip, knee) and conditions (e.g., tennis elbow and plantar fasciitis) often accompany primary conditions noted above, thus are naturally part of our repertoire to evaluate and treat.
Our physical therapists have additional strong interests in women’s issues to include pelvic pain, dysmenorrhea, (without underlying endometriosis), urinary incontinence (stress, urge and mixed), dyspareunia, cystocele and rectocele. These conditions often accompany similar muscular imbalances and weaknesses as are addressed in spine rehab. To ensure privacy, your patient can be referred directly into PT.
