Key points from this video
- Physical therapy is an active treatment that can be adjusted to the person’s irritability, strength, mobility, and goals.
- A nerve-root injection is more targeted to radiating nerve pain than to generalized low back aching.
- An injection may provide temporary relief; response is not guaranteed and it does not remove every structural cause.
- Urgent or progressive neurologic findings can change the sequence and should not be delayed by a routine treatment ladder.
What this video can—and cannot—tell you
Treatment comparisons become misleading when axial low back pain and radiating nerve pain are grouped together. A useful plan first defines the dominant symptom, the examination pattern, the expected natural history, and the outcome the patient wants to regain.
This is general educational information, not medical advice. Symptoms vary by person — a clinical evaluation is the only way to know what’s right for you.
Full video transcript
A ranking chart places physical therapy in the S tier and transforaminal steroid injection in the A tier. An inset shows a needle approaching the spine. When Dr. Greenberg says “right here,” he points to the lower lumbar portion of the spine model.
[Prompt] Physical therapy.
[Answer] S tier. This is something that every single patient that comes to see a spine surgeon needs to try at least for 6 weeks. Obviously, there are exceptions, but the majority of patients that complete a round of physical therapy, especially for low back pain, notice a significant improvement at very minimal cost for most patients. [Prompt] Transforaminal steroid injection.
[Answer] This one's an A tier. This is a great one because it has diagnostic and therapeutic value. The reason why I say that is diagnostically, if I inject your L4 nerve root and you get a lot of benefit from that, even for a day, that tells me that's the nerve root that's causing your problem. From a therapeutic perspective, I'm putting high dose corticosteroid right here. That may make you feel better for years.
