Neck and Back Pain

Understanding Neck and Back Pain

Neck and back pain are broad terms used to describe discomfort or pain in the cervical, thoracic, and lumbar regions of the spine. These types of pain can range from mild discomfort to severe, debilitating pain that limits movement and daily activities.

Neck Pain (Cervical Pain)

Neck pain typically refers to discomfort in the cervical spine, which can be localized to the neck or radiate into the shoulders, arms, and even the head. Some common causes of neck pain include:

Muscle strains: May be due to forceful movements, sporting or work injuries, or unexpected sudden movements.
Cervical facet joint dysfunction: Involving pain originating from the small joints in the cervical spine.
Cervical radiculopathy: Pain caused by compression or irritation of nerves in the cervical spine, often radiating into the shoulders and/or arms.
‘Degenerative’ changes: (Often normal) Age-related changes, such as ‘osteoarthritis’ or ‘disc degeneration’, may contribute to neck pain.

Back Pain (Thoracic and Lumbar Pain)

Back pain can involve the thoracic spine (upper/mid-back) or lumbar spine (lower back). While thoracic spine pain is less common, lumbar spine pain is particularly prevalent, as it’s the region most commonly involved in lifting, bending, and supporting body weight. Causes of back pain may include:

Muscle or ligamentous pain: May be due to overexertion, excessive load, sporting and work injuries, heavy lifting, or repetitive activities.
Disc herniation or bulging: Pressure on the spinal nerves from a herniated or bulging disc may cause localized or radiating pain.
Facet joint pain: Irritation or inflammation in the small joints that connect the vertebrae can lead to pain during certain movements or prolonged postures.
Sacroiliac joint pain: Pain originating from the sacroiliac joints, which connect the spine to the pelvis, may be a cause of lower back pain.

Both neck and back pain can have various causes, including mechanical issues, nerve impingement, sustained postures, repetitive stress, trauma, and in some cases, underlying medical conditions such as autoimmune or inflammatory diseases like rheumatoid arthritis. It is important to assess each case individually to tailor the treatment effectively.

Comprehensive Osteopathic Assessment

Osteopathic management begins with a detailed assessment that considers not only the physical aspect of the pain but also factors such as lifestyle, occupational demands, stress levels, and overall health. This holistic approach helps to identify contributing factors and underlying causes of the pain.

What to Expect During Assessment:

History taking: The osteopath will ask about the onset, duration, intensity, and nature of the pain. They’ll also explore any associated symptoms, such as radiating pain, numbness, or weakness.
Physical examination: A thorough examination of posture, movement patterns, joint mobility, and muscle function is conducted to help pinpoint the source of the pain.
Orthopaedic and neurological testing: These tests help assess nerve function and joint integrity, ensuring that serious conditions, such as neuropathy or disc injury, are properly identified.
Functional assessment: The osteopath may assess how the pain affects your ability to perform everyday tasks, such as sitting, standing, or lifting.

After the assessment, an individualized treatment plan is formulated, addressing both the immediate symptoms and the root causes of the pain.

Osteopathic Treatment Modalities for Neck and Back Pain

Osteopathic treatment is built on the philosophy that the body functions as a unit, and optimal health depends on the interplay between the biological components (muscles, joints, nerves, bones, ligaments etc..), the social components (relationships, work, rest, physical activity), and psychological factors (stress, anxiety, depression, happiness, joy, satisfaction). These are all considered in the development and re-evaluation of management plans.

1. Manual Therapy

Manual therapy is a cornerstone of osteopathic care, incorporating various techniques that aim to improve mobility, reduce pain, and enhance function.

Soft tissue manipulation: Massage techniques to reduce muscular tension, influence inflammation, and (ideally) have a positive impact on pain.
Joint articulation and mobilisation: Passive movements of joints to increase range of motion and reduce stiffness, particularly useful in conditions like facet joint pain.
High-Velocity, Low-Amplitude (HVLA) thrusts: Commonly referred to as "adjustments," these techniques aim to improve mobility to joints that have reduced range of motion, reduce pain (by influencing the nervous system), and reducing local stiffness in muscular tissues.
Dry needling: Inserting acupuncture needles into muscle, tendon, or ligamentous tissues with the aim of reducing pain and stiffness.

2. Postural and Ergonomic Advice

Posture, particularly during prolonged sitting or repetitive activities, may contribute to neck and back pain. Osteopaths provide personalized advice on whether altering your posture and/or modifying workstations may reduce strain on tissues and reduce feelings of stiffness and discomfort. This may include tips on:

Modifying desk setup: Adjusting chair height, monitor positioning, and the use of lumbar support.
Lifting techniques: Modifying the way you move or lift objects or providing exercise prescription to make these tasks easier.
Ergonomic interventions: Tailored advice on how to manage repetitive tasks or sustained postures in a way that minimizes stress on the body.

3. Exercise Prescription

Evidence strongly supports the use of exercise in the management of neck and back pain. Osteopaths often prescribe individualized exercise programs to improve strength, flexibility, and endurance. These exercises can include:

Strengthening exercises: Focused on building ‘core’ and other muscle strength to improve your capacity for daily activity and increase overall functional ability.
Stretching exercises: Designed to improve flexibility and range of motion in stiff muscles or joints.
Nerve gliding exercises: Particularly useful in cases of nerve entrapment, such as cervical radiculopathy or ‘sciatica’, these exercises help improve nerve mobility and reduce symptoms of numbness or tingling.

4. Education and Self-Management

Education is a key component of osteopathic care. Patients are empowered with knowledge about their condition and taught strategies for managing pain at home. This may include:

Pain neuroscience education: Helping patients understand that pain doesn’t always equate to damage and that movement can be safe and beneficial, even in the presence of pain.
Activity modification: Guidance on how to stay active and adapt exercises or daily activities to prevent exacerbation of symptoms.
Lifestyle advice: Recommendations on maintaining a healthy lifestyle, including nutrition, sleep, and stress management, all of which can influence musculoskeletal health.

Evidence-Based Approaches

Osteopathic care aligns with current evidence in pain management by emphasizing a biopsychosocial approach—addressing not only the physical factors contributing to neck and back pain but also considering emotional, social, and lifestyle factors.

What Does the Evidence Say?

Manual therapy: Research suggests that spinal manipulation and soft tissue techniques can provide short-term relief for acute and chronic low back pain, particularly when combined with exercise and education.
Exercise therapy: Strong evidence supports the use of exercise, particularly in managing chronic back pain. Exercises that strengthen the core, improve flexibility, and increase overall fitness can significantly reduce pain and prevent recurrence.
Posture and pain: While traditionally poor posture was often blamed for back and neck pain, current evidence suggests that posture alone is rarely the cause of pain. Instead, it’s prolonged or sustained postures that can contribute to musculoskeletal discomfort, highlighting the importance of movement and regular postural changes.