starbucks coffee cup -- the way I see itI perform spine and hip surgery and I see patients in consultation in my office in Monterey, California.  I have written this guide so that you will know in more in advance about my practice philosophy.  I am a direct and open communicator and I strive to educate patients as completely as possible.  I use the medical literature as a guide towards treatment decisions — what we refer to as evidence based medical practice — but please understand that I do have my own biases and opinions.  I am presenting those biases and opinions here so that you may decide in advance if we are likely to form a constructive doctor-patient relationship.


If we examine the causes of disability in the United States of America, we find that arthritis and back and neck pain is identified as a cause of disability in 30% of the population and this is more than all of the other major causes of disability in the US combined.  These are copies of slides from one of my talks on common causes of back pain…click on the thumbnail image to enlarge the slide.

spinal disease and arthritis causes the majority of disability in the united states  80 percent of people have an episode of back pain during a year  only 10% require an operation

When someone with back or neck pain is referred to a spine clinic, reasonable guidelines suggest that 100% of those patients need to be educated about their condition, 80% would probably benefit from physical therapy, 20 to 30% may need some sort of a minor medical intervention such as an injection, and less than 10% of patients should require operative intervention.  In my practice, it is quite common to see a patient who has had a 1 to 2 month history of low back pain with an MRI scan of the lumbar spine that is described as showing disk bulging and degenerative changes.  This patient is often taking narcotics on a daily basis and states that he or she has tried physical therapy a few times and “failed”.  They are now seeking answers and further care.  Often, this patient is obese, sedentary, and from the perspective of someone who lives in coastal california, leads a relatively unhealthy lifestyle.  This type of patient is often unhappy with the results of their consultation with me because they have unrealistic expectations about how medical science can help them.  Let us examine each of these elements so that we can understand why….

The four things that everyone with back pain should know:

  1. The MRI scan is normally abnormal
  2. Narcotic pain medications are not a great idea for open-ended diagnoses
  3. PT involves more work than you think
  4. Lifestyle choices have a huge effect on back pain