Spine & Back Pain Specialists in San Francisco
Finding the Cause of Back Pain
Back pain is one of the most common reasons patients come to Physicians’ Back Institute—and one of the areas in which we have the greatest experience.
Robert Minkowsky, MD, and Irène Minkowsky, MD, are board-certified medical doctors with extensive postgraduate training in osteopathy. For decades, they have evaluated and treated patients with acute and chronic back pain, disc problems, spinal stenosis, scoliosis, sciatica, and other complex spine conditions.
Many of our patients come to us after physical therapy, medications, injections, specialist consultations, or even surgery have failed to resolve their symptoms.
Our first question is not simply “Where does it hurt?” It is “Why does it hurt?”
Back Pain Is a Symptom, Not a Diagnosis
Low back pain can arise from many structures, including the discs, facet joints, muscles, ligaments, sacroiliac region, and nerves.
Sometimes the painful area is not the primary source of the problem at all.
A detailed history and physical examination help us determine what is contributing to the pain and why the spine is not functioning normally.
Diagnosis comes before treatment.
Imaging Is Only Part of the Picture
MRI and X-ray studies can provide important information about the structure of the spine. But abnormalities on imaging do not necessarily explain a patient’s symptoms.
Disc degeneration, arthritis, stenosis, and other structural changes become increasingly common with age—and many people with these findings have little or no pain.
We therefore interpret imaging in the context of the patient.
We examine posture, spinal mobility, neurologic function, muscle strength and balance, the pelvis and lower extremities, and the way different parts of the musculoskeletal system work together.
An MRI shows anatomy. The examination helps us understand function.
Common Spine Conditions We Evaluate
Disc Injury & Herniation
Disc problems can cause acute back pain, muscle spasm, restricted movement, and sometimes nerve irritation resulting in leg pain or sciatica.
Spinal Stenosis
Narrowing around the spinal nerves becomes increasingly common with age. When symptomatic, it may cause back or leg pain, numbness, weakness, or difficulty walking and standing.
Scoliosis
Scoliosis changes the mechanics of the spine and surrounding muscles. Treatment is directed not simply at the spinal curve but at maintaining strength, balance, mobility, and function.
Sacroiliac & Pelvic Dysfunction
Problems involving the pelvis and sacroiliac region can contribute to low back, buttock, hip, and leg symptoms.
Sciatica & Nerve Pain
Pain traveling into the buttock or leg requires careful evaluation to determine where and why a nerve is being irritated.
Neck & Arm Pain
Posture, prolonged computer use, disc problems, arthritis, muscle imbalance, and nerve irritation can contribute to neck pain and symptoms extending into the shoulder, arm, or hand.
The Spine Is Part of the Whole Body
The spine does not function in isolation.
The pelvis, hips, legs, feet, ribs, shoulders, muscles, and nerves all influence spinal mechanics.
When one region is restricted or weak, another may compensate. Over time, the area doing the compensating may become painful.
This is where our extensive training in osteopathy adds an important dimension to the medical examination. Hands-on evaluation helps us assess movement, restriction, tissue tension, and mechanical relationships that may not appear on imaging.
Where you hurt is not always where the problem begins.
Individualized, Nonsurgical Treatment
Treatment depends on the diagnosis.
Depending on the condition, we may recommend osteopathic manual treatment, therapeutic exercise, strengthening and stretching, rehabilitation, changes in posture or ergonomics, medication when appropriate, or selected injection procedures.
When additional testing, surgical consultation, or another specialist is appropriate, we recommend it.
Our objective is not to avoid surgery at all costs. It is to avoid unnecessary intervention while recognizing when more invasive treatment is necessary.
Our goal is to restore function using the least invasive approach appropriate for your condition.
Finding the Cause.
Restoring Function.
Whether your back pain began suddenly or has persisted for years, we take the time to understand your history, examine how your spine and entire musculoskeletal system are functioning, explain what we find, and develop an individualized treatment plan.