Being taken seriously first
Most people arriving with back pain have already been through several rounds of being told to rest, stretch, lose weight, or wait. Some have an MRI report full of words like degeneration and bulging, and no clear account of which of those findings, if any, is producing their pain.
The first appointment here is an examination and a conversation, not a scan referral. Where it hurts, what makes it worse, what you were doing when it started, what you have already tried, what you are no longer able to do. Then a physical examination — how the spine moves, where it is tender, what the nerves are doing, how the hips and the surrounding muscles are compensating.
The goal is a working explanation of what is generating the pain. Without one, treatment is guesswork.
Who Dr. D’Alessio is
Dr. Donna D’Alessio is board-certified in Physical Medicine & Rehabilitation, and was Chief Resident in PM&R at Mount Sinai Hospital. PM&R is the specialty built around restoring function — it is the discipline of working out what a body is failing to do and getting it doing it again, without going to the operating room as the first move.
That orientation is the reason this practice exists in the form it does. A back is not a picture on a screen; it is a person who cannot lift their child or sit through a meeting.
What the common causes look like
Facet joint irritation — pain worse with standing, extending backwards or turning, often eased by leaning forward.
Disc-related pain — worse with sitting, bending forward and coughing, sometimes radiating into the leg.
Muscular pain and trigger points — a tight, tender band that refers pain in a predictable pattern, frequently secondary to something else that has been compensated for.
Sacroiliac joint pain — felt low and to one side, often mistaken for hip pain.
Degenerative change with stenosis — heaviness or pain in the legs when walking that eases when sitting or leaning on a trolley.
These behave differently, examine differently and respond to different treatment, which is why the distinction is worth the time it takes to make.
Non-surgical treatment
Treatment follows the diagnosis. Depending on what is found:
- Trigger point injections into a muscle that is locked in spasm, to break the cycle and allow rehabilitation to start.
- Joint injections to settle an inflamed facet or sacroiliac joint, both relieving pain and confirming the source.
- PRP where the aim is to support healing in a damaged tissue rather than only to reduce inflammation.
- A rehabilitation plan addressing the mechanics — because an injection that calms a joint, given to someone who then returns to whatever was loading it, buys months rather than years.
What we will not do
We will not promise a single injection that solves chronic pain. We will not present a treatment plan before we can say what we think is causing the problem. And where the honest answer is that you need a surgeon, or an entirely different specialty, you will be told that instead of being treated.