Dr. O'Donnell is a sports-medicine orthopaedic surgeon, not a spine surgeon. He treats the neck and back injuries that occur in athletes and active adults and that, in about 9 in 10 cases, resolve without an operation: low back sprains and strains, neck sprains, disc herniations, sciatica, degenerative disc disease, and stingers and burners in contact sport. Patients include University of Miami athletes, weightlifters and golfers with a back that seized during a lift or swing, and adults in Coral Gables and Miami with leg pain from a herniated disc.
The first visit separates a soft-tissue injury from a nerve problem and rules out the small number of conditions that need urgent care. The exam checks strength, reflexes and sensation for each nerve root and includes the straight-leg raise and Spurling's test. X-rays are ordered after trauma, in older patients and when the pain has not improved at 6 weeks; MRI is reserved for weakness, red flags, or leg- or arm-dominant pain that has failed 6 to 12 weeks of care, because disc findings on MRI are common in people with no symptoms. Treatment is active: walking rather than bed rest, directional-preference exercises and nerve glides, then a core stabilization program or, for the neck, deep neck-flexor and scapular strengthening, following Dr. O'Donnell's written cervical and lumbar protocols. An epidural steroid injection is arranged when pain stays severe at 2 to 4 weeks or blocks therapy.
When surgery is indicated, Dr. O'Donnell refers to a spine surgeon partner and stays involved in the athlete's return-to-sport decision. Out-of-town patients can send imaging through mymedicalimages.com and arrange telemedicine consults and post-operative visits.
When to see a specialist
Most episodes of neck or back pain improve within two to six weeks with movement and simple measures. The following signs need assessment within days, and the first two need emergency care the same day:
- New difficulty controlling the bladder or bowel, or numbness in the groin and inner thighs
- Weakness that is getting worse: a foot that slaps or drags, a knee that buckles, a hand that drops objects
- Pain, numbness or tingling that travels below the knee or into the hand and has lasted more than two weeks
- Neck pain after a collision or fall with any arm or leg symptoms, or a stinger that has not cleared within 15 minutes or that involves both arms
- Back pain with fever, unexplained weight loss, or a history of cancer
- Back or neck pain that has not improved after 6 weeks of correct treatment
How Dr. O'Donnell decides between rehab and surgery
Almost every patient is treated without surgery, and the decision Dr. O'Donnell makes is when to escalate and when to refer. A low back strain or neck strain with a normal nerve exam gets no imaging and an active program; if it has not improved at 6 weeks, X-rays and a review of the diagnosis follow. A disc herniation with leg or arm pain is treated for 6 to 12 weeks, with an epidural injection added at 2 to 4 weeks if the pain is severe, because most herniations resorb in that window and one-year outcomes are the same with or without surgery for most patients.
Referral to a spine surgeon is made in three situations: weakness that is progressing or severe at presentation, cauda equina symptoms, which are an emergency, and limb-dominant pain that has failed 6 to 12 weeks of care including an injection, where a microdiscectomy relieves leg or arm pain reliably. For stingers, referral follows an MRI showing cervical stenosis, cord signal change or a herniation with persistent weakness, or three or more stingers in a season despite a full program; return to contact sport is then decided with the surgeon and the athlete.
Spine conditions we treat 6
Rehabilitation protocols
Dr. O'Donnell's written physical therapy protocols for this joint, shared with your therapist and progressed on criteria rather than dates.
Frequently asked questions
Do I need an MRI for back pain?
Not in the first 6 weeks unless there is a red flag: progressive weakness, bladder or bowel change, fever, a history of cancer, or major trauma. Disc bulges and degenerative changes appear on the MRIs of most adults with no pain at all, so an early scan tends to mislead. MRI is ordered for leg- or arm-dominant pain that has failed 6 to 12 weeks of care, when it would guide an injection or a referral.
Is Dr. O'Donnell a spine surgeon?
No. He is a board-certified orthopaedic surgeon with fellowship training in sports medicine, and he manages the neck and back injuries of athletes and active adults that do not need an operation, which is the large majority. When surgery is indicated, he refers to a spine surgeon partner, shares the imaging and exam findings, and remains involved in rehabilitation and the return-to-sport decision.
How long does sciatica take to go away?
Most sciatica settles within 6 to 12 weeks. The first two weeks are walking rather than bed rest, avoiding the positions that provoke the leg, and an anti-inflammatory or a short oral steroid taper for severe pain. Physical therapy starts early. An epidural steroid injection is arranged when pain remains severe at 2 to 4 weeks or is preventing therapy. Leg pain that persists beyond 12 weeks despite this is discussed with a spine surgeon.
Can I be seen the same week after a back or neck injury in sport?
Yes. Same-week appointments are kept for acute injuries, and any athlete with arm or leg weakness, a stinger involving both arms, or symptoms that have not cleared is seen within days. The visit includes a full nerve exam and the imaging the findings call for. A player with residual weakness or numbness stays out of contact until the exam is normal, and the cervical strengthening program starts once symptoms have cleared.
