COMPASSIONATE. THOROUGH. HEALING.

Our Doctors

Dr. Adrian Grunfeld

Medical Director of Herzog Pain Relief

Director of Acute Pain Department at Sheba Hospital Tel Hashomer. Dr. Grunfeld is a specialist in Pain Management and Anesthesia. In 1998 he was one the pioneers of the invasive treatment “OPEN MRI.” In 2003 he introduced the use of ultrasound in regional anesthesia and in invasive treatment of pain at Sheba Hospital.

Dr Joseph David

Dr. Joseph David is board-certified and Misrad Habriut-recognized in Physical Medicine and Rehabilitation. He was trained in the United States. He is fellowship-trained in Musculoskeletal Medicine and Interventional pain, including ultrasound-guided nerve blocks, joint, muscle and tendon injections, and fluoroscopically-guided spine injections. His medical interests include non-operative treatment of pain and musculoskeletal conditions, regenerative medicine, as well as the rehabilitation and prevention of injuries.

Dr. Edward Shane, BSc, DC Hons, FCCPOR(C)

Chiropractor, Dry Needling Expert

Dr. Edward Shane is a duly qualified chiropractor, registered to practice in the province of Ontario, Canada. He is a Specialist in Rehabilitation as a Fellow of the Chiropractic College of Physical and Occupational Rehabilitation, which is recognized by the College of Chiropractors of Ontario. He is a past president of the College of Chiropractic Rehabilitation Sciences [Canada]. Dr. Shane is also a Diplomate of the American Chiropractic Rehabilitation Board. He is a Diplomate of the Canadian and American Academies of Pain Management and a Senior Disability Analyst of the American Academy of Disability Evaluating Professionals. He is currently a member of the Canadian and Ontario Chiropractic Associations and the Canadian Society of Medical Evaluators. Dr. Shane has been providing assessments and treatments for patients with musculoskeletal injuries since 1980. He has conducted many hundreds of assessments from both a medical/rehabilitation and disability perspective since 1994, initially as a rostered practitioner to 3 DAC facilities and then as an Insurer Examiner and Independent Medical Assessor. For more than 4 years, his practice has been focused on the assessment and treatment of patients with Chronic Pain. He currently conducts Multi-Disciplinary Chronic Pain Assessments and is a consultant for several rehabilitation and chronic pain programs in Ontario; he has has been practicing for several years at the Sheba Rehabilitation Hospital in Israel as a treating practitioner at the Complementary and Integrative Medicine.

Dr. Steven Richeimer

Steven Richeimer, MD, a pain consultant at Herzog Pain Clinic, is trained in the fields of pain medicine, anesthesiology, and psychiatry. He is a Professor of Anesthesiology and Psychiatry, and the Chief of the Division of Pain Medicine at the Keck School of Medicine at the University of Southern California (USC). For 25 years, he has been treating patients with various chronic pain conditions, and has been mentoring fellows and students in Pain Medicine. He has published various books and journal articles on the treatment and psychosocial aspects of chronic pain, including “Confronting Chronic Pain,” published by Johns Hopkins University Press. He is the Director of the USC online Master’s Degree in Pain Medicine, an innovative program that makes advanced pain education available to all clinicians.

Dr. Shahin A. Sadik, MD, Q.M.E.

Dr. Shahin Sadik is one of the founding physicians of Herzog Pain Relief Center and is also the Medical Director of Universal Pain Management in Beverly Hills, California. Dr. Sadik received his medical degree at Eastern Virginia Medical School of Medical College of Hampton Roads. He then completed his residency in anesthesiology and fellowship training in pain management at the University of Pennsylvania. Currently, Dr. Sadik works as a pain management physician and Medical Director at Universal Pain Management in California and as a consultant to Herzog Pain Relief Center.

Board-certified by the American Board of Anesthesiology with special qualification in pain management and also by the American Board of Pain Medicine, Dr. Sadik has vast experience managing chronic pain. In addition to his duties at Universal Pain Management, Dr. Sadik holds a faculty position at the University of Southern California, Keck School of Medicine as Assistant Professor of Anesthesiology.

Treatments

Intramuscular Stimulation / Dry Needling

This technique is based on the insertion of acupuncture needles into trigger points of affected muscles. IMS is not an eastern form of treatment based on meridians or Chinese acupuncture points.

It is a conventional method based on muscle anatomy and function as well as nerve supply and the interaction of these together. To practice it, one requires a very good knowledge of anatomy in order to insert the needles into the appropriate places. 

Left untreated, trigger points (TPs) can continue to contract for months to years, causing local ischemia within the muscle, inefficient muscle activity, weakness within the muscle and most importantly of all, severe pain. These trigger points result from either injury or from prolonged strain such as poor posture, ergonomics, lifting techniques, and sleep hygiene. Trigger points can develop both within weak and stretched or shortened and relatively overactive muscles. All of these cases can be needled successfully.

The IMS method of treatment uses acupuncture needles, which, if inserted correctly, stop the vicious cycle, and ‘resets’ the trigger point within minutes or even seconds. This method actually has a similar effect on the muscles as does massage, however the results with IMS needling are much more long-lasting.

In contrast to the Eastern acupuncture method in which needles are left for 20 minutes, in IMS the needles are left in for seconds to a few minutes at the very most. However, they continue to affect the trigger points for 48 hours after being taken out giving rise to much more long-lasting results. The longer the condition has lingered on for, the more muscles will need to be needled and the more treatment sessions will be required. Usually 2-5 treatment sessions are sufficient however this depends on the compliance of the patient in adopting healthier postures and doing the appropriate exercises.

Several studies have been done comparing dry needling with trigger point injections of various solutions: corticosteroids, local anaesthetic, saline, sterile water and Botox, all of which showed that dry needle was not inferior to TP injections (Cummings and Baldry 2007). The advantage of IMS is that one can be more thorough and treat the musculoskeletal system as a whole, without being concerned about the overdosing of the medication being injected. One can then address the neighbouring areas, which, according to the musculoskeletal physician, must also be addressed in order to lead to longer lasting effects.

Prolotherapy and Platelet Rich Plasma (PRP)

Prolotherapy is also known regenerative injection therapy. These names mean respectively:

• Prolotherapy: injection of proliferant substance
• Regenerative injection therapy: injection of solutions for the purpose of regeneratingtissues

Cortisone injections have become the panacea treatment of almost all musculoskeletal injuries; cortisone is injected to injured tendons and ligaments, as well as to arthritic joints with the purpose of reducing the inflammation resulting from the injury. However, cortisone has well known side effects which can be categorised into local and systemic. Cortisone is ‘catabolic’, that is, it breaks down proteins, thereby weakening collagen tissue. However, this may well interfere with the body’s response to healing, and increases the risk of a rupture of the ligament or tendon. When injected into joints repeatedly, a ‘steroid arthropathy’ results, which is further degeneration of the cartilage. When absorbed into the bloodstream, cortisone causes significant appetite and weight gain, increases blood pressure, reduces the immune response, and may even lead to depression.

The weakening effect of injected cortisone is especially pronounced in weight-bearing structures, such as the knee joint and ligaments, and the Achilles tendon. It has been recommended by many clinicians not to inject cortisone into such structures.

In contrast, the proliferant solution, usually dextrose, injected in prolotherapy stimulates the synthesis of more collagen tissue in the ligament or tendon. This enables the ligament or tendon to withstand the forces applied to it and makes them more resistant to further wear and tear. In addition, it has also been proposed in research studies that the dextrose injected has an effect in reducing pain perception. This treatment is a much healthier and rehabilitative method than cortisone injections. Prolotherapy is especially recommended for the treatment of ligaments and tendons of weight bearing joints.

Both prolotherapy and PRP share common mechanisms of action.  PRP is considered a type of prolotherapy. Generally, PRP can be used in the treatment of any condition that dextrose prolotherapy is used for, whether the shoulder, knee, ankle, or even lower back and sacroiliac ligaments. PRP is more versatile in repairing partial tendon and ligament tears than dextrose. Full tears will not be healed by either; however, in some cases as in the shoulder, stability can be improved markedly with these injections to the surrounding structures.

For the prolotherapy and PRP to have maximal effect an environment conducive for tissue regeneration should be maintained (de Vos et al. 2010; De Pascale et al. 2015). The patient should be active, though not excessively, in order to encourage motion, mechanical loading, and increased blood supply to the treated tissues. Recommendations for an active life, proper exercise and good ergonomic advice go hand in hand with promoting, maintaining and maximizing the effect of these treatment methods.

Substances Injected

There are many substances that were once used in prolotherapy; these include phenol, glycerine, and dextrose. It has become more common practice in recent years to simply inject dextrose with local anaesthetic; the alternate solutions have been slowly abandoned for safety reasons. Dextrose is the exact same sugar molecule that exists within the body so that nothing foreign to the body (except for local anaesthetic) is being introduced. When indicated, our physician will inject dextrose in a final concentration of 20-25% together with local anaesthetic. This is much less painful than the other solutions used in the past, has fewer side effects, and is safer to inject. The volume injected into each point is minimal: between 0.2 and 0.5 cc, and will therefore not affect the blood sugar level, even in diabetics. In fact, intense pain causes the body to release more glucose into the bloodstream, so that diabetic patients with unresolved pain will have high levels of circulating glucose in their bloodstream anyway. If the treatment works in reducing pain, the sugar levels will fall!

In addition, using PRP, platelets can be concentrated from the patients’ blood and injected into the injury site.

The longer treatment is delayed the more treatment sessions will be required. This is because wear and tear is increased on already dysfunctional areas of the bodywhich impose stress on neighbouring areas. In addition, patients tend to compensate poorly, such as with limping, sitting lopsided or refraining from moving the involved limb which increases wear and tear on the better functioning areas.

There are many substances that were once used in prolotherapy; these include phenol, glycerine, and dextrose. It has become more common practice in recent years to simply inject dextrose with local anaesthetic; the alternate solutions have been slowly abandoned for safety reasons. Dextrose is the exact same sugar molecule that exists within the body so that nothing foreign to the body (except for local anaesthetic) is being introduced. In my practice, our physician may l inject dextrose in a final concentration of 20-25% together with local anaesthetic. This is much less painful than the other solutions used in the past, has fewer side effects, and is safer to inject. The volume injected into each point is minimal: between 0.2 and 0.5 cc, and will therefore not affect the blood sugar level, even in diabetics. In fact, intense pain causes the body to release more glucose into the bloodstream, so that diabetic patients with unresolved pain will have high levels of circulating glucose in their bloodstream anyway. If the treatment works in reducing pain, the sugar levels will fall!

Using PRP, platelets can be concentrated from the patients’ blood and injected into the injury site.

The longer treatment is delayed the more treatment sessions will be required. This is because wear and tear is increased on already dysfunctional areas of the bodywhich impose stress on neighbouring areas. In addition, people tend to compensate poorly, such as with limping, sitting lopsided or refraining from moving the involved limb which increases wear and tear on the better functioning areas. 

Examples of Where Prolotherapy May Be Useful

Sacro-Iliac Joints (Pelvic Joints or SI ligaments) and the lower back

The sacro-iliac ligaments are capable of referring pain locally as well as all the way down the leg (figure 1). Pain can be chronic and incapacitating. If there are positive clinical signs on the physical examination of sacro-iliac dysfunction, then prolotherapy to these ligaments can lead to lasting relief of severe pain and prevent future relapse of pain. In addition, patients usually feel that they function better, are better able to sit, walk and stand, are more stable and that their legs don’t give way as much as they used to.

There are a number of ligaments (see figure 2) that may be the cause of the pain, each one causing a different pain referral pattern. Since the whole SI region is pivotal to normal bio-mechanic functioning of the musculoskeletal system, it is important to treat it as a whole system even if it is not the direct cause of the pain.

Because these ligaments act as shock absorbers, they also suffer from tremendous stress when the lumbar spine is limited in movement due to pain, spinal stenosis and especially after a spine fusion. They also suffer when the hip has pathology such as osteoarthritis or fracture.

A thorough treatment to the lower back must address all of these structures.

Figure 3: 
Grade 1 slippage of the L4 vertebra on L5

Spondylolisthesis and Back Pain

As we age and the disc height decreases, the ligaments become slack, which can lead to vertebrae slipping one on the other- a condition called “spondylolisthesis”. The direction of slipping can be from side to side or front to back (see figure 3). Often CTs and MRIs do not pick up very mild cases as this is a functional dynamic phenomenon which is not always detected when we lie still on our backs, unless the situation is more pronounced. The extra traction caused by the slipping movement can add to the pressure or traction on nerve roots. These ligaments are targeted during prolotherapy treatments.

Stabilising the lumbar spine through prolotherapy often relieves pain from disc lesions and from spinal stenosis; the method by which this occurs is unclear. Cortisone injections, on the other hand, will likely mostly have a very temporary effect. Although epidural injections will relieve inflammation around an irritated nerve root that has arisen from mechanical traction described above, in the long term they are unlikely to achieve improvement in function of the structure.

Rotator Cuff Tears

Prolotherapy and platelet rich plasma can not only help repair partially torn tendons but also helps to stabilize the shoulder joint. Prolotherapy can be combined very effectively with intramuscular stimulation in order to bring the whole of the shoulder girdle to normal alignment and function. This is in contrast to cortisone injections which have been found, at best, to bring about short term relief only (Buchbinder, Green, & Youd, 2003)(Buchbinder, Green, Youd, & Johnston, 2006). A review in The Lancet has shown that if cortisone injections are repeated over and over, whether in the shoulder or other areas such as the elbow, the condition ends up worse than what it was prior to the beginning of the treatment. The shoulder girdle is comprised of 4 joints; the glenohumeral, acromio-clavicular, sterno-clavicular and the scapula-thoracic joints. The latter 3 are often neglected by most practitioners. Treatment of the shoulder must always address the shoulder girdle as a whole and not just the glenohumeral joint in order to achieve long-lasting results. Neglecting to include these three joints will leave excess stress on the rotator cuff tendons and therefore no matter what treatment the patient receives the problem is likely to recur.

The smaller the tear, the greater the success. However even when there is a complete tear, stability can be improved provided that the joint cartilage has not been damaged severely.

Chronic Ankle and Foot Pain

One of the most common causes of chronic ankle pain results from ankle sprain and sprains secondary to fractures. A sprain in the general case is a partial tear of the ligament, muscle or tendon. In an ankle sprain the stabilizing ligaments are partially torn; in addition to just causing pain, this also contributes to further instability. The proliferant solution injected in prolotherapy can stimulate repair of the torn ligament and leads to increased stability of the ankle joint.

An injury strong enough to cause a fracture will invariably be strong enough to cause damage to the surrounding ligaments as well. Bone, under healthy and normal circumstances, heals well, however ligaments often remain stretched and therefore cannot stabilise the joint as well they did prior to the injury. These must be addressed in a methodical manner that considers total function of the ankle and surrounding joints.

Knee Injuries and Osteoarthritis (OA)

Knee Injuries often result from car accidents and sports injuries. Common findings are torn collateral ligaments and meniscal tears. The menisci are attached to a ligament called the “coronary ligaments”. The injection of prolotherapy solutions into the knee is not intended to heal the tear within the meniscus. However, in the case of a mild tear, when prolotherapy solutions are injected into the coronary ligaments, it is thought that the coronary ligaments tighten up, preventing the loose section of the meniscus being thrown around within the knee joint during movement. Prolotherapy can also be used to treat patella tendonitis.

Surprisingly enough, according to several studies, injection of dextrose into a mildly to moderately arthritic joint has been found to be of benefit. This is in contrast to injection of cortisone which leads eventually to a steroid arthropathy in which case the cartilage is more degenerated than to begin with. Most studies on prolotherapy for osteoarthritis have been targeted to the knee (Rabago, Slattengren, and Zgierska 2010; Rabago et al. 2012), however, dextrose can be injected intra-articularly to most joints such as the hip, shoulder, hand joints and even the temporo-mandibular (jaw) joint. Much more literature is available on the treatment of OA with PRP, however prolotherapy can definitely help in mild to moderate cases of osteoarthritis. The mechanism by which this works is unclear, however it is clear that the induction of growth factors plays a factor in the response, theoretically much more so with PRP.

Whiplash Injury

Whiplash injury can cause chronic neck pain in which muscles and ligaments in the neck are sprained leading to muscle spasm which limits movement. The IMS technique discussed in a separate section addresses the muscle spasm and asymmetries. Prolotherapy is targeted to ligaments which may have been damaged and sprained, bringing lasting relief. Both of these techniques work wonderfully together to achieve good results. However, in order to achieve lasting relief, it is imperative to adopt healthy sitting, working and sleeping postures and avoid the “head forward position” so rampantly adopted in our modern society.

Elbow Pain and Other Tendinoses

Prolotherapy and PRP has been compared to cortisone in several research studies and has been found to be superior to cortisone injections for the treatment of golfers and tennis elbow. The IMS technique combines well with prolotherapy in the treatment of these conditions. However, in order for these treatments to be effective, the ergonomic issues leading to the problem must also be addressed and treated.

A very methodical review of 41 research studies on injections for treating tendinoses was published in The Lancet in 2010 (Coombes, Bisset, and Vicenzino 2010b). Corticosteroids were found on the whole to be beneficial in the short term only; repeated injections not only had no beneficial effect but actually worsened the patient’s condition relative to pre-treatment state. This finding must be internalized by practitioners, considering that until today, steroids are still the mainstay treatment of tendinoses. In contrast, the studies cited using prolotherapy solutions and PRP showed positive long term results. Both prolotherapy and PRP have been found to improve long term function and structure of the tendons (quote). PRP is perceived by many orthopedists as having more healing power than prolotherapy but it has never been compared head to head with prolotherapy.

Temporo-mandibular Joint (TMJ) Dysfunction

Pain arising from the TMJ can be due to various factors; trigger points, loose ligaments, a disrupted disc, or a combination of these. A previous whiplash injury can precipitate TMJ pain. Treatment involves a combination of dry needling and prolotherapy injections as well as addressing posture and ergonomics.

Platelet Rich Plasma (PRP)

Platelet are small cells whose role is generally considered in forming a clot of blood to prevent bleeding in the time of injury. PRP is proving to be a versatile and effective method of treatment for a number of conditions due to its very rich supply of growth factors which are produced within the platelets’ granules and are ready to be act on our injured tissues. In contrast, regular prolotherapy must incite the production of these growth factors. Over 7,600 articles, including thousands of research projects, have been published in recent years on PRP.

Platelet rich plasma (PRP) is a method whereby the patients’ blood is taken, spun, and platelets are concentrated; the rest of the blood is discarded. The platelets are then injected into the injured area.

There are many methods of producing PRP. One can spin the blood manually in a centrifuge and extract the platelets, or one can use specially equipped centrifuges which automatically separate the blood producing the desired concentration of platelets. The disadvantage of the latter is that the kit required for every treatment is very expensive, in the order of between 1,200 and 2,000 NIS and this does not include the doctor’s treatment. At the moment PRP is not covered by the Israel Health Funds. Because of this huge expense, I chose to use the manual method, making this considerably cheaper.

PRP has been used in:

• The treatment of orthopedic disorders, such as partial tendon and ligament tears, 
• Tendinosis and degenerative arthritis
• Bone and tendon grafts
• Dental implants
• Aesthetic medicine; hair regrowth for men, anti-aging facial treatments for women

Growth factors released by platelet granules include: 

• Platelet derived growth factor: for connective tissue proliferation
• Transforming growth factor: for extracellular matrix and collagen synthesis
• Vascular endothelial growth factor: for angiogenesis
• Insulin-like growth factor: for collagen synthesis
• Fibroblastic growth factor: for collagen, cartilage and muscle repair, skin aesthetics
• Platelet derived epidermal growth factor: for skin repair (de Vos et al. 2010; De Pascale et al. 2015; Pintan et al. 2014)

Common conditions in which IMS works very well:

• Back and neck strains and sprains, whiplash injuries
• Back pain 
• Neck pain 
• Some types of frozen shoulder
• Many cases of neck pain referring to the arm
• Elbow pain, tennis elbow
• ‘Hip bursitis’

Some dramatic examples where IMS works almost miraculously are:

• Treatment of back sprains commonly associated with trigger points in one or more of the following muscles: Quadratus lumborum (see photo), Gluteus medius, Multifidus
• Nerve entrapments of the ulnar nerve (see photo top of page) and entrapment of the brachial plexus
• Acute to sub-acute whiplash injury

Platelet Rich Plasma (PRP)

Platelet are small cells whose role is generally considered in forming a clot of blood to prevent bleeding in the time of injury. PRP is proving to be a versatile and effective method of treatment for a number of conditions due to its very rich supply of growth factors which are produced within the platelets’ granules and are ready to be act on our injured tissues. In contrast, regular prolotherapy must incite the production of these growth factors. Over 7,600 articles, including thousands of research projects, have been published in recent years on PRP.

Platelet rich plasma (PRP) is a method whereby the patients’ blood is taken, spun, and platelets are concentrated; the rest of the blood is discarded. The platelets are then injected into the injured area.

There are many methods of producing PRP. One can spin the blood manually in a centrifuge and extract the platelets, or one can use specially equipped centrifuges which automatically separate the blood producing the desired concentration of platelets. The disadvantage of the latter is that the kit required for every treatment is very expensive, in the order of between 1,200 and 2,000 NIS and this does not include the doctor’s treatment. At the moment PRP is not covered by the Israel Health Funds. Because of this huge expense, our doctors  chose to use the manual method, making this considerably cheaper.

PRP has been used in:

• The treatment of orthopedic disorders, such as partial tendon and ligament tears, 
• Tendinosis and degenerative arthritis
• Bone and tendon grafts
• Dental implants
• Aesthetic medicine; hair regrowth for men, anti-aging facial treatments for women

Growth factors released by platelet granules include: 

• Platelet derived growth factor: for connective tissue proliferation
• Transforming growth factor: for extracellular matrix and collagen synthesis
• Vascular endothelial growth factor: for angiogenesis
• Insulin-like growth factor: for collagen synthesis
• Fibroblastic growth factor: for collagen, cartilage and muscle repair, skin aesthetics
• Platelet derived epidermal growth factor: for skin repair (de Vos et al. 2010; De Pascale et al. 2015; Pintan et al. 2014) 

Exercises & Ergonomics

Why Exercise?

Regularly exercising muscles in a balanced way is important for the following reasons:

• Restores a sense of balance
• Reduces load on tendons and ligaments
• Reduces forces acting on the spine
• Enables energy efficient motion

Typically, a patient goes to a doctor complaining of back pain, and leaves the clinic with a recommendation to do exercises. But how can the patient know which exercises to do?

Going to the gym is a great thing to do in terms of getting out and moving about, getting into shape and keeping fit. However, doing exercises without any guidance is not so healthy for our musculoskeletal system. We are unaware of weak muscles that are not playing their role in maintain muscle balances, and tend to strengthen muscles that already function well, and then reinforce certain pathological patterns of movement that were already there previously to a lesser degree.

A patients’ posture and gait gives us a good picture of muscle imbalances and can therefore guide as to which exercises the patient can do in order to restore an ideal balance. The most common example of gross muscle imbalance is seen in the typical “C” shaped spine so rampant in today’s society (see figure 1). Many of us sit in front of computers all day long, with our arms stretched out to the front pulling on our scapulae outwards. The chest muscles are in a shortened position for many hours of the day; the upper back muscles become stretched and weak. We are then unable to hold ourselves in an erect sitting or standing posture. Our upper back muscles are so weak, sometimes even two minutes of sitting up straight is too demanding and cause pain! This does not mean that is it bad for you. It means you need to do some work to strengthen these weak muscles. A good physiotherapist will be able to diagnose this muscle imbalance and prescribe exercises to strengthen the upper back muscles and not the chest muscles.

Finally, prevention is better than cure. Here are a couple of tips which are helpful in preventing relapse of the pain if this comes from a musculoskeletal source.

It is very important to learn how to correctly sit, get up and particularly how to bend down and lift things. Instruction regarding the height of the table you sit at, the computer, the type of keyboard and mouse in use, are all important. If working at the computer for long periods of time, try to focus on a faraway object for a few seconds every 20 minutes or so. Try and a chose something at least 3-4 metres distant. This allows the eyes some rest and prevents excess strain on them.

Sprains to back muscles come not necessarily from lifting heavy things but mainly from bending down incorrectly. Bending down on an angle to pick up even a piece of paper can lead to a sprain of the back muscles, causing excruciating pain for weeks. If you have to pick something up the following steps must be made to safeguard your back: 

Bring yourself close to the object you want to lift:

• Face the object
• Bend down while bending your knees
• Grab the object as close as possible to your feet so you don’t have to stretch out far
• Raise yourself by slowly straightening your knees.
• Straighten your spine LAST

Services

At the start of your treatment, you will receive a medical evaluation by a Certified Pain Specialist designed to pinpoint the cause of your pain. Your treatment plan will be outlined, and we will make recommendations to restore you back to maximum function. In some cases, patients improve rapidly with a few simple procedures, while others require a more multi-faceted and complex approach.

Your personalized treatment plan could involve a combination of medication management, physical therapy, acupuncture, chiropractic, psychological therapy and minimally-invasive pain control therapies.

We also encourage patients to explore other non-invasive methods of improving pain, including:

• Focusing on Building Strength and What You Can Achieve
• Following Your Agreed-upon Treatment Plan

Our in-office interventions include:

• Percutaneous Disc Nucleoplasty
• RACZ Caudal Neurolysis
• Sacroiliac Joint Steroid Injection
• Spinal Cord Stimulator Implant
• Stellate Ganglion Block
• Trigger Point Injections
• Vertebroplasty

CONSULTATION FEE FOR PRIVATE PATIENTS ONLY

At the time of the appointment an initial PRIVATE consultation fee of 1000 NIS is due for a rehabilitative consultation, diagnosis and treatment plan which fee includes a trigger point injection and/or laser treatment. If indicated and required by the treatment plan an advanced intervention such as a nerve block or epidural injection may be suggested and scheduled, in which case an additional fee will be required. 

During your first consultation, our pain specialist will:

• Perform a very thorough clinical examination
• In most cases reach a specific diagnosis of the contributing factors to your pain
• Define a specific course of treatment tailored to your individual complaint
• Recommend exercises that are specific for you individually in order to prevent relapse of pain
• Recommend ways to improve posture, gait and ergonomic issues
• Offer you a good chance for a return to improved function and quality of life

The emphasis during your first consultation at the clinic is the clinical evaluation. The clinical evaluation is extremely important; usually much more so than imaging scans. In many cases patients can have findings from CT and MRI scans that do not match their symptoms. In fact, CT and MRI scans on a random healthy population would show that 40% have disc lesions, whether they are in pain or not and this increases up to 100% as one reaches the age of 70! Many people have findings on imaging that are totally irrelevant to their lives. So, the correct order is firstly to make a clinical evaluation, decide how the patient’s function is affected, and only then to optionally order any scan such as X-ray or CT.

The clinical evaluation includes a general orthopedic and neurological examination, as well as assessing movement and function. A patient who complains of shoulder pain will have a thorough shoulder, upper back and neck examination. One with back pain will have a lower and upper back examination, as well as that of the pelvic ligaments and a neurological examination.

The purpose of the clinical examination is to assess not only where the pain is coming from, but to assess dysfunction of the muscles, tendons and ligaments. In many cases there is a degree of imbalance between these, leading to pathological posture and biomechanics during movement. In order to achieve longer lasting treatment results, one must treat these contributing factors to prevent recurrence of the problem.

How to Find Us at Herzog Hospital

When you pass the Reception desk within Herzog Hospital, the Reception Desk will be behind you. You are now on Floor Four. Walk 50 feet along the corridor away from the Reception Desk with the Reception Desk at your back. Turn right and walk up the slight ramp for 30 feet and on your left take the elevator down to Floor One. Turn left out of the elevator and again turn left and walk 20 feet to arrive at Herzog Pain Relief Center. We are located within the XRAY DEPARTMENT. Please introduce yourself to the reception staff. We will be pleased to serve you and wish you a Refuah Shleimah B’Karov!