Conditions · Low back pain

Low Back Pain Treatment in Midtown NYC

Sports medicine and hands-on care for back pain that keeps coming back.

Hiro Nakano, DC, DACBSP · Team USA medical staff · In Midtown since 2010

How I help

Find the why

A 90-minute first visit: your history, a hands-on exam, and a look at your hips and whole-body movement — not just your lower back. I want to know why the pain started and how it keeps coming back.

Treat and rebuild

Hands-on care to calm the pain and help you move, then step-by-step exercise matched to how your back responds. If squats hurt, we find a version you can do today and build from there.^[3]

Proactive, not reactive

No pain is the beginning, not the end. Like athletes, we keep building strength and capacity so you’re ready for what comes next — instead of waiting for the next flare-up.^[5]

The truth about back pain

An X-ray rarely explains back pain.

X-rays are still the most commonly ordered imaging test for back pain^[10], but they show bone — not the discs, nerves, and muscles where most back pain comes from. The “degeneration” they often reveal is common in people without pain and only weakly linked to it.^[7] In clinical trials, routine imaging didn’t improve pain or function, and in one study people who had an X-ray reported more pain at three months and went back to their doctor more often.^[8]^[9] An image without a physical exam is a picture without a story. X-rays are useful when the exam points to something specific, like a possible fracture — not as a stand-alone answer.

An MRI finding isn’t the whole story.

Many people are told “you have a disc problem” and stay married to that diagnosis for decades. Research shows disc changes are very common in people with no back pain at all, and they become more common with age. An abnormal image doesn’t mean your back will hurt forever. I look at the person, not just the MRI.^[6]

It’s rarely just “posture,” “weakness,” or “subluxation.”

Depending on who you see, you’ll hear that it’s your posture, your weak core, or a bone “out of place.” I wish it were that simple. Sometimes one of those really is the missing piece, but no single approach works for everyone.

Sometimes the disc really is the problem.

When a disc is irritating a nerve, an injection or medication from a pain management physician can calm things down much faster than manual therapy and rehab alone. When that’s the case, I’ll tell you and refer you, and we keep working together. That’s the honest reality.

Feeling better isn’t the same as being recovered.

Pain can ease while the strength, control, and endurance your back needs are still missing.

Back pain often comes back — and that’s manageable.

In one study, 69% of people had another episode within a year of recovering.^[4] The goal isn’t a promise that it never returns. It’s a body that handles it better and recovers faster.

I’m not the only answer — and I don’t need to be.

The way the U.S. healthcare system handles back pain isn’t working as well as it should. The U.S. spends more on low back and neck pain than on almost any other health condition — about $134.5 billion in 2016 alone — and spending has grown without a matching improvement in how patients feel.^[1]^[2] Yet about 3 in 10 American adults report low back pain in any three-month period,^[11] and the number of people living with back pain worldwide keeps growing, from about 619 million in 2020 to a projected 843 million by 2050.^[12] If more treatment alone were the answer, we would see fewer patients and lower costs.

No single treatment or profession has the whole answer — including me. That’s why I bring everything I have to each person: my knowledge, hands-on skill, experience, and clinical judgment.

In my experience, most back pain is mechanical. Some combination of how you move, your habits, and the demands of your life puts more load on certain tissues than they can handle — and your pain system responds. That pattern is different for every person. Everyone has their own story, so we take the time to find yours and work on it together.

Sometimes it’s simple, and a few visits make a big difference. Sometimes it takes more patience, more work, and a team. Either way, I’ll do whatever it takes to help your back get better — and sometimes that means working with your trainer, acupuncturist, physical therapist, or pain management physician. As long as you’re getting better and stronger, I’m happy.

Your first visit

About 90 minutes, $300. I listen, examine you, rule out anything that needs other medical care, and explain what I find in plain language. You leave with hands-on treatment, exercises you can start right away, and a written summary of the plan. When imaging is truly needed, I can order X-rays or MRI directly — no referral required.

More about your first visit →

Not sure yet? Text me first.

By now you’ve probably heard a lot of different opinions and searched for a lot of answers. I understand that completely — I’d feel the same way. If you have questions, send a text to 212-931-8544 and ask. Most things make more sense once we talk. Come in when it makes sense to you.

Book an Initial Visit Text a Question

Dr. Hiro Nakano assessing low back and hip control in a seated position at TAI NYC in Midtown Manhattan

Common questions

Should I rest or keep moving with low back pain?

For most back pain, staying gently active helps more than bed rest. The key is finding movement your back tolerates — easing off what clearly makes it worse, without stopping everything. I help you find that level and build from it.

When should I go to the ER for back pain?

Most back pain isn’t dangerous, and it rarely needs the ER. But don’t wait for an appointment if your back pain comes with numbness around the groin or inner thighs, new trouble controlling your bladder or bowels, or leg weakness that keeps getting worse. The same goes for back pain with a fever, a history of cancer or unexplained weight loss, or pain that started after a bad fall or accident. These situations are rare, but they need to be checked right away. When in doubt, get checked.

Do I need an MRI for back pain?

Usually not at first. Many MRI findings are common in people without pain, so imaging is most useful when the result would change your care — for example, with red-flag symptoms, progressive weakness, or pain that isn’t improving as expected. When it is needed, I can order it directly.

Is it safe to exercise with back pain?

In most cases, yes — with the right dose. In early stages I keep exercise well inside a safe range and judge progress by how you feel the next day. Pain that settles quickly is usually fine; pain that builds or lingers means we adjust.

How many visits will I need?

It depends on your condition, history, and goals. Many people notice a change within the first one or two visits; long-standing problems take longer. There is no long-term contract — we decide together as you progress.

Ready to get back to what matters?

You don’t need to be fit or confident to start. Tell me what’s bothering you and what you want to be able to do again.