Back Pain

Middle and Lower Back Pain, Disc Herniation, Pinched Nerves and Spinal Stenosis

Middle and lower back pain is a common complaint. Back pain can become chronic and worsen over time if left untreated. In general, symptoms lasting more than two weeks or symptoms that are getting worse should be checked by a doctor. If the pain begins to radiate to the hip, buttock or down the leg you should see a doctor. The history, precise location and severity of your back pain provide important clues in determining what might be causing it. It is also common for middle back pain to radiate to the shoulder blades or rib cage.

What Causes Middle and Lower Back Pain?

  • Strains between the shoulders or ribs
  • Abnormalities in the bone or joints
  • Trauma
  • Poor posture
  • Arthritis – Degenerative diseases
  • Tumors
  • Muscle strain
  • Herniated disc
  • Pinched nerves
  • Joint inflammation

How Is Back Pain Diagnosed?

History and Examination: A history of your complaints including duration, what makes it better and worse is very important. Previous treatments and outcomes, as well as orthopedic examination of the muscles, joint, movement and strength are also used for diagnosis.

X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.

MRI: Magnetic Resonance Imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements.

Myelography/CT scanning: Sometimes used as an alternative to MRI

Electrodiagnosticstudies: Nerve Testing: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnosis neck pain, arm pain, numbness and tingling.

What Treatments Do We Offer To Help Back Pain?

Our multi-specialty team is medically supervised and treatments can include one or a combination of prescription medication, physical therapy, chiropractic manipulation, trigger point injections, epidural nerve blocks or facet joint injections.

New Treatment Using LIPOGEMS® Could Be the Answer for Arthritis Pain

LIPOGEMS® is a new treatment option for arthritis pain now offered by Dr. Norma Bilbool, M.D., a double board certified physician specializing in Physical Medicine and Rehabilitation and Pain Medicine and Richard D. Striano D.C., RMSK Registered in Diagnostic Medical Musculoskeletal Sonography. The combination of advanced imaging techniques with ultrasound to diagnose and precisely guide treatment, and physician experience with treating all joints with minimally invasiveLIPOGEMS® has led to the majority of patients treated having significant improvement with less pan, improved function and quality of life.

LIPOGEMS® could be the solution to those who suffer from pain in the shoulder, lower back, hip, knee, ankle and other joints including the rotator. Optimum Joint, is equipped and has been performing ongoing clinical studies on the shoulder, rotator cuff, lower back, hip and ankle pain where a patient’s own fat is used to alleviate arthritis related conditions many of which have failed to respond to other treatment methods including bone-on-bone joints. Optimum was among the first practices in the USA trained in the state-of-the-art treatment through LIPOGEMS® technology that is a minimally invasive same day procedure, performed in about an hour, using local anesthetic with no sedation required and no down time. This could be the answer for many of those looking to avoid surgery.

The Autologous (fat from you and put back into you) Micro-Fragmented Adipose Tissue (LIPOGEMS®) is a NEW technology where fat is taken from the patient, using a local anesthetic, washed, and micro-fragmented, using the LIPOGEMS® system. Micro-fragmented fat using the LIPOGEMS® system mechanically supports and cushions joints, and holds regenerative capabilities and when re-injected can decrease inflammation, cushion, repair or replace defects in damaged tendons and cartilage, or other tissue.

The fat is injected using continuous ultrasound guidance to ensure pin point accuracy in treating the joint and surrounding damaged tendons to repair and restructure damaged tissue with pin-point accuracy. Research has shown non-guided “blind” injections are accurate 36% – 60% of the time while ultrasound guided injections are 100% accurate. Accuracy in delivering regenerative treatments is essential. We are evaluating the LIPOGEMS®, made with an FDA cleared device, for their ability to cushion, repair, or replace damaged tissue and the regenerative effects of the fat it contains, to jump-start repair and decrease inflammation.

“This is an extraordinary study because of its use of micro-fragmented fat tissue, which makes it more bioavailable to the area we inject, and by using the precision of ultrasound guidance the treatment is visualized being delivered to each area of the joint and tissues in need of repair. This combination of support and regenerative regenerative elements with the precision of advanced ultrasound guidance is contributing to the long term impressive results.

 NEW STUDY: Adipose tissue contains Adipose Derived Stem Cells “ADSC’s” and more than 600 secreted proteins and included key molecules involved in tissue regeneration. Stem Cell Res Ther. 2015; 6: 221.

NEW STUDY: Lipogems Product Treatment Increases the Proliferation Rate of Human Tendon Stem Cells without Affecting Their Stemness and Differentiation Capability. Results showed that the Lipogems product significantly increases the proliferation rate of hTSCs (human tendon stem cells). Moreover, treated cells increase the expression of VEGF, which is crucial for tissue healing. Stem Cells International Volume 2016 (2016), Article ID 4373410, 11 pages

Dr’s Bilbool and Striano are among few doctors in the country offering IRB- approved regenerative treatment options, with a focus on minimally invasive alternatives to surgery. Their work has been recognized and new studies are being published this year.

Pain Medicine

Because back pain arises from a variety of sources, many patients require pain management with prescription medication when over the counter medications likeAleve, Motrin, Tylenol or Advil do not provide relief.

Have you tried Physical Therapy in the past and it hasn’t worked for you?

A Different Approach Other Than Routine Painful Exercises:

We see many patients who come to us in chronic pain. Many have also had experience with physical therapy where they spent much of their sessions doing exercises and it hasn’t helped. Think of being in pain, having joint stiffness, loss of range of motion or chronic inflammation and then doing exercises to get rid of it. In most cases, you’ll feel worse not better.

Exercise is critical to maintain proper joint strength, but done at the wrong time and your pain often becomes worse. That is why we take an entirely different approach with treatment plans using three phases:

  • Therapeutic Modalities:

Our physical therapy team specializes in using certain modalities like electrical stimulation or ultrasound to reduce swelling and inflammation and increase local circulation to help the healing process. Different modalities can be applied to successfully address spasm, trigger points, inflammation, edema, swelling and damage from tendonitis and tears.

  • Joint Release Techniques:

Techniques are done by hand to gently stretch, massage and release the pressure in each of the muscles, tendons and ligaments surrounding the joint. The result is a soothing improvement in joint pain.

  • The Selective Functional Movement Assessment:

Our physical therapy team is certified in the Selective Functional Movement Assessment (SFMA), which is a series of 7 full body movement tests designed to assess fundamental patterns of movement such as bending and squatting in those with known joint pain. When the clinical assessment is initiated from the perspective of the movement pattern, our therapy team has the opportunity to identify meaningful impairments that may be seemingly unrelated to the main joint pain complaint, but contribute to the pain.

Think of having a painful right knee and favoring that side for an extended period of time. Following a period of uneven gait you may develop pain on the opposite unrelated side. This concept, known as Regional Interdependence, is the hallmark of the SFMA.

The assessment guides our clinical physical therapist to the most dysfunctional non-painful movement pattern, which is then assessed in detail. By addressing the most dysfunctional non-painful pattern, the application of targeted interventions (manual therapy and therapeutic exercise) is not adversely affected by pain.

Chiropractic Care

Doctors of Chiropractic are experts in detecting areas in the spine where there is a loss of movement and local inflammation that causes irritation to delicate spinal nerves, muscles, ligaments and tendons.

Dr. Striano is an expert in gentle manipulation techniques to ease pressure in the joints of your spine. By gently stretching the muscles, using pressure applied in areas of spasm and tenderness and mobilizing the vertebra or spinal bones, painful inflammation and irritation is resolved.

Dr. Striano’s skillful chiropractic care is gentle, safe and effective in managing spinal pain. He is also skilled in manually relieving trigger point pain in tender muscles and tendons.

Dr. Striano is board eligible through the American Registry for Diagnostic Medical Sonography (ARDMS) to be one of the first doctors in the USA to become certified in Diagnostic Musculoskeletal Ultrasound Imaging (RMSK).

Dr. Striano regularly attends several conferences per year on ultrasound diagnosis and ultrasound guided medical procedures in interventional medicine taught by leading doctors and radiologists from all over the world at various national locations including The Mayo Clinic.

Dr. Striano has spent the past 15 years in the multi-specialty field workinghand in hand as a team with the physicians and physical therapists at Optimum Joint to provide the leading edge in cooperative care for the joints and spine. His vast experience and knowledge is applied on a daily basis in pain management.

Trigger Point Injections:

Arthritis and Trigger Point Injections: Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. Local corticosteroid injection is often helpful for trigger points and arthritis.
Injections adjacent to the spine, called para-vertebral injections are administered using continuous live ultrasound guidance ensuring pin point accuracy exactly where the injection is needed.

What Happens During a Trigger Point Injection?
In the TPI procedure, a small needle is guided under continuous ultrasound imaging into the painful trigger point. The injection contains a local anesthetic that sometimes includes a steroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment that can include weekly injections over the course of several weeks is required to alleviate all of the pain resulting in sustained relief. The injections are not painful, as the skin is first coated with a freezing spray and a local anesthetic is used. Injections take just a few minutes and you’re on your way. Several sites may be injected in one visit. If there are allergies to a certain drug, a dry-needle technique (involving no medications) can be used.

When Are Trigger Point Injections Used?
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. The techniques are also used to treat myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) when unresponsive to other treatments.

Epidural Spinal Injection: Using local anesthetics

Patients with known diagnoses of herniated discs or pinched nerves in their neck have complaints that include numbness and tingling, as well as weakness in the arms or hands. Patient may feel weakness in the grip, holding or squeezing objects.

What is the epidural space?

The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the neck, shoulder and arms. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structure of the spine in some way.

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, reducing the pain in the neck, shoulders and arms, as well as numbness and tingling into the arms. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or a period of pain relief for several months while the injury or cause of pain is healing.

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient where patients are able to pick up and go right after their visit.

What happens during the procedure?

The patient is placed on the injection table with stomach facing downward.The injected area is cleaned and sterilized and a local anesthetic is administered to numb the area of the injection site. After the numbing medicine has been given time to be effective, we direct a small needle, using x-ray guidance called fluoroscopy into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Facet Joint Injection

The small joints in your neck that guide movement back and forth, up and down and around arecalled facet joints. They are small circular joints that are surrounded by a joint capsule. Facet joints are commonly affected by arthritis and inflammation of the capsule called capsulitis. This type of condition results in stiffness and pain with ranges of motion and physical activity, in addition to the constant need to change sleep positions.

When the facet joints and capsules are the primary problem, pain is most often localized to the neck on either side, and usually does not include numbness or tingling into the arms or hands.

What is a Facet Joint Injection?

Facet Joint Injection is an injection of long lasting steroid (“cortisone”) in the facet joints, which are those that guide movement in your neck. These are actual joints with joint capsule that contains lubricating fluids.

What is the purpose of a Facet Joint Injection?

The injected steroid reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation and irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like Lidocaine or bupivacaine) and the steroid medication (methylprednisolone – Depomedrol).

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia. This makes the visit quick and convenient, allowing patients to get up and go right after.

How is the injection performed?

It is done lying on the stomach. The skin on the back of the neck is cleaned and sterilized, and local anesthetics injected to numb the injection site. Using x-ray guidance (called fluoroscopy) a small needle is guided to the facet joint. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the facet joint capsule. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. In some cases where the arthritis covers several locations, more than one joint can be injected during the same visit.

Patients are able to get up and drive home after the procedure, as we do not use any general anesthesia. The procedure is performed in the office and takes approximately 30 minutes.

Our Mission Statement

We want to make a difference. We are dedicated to providing our patients with updated and current treatment alternatives for adults suffering with joint and spine pain. Our staff regularly attends several conferences per year on ultrasound guided interventional medicine with new and innovative, as well as traditional techniques in treating joint pain. This allows us to utilize and implement the practices and techniques of leaders in diagnostic ultrasound imaging and ultrasound guided treatment from Europe, Asia, Canada and the United States at prestigious institutions including the Mayo Clinic. We remain on the cutting edge of treatment objectives to help our patients feel better!



Can an OptimumJoint traditional or regenerative medical procedure help me? To find out if you might be a candidate for an OptimumJoint medical treatment procedure, complete our Optimum Joint Procedure Candidate Form online.