Back Pain and Neck Pain Consultation

Back and neck pain: what patients usually notice

• Back pain while sitting for long periods, bending or standing
• Pain between the shoulder blades, or neck stiffness after waking up
• Pain going from the back into the buttock and leg, sometimes called "back pain going down the leg"
• Tingling, numbness or weakness in the leg, or in the arm when the neck is involved
• Pain when bending, lifting or getting up from bed
• Tailbone (coccyx) pain when sitting

Medical terms you may hear

Patients often say "slip disc" for a herniated or prolapsed intervertebral disc, where disc material presses on or irritates a nearby nerve. Lumbar spondylosis and cervical spondylosis are age-related wear of the spinal discs and joints in the lower and neck regions. Sciatica is pain that follows the sciatic nerve, and radiculopathy means irritation of a nerve root. Mechanical back pain comes from the muscles, ligaments or joints of the spine.

Common causes

• Muscle strain from lifting, sudden movement or prolonged poor posture
• Long hours of sitting, desk work or driving
• Age-related changes in the spinal discs and joints
• Disc problems that press on a nerve
• Less commonly, fractures, infection or other serious causes, which is why warning signs are checked at every consultation

What a consultation includes

• A history of your pain, including where it spreads and what eases or worsens it
• A neurological examination: strength, sensation and reflexes in the legs or arms
• Review of any previous X-rays or MRI reports
• X-rays or an MRI scan only when they are clinically needed; not every back pain needs scans
• Advice on activity, posture and an exercise plan

Treatment options

Most back and neck pain improves with staying active, a graded exercise programme, pain-relieving medicines as prescribed, and advice on posture and daily activities. A physiotherapist can supervise exercises. Injections are considered in selected cases. Surgery is reserved for people with persistent, severe symptoms, progressive nerve damage such as increasing weakness, or those whose symptoms have not improved with non-operative care. Surgical options are explained in detail before any decision.

When to arrange an assessment

• Back or neck pain that has not improved after several weeks of self-care
• Leg pain with numbness or tingling that affects walking
• Pain that wakes you at night or does not ease when lying down
• Pain that is steadily getting worse
• Neck pain with arm symptoms or hand clumsiness