By Lewis Maharam, M.D.
I am a New York Mets fan. I just read that David Wright has spinal stenosis and back pain. I hope you know something about backs. Is this career ending or does he need surgery? Could there be something else to help him?
— Johnny R. Flushing, NY. 
Thank you, Johnny for the question. Yes, I do know something about back pain and have made it a subspecialty to my practice of sports medicine. Back when I was a fellow working with Dr. Allan Levy of the New York Giants, he asked me to see the patients with back pain coming into his office. At that time all back pain was treated with the same set of exercises. It was like shooting buckshot at a barn and hoping to hit a bull’s-eye. I applied sports medicine principles of finding an exact diagnosis and developing specific treatment plans depending on the diagnosis.
The spinal canal is the place where the spinal cord runs down your back and spinal nerves exitat each level of vertebra. When the canal is congenitally small it is called spinal stenosis. You can’t pick your parents and some people are just born this way. Some people never have a problem with a small canal. Others may reach a “critical mass” (like when atoms reach a certain speed there can be a nuclear explosion) at any age and the small canal results in rubbing of nerves causing inflammation and then pain.
A good history is usually enough to make the diagnosis. When the examiner asks “is there anything that you do that brings on the pain?” the patient will usually say: “Yes, when I brush my teeth in the morning I feel the pain.”