Spinal pain is an issue affecting a large proportion of Scottish society in some form or another. There are many types of spinal pain but it is known that most people during their lifetime will experience what is termed “mechanical” pain.
Most often spinal pain is a short lived inconvenience but can resolve naturally over a short period of time.
In other instances people can develop more chronic or persistent symptoms that can have a long lasting and large impact on their lives.
In Ayrshire and Arran we have developed this website and workbook to try to help people better understand their spinal pain. Common spinal complaints are highlighted and it is hoped the information provided will enable us to educate, reassure and help people resolve spinal problems they may encounter.
For ease of use we have split the spine into neck, thoracic and lumbar sections. They have their own individual features but much of the advice and exercise is applicable for the whole spine.
We will address commonly held myths and beliefs and will give suggestions on how to deal with spinal pain. An important feature of this website is to encourage normal movement and function. The exercise information is therefore particularly important.
As mentioned this website and workbook can be used alone or with your health professional.
Hopefully you will find this information useful but if you are in any doubt about your symptoms then please contact an appropriately qualified health professional such as your family doctor (GP) or Chartered Physiotherapist for further advice.
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General pain considerations
It is important to gain an understanding of how pain works in general as this has been shown to improve people’s ability to manage their condition more effectively.
How is this relevant to you?
The most important thing you should know is that pain does not always mean harm. It is possible to feel no pain with damage to our body. It’s also possible to experience a lot of pain even when no damage to our bodies has been shown.
We know now that pain is far more complex than only what is going on in our bodies and can be influenced by other areas of your life. These include:
- Mood and emotions
- Beliefs about pain
- Avoiding meaningful activities/social contact.
- Lifestyle choices
This is often referred to as “The Bio – Psycho – Social model of pain”. This means all areas of your life can influence pain. It is important to look at your life as a whole when dealing with neck pain to see if there are any other contributing factors.
Further information can be found by clicking the link below:
https://www.nhsaaa.net/pain-management-service/
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Anatomy of the spine
The spine is one of the strongest parts of your body and it has been designed to encourage movement. It is made up of 33 bones (known as vertebrae), one sitting on top of the other with discs in between.
At each spinal level there are facet joints linking one spinal level to the next. These joints are synovial joints and have similar features to a knee, finger or hip joint.
There are seven cervical (neck), 12 thoracic (mid-back) and five lumbar (low back) vertebrae. There are also five fused sacral and four fused coccyx vertebrae which tend to cause less trouble than the cervical, thoracic or lumbar areas.
Diagram 1: Picture of the Human Spine
The spine is surrounded by strong muscles and ligaments which support and protect the back giving it strength.
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What causes neck pain?
Neck pain is a very common problem that can affect two out of three people at some point in their lives. It can have a variety of different causes:
- Muscle strain or sprain
- Staying too long in one position
- Stress
- Worry
- An accident
- Altered sleeping position
- Flare up of underlying condition such as cervical spondylosis
Remember that severe pain doesn’t necessarily mean there is a serious problem.
What is the neck made up from?
Your neck is made up of a column of bones (vertebrae) stacked one on top of the other. These bones are very strong and help to support your head and protect your spinal cord.
The neck consists of the top seven bones (vertebrae) of the spine known as the cervical vertebrae or cervical spine. The bones are linked together by small joints known as facet joints. Together with the neck muscle they allow you to move you head in different directions.
Diagram 1: Front view of the neck
Diagram 2: Rear view of the neck
The bones (vertebrae) have a disc between one another and this is known as the intervertebral disc. At each level, nerve roots branch out from your spinal cord, passing through an opening in your spine that run the full way down your arms to your fingers.
Finally, four arteries carry blood from your heart to your brain. Two of these run inside the bones of your spine and supply the part of your brain that controls your balance.
What are the signs and symptoms of mechanical neck pain?
The most common symptoms are:
Pain and stiffness
As well as the neck area, pain can extend to the shoulder, shoulder blade (scapula), or to the upper chest. The pain may also travel to the back of your head, and sometimes behind your eye, ear or forehead.
It may be painful to move your neck and the muscles may feel tight, especially if you have been resting or sitting in a position for a long period of time.
Numbness or tingling
If a nerve in the neck has pressure near it, or is irritated or compressed you may feel numbness, pins and needles or tingling down one or both arms. Occasionally you may also experience a feeling of weakness in your arm or hand.
The level where the nerve is pinched will usually correspond to where you get your symptoms in your arm. For example, if the C8 nerve root is affected, symptoms may be felt in the 5th finger area.
Diagram 3: Where the Nerves of the Neck Supply
Clicking
You may hear or feel a clicking noise as you move your neck. This is called crepitus. Although it can sound or feel alarming, this is nothing to worry about.
Muscle spasms
Sometimes if you have neck pain you may also have muscle spasms that prevent you from turning your head in one direction. This is known as torticollis or wry neck. It can be unpleasant but generally it will settle within a few hours or days. Occasionally, it can take several weeks to settle.
Should I speak to a health professional about my spinal pain?
Most of the time spinal pain will be self-limiting and short lived. Many of our patients have a combination of spinal pain and symptoms affecting the arms or legs such as pain, tingling, or numbness. These symptoms can be very distressing but don’t necessarily need emergency medical attention.
There are some signs and symptoms that you should look out for that would indicate you do need further assessment. If these symptoms develop you should seek urgent assessment. These are:
- Pins and needles or numbness increasing in both arms or legs at the same time
- Dizziness (vertigo, light-headedness or giddiness)
- Double vision
- Trouble swallowing food
- Slurred or slow speech
- Fainting or blackouts
- Facial numbness
- Nausea (feeling sick) with spinal movements
- Uncontrolled movement of your eyes (nystagmus)
- Significant change in your walking or balance
- Increased clumsiness or weakness with arms and legs
- A feeling of slapping your foot/feet when you are walking
- Severe night pain or night sweats
- Rapid unexplained weight loss
- If you develop severe pain and you have osteoporosis (thinning of the bones)
- If you are less than 20 or over 50 years old and the pain develops for no reason
- If you have a history of cancer, drug misuse, HIV infection, if you have a poor immune system or have been on steroids for six months or more
- If you are feeling generally unwell, for example, have a high temperature or have unexplained weight loss
- If you have had a recent infection
- If your pain does not change with movement or a change of position
- If your pain fails to improve over a reasonable period of time (two to four weeks of treatment)
- If your pain is associated with severe stiffness in the morning lasting for one to two hours or more
- If your spine changes shape or you develop lumps or bumps
In rare occasions low back pain and leg symptoms can progress into a very rare but serious condition known as Cauda Equina Syndrome. This can lead to permanent damage or disability if not dealt with promptly. Someone developing this condition would need to be seen by an Emergency Specialist Spinal Team. Please see below for some warning signs of Cauda Equina Syndrome:
- Loss of feeling/pins and needles between your inner thighs or genitals (private parts)
- Numbness in or around your back passage or buttocks
- A different feeling when using toilet paper to wipe yourself
- Increasing difficulty when you try to urinate (pee)
- Increased difficulty when you try to stop or control your flow or urine
- Loss of sensation when you pass urine
- Leaking urine or if you have recently started to need to use pads
- Not knowing when your bladder is either full or empty
- Unable to stop a bowel movement or leaking stools (poo)
- Loss of sensation when you pass a bowel motion
- Change in your ability to achieve an erection or ejaculate
- Loss of sensation in genitals during sexual intercourse
Any number or combination of these warning signs could be symptoms of Cauda Equina Syndrome. If you develop these, you should seek emergency medical advice or assessment within 12 to 24 hours.
You could do this by contacting NHS24 on 111, your GP or the Emergency Department (A&E) if necessary.
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Review Date: July 2024
Common spinal myths and beliefs
Myth: Spinal Pain is Caused by Injury
Fact: In many cases, it is not possible to identify the exact cause of spinal pain. Many physical and psychological factors (and often a combination of these) can be involved in back pain. They could be:
- physical factors such as a simple strain
- psychological factors such as being stressed, feeling down, or worried about not getting better
- social factors such as difficult relationships at work or home, or stressful life events like family illness
- general health or lifestyle factors such as being overweight, smoking or not getting quality sleep or physical activity
Each of these factors can influence how we experience pain, and gaining a greater understanding of them can help you manage your condition better.
Myth: Bed Rest is the Best Cure
Fact: In the first few days after a new episode of spinal pain, avoiding some activities may help. Scientific studies now advise that prolonged rest and protection of the spine actually leads to higher levels of pain and poorer recovery. Staying as active as possible and gradually returning to normal activities helps recovery. This includes staying in work where possible.
Myth: Exercise will make my Spinal Pain Worse
Fact: Exercise is shown to be very helpful for tackling spinal pain and is also the most effective way to prevent future episodes. Start slowly and build up gradually. No one type of exercise is proven to be more effective than others, so choose an activity that you enjoy and that fits in with your schedule.
Myth: Always Sit up Straight
Fact: Slouching is not good for you if you do it a lot or for extended periods. Sitting up too straight or sitting in any static position for long periods can also put a strain on your spine. There is no single ‘correct’ posture. Take breaks from static positions. Lean back in your chair with your feet on the floor and let your back curve slightly. Try standing for part of the day, perhaps while you’re on the phone or reading. Try to keep moving regularly through the day. The spine likes movement.
Myth: Bending will make my spinal pain worse
Fact: Your back is a resilient structure, and is designed to be flexible and allow us to move. Bending forward is a normal function of the spine and doesn’t need to be feared or avoided. It may be possible that an individual will develop pain when bending activities are performed repeatedly if they are not used to doing this. One example is shifting boxes when moving house. This may expose the individual’s spine to repeated loads which is over and above their normal. This is more to do with the build-up of stress over time which their spine is not accustomed to, rather than the act of bending. Bending is safe!
Myth: I need Investigations for my Spinal Pain
Fact: You rarely need a scan and it can actually do more harm than good. Even though it is perfectly normal for a scan to show changes in the spine, such as ‘degeneration’ or ‘wear and tear’ this can cause people to avoid or be fearful of activities they should be doing to get better. It is important to know that there is not a strong link between X-ray and MRI scan findings of ‘spondylosis’ or ‘degeneration’ and a person’s pain. Although investigations are rarely required, your GP or physiotherapist can decide if this is required if your spinal pain does not settle as expected.
Myth: My Spinal Pain is Due to “something being out of place”
Fact: Although this a feeling that people often experience, there is no evidence that spinal pain is caused by a bone or joint being out of place. For most people with spinal pain, X-rays and scans do not show bones or joints being out of place.
Myth: Wearing a Collar or Corset will help my pain!
Fact: Collars and corsets were commonly used in the past to treat spinal pain. Current evidence shows that there is no benefit in the short, medium or long-term. Over-use of a collar or corset may weaken the spinal muscles causing increased pain and more long-term issues.
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Review Date: Jul 2024
Do I need investigations for my spinal pain?
Investigations for spinal pain are generally not required. This is true especially if there has been an obvious cause of pain, for example, doing a spot of gardening if you are not used to it.
X-rays often show “wear and tear” which is part of a normal aging process. It is known that there is no strong link between these findings and a patient’s pain. X-rays often do not tell us any more than we would expect from the patient’s age.
MRI scans can be useful in certain conditions. For example, if your pain does not settle as expected or if you develop any worrying features (as mentioned previously in the individual spinal sections).
Sometimes having investigations can do more harm than good. Each X-ray for example carries a small dose of radiation which in a small number of cases can cause problems.
MRI’s often highlight false positives. These are findings that are not responsible for the patient’s symptoms and can lead to confusion and unnecessary worry for the patient. In some cases this can be a barrier to them getting better.
As a general rule your healthcare professional knows when tests should be required. Please discuss with them any questions you may have on this topic.
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Do I need surgery for my spinal pain?
It is uncommon to require spinal surgery. Decompression surgery is a type of operation used to treat compressed nerves in the spine. It aims to improve symptoms such as pain and numbness in the arms or legs. Surgery is only considered in a very small number of cases if arm or leg symptoms have not improved with appropriate medication and exercise, adequate time, changes in lifestyle, including weight loss if required.
In people with severe arm or leg symptoms due to compressed nerves, decompression surgery can be an effective treatment, however it would rarely be considered for neck pain or back pain only. It should also be remembered that spinal surgery carries a risk of complications. It is important to persevere with non-surgical strategies to manage your symptoms.
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Review Date: July 2024
What can I do to help myself if I have spinal pain?
There are lots of things you can do to help manage your symptoms. The best person to help is you! Changes in lifestyle and modifying your activities can reduce your symptoms and stop things getting worse.
Try not to worry
It is only natural to feel worried. Feelings such as worry, anxiety and fear, or negative expectations about treatment are barriers in preventing people recover.
Painkillers
A range of different medications may be available to help reduce your pain to allow you to move more comfortably. Do not exceed the daily allowance of these medicines even if your pain is high. Always consult a health professional prior to taking any new medication. If you are unsure of what medication you can take, speak with your local pharmacist, practice nurse or GP for guidance.
If you are prescribed medication it is important that you take them regularly and at the recommended dose (see medication packet for details). All medicines can cause side-effects, particularly if they are not used as prescribed. Side-effects range from “common” to “uncommon” and vary from person to person. Information on possible side-effects is available on the leaflet inside the packaging of your medication. It is important to speak to your local pharmacist, practice nurse or GP who may be able to change the dose or the medication itself to something that is more suitable.
You should try to use any prescribed medication at the recommend dose. Some medicines can take a number of weeks to have an effect, this depends on the person. It is best to speak again with your GP or pharmacist about what other options are available if you don’t feel your medicines are helping.
Heat/ice
A hot water bottle or ice pack (such as a bag of ice cubes) can be used regularly to help control pain in the early stages of new onset of spinal pain or a flare up of existing pain.
If using ice, wrap the ice pack in a towel and apply to the painful area for 10 minutes every two hours.
If you are using heat, wrap the warm compress in a towel and place it on the painful area for 20 minutes every two hours.
If you have any concerns about the feeling on the skin where you are placing any of the mentioned compresses, ask a health professional to assess this before following this advice.
Lifestyle adaptations
Plan your activities in advance. Some simple changes in how you perform your daily tasks may help. For example:
- try to spread activities out over the course of the day or week. Take short breaks regularly and plan for these breaks before the point of pain.
- change your position regularly and take breaks from static positions. If you drive long distances, consider a rest point and get out the car before the pain makes you stop
- consider options which may make activities easier, for example, allow others to help, use step ladder / trolley.
General Health
It is important to look after you, and not just your spine. There are many factors which affect spinal pain. For example,
- smoking
- carrying extra weight can increase your chances of developing back pain.
Reducing smoking, losing weight, increasing your fitness and reducing stress can all have a positive impact on your pain.
If you need help reducing or quitting smoking then click - Quit Your Way
If you feel you may be carrying some extra weight then click - BMI Calculator to assess you Body Mass Index
If you need help losing weight the click - Weight Management Advice
Relaxation/mindfulness
Stress, anxiety and muscle tension can make spinal pain worse. One way of reducing the effects of stress is to learn how to relax your spinal muscles. The best way is to aim for a balance between exercise and relaxation.
Local NHS Ayrshire and Arran physiotherapists have created mindfulness tracks to assist with relaxation. These can be found on the NHS Ayrshire and Arran Pain Management website or click HERE to take you direct to the mindfulness tracks.
Manual therapy
There is some evidence to suggest that manual techniques may be useful in helping your symptoms in the short term. This should only form part of your management plan. Manual therapy or manipulation may give a “window of opportunity” to help you move and exercise normally. It is this normal movement and exercise which will provide benefits in the long term.
Sleeping
Sleep is very important. Our bodies repair while we sleep so it’s useful to practice healthy sleep habits.
People with persistent pain often find that they have difficulty getting to sleep or waken frequently throughout the night.
In the dark, our whole attention is free to focus on the pain. This makes it much louder. Like the ticking of a clock that we don’t notice till the lights are out. If we are not getting enough sleep and repair, this may contribute to the ill health and sensitivity of our tissues.
Many things may prevent good sleep, including:
- Napping during the day or sleeping late to catch up
- Not doing enough during the day to get tired
- Worry, adrenaline and stress
- Alcohol, caffeine and smoking
- Staying up most of the night, in bed a lot of the day
- Using electronic equipment, mobile phones in bed before sleeping
Identifying and addressing some of these factors can be very useful if your sleep is disturbed.
Should I change my pillow or mattress?
The answer to this is not as simple as a “yes” or “no” because everyone’s needs are different.
Expensive pillows and mattresses do not mean that they are the best solution to your spinal pain so it is worth trying a few simple changes first.
If your pillow is too soft, too firm or too thick this could be contributing to your neck discomfort. Simply changing the number of pillows you use may be helpful.
The general suggestion for pillow use is that your head should be supported and isn’t pushed too far forward or to the side. The pillow should fill in the natural hollow between the neck and shoulders.
If your mattress is old, sagging or simply too hard consider a change. Remember we are all made slightly differently so each of us will have our own “comfortable” type of mattress.
Please follow this link for further information on sleeping – click HERE
Exercise
Targeted exercises are effective for improving movement, strength and reducing pain. Local physiotherapists have researched the evidence to provide the most current exercises to improve your symptoms. Click HERE for neck pain exercises
Aerobic Fitness
Physical activity is good for everybody and too much rest can lead to stiffness and weakness. Our bodies are built for movement and research has shown that bed rest for more than a couple of days doesn’t help spinal pain and in the long-term actually makes your symptoms worse.
General exercise as well as targeted spinal exercises can help your fitness and improve your movement and pain. Exercising may make you feel a bit sore at first but it doesn’t cause any harm, so don’t be put off!
When you are in pain exercise should start slowly and you should try to gradually increase the amount that you do. It may be helpful to take your prescribed medication before you exercise but do not exceed the daily recommended amount.
As well as doing targeted exercises for the spine, it is important to remember that general exercise, such as walking, cycling and swimming, can also help to improve your movement and pain. The NHS Fitness Studio also provides good information on exercise. (Fitness Studio exercise videos – NHS (www.nhs.uk)
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