Back & Neck Pain

Low back pain is one of the most common causes of disease burden worldwide. Low back pain is triaged to identify individuals who need to be cleared of having “red flag” or more serious conditions, and those with a nerve root compromise. However, more than 95% of people suffering from low back pain are triaged as having “Non Specific Low Back Pain”, which simply means that they do not have a serious pathology causing their pain, or compromise to a nerve root. For this reason, imaging is generally not recommended in acute cases of low back pain (you can read more about this here).

Non specific low back pain has no identifiable patho-anatomical cause, so treatment focuses on reducing pain, improving range of motion, and regaining strength and function (and not a specific structure). Treatment can vary greatly between individuals and therapists, but may include education, advice on the use of analgesics or anti-inflammatories, manual therapy, exercise therapy, home exercise routines and advice.

The recurrence rate of low back pain is extremely high, estimated at approximately 80%. That means, once you have experienced low back pain once, you most likely will again. However, with the right treatment and education, you can minimise the length and intensity of the episode and the disruption to your daily life.

We recommend treatment commence right away, as prognosis tends to be more favourable when treatment commences during the acute phase.

The Thoracic Spine (or mid-back region) is the longest segment of the spine located between the neck and low back. It is made up of 12 vertebrae, labelled T1 to T12, each with a rib attaching to it from either side. In total, this amounts to 72 different joints in this part of the back, all located close together.

Thoracic spine is a very common presentation, although less common than neck and low back pain, and can occur across the lifespan. Pain may be localised to the spine either centrally or on one side, or may radiate across the back into the side or front of the chest wall. It may also refer up towards the neck and shoulder, or down towards the low back. Symptoms can vary greatly and may include aching, throbbing, sharp pain, tingling, numbness, burning or catching, and may be constant or intermittent. Symptoms may be associated with static postures e.g. sitting at a computer or driving, or activity e.g. swimming, throwing, weightlifting. Rotation and extension are the movements most commonly compromised. Treatment usually involves both manual therapy and exercise to regain range of motion and reduce pain. Generally speaking, the quicker range of motion can be restored, the quicker symptoms settle. Recovery tends to be quicker than injury to other areas of the spine, depending on your diagnosis.

Non-specific neck pain is an extremely common condition experienced by people across the lifespan. Neck pain, like low back pain, is triaged to identify individuals who need to be cleared of having “red flag” or more serious conditions, and those with a nerve root compromise. However, the majority of people suffering from low back pain are triaged as having “Non Specific Neck Pain”. Put simply, non-specific neck pain is neck pain with no known specific cause, though it is generally put down to postural or mechanical causes. Assessment of your neck pain will help determine what your deficits are and potential causes and contributing factors.

Symptoms can vary greatly between individuals and may include pain, restricted mobility of the neck and/or mid-back, tingling and numbness, pain in the neck and/or shoulder and/or arm and hand, headaches, dizziness, catching or grinding sensation in the neck, weakness of the arm, heaviness of the arm, thoracic spine pain and facial symptoms.

Non specific neck pain has no identifiable patho-anatomical cause, so treatment focuses on reducing pain, improving range of motion, and regaining strength and function (and not a specific structure). Treatment can vary greatly between individuals and therapists, but may include education, advice on the use of analgesics or anti-inflammatories, manual therapy, exercise therapy, home exercise routines and advice.

Non-specific neck pain has a moderate recurrence rate of approximately 50%.

Nerve root compromise or radiculopathy is a condition where the spinal nerves that exit the spine become compromised, leading to a malfunction of the affected nerve. It affects less than 5% of people who suffer from neck or back pain.

Spinal nerves exit the spine via foramina (or holes) created between a vertebrae and the one below or above it. Each spinal nerve contains sensory fibres and motor fibres that control a particular group of muscles in our arms or legs, and is responsible for certain reflexes, and the sensation on a particular patch of skin.

Compromise can occur in many ways, but a common cause is a narrowing of the exit foramina, which in turn may be caused by (but certainly not limited to) bone spurs, disc herniation, or inflammation in the area.

When the spinal nerve is compromised, the nerve loses it’s full function, and this may result in tingling and/or numbness in a particular area, weakness in one or more muscles, and absent reflexes. depending on which nerve is affected, your presentation will vary. Radiculopathies are usually associated with neck or low back pain, as well as symptoms that radiate into the arm or leg of the affected side.

Treatment does not usually differ from that of non-specific spinal pain, in that treatment is always targeted towards improving your pain, range of motion and function. Treatment may include education, advice on the use of analgesics or anti-inflammatories, manual therapy, exercise therapy, home exercise routines and advice.

Radiculopathy and nerve root compromise are most commonly managed without surgery. Investigations such as MRI may be indicated if you fail to improve with conservative management, but this is usually only to confirm our diagnosis and inform prognosis (that is, your recovery timeline). In some cases, invasive treatment such as cortisone injections and (less commonly) surgery is indicated if conservative management fails.

Spinal discs are located between each vertebrae of the spine. There are 25 discs in our spine - 7 in the neck, 12 in the mid-back, and 5 in the low-back, and 1 sacral disc. These discs account for approximately 30% of the length of our spine, and allow our spines to be flexible without losing strength, as well as functioning as shock absorbers.

There are many different types of disc injuries, including:

• Disc Bulge: where the circumference of the disc extends beyond the vertebral bodies

• Disc Herniation: where the nucleus pulposus (the inner part of the disc) is also involved

• Disc Protrusion: the width of the protrusion is wider than the disc material that is injured

• Disc Extrusion: the nucleus pulposus herniates beyond the normal disc boundary

• Disc Sequestration: the herniated material breaks off

• Disc Dessication: common in ageing, the disc becomes flattened and loses its shock absorbing and movement capabilities

Disc injuries may or may not be the source of pain. Many studies have been done that show that individuals without symptoms have disc injury on MRI, and those with long-standing symptoms may have no disc injury at all.

Regardless of whether a disc injury is picked up on imaging, or whether your assessment leads your therapist to consider disc injury as a source of your pain, treatment will not be directed towards that specific disc, but rather towards treating your pain and function. In fact, approximately 85% of patients with symptoms associated with disc injury recover within 8-12 weeks, which is no different to the prognosis of low back pain and neck pain in general.

Treatment does not vary to that of “non-specific spinal pain”, that is, treatment may include education, advice on the use of analgesics or anti-inflammatories, manual therapy, exercise therapy, home exercise routines and advice.

Cervicogenic Headaches

Cervicogenic headaches are a type of secondary headache that account for 15-20% of all headache presentations. They are associated with neck pain and stiffness, usually located on only one side of your head, and usually start at the back of your head or top of your neck and refer elsewhere in the head. Occasionally they can also be associated with arm discomfort on the same side. Intensity can range from mild to severe and the duration of the headache may vary, but usually lasts hours. Cervicogenic headaches differ from tension-type and migraine headaches in that they are not usually associated with nausea, or sensitivity to light or sound, and occur exclusively on one side of the head, and have a direct relationship to neck function. Cervicogenic headaches do not often respond to medication. Physiotherapy involving manual therapy to the neck and thoracic spine, and exercises to address muscle tightness, joint stiffness, and muscle weakness and dysfunction, as well as addressing postural deficits, is highly effective in treating this condition.

Cervicogenic Dizziness

Dizziness can also originate in the neck - this is referred to as cervicogenic dizziness. Cervicogenic dizziness is characterised by the presence of dizziness with associated neck pain or dysfunction. Patients suffer from imbalance, unsteadiness, disorientation, neck pain, limited neck range of motion, and at times can be accompanied by a cervicogenic headache. Cervicogenic dizziness is a diagnosis of exclusion - that is, there is no test to diagnose the condition and cannot be verified by imaging or blood tests, and all other competing diagnoses have been ruled out. Treatment is similar to cervicogenic headache, with the focus being treatment of the cervical spine and any identified deficits.