Terry Streetman (Host): Welcome back to Well Within Reach. I'm Terry Streetman, Riverside Marketing Communications representative. We're here today with Dr. Akhil Shori from Riverside Orthopedic Specialists to discuss interventional pain medicine and how it can help with different causes of lower back and lower body pain such as sacroiliac joint dysfunction and piriformis syndrome. Thanks for joining us, doctor.

Dr. Akhil Shori: Thank you. I really appreciate it, bringing me on and I'm looking forward to talk to you and chat with you and give some more information about all these things.

Host: Awesome. Well, before we get into the questions, we'll take a quick break for a message about myChart.

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Host: Okay. So, this is your first time with us here on the podcast. Can you tell us a little bit about your background and your role here at Riverside?

Dr. Akhil Shori: Yeah. So, my name is Akhil Shori. I'm one of the pain physicians here at the Riverside Orthopedic Center in Bourbonnais. My background is I did my medical training in Nepal where I did my med school, and then I did orthopedic residency back in India and then practiced as a trauma surgeon in India and south of India for one and a half year and then finally decided to come here to U.S. to do further training in Physical Medicine and Rehabilitation and Interventional Pain Management. So, I did my residency at University of Minnesota, and then also did Pain Management fellowship at University of Minnesota as well.

Host: Okay. So, we're here to talk about, you know, Interventional Pain Medicine. Can you talk a little bit about what that means in general and then what drew you to this kind of practice?

Dr. Akhil Shori: So, interventional pain medicine, we use minimally invasive techniques, injections, minimally invasive procedures to get pain relief. So according to my background when I was an orthopedic surgeon back in India, I was seeing a lot of pain patients and low back pain patients. And we operated on a lot of people. Some of them would get better, but some still had like pain even after surgery. And then, I was just researching about it, like how to help these patients who, you know, still had pain post-surgery. And then, just was searching on Google and a website popped up for Physical Medicine Rehabilitation, and then I researched more about it, came to the U.S. and did a couple of rotations in University of Miami, NYU, and found out that there are multiple ways for rehab and advanced interventions that can be done and then pursued my career in Physical Medicine Rehabilitation at University of Minnesota, and then transitioned into Interventional Pain Medicine, and finding avenues and different modalities that could be used to treat these patients. So, sometimes need surgery, sometimes they don't need surgery, and it's important to kind of find out what their cause of pain is and getting to the root cause and tackling it right away.

Host: Okay. You talked about seeing a lot of folks with lower back and lower body pain. Can you talk about some of the common causes of that pain, such as SI joint dysfunction and piriformis syndrome?

Dr. Akhil Shori: Yeah. So, low back pain can be a very vast area. As from a patient perspective, it is just low back pain, but there are different anatomical structures in and around the lower back area, such as your sacroiliac joint, which is one of the joints where your sacrum bone, basically your spine bone, where it ends, it meets your pelvis, and the iliac bone of your pelvis. So, it's called sacroiliac joint. And then, that can be a cause of pain. And especially for patients who have gone through low back surgeries or hip replacements, knee replacements, they can have changes in their gait, because your weight-bearing line, which is basically your spine, your upper body, your whole weight is basically transferred to your lower body through this sacroiliac joint into the hip bone and then to the lower body. So, any gait mechanics alteration with knee replacement, hip replacement, ankle surgeries, if your gait is not stable, you can have that pain originating from that sacroiliac joint.

And then, there are other structures around your lower back. The pain can originate from facet joints, which are small little joints in your lower back. Pain can come from piriformis muscle, which is one of the deeper muscles underneath your gluteal, basically buttock muscle. And then, that muscle is a stabilizer of your hip. So if you have gait dysfunction or, you know, previous surgeries, you know, you can very easily irritate that muscle as well, which could be a pain generator. And then, also, you could have greater trochanter, which is the part of your bone on the side of the hip, which has a bursa, which can get inflamed, and you can have pain potentially from there. So, there could be like six, seven different anatomical structures around the lower back area, which could manifest as low back pain, but weeding them out is super important.

Host: Okay. So, with these kind of pains that a lot of folks obviously deal with, are there things that people can do, preventative measures that people can take to reduce the risk of developing these conditions?

Dr. Akhil Shori: So, all our bones have muscles attached to it. And as we go through life, after 30 years of age, your bones start to have their demoralization at a very low pace and your muscles also start to lose their muscle mass. So as we go through life, we always have to work hard towards making your posture right, making your muscles active. And physical therapy can really help with that. And also, daily exercises to kind of keeping that form of your muscles and also keeping your posture is really, really important. Like if you have a sitting job all day, you can irritate that muscle like the piriformis muscle very easily. And, you know, if you're not doing stretches in between your work, you're just sitting all day and your muscles get like really, really tight. So, stretching those muscles, taking breaks in between, getting walks, and even using like a standing desk, if you're working on a computer for a long time. Those things can really, really help and delay this process and keep you in check.

Host: Well, yeah, that sounds very relevant as someone who sits at a desk most of the day. So with that said, I think a lot of us experience back aches and back pains. Can you tell us sort of at what point do those become a concern that needs to be addressed by a doctor?

Dr. Akhil Shori: Yeah. So, any time your pain is more than a couple of weeks and it's still lingering on, you've tried some Tylenol and ibuprofen and it's not helping, and then it is affecting your quality of life, that is like really, really important where you were doing some fishing or, you know, going out for runs and you can't do it anymore because of your pain, that's the ideal time to kind of see a professional to figure out and weed out where this pain is coming from and get a little bit more relevant evaluation for the patient to figure out when to see a doctor.

I would suggest that if you have any pain that is affecting your quality of life and then that pain is lingering on more than like two to three weeks. I think that's the ideal time when you can see a professional to manage this pain.

Host: Okay, thank you. That's super helpful, I think, for a lot of us. Before we go to our next question, we'll take a moment to talk about the importance of primary care.

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Okay. So, we're back. We've got a few more questions here. For folks who are noticing that difference in quality of life, what's the process then that somebody would go through to diagnose a condition like that?

Dr. Akhil Shori: So, the most important thing when the patients come in is the history and physical exam that we do. History is like super important that we want to rule out they didn't have any acute injury, acute trauma, acute fractures. And then also, about the description of the pain, how they describe that pain, how does it start, what are the positions that their pain is coming from. And then, that comes all in the history part of it. And then, we also want to make sure that, if you had any injections in the past, we want to get all the data collected when we talk to you, trying to figure out what things have helped you in the past and if anything new is happening at the same time.

So, history in that sense kind of helps a lot. And then, with physical exam is the main key where we kind of read out all these different anatomical structures that I was talking about, whether it's like facet joints whether it's a radiculopathy, which is irritation of your nerve roots, whether it's an injury to your ligaments or the muscular mechanical kind of back pain, or is it coming from like sacroiliac joint, or is it from piriformis muscle, or is it from greater trochanter?

All this areas can be differentiated with physical exam, corroborating along with whatever history we have gained from the patient. So, combining them together, we try to decide what we can do. And there are other modalities like diagnosis, which can help aid making the final diagnosis, which could be getting an MRI done to rule out any radiculopathy or nerve irritations.

For SI joint, it's purely like physical and history exam. We can really weed out. There are special tests that we do for SI joint, which could be Gaenslen test, distraction, compression of your SI joint, thigh thrust. So, we do five or six different exam maneuvers to kind of weed out if it's coming from the SI joint versus piriformis versus low back pain.

Host: Okay. Yeah. It sounds like a really thorough process to make sure we pinpoint exactly where that's coming from. All right. So with all these different causes and locations and structures, what are some of the treatment options that people see success with? Is it just surgery? Are there non surgery options?

Dr. Akhil Shori: I mean, a lot of interventional pain medicine is based on like minimally invasive and get you back to the quality of life that you need and that you want. So in that aspect, we do a lot of minimally invasive techniques like a lot of injections in the SI joint, which is a steroid medication that goes right into the joint area, which we do it in the hospital under an x-ray guidance. So, make sure exactly we are in the right spot of the SI joint. And we use a contrast diet to be in the safe spot in the joint. And then, we put some numbing and steroid medication for that procedure. And then, for piriformis muscle as well, we use the x-ray guidance to find exactly where the piriformis muscle is and get the medication right there.

But the big cornerstone for all these modalities is to get you some pain relief so that you can participate with physical therapy, which is the cornerstone because we want our muscles to get stronger so that they can offload the joint around the SI joint. And then, that's where the physical therapy piece of it comes in. And then, if you continue doing the exercises, making those muscles stronger, and we take away your pain, it goes a long, long way.

Host: Yeah. Sort of an all-around approach. And you kind of just touched on this, can you talk about the value of how your team works with, you know, we've got orthopedics, podiatry, physical therapy.

Dr. Akhil Shori: We work in Orthopedics Surgical Center here in Bourbonnais, and we have all our colleagues together, so we have orthopedic team, and then we have our neurosurgeons coming in a couple of days a week, and then we have our Podiatry team, so we all work together in the same building. And then, we're always running to each other, you know, kind of finding the answers and best solutions for our patients. And then, we talked through the Epic chart system as well, that we are seeing each other's notes. And it's so easy to kind of communicate with all the doctors around here. And it's a very collaborative effort. And we have a big physical therapy gym downstairs where our trained physical therapists work together with us, and we go back and forth getting our information about our patients, how well they are doing, and then they give us our input as well, like what exercises are working for our patients.

So, it's a very collaborative approach towards our general like kind of pain management here, which actually the pain management needs all the multimodal, multidisciplinary approach to manage chronic pain and even pain in the lower back and SI joint pain. So, we have a very collaborative effort between all the colleagues that work together. Whether it's Orthopedic Surgery, Podiatry, Neurosurgery, we are all together.

Host: Awesome. Well, I'm sure that's really reassuring, too, for patients to know they have that whole team behind them. Okay, well, we're getting close to the end. If you had to sum up what we've talked about, what's the one biggest takeaway that you would want our listeners to take with them?

Dr. Akhil Shori: So, the biggest thing is that we want to make sure that the patients have to have their quality of life. So if any time any patient who's having chronic pain or pain in that lower back SI joint region, and that's affecting their quality of life, they can do things that they enjoy doing going for a walk as we are approaching the summer now, like that's the real time that you want to see a professional who can do a thorough history and physical exam to pinpoint where the pain is coming from and then give you the intervention that you need and collaboratively with our physical therapists and our Neurosurgeons, orthopedic surgeons combined together, ruling out if anything else or bad is happening, and then making sure that we get you that pain relief. I think the right time is if it's affecting your quality of life more than a couple of weeks, you should come see us.

Host: Okay. Well, that's all I've got for the questions. Before we wrap up, is there anything else you'd like to add?

Dr. Akhil Shori: The most important thing, even with chronic pain and any kind of generalized pain, the most important thing is the physical therapy and keeping your muscles really, really active. And if the pain is bothering you really badly with your quality of life, I think, it's the time to see a professional to get it checked and find out what the right solution for you is.

Host: Well, thank you again for joining us today. We really appreciate all the information that you've been able to share. To learn more about how Riverside Orthopedic Specialists can help manage and treat back pain, call 815-802-7090 or visit myrhc.net/orthopedics. Thank you for tuning in to Well Within Reach, presented by Riverside Healthcare. Please take a moment to rate and leave a review for Well Within Reach on Apple, Spotify, or wherever you get your podcasts. To learn more about Riverside, visit riversidehealthcare.org.