Back Pain When Hiking: Helping Agnes Scale Her Personal Mountain

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back pain when hikingI love the creative ways patients find to let us know that they’re doing better. This last week, I received this great shot from Dr. Pitts who had treated Agnes, a patient who had significant back pain with hiking. Here she is, having just climbed Colorado’s Mt. Elbert at 14,433 feet!  So how did we help her avoid back surgery?

What Was Wrong with Agnes?

Agnes had an annular tear on her MRI. What is this? The low-back discs have two main parts. The inner gel is called the nucleus, and the outer covering is known as the annulus. The latter has many strong fibrous layers that are constructed like an onion. It’s possible to tear the fibers of the annulus, and this can cause pain. It’s also something that can happen with wear and tear and likely doesn’t cause pain. It’s thought that these tears in the annulus lead to degeneration of the disc over time.

Given that we were the first clinic on earth to treat damaged low-back discs by injecting stem cells, we’ve learned a thing or two through the last 12 years. While it’s easy enough to inject the disc, this isn’t always the answer. First, it’s more invasive that just injecting other structures, like the area around the irritated nerves (epidural), the facet joints, or the ligaments. Second, if the patient can be made better without injecting the disc, why take the additional risks of injecting that structure? These risks include the possibility of damaging the disc and the rare possibility of a disc infection known as discitis.

What Did Dr. Pitts Do for Agnes?

Agnes was injured in a car crash. While her MRI showed an annular tear, her exam looked like she may have injured her facet joints and ligaments. The facets are small joints that help guide the movement of each individual low-back disc along with the ligaments. Dr. Pitts also suspected that these ligaments had been injured, and this additional motion allowed by now-loose ligaments may be irritating the low-back spinal nerves. All of this was certainly enough to give her back pain when hiking.

Even though injecting the disc with platelets or stem cells can be very helpful, Dr. Pitts knew that there was a significant chance we could help Agnes without injecting inside the disc. So after a careful exam and review of her imaging, he chose to inject HD-PRP and HD-platelet lysate (HD=high dose) into her injured facet joints, around her irritated nerves, and into the damaged ligaments. How did she do? This is the note she sent Dr. Pitts:

“Hello Dr Pitts.
Yesterday has been one year since I had my second PRP injection. Iam still rebuilding my core through PT and as a result I have been stronger than ever. I have very little back pain and feel very fortunate to have found Centeno, you, and a great PT. I am back to yoga, just landed my first headstand;) my back pain is not cured, but I got the tools from you to live and thrive while working with my body.  I climbed 11 hours this summer to summit my first 14 er on mt Elbert!
Can not thank you enough.  Please feel free to use me as a reference for similar cases like mine, also happy to talk to anyone who has questions and doubts.

The upshot? We can’t help every patient, but the wide array of proprietary technologies that we have available to us allows our Regenexx providers to treat many different spinal problems. We’re glad that we helped Agnes climb and conquer her personal summit! Hopefully, now she can put back pain with hiking behind her!

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2 thoughts on “Back Pain When Hiking: Helping Agnes Scale Her Personal Mountain

  1. Jan Tucci

    I have had stem cell injections in both knees. I felt relief for 18 months when my right side appeared affected by a nerve/muscular event. Bi had difficulty walking and was willing to apply for a cortisone injection in the right knee. Luckily my orthopedic Doc suggested a hip injection instead. After a week I found that indeed the hip was the source … knee is back to normal. I have been advised to receive a cortisone injection in my spinal column at end of month. Little scary? But maybe it will add to my mobility. Any thoughts?

    1. Regenexx Team Post author

      Really glad you asked as cortisone injections are a huge net negative! While they are covered by insurance, and often give temporary relief, they escalate the problem by killing stem cells which are the joint’s repairmen, breaking down cartilage in the joint and hurting the tendons. Figuring out what the problem is and treating it with regenerative tools like prolotherapy or PRP, stem cells is a net positive. Please see: and

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