Can A Herniated Disc Cause Muscle Spasms?

Herniated Disc and Muscle Spasms

A herniated or lumbar disc rupture or lumbar disc is one of the most common causes of lower back pain and leg cramps. A herniated disc can lead to dull or severe pain, muscle spasms or cramping, sciatica, weakness in the legs, and loss of leg function. This can intensify the pain by coughing, sneezing and bending.

Rarely does bowel or bladder control become lost. Seek medical attention immediately. **Sciatica** refers to a lumbar herniated disc. One or more nerves that connect to the sciatic nerve may be put under pressure. This can cause burning, tingling, pain, and numbness. It can extend from the buttock up into the leg, sometimes even into the foot. It is usually the affected side (left or right).

Anatomy: Normal Lumbar Intervertebral Disc

A brief overview of spine anatomy is necessary to better understand how lumbar herniated spinal discs can cause leg and lower back pain. A disc is a hard fibrous shock-absorbing padding that sits between the 5 lumbar vertebrae. The ends of each vertebra are lined with endplates which hold the individual discs in their place. Annulus Fibrosus is a tire-like outer layer that surrounds the disc and contains a gel-like substance (nucleus Pulposus).

When the annulus fibrous ruptures or cracks, disc herniation allows the nucleus of the nucleus to escape. This is also known as a herniated annulus pulposus or herniated disc. You may also have heard it called a ruptured or bulging disc.

If a disc ruptures, it can press against the spinal cord or nerves. Your spine is lined with nerves that branch from the spinal cord, and travel to various parts of your body (to help you feel and function). Nerves pass through small passageways that run between the vertebrae. If a herniated or bulging disc presses into this passageway, it can cause the nerve to compress (or “pinch”) itself. This can cause the discomfort associated with herniated discs.

Risk Factors for Lumbar Herniated Disc

Numerous factors increase the chance of disc herniation. Poor disc health can be caused by lifestyle choices, such as smoking and insufficient exercise. As our bodies age, biochemical changes can cause discs gradually to dry out. This can have a negative impact on disc strength and resilience. The aging process can affect the ability of your intervertebral Discs to absorb shocks from your movements. This is their primary job.

Bad posture, combined with poor body mechanics, stresses the lumbar spine. This reduces its capacity to support the body’s bulk. This is just a small part of the reasons discs can herniate. An example: incorrect lifting can increase disc pressure by several hundred pounds per square inch.

How a Disc Herniates Works

A herniation could occur suddenly or slowly over weeks or even months. There are four stages that can lead to a herniated disc:

  • Disc Degeneration is caused by chemical changes in the body that are associated with aging. However, discs do not become weaker.
  • Prolapse is when the disc becomes displaced by slight impingement in the spinal canal or spinal nerves. This stage is also known as a bulging disc, or a protruding disc.
  • Extrusion: This is where the gel-like nucleus of pulposus penetrates the tire-like wall, annulus fibrosus, but remains in the disc.
  • Sequestration, or Sequestered disc: The nucleus poplu breaks through the annulus Fibrosus and can then travel outside of the intervertebral disc.

Diagnosis for Lumbar Herniated Disc

However, symptoms may not be present in every herniated disc. Some people are able to see a bulging or herniated disc on x-rays. Most often, symptoms, including pain, will prompt the patient or their doctor to seek medical treatment. The doctor will usually perform a physical and neurological exam. Your medical history will be reviewed and questions asked about your past and current pain management efforts.

A x-ray may also be required to rule out other causes such as osteoarthritis or spondylosis. A CT or MRI scan is used to determine the extent and position of disc damage. Sometimes a myelogram will be required. A dye injection will be performed during that test. The dye will appear well on a CT scan and will allow your doctor to pinpoint problem areas more clearly.

Lumbar Disc Herniation Treatment that is Non-Surgical

Doctors may recommend cold therapy or medication after an injury has occurred. In the first 24 to 48 hour, cold therapy reduces swelling, muscle spasm and pain by decreasing blood flow. Apply cold or ice to the skin only once you have wrapped the towel in it. Some medications may contain an anti-inflammatory to reduce swelling and a muscle relaxant or pain-killer (acute pain) to ease intense, but brief-lasting pain.

Non-steroidal Anti-Inflammatory Drugs (NSAIDs), may be used for mild to moderate pain. These drugs relieve both pain and swelling. Discuss any of these medications with your doctor first. The majority of heat therapy can usually be used within 48 hours. To warm and relax the soft tissues, heat increases blood circulation. An increase in blood flow aids in flushing out irritating toxins. Don’t apply heat directly on the skin, as it is dangerous. Wrap the heat source with a towel for not more than 20 minutes.

Spinal Injection

An epidural steroid injection may be prescribed if severe leg pain is present or if there is a possibility of leg weakness. An epidural steroids injection is a procedure that injects anti-inflammatory medication into the area around the affected nerves of your lumbar spine. Before beginning treatment, you should talk with your doctor about this option and discuss potential side effects.

Physical Therapy

A doctor might recommend physical therapy. The prescription from the doctor is transmitted to the physical therapy. Physical therapy is a combination treatment that helps to reduce pain and improve flexibility. Your physical therapist can help you determine the best treatment for your pain and other symptoms. The good news? Most patients feel relief within four to six weeks.

Lumbar Herniated Disc Surgical Treatment

Spine surgery can be considered when non-surgical treatment fails to alleviate symptoms. A further evaluation is needed if you experience constant pain, weakness in your legs, or loss of functionality. Rarely does lumbar herniated dist cause bowel/bladder dysfunction or groin/genital pain. These conditions require immediate medical attention.

Ask about the purpose of surgery and the expected outcomes. Make sure you understand everything that is being suggested. Don’t be afraid to ask for a second opinion from a spine surgeon. It is a major decision that you don’t want made lightly.

A discectomy (removal or partial of the intervertebral disc) is usually performed to relieve nerve pressure and leg discomfort. A surgeon may also be required to access the herniated nerve by removing part of the bone surrounding it. This is known as a laminotomy. These procedures can often be performed using minimally invasive techniques. Minimally invasive spine surgery is not a complicated procedure. It involves small incisions and the use of specialized instruments such as an endoscope and microscope.

Is it possible to prevent a Lumbar Herniated Disc

In this article we mentioned that a common cause for a lumbar herniated spine is aging. We can’t change that. Do you think that you cannot prevent a lumbar herniated disc? You can’t. It is possible to control several things. You can exercise and take good care your spine by watching your posture and not smoking. Although you may not avoid a lumbar herniated, they can help to alleviate lower back pain.

Your Spine, Your Nerves

Between vertebrae, spinal discs act like shock absorbers. They are composed of an outer layer (the annulus fibrosus) that is hard and covers a soft, jelly-like center (the nucleus pilosus). If a disc becomes damaged, it can bulge out of its normal boundaries and cause irritation to nearby spinal cords. In more severe cases, an annulus fibrosis could weaken or tear allowing the nucleus material to leak out.

This can result in the spinal cord becoming compressed or nerves being paralysed. They might not function properly and abnormal signals can be sent from and to the brain. Five vertebrae are located near the base and lumbar regions of the spine are the most common locations for lower back herniations. A sciatic nerve irritation can lead to severe pain in this area of the spine. It runs from the lower spine down the legs. It is the largest nerve of the peripheral nervous systems, and connects the brain to the rest.

A variety of causes can lead to herniated discs. These include age-related degradation, obesity, trauma, excessive spin, and lack of conditioning.

Pain and other related symptoms

Due to nerve irritation, muscle spasms, inflammation, and lower back pain, the most common sign of herniation is lower back pain.

Radiculopathy is also a common condition that results in abnormal nerve signaling. These symptoms include:

  • Electric shock pain: A nerve pressure can cause abnormal sensations that are often referred to as electric shock pains. Lumbar herniations: The shocks can be sent down one leg or both.
  • Tingling//or numbness: Many patients experience unusual sensations, such as tingling, pins and needles, down one or both their legs, or numbness.
  • Muscle weakness. The brain’s nerve signals may be disrupted, which could lead to lower-body muscle weakness.
  • Bowel and bladder problems: These symptoms may indicate cauda-equina Syndrome, a rare condition that results from a herniated disc separating the L5 vertebrae from the first vertebrae.

You should immediately see a healthcare professional if your back/leg pain is accompanied with problems urinating, having bowel movements or numbness around the anus. This is considered a medical emergency.

Severe cases

A herniated disc can cause spinal cord compression.

  • Balance and walking difficulties
  • Apparent clumsiness/dropping of things
  • Leg cramps or weakness
  • Difficulty in handwriting, picking small objects up, or with other fine-motor tasks
  • Bladder and bowel dysfunction

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Michael Wolff, M.D. - Southwest Spine & Sports