What the work does
Public works is not one job, and the bodies arriving from it have different problems depending on which part of it they do.
Lifting and loading — sanitation and DPW crews handle repeated lifting, often awkward, often from bad positions, in all weather. Lower backs, shoulders and knees.
Standing — road crews, utility work, anyone at a site for hours. Prolonged standing is the classic occupational driver of venous insufficiency: the calf muscle pump that moves blood back up the leg only works when you walk, and standing still leaves one-way valves loaded by gravity with no relief.
Driving and operating — hours of whole-body vibration and sustained sitting, both recognised contributors to lower back pain. And sitting is not rest for leg veins either, for the same reason standing is not: the pump is off.
Most municipal workers who come in have a mix, because most municipal jobs are a mix.
The question worth answering first
Pain that runs from the lower back into the leg has at least two explanations, and they are treated in opposite directions.
Spinal — sharp or electric pain travelling from back or buttock down the leg, often with pins and needles or numbness, worse sitting, coughing or bending, usually one side.
Venous — heaviness and aching that build through the shift, swelling around the ankle that is worst in the evening and gone by morning, cramps at night, visible veins.
Sorting that out is the first job here, and it is why a practice that treats both is the right place for it. Dr. D’Alessio is board-certified in Physical Medicine & Rehabilitation — the specialty built around restoring function rather than operating.
What happens
An examination: how the spine moves, where it is tender, reflexes, power, sensation, what the hips and surrounding muscles have been compensating for. And, where the history warrants it, a standing duplex ultrasound of the leg — painless, about half an hour, performed upright because gravity is the load being tested.
You leave knowing what is thought to be causing it, and what can be done about it.
Treatment
Veins are closed in the office under local anaesthetic — radiofrequency ablation, Varithena® microfoam, sclerotherapy for surface vessels — and you drive yourself home.
Back, knee and shoulder pain is treated without surgery: targeted injections where indicated, and a rehabilitation plan built around the actual work rather than an ideal one. Graduated compression is the practical measure for the legs in the meantime, and it needs to be a real pressure, properly fitted.
This is a non-surgical practice. Where an examination points to something that needs a surgeon, you will be told and referred rather than treated here indefinitely.
On benefits
Municipal, county and union plans frequently include out-of-network benefits. Whether yours does, what it covers and what you would be responsible for are verified and explained before anything is scheduled.