Spine / Neck

This can involve a disc strain (tear), disc herniation (bulge) or a disc prolapse (ruptured disc), normally seen in young to middle aged adults and often associated with a compressive injury, such as lifting.

If the associated inflammation or displaced disc material makes contact with pain sensitive structures adjacent to the disc, such as the retaining ligaments this can cause back pain; if it contacts a nerve it can cause nerve pain (radicular pain) into the lower limb, such as sciatica. The pain will often be worse when sitting.

In rare cases the disc bulge can compress the spinal cord causing a condition called Cauda Equina Syndrome where pain/numbness/pins & needles is experienced in both legs, often the inside of the thighs, weakness in the legs and feet and loss of bowel and bladder control (incontinence), which requires urgent medical assessment.

This is pain caused by Disc Degeneration (Degenerative Disc Disease or Spondylosis). This is a natural process as we get older, where the disc dries out and is not normally the cause of pain.

However as the disc dehydrates, it flattens and displaces which can cause compression of adjacent pain sensitive structures discussed above, causing back pain and trapped nerve. This pain will often be worse when transitioning from sitting to standing.

This is normally caused by degeneration and dehydration in the discs (see above) which results in a loss of height between the vertebrae which in turn causes a compression and narrowing in the spinal canal or foramina, where the nerves pass through or exit the spine. The pain will often present on standing or walking for a short while and is normally relieved immediately by sitting down. Because it is a degenerative condition it normally presents in older age.

There are two types:

Spinal Stenosis where the spinal cord is compressed, causing referred pain/numbness and pins & needles into the legs. in extreme cases this can cause a condition called Cauda Equina Syndrome, where pain/numbness/pins & needles is experienced in both legs, often the inside of the thighs, leg/foot weakness and loss of bowel and bladder control (incontinence), which would require urgent medical assessment.

Foraminal Stenosis when the exiting nerve root is compressed, causing nerve root (radicular nerve) pain/numbess/pins & needles/weakness into the lower limb.

In addition to the intervertebral disc joints, there are two small joints at the back of each vertebrae.

Over time, as we age, these can be subjected to wear & tear that can create osteoarthritis. This can give rise to marked pain and discomfort in the lower back, and it can refer into the buttocks and thighs.

It normally presents when the patient stands or extends their spine backwards. As with all degenerative problems this presents more in the older population.

Although we will all experience muscular aches and pains in our spine from time to time, often after unfamiliar/excessive activity, such as sport, gardening, DIY, this can sometimes persist. This will often be related to a postural or lifestyle factor that is driving the problem.

This can include:

Developmental/Postural Conditions; causing curvatures in the spine, such as Scoliosis or Kyphosis.

Pregnancy Related Postural Changes; this relates to the adaptations in posture that occur as a woman’s body changes during pregnancy, as a result of weight gain, altered centre of gravity and hormonal changes that allow the skeletal frame, particularly in the pelvic girdle, to prepare for childbirth

Hypermobility; where there is an inherited Ligament Laxity which means the ligaments are less able to support our joints as they should, causing the supporting muscles to become overloaded

Work Related; such as poor work station set up/ergonomics or overuse of laptops and handheld devices

Sedentary Lifestyle; the spine needs to be moved, so inactivity will inevitably result in shortening/tightening of muscles as well as weaker muscles, creating an overload on the supporting muscles

Stress Related; stress in our lives will cause muscle tension, which normally presents as a dull ache rather than sharp pain. There might also be stiffness and loss of range of movement.

Stress/Compression Fractures, normally seen in the older population and related to underlying poor bone health, such as Osteoporosis - hormonal factors (post menopausal women), dietary factors such as Vitamin D/Calcium deficiency and reduced loading activity which helps to maintain bone health.

Pars Fractures (Spondylolysis) of the pars interarticularis, the part of the vertebra that connects the vertebral body to the neural arch at the back of the vertebra. This normally affects the lowest two lumbar segments (L5 & S1) and will normally present in active young adolescents who play lots of sport, particularly those that require repetitive extension and stress loading of the spine, such as fast bowlers playing cricket, gymnasts etc. 

This is a condition where one vertebra “slips” forward on the vertebra beneath it. This can occur in an undiagnosed Pars Fracture (see above) or as a result of a degenerative disc compression. This normally happens very gradually and in time can cause back pain and occasionally referred nerve pain into the lower limbs.

The Cervical Spine (neck) is subject to the same problems that affect the lower spine including disc injuries, degeneration and arthritis.

Additional causes of neck pain include:

Cervical Radiculopathy (trapped nerve); when the nerves in the neck become compressed, usually as a result of a disc bulge, this can cause pain, numbness and pins & needles and sometimes weakness into the arm

Cervical Myelopathy; This is a condition when the spinal cord is compressed (similar to Spinal Stenosis in the lower spine). This normally occurs as a result of a disc bulge displacing into the spinal canal, but can also be related to a developmental problem where the spinal canal is narrower than it should be. This can cause pain, numbness, pins & needles and weakness in the hands. Additionally it might be become difficult to control your fine hand movement, causing an awareness of becoming clumsy as well as affecting gait/walking and bowel/bladder control. These conditions require urgent medical assessment.

Stress Related Muscle Tension; stress in our lives will cause muscle tension, which often presents as a dull ache in the neck, shoulders and upper back. There might also be stiffness and a loss of range of movement in the neck. When this affects the upper neck, as it often does, it can lead to headaches.

Whiplash Associated Disorder (WDA); this term  applies to soft tissue related injuries, after an acceleration-deceleration injury, such a motor vehicle accident (RTA). It can cause neck pain, stiffness, muscle spasm and headaches and is unpredictable in its duration.

Torticolis; (wry neck) is a condition where the neck muscles contract involuntarily, causing the head to twist or tilt to one side. It can be either congenital (present at birth) or acquired (developing later in life), often as a result of exposure to a cold draft, trauma but occasionally due to neurological conditions and infections.

Rib Joint Sprains, often caused by twisting injuries, coughing/vomiting or direct loading.

There are two rib joints: Costo-Vertebral Joints; these joints attach each of the 12 ribs to the 12 thoracic vertebrae. An injury here will cause pain in the mid back that can sometimes refer through or around the chest wall to the front of the chest. Costo-Condral Joints; These joints attach the ribs to the sternum at the front of the chest. If they become inflamed it can cause Costochondritis, causing a sharp pain in the middle of the chest wall at the front and has been associated with inflammatory arthritis, such as Ankylosing Spondylitis.

Stress/Compression Fractures; common in the thoracic spine, they are typically due to excessive loading forces that exceed the bone’s strength, resulting in a collapse or wedging of the vertebra. Caused by:

• Osteoporosis/age related – where a vetebrae, weakend by metabolic/menaporsal/sedentary factors is more susceptible to fracture from minimal trauma or even normal activity

• Trauma – such as falls, car accidents, or heavy lifting.

• Repetitive stress – in athletes or individuals with high spinal loading (e.g., gymnastics, weightlifting)

• Pathological causes – including metastatic disease or other bone-weakening conditions

Presenting Symptoms:

• Sudden onset of sharp or deep back pain, often in the mid or lower back

• Pain worsens with movement or standing, relieved by lying down

• Possible loss of height or visible spinal curvature (e.g., kyphosis)

• In more severe cases, neurological symptoms if the fracture impinges on spinal nerves

This occurs when coccyx (tail bone) becomes inflamed, normally following a fall or trauma and will present with pain at the bottom of the spine, particularly on sitting.

This includes inflammatory arthritis such as Ankylosing Spondylitis, Neoplasms/Tumours. Whilst these problems are not something an osteopath would treat, we are trained to recognise these conditions and when to make appropriate medical referral for further investigations.