Living Pain-Free: Back pain
Are you living with pain? Whether you suffer from joint pain or muscle pain, this program is here to help. Welcome to Living Pain-Free with Dr. Marc Darrow, MD, and Dr. Thomas Grove, DO, from the Stem Cell Institute in West Los Angeles. This show offers effective solutions for pain you may have been dealing with for years.
Dr. Marc Darrow is a board-certified medical doctor who studied at UCLA. He specializes in using stem cell therapy and platelet-rich plasma (PRP) to promote healing within your body. Dr. Darrow is dedicated to teaching about the benefits of stem cells, PRP, and prolotherapy for pain management and recovery.
Dr. Thomas Grove is a regenerative medicine specialist with expertise in ultrasound-guided injections. His background includes extensive experience as an athlete and a strength and conditioning coach. Dr. Grove’s knowledge and skill in regenerative techniques offer hope for those seeking a life free from pain.
Back pain
Many people follow the traditional route of pain medication, anti-inflammatories, steroid shots, and even elective orthopedic surgery. If you wonder whether another option exists to help heal and fix your problem, regenerative medicine may be the answer. This approach harnesses your body’s own healing cells, including platelets and stem cells found in fat, blood vessels, and bone marrow. These cells use molecular signals, such as exosomes, to jumpstart the healing process.
The central philosophy of regenerative medicine is to heal the body from the inside out, rather than simply masking pain. By addressing the root cause and promoting natural healing, the aim is to keep you moving and avoid unnecessary surgery. If you or a loved one is dealing with aches or pains, considering surgery, or recovering from a previous operation, this program offers a conservative path forward to address your symptoms and improve your quality of life.
Many people experience anxiety when reviewing their radiology reports, especially if they indicate significant damage to the spine. This concern is understandable, as spinal issues are a leading cause of disability worldwide. Among the most frequent causes of low back pain are problems with ligaments, tendons, and muscles. Injuries such as sprains to the strong ligaments in the lower back are common, much like spraining an ankle. While radiology reports often highlight disc issues, these are not always the primary source of pain.
Disc Issues and Imaging Findings
Disc problems, such as protrusions or bulges, are widely observed in imaging studies. One notable study from the American Journal of Neuroradiology in 2015 (1) systematically reviewed imaging features of spinal degeneration in populations without back pain. The findings demonstrated that a large majority of people over age 40, even those with no back pain, showed disc abnormalities on imaging. This evidence suggests that disc changes are frequently a part of normal aging and do not necessarily cause pain.
Basic Anatomy of the Lower Back
The lower back, or lumbar spine, consists of five vertebrae known as L1 to L5. L1 is located closer to the midback, while L5 is situated lower down. These vertebrae are the largest bones in the spine compared to those in the upper back or neck. The lumbar vertebrae connect to the big pelvic bones, called the ilium, on either side. Attached directly to the lower back is the sacrum, a large, triangular bone made up of five fused bones. Numerous ligaments, tendons, and muscles bind these structures together.
Functions and Importance of the Lumbar Spine
The lumbar vertebrae provide stability to the entire spinal column and serve as major attachment points for muscles and ligaments. These structures handle significant forces during activities such as walking, running, and jumping, transmitting body weight through the lumbosacral junction. The lumbar area is the most common site for injuries due to its involvement in movement and exercise. It also protects crucial body structures like the spinal cord.
Disc Damage and Herniation
The spine is divided into three main sections: the cervical spine (neck), thoracic spine (upper back), and lumbar spine (lower back). Among these, the lumbar region is most frequently affected by injuries, which can greatly impact mobility and daily activities. Neural networks are the primary systems responsible for sensing pain, temperature, and movement, as well as allowing us to feel touch. These networks are essential for controlling and protecting our bodies, making them very important to our overall health and function. In medicine, much attention is given to the intervertebral discs. This focus is largely due to the frequency of surgical procedures performed on discs. Medical imaging techniques such as CT scans, MRIs, and X-rays often prioritize examining the discs. When abnormalities are detected, surgery is frequently considered as a treatment option.
Is the Disc the Problem?
It is crucial to determine whether a disc abnormality is truly causing pain, as many individuals have disc issues visible on imaging but experience no associated discomfort (as discussed above). It is important to recognize that not all disc abnormalities cause pain. Clinicians must match imaging findings with the patient’s clinical presentation, reproducing symptoms through physical examination and listening to the patient’s description of their issues. Without such correlation, the disc should not be assumed to be the main source of pain.
The disc itself is a strong, shock-absorbing structure situated between the vertebrae. It consists of two main parts: the tough outer layer known as the annulus fibrosis, which is composed of 15 to 25 fibrous rings similar to those seen in a tree trunk, and the inner jelly-like layer called the nucleus pulposis. These structures are made primarily of water and type II collagen, with the annulus fibrosis being particularly resilient to the forces encountered during everyday movements such as walking, jumping, squatting, and lunging.
Despite their toughness, discs can suffer various forms of damage. One severe form is a large herniated disc, which may also be referred to as disc sequestration. When the outer layer weakens, the inner jelly layer can protrude through this weak point, potentially compressing a nerve or the spinal cord. This compression can result in symptoms such as weakness or numbness that radiates down the leg, sometimes described as a lightning bolt of pain, a condition known as radiculopathy.
Treatment Approaches
The primary approach to addressing disc issues often involves attempting to fix the imaging abnormality, most commonly through surgery. However, studies have shown that conservative treatment, such as avoiding surgery, may be effective for patients with significant disc herniations and symptoms.
Stem cell therapy for failed back surgery syndrome | Postoperative chronic back pain syndrome
Spontaneous Regression of Lumbar Herniated Discs
A significant study published in 2015 in the journal Clinical Rehabilitation(2) investigated the likelihood of spontaneous regression in patients with lumbar herniated discs. The study, titled “The Probability of Spontaneous Regression of Lumbar Herniated Disc: A Systematic Review,” examined a large group of individuals diagnosed with disc herniations who chose not to undergo surgical intervention.
The key findings from this research revealed that 96% of these patients experienced spontaneous improvement in their symptoms. This high percentage demonstrates that the majority of lumbar disc herniations may resolve on their own, without the need for surgery. These results suggest that conservative management can be highly effective for most individuals dealing with disc issues, offering reassurance that symptoms often improve naturally over time.
Challenges of Traditional Pain Management
Throughout my career, which now spans almost two decades, I have witnessed significant progress in injection techniques. As technology continues to improve, we now have the ability to visualize anatomical details more clearly, enabling us to inject areas that were previously inaccessible. Today, our focus is on lower back treatments, and spine injections have become one of my preferred procedures thanks to extensive training and the high frequency of patients presenting with these issues.
Managing pain in the traditional sense often involves medication that simply masks discomfort without addressing the underlying cause. While this approach may provide short-term relief, it does not contribute to true recovery. I am not a strong proponent of methods that only block pain temporarily, as feeling better does not necessarily equate to healing.
Limitations of Conventional Injection Techniques
Examining the science behind standard pain medicine techniques reveals their limitations. For example, numbing injections may provide immediate relief, but they do not resolve or heal the affected tissue. The research further indicates that numbing medications and steroid shots can be toxic to tissues. This means that not only are we failing to address the root problem, but we may also be contributing to long-term tissue damage.
Although conventional methods can offer temporary improvement—sometimes lasting days or even months—the ultimate goal should be to promote tissue healing and regeneration. Preserving structural integrity and restoring mobility are critical objectives. The aim is to support your recovery from the inside out, keeping you active and avoiding unnecessary elective orthopedic surgeries whenever possible.
Even successful interventions do not guarantee a lifetime free from pain, as it is possible to sustain a new injury in the future. This presents a challenge, particularly for active individuals. While we can often resolve issues, reinjury may occur, requiring further treatment. Patients might report that relief lasted for a couple of years before symptoms returned, which often signals a new injury rather than a failure of the original treatment.
Fortunately, our approach allows for repeated targeted injections to stimulate healing as needed. The goal remains to heal tissues internally, minimize surgical interventions, and help patients maintain an active lifestyle. This kind of regenerative medicine represents, in my view, the most rewarding work in healthcare.
Let’s return to today’s topic—lower back pain. This is an area with a wealth of research, and I wanted to highlight some of my favorite studies for discussion.
Research Studies on Lumbar Disc Herniation
One notable study from 2010 was published in the Spine Journal (3), which is the official journal of the North American Spine Society. The study was titled “Inciting Events Associated with Lumbar Disc Herniation.”
Researchers examined approximately 150 patients who were experiencing pain due to lumbar disc herniations. Participants were asked to identify the exact moment when their pain began. Traditionally, it was thought that lumbar disc herniation would occur during a high-intensity activity, such as a maximum effort deadlift, squat, or other heavy lifting. However, the study revealed some surprising results. About 26% of participants could pinpoint a specific inciting event, which often involved everyday tasks—such as rolling out of bed or picking up groceries from the floor. In contrast, only about 6% reported that their pain started during a heavy lifting activity. This finding suggests that most disc herniations are not caused by a single intense event, but rather by ongoing, subtle wear and tear mechanisms.
These results reinforce the idea that the spine is strong and resilient, and that we should not be afraid to use it. Resistance training, in particular, is a valuable component of holistic healthcare. Strengthening the muscles surrounding the spine through exercise can help prevent injury and improve overall health.
When injuries prevent you from exercising, regenerative medicine offers a promising solution. This approach involves harnessing the body’s healing cells—such as platelets from blood or stem cells from bone marrow—and injecting them into affected areas to promote healing and help patients regain mobility. An injury that stops you from exercising can trigger a cascade of health issues: weight gain, hormonal imbalances, disrupted sleep, loss of muscle mass, decreased bone density, osteoporosis, and even fragility fractures. Resistance training is an effective way to reverse many of these negative effects.
Part 2
Many individuals experience disc herniations but can recover on their own without the need for surgery. It is important to note that having a disc issue is common, and it does not always result in back pain. This is a confusing area of medicine because the presence of disc abnormalities on imaging does not always correlate with symptoms.
The Role of Imaging and Physical Exam
When patients present with MRI scans showing a disc bulge or herniation, the immediate question should be whether this finding is actually causing their pain. Identifying the true cause of pain is crucial. The foundation of musculoskeletal medicine requires a thorough hands-on physical examination to pinpoint the anatomical source of the symptoms. It is essential to determine which structures are responsible for the patient’s issues rather than relying solely on imaging reports. Often, imaging findings can be distracting, so it is important to align the results with the patient’s clinical picture and symptoms.
Typical Management and Surgical Options
For many disc-related problems, patients are commonly referred to spine surgery. Surgeons perform a variety of procedures in these areas. For example, a disc bulge may be treated with a discectomy, which involves trimming the affected portion of the disc. In some cases, patients undergo artificial disc replacement, where the problematic disc is swapped out. However, complications can arise, such as nerve stretching if the replacement disc is too large, which can lead to significant and sometimes irreversible issues. Once nerves are damaged from these surgeries, there are limited options for further intervention.
There are instances where surgery is pursued even when there is no clear link between the disc abnormality and the patient’s pain. One of the most extensive surgical procedures is spinal fusion, which involves the use of rods and screws to stabilize segments of the spine. These surgeries carry considerable risks, including complications and long-term consequences. It is not the intention to speak negatively about surgery, but patients must understand the risks involved. If surgery can be avoided, it is best to explore all other options first.
Research: Some Spinal Surgeries and Mris Are “unjustified and Wasteful”
Fusion Surgery: Last Resort
Fusion procedures should be reserved as a last resort, not as a primary treatment. Conservative measures should be exhausted before considering fusion surgery. When segments of the spine are fixated, the adjacent segments above and below are at risk for additional wear and tear, leading to adjacent segmental disease, increased arthritis, or degeneration of other discs. These changes can alter movement patterns and worsen the patient’s condition. Therefore, fusion surgery should only be considered when there is a compelling reason to proceed.
Caller with knee pain
Edward has been experiencing ongoing knee pain for several months. He received a cortisone injection, which provided relief for only a day or so. Following this, he underwent an X-ray and consulted with an orthopedic surgeon, who recommended an MRI. The MRI was completed on approximately February 7th. Based on the findings, Edward was not considered a candidate for surgery, but issues with his knee were identified.
The orthopedic surgeon suggested hyaluronic acid injections as a treatment option. Edward received a series of three injections, spaced one week apart. The final injection was administered on March 18th. Unfortunately, his knee pain worsened after the injections, making it difficult for him to bear weight on the affected leg.
Edward conducted research into Platelet-Rich Plasma (PRP) therapy and inquired about the suitability and timing for PRP following hyaluronic acid injections. He asked whether he could proceed with PRP or if it was too soon after the previous treatment.
Dr. Grove responded that there is generally not much of a barrier between hyaluronic acid injections and PRP therapy. However, he emphasized the importance of a thorough hands-on physical examination and a musculoskeletal ultrasound to accurately diagnose the issue. This evaluation would help determine if the problem is related to the joint itself or other structures such as ligaments, tendons, or muscles.
In cases where there is significant joint fluid buildup (“water on the knee”), it may be necessary to remove some fluid before proceeding with regenerative treatments like PRP. Edward confirmed that his MRI showed several issues with the knee, including meniscus and tendon problems. Dr. Grover noted that these findings would be considered during the evaluation and treatment planning process.
A Caller with arm pain and swelling
Angel called into the show and spoke with Dr. Grove, sharing his recent experience with arm pain and swelling following a workout at the park. On Sunday, Angel woke up early and went to the park around 6:00 AM to do chin-ups. His goal was to complete 20 chin-ups, but after a few, he needed assistance and alternated between sets and recovery until he reached his target. After returning home, Angel continued his workout by performing bent over rows, completing 10 sets with lighter weights.
The next day, Angel noticed severe arm pain, stiffness, and soreness. His left arm appeared swollen from the wrist up to the biceps, resembling a muscle pump but was actually swelling. The swelling had mostly cleared in the bicep area but remained prominent in the forearm, especially on the pinky side, about two inches above the wrist extending towards the elbow. The forearm looked swollen and different from the right arm, with a “bowling pin” appearance—thin at the wrist and protruding outward towards the elbow. The swelling was firm and hard but not painful.
Angel also observed that the thickness of the muscle was more apparent on the left arm compared to the right. Additionally, the vascularity, or the visibility of arteries, was diminished in the left arm, which previously had prominent muscularity and arteries showing.
Despite the swelling, Angel reported no pain in his left arm, but his muscles continued to feel very tight, with some soreness and tension extending from the forearm to the bicep.
Dr. Grove praised Angel for staying active and using creative workout methods. He explained that swelling could result from various causes and emphasized the value of musculoskeletal ultrasound for diagnosis. Dr. Grove suggested a clinic visit for a physical exam and ultrasound to check for possible tendon or soft tissue injuries, especially considering the pulling motions involved in Angel’s workout. He recommended that Angel avoid exercises that cause discomfort or swelling and encouraged listening to his body.
If the issue does not resolve or worsens, Dr. Grove advised Angel to come into the clinic for further evaluation. He noted that if the swelling is only on one arm, Angel could continue single-arm exercises but should remain cautious.
Angel shared that he was a patient of Dr. Darrow about ten years ago for severe shoulder issues. After two treatments, Angel experienced significant improvement and was able to return to normal activities. He recalled an instance where a needle was inserted into his shoulder during treatment, producing an audible crunching sound, likely from scar or adhesive tissue.
Dr. Grove recommended a clinical evaluation to ensure proper diagnosis and treatment, emphasizing the need to avoid aggravating activities and to seek professional help if symptoms persist.
A Caller with spinal stenosis
Dr. Grove welcomed a new caller, Shel, thanking him for his patience and asking how he was doing this morning. Shell responded positively and indicated his interest in learning more about spinal stenosis and potential treatment options.
Shel asked whether spinal stenosis could be helped with PRP (Platelet-Rich Plasma) therapy. Dr. Grove explained that spinal stenosis refers to the narrowing of spaces within the spine, which can occur in two main areas: the central canal where the spinal cord resides, or the foramina, which are the small openings where nerves exit the spinal cord. He asked Shell if he knew whether his stenosis was foraminal or central canal. Shel clarified that he has canal stenosis in two different places, and it has been identified as severe. He shared that he has been on pain medication for some time and his physician has suggested a MILD procedure. Shell inquired if Dr. Grove was familiar with this procedure.
Dr. Grove affirmed his familiarity with the MILD procedure and discussed that spinal stenosis is often seen on radiology reports, but it does not always cause symptoms. He asked Shell where his pain was located—whether it was in the back, buttocks, or legs.
Shel responded that his stenosis is at L4-5 and L2, with pain radiating down his legs and buttocks. Dr. Grove noted that many patients with stenosis experience referred pain patterns, which can originate from structures outside the stenosis, such as ligaments, tendons, or muscles. He mentioned SI joint issues and other connective tissues as common sources of such pain, which can often be addressed with regenerative medicine.
Shell shared his medical history, noting that he underwent a discectomy in 2015, which resulted in a severe infection. Following extensive treatment, he developed severe back pain that made it difficult to sit or stand, and required him to lie down. Over time and with medication, he was able to manage the pain, but has remained on medication since. Shell believes that scar tissue from the infection has contributed to his stenosis.
He described how, based on MRI imaging, he could visualize the severity of the narrowing, which prompted his doctors to recommend the MILD procedure.
Dr. Grove emphasized the importance of a thorough physical examination to determine the exact cause of Shell’s symptoms. He suggested that a hands-on evaluation at the clinic would help clarify whether the pain is positional or localized to a specific structure. Dr. Grove expressed caution about further spinal surgery, especially given Shell’s history of post-surgical infection and scar tissue formation. He preferred a treatment approach focused on identifying damaged structures and promoting healing with regenerative medicine to avoid surgical complications.
PRP and Spinal Stenosis
Shel asked how PRP could impact his situation, considering the narrowing and crowding of his spinal cord. Dr. Grove explained that PRP would not alter the shape of the bones or the size of the spinal canal. Instead, PRP treatment could potentially address symptoms if they are caused by issues other than the anatomical stenosis, such as musculoskeletal pain. He reiterated the need to determine whether the stenosis seen on imaging is truly the source of Shell’s pain, as some patients with severe stenosis have no symptoms at all.
Dr. Grove shared an example of a patient with severe stenosis but pain in a different area, highlighting the importance of matching symptoms with imaging findings before proceeding with surgery or other interventions. Shell agreed to make an appointment for further evaluation. Dr. Grove thanked Shell for calling and expressed hope to see him in the clinic soon.
References
1 Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology. 2015 Apr 1;36(4):811-6.
2 Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation. 2015 Feb;29(2):184-95.
3 Suri P, Hunter DJ, Jouve C, Hartigan C, Limke J, Pena E, Swaim B, Li L, Rainville J. Inciting events associated with lumbar disc herniation. The Spine Journal. 2010 May 1;10(5):388-95.
