Back and neck pain are common issues that many people experience during their lifetime. In fact, according to our specialists, 80% of adults will complain of significant low back pain at some point in their life. As the second most common reason for patients to call a doctor, back issues represent a significant annual healthcare cost of almost $100 billion.
But while back and neck pain can impact your well-being, there is hope. Of the patients who experience low back pain, 90% will have that pain resolved within one year of symptom onset.
Experts from The Christ Hospital Health Network including orthopedic spine surgeon
Jared Crasto, MD, physical medicine and rehabilitation physician
Nick Godby, MD, and physical therapist Taylor Jordan, PT, DPT answer questions about proven treatments and ways to prevent back and neck pain.
What are the risk factors for back pain?
Several factors can put you at risk of back pain. These include:
Where is my back pain coming from?
“While we can treat back pain, a lot of it depends on the source,” Dr. Crasto says. “Finding the correct diagnosis can help resolve the pain faster.”
The most common cause of low back pain is muscle strain. “When you hear someone say, ‘my back went out,’ that’s usually a muscle spasm in the back,” Dr. Crasto explains.
Other causes of back pain include
spinal degenerative disorders. Degeneration occurs when the discs in the spine, which serve as the cushioning between the vertebral bones, wear out.
Vertebral bones can also come in contact when one bone slips onto the next, known as
spondylolisthesis. the sacroiliac joint can also undergo arthritic changes and become panful.
A herniated (slipped) disc or lumbar spinal stenosis (narrowing of space in the spinal canal) can cause compression and pinched nerve pain.
And
spinal deformities, like scoliosis, can also be a source of pain.
But back pain doesn’t have to start in the spine. “When we evaluate patients for low back pain, we consider the hips, knees, and other areas as potential contributing sources,” Dr. Crasto says. “We consider two classes of back pain: axial and radicular.”
Axial pain
“Axial pain originates in the back itself,” Dr. Crasto explains. “It doesn’t tend to shoot down the legs or travel anywhere outside the back.” There are several types of axial pain.
Muscular – Usually associated with physical activity, this is the most common form of axial pain.
Discogenic – Caused by a degenerative disc, this pain is often slow-building and long-lasting.
Mechanical – Mechanical pain is usually due to arthritis and worsens with prolonged standing or lifting.
Sacroiliac – This pain begins in the joint where the spine meets the pelvis.
Radicular pain“Sometimes, when people have problems in their back, they feel the symptoms elsewhere,” Dr. Crasto says. This is known as radicular pain.
Radicular pain typically comes down one or both legs. Caused by the compression of nerve roots, radicular pain creates a burning, pins-and-needles-type sensation.
And then there’s a condition called neurogenic claudication. “This happens when your legs get heavy after standing or walking for a period of time,” Dr. Crasto mentions. “But when you sit down, it’s like hitting a reset button. You feel so much better. However, it’s only a matter of time until the same thing happens, and you’re looking for another place to sit.”
Compression of the lumbar nerve roots can also affect other areas, like the bowel or bladder, making patients lose their control over those functions. Another symptom is saddle anesthesia, a condition where the areas around the genitals and groin region go numb.
“A lot of these symptoms happen very slowly, and there’s no danger in monitoring them,” Dr. Crasto advises. “But if you start getting severe weakness in one or both legs, it’s time to tell your doctor.”
What are the risk factors for neck pain?
“Though not as common as low back pain, neck pain is still a problem many people deal with,” Dr. Godby says. More common in women, one in three people have neck pain at least once a year. Depending on the cause, it can be acute or chronic.
There are several risk factors for neck pain:
Where is my neck pain coming from?
As with back pain, neck pain can also be axial or radicular. Axial pain only involves the neck, while radicular pain can radiate to other body parts, like the arms and hands. Numbness, tingling, and weakness typically accompany radicular pain.
Sometimes, neck pain symptoms will point to something more serious, like myelopathy (spinal cord damage). These symptoms might include clumsiness, reflex changes, muscle contractions, loss of bowel and bladder control, and headaches.
“When it comes to neck pain, muscle strain is the most common cause,” Dr. Godby says. “Muscle strain can happen from poor posture, acute injury, or whiplash from a fall or accident.”
Discogenic pain is another cause of neck pain. The neck is usually stiff and pain radiates into the arms and upper back.
“And then there’s facetogenic pain,” Dr. Godby adds. “This creates a dull pain and decreases the range of motion in the neck. It can also cause headaches.”
Pinched nerve or stenosis?
Like the lower back, you might experience a pinched nerve in your neck. This creates pain that radiates down one arm.
But how do you know if it’s stenosis? Dr. Godby explains, “The main difference is that when your spinal canal narrows during stenosis, it can pinch several nerves. This creates tingling and weakness in the arms and hands and can cause gait changes.” Symptoms usually progress slowly during stenosis, but if left untreated, it can cause significant problems like spinal cord compression or paralysis.
“Most of the time, the pain gets better, but it doesn’t always,” Dr. Godby says. “It’s time to seek treatment if it starts to affect your day-to-day activities.”
What are my treatment options?
Treatment at home
There are many ways to treat back or neck pain, and it can start at home. Dr. Godby recommends applying heat or cold. “I don’t strongly prefer one or the other,” he says. “Most of the time, patients know which will work better for them. Either way, apply it for 20 minutes and take a break to avoid damage to your skin.”
Another option is to provide electrical stimulation to the area of discomfort. “The idea behind this is that the electrical stimulation disrupts the pain signals to your brain and helps the muscles relax,” Dr. Godby says.
Dr. Godby also recommends manual release therapies like foam rolling, cupping, and massaging. These apply pressure to tender areas and muscles to help them relax.
“Cupping is an old treatment in which a therapist puts cups on your skin and applies a pump or flame to create a vacuum inside the cup,” he says. “We leave the cups on for five to ten minutes, and the idea is that this increases blood flow to the painful area.”
Dr. Godby also mentions inversion tables as an at-home treatment. “Just be careful,” he says. “I’ve had patients who tip over in their inversion tables, and you don’t want to cause more problems than you’re solving.”
Cervical traction units can also provide relief. “This is a pulley that goes over the door, and you suspend a bag of water to apply traction to the neck and decompress the vertebrae,” he explains.
With short-term use, soft cervical collars or lumbar support can also help. “But you really don’t want to depend on them because you’re just going to weaken those muscles,” Dr. Godby advises.
Interventional non-surgical treatments
Several non-surgical interventional treatments are also available. The first of these is epidural steroid injections, which are injections of the steroid around pinched nerves to decrease inflammation and provide pain relief.
“Patients often worry about the idea of somebody giving them an injection in their spine,” Dr. Godby says. “But usually, most patients say it wasn’t as bad as they thought it would be.”
A more common treatment is radiofrequency ablation. This is usually a two-part procedure. “In the first part, we inject numbing medicine to block the nerve that’s supplying the joint involved,” Dr. Godby says. “If this provides significant pain relief, then you follow up for a radio frequency ablation where we burn the nerve away to provide pain relief.” However, this pain relief is not permanent. “The nerve will eventually grow back, but it can last anywhere from 6 to 9 months,” he says.
There are also noninvasive procedures for low back pain, including MILD and Intracept. “We primarily use the MILD procedure for stenosis,” Dr. Godby says. “It uses a tool that will scrape out some ligaments in the back to widen the spinal canal and relieve compression.” Intracept uses an instrument in the vertebrae to burn the affected nerve away.
Non-surgical therapies
No matter the type of back or neck pain, the diagnosis is important. And posture and workstation management can make all the difference. “If you’re at your desk all day, take frequent breaks,” Dr. Godby recommends. “Keep your computer at eye level and take your wallet out of your pocket when sitting for long periods. You’d be surprised how much that can affect your back pain.”
Soft tissue therapies like dry needling, acupuncture, and trigger point injections are other ways to find relief.
With clearance from your physician, Dr. Godby also recommends chiropractic or massage therapies. And for short-term relief, topical creams and non-opioid medications are beneficial.
Physical therapy
Everyone’s physical therapy experience can be different. Physical therapist Taylor Jordan explains how The Christ Hospital approaches physical therapy with spine dysfunction.
“First, we want to determine your deficits,” she says. “This comes from a diagnosis, but it really supports how we understand your pain. We’ll do an examination that thoroughly assesses your joint range of motion, muscle weakness, and reduced motor control.”
She explains that sometimes the deficits are clear, like after surgery or injury. Other times, they can be difficult to identify, especially if there is an unknown issue.
“Next, we want to manage the pain, of course,” she says. “And that occurs through hands-on treatment and therapeutic exercises tailored to you and your needs.”
“Finally, our big goal is to restore your function. We want to know what a successful outcome looks like for you,” Jordan says.
What’s found during an examination?
Poor posture is the most common issue found during examination. “We commonly see forward head posture and rounded shoulders,” Jordan says.
“Next, we’ll assess your movement, noticing how you rotate your head side to side and up and down,” she says.
“We will also look above and below the affected area and try to find any painful trigger points,” Jordan adds.
“Difficulty with range of motion and muscle weakness in the core or glutes can increase joint stress in the spine,” Jordan says. “We’ve also seen tightness in the hamstrings as a common problem.” This pressure can send nerve tension down the sciatic nerve, which trails down the back of the leg.
“Looking at all these areas, we’re using clues that can help us get to the real root of the problem,” Jordan says.
What does a PT session look like?
Many therapists provide hands-on intervention. “This means we can get our hands on your stiff joints to help improve your mobility and reduce muscle tightness,” Jordan says.
“A lot of the intervention includes the mobility and corrective exercises tailored to your needs and deficiencies,” she says. These include stretching, strength exercises, and core stability training.
“But we can’t underestimate the power of education,” Jordan states. “Above all, we want to equip you to care for yourself and restore your independence. We’ll make sure you have the tools to help yourself with our home exercise program.”
When is it time to consider surgery?
“If symptoms fail to respond to treatments like medications, injections and physical therapy, it might be time to consider surgical treatment,” Dr. Crasto recommends.
Other conditions where surgery may be appropriate include:
Conditions at risk of progressing to cause nerve or spinal cord damage, such as spinal instability, deformity, trauma, cancer, or infection
Conditions with evidence of ongoing nerve or spinal cord damage, such as progressive weakness
Cauda equina syndrome, which is severe compression of the lumbar nerve roots causing weakness, numbness, and loss of bowel and bladder control
Myelopathy, or severe compression of the spinal cord, which causes balance or gait dysfunction, loss of fine motor control, loss of hand dexterity, and loss of bowel and bladder control
What are my surgery options?
There are three major types of spine surgery.
Decompression surgery relieves nerve compression by opening space in the spinal canal and around the nerve roots.
Stabilization or fusion surgery involves fusing two bones together.
Deformity correction surgery is when a surgeon changes spinal alignment and holds it in place to fix deformities.
“These three surgeries are not mutually exclusive,” Dr. Crasto says. “So, some surgeries may employ one, two, or all three of these concepts.”
Decompression surgery
Several conditions may require decompression surgery. These include:
One example of a decompression surgery is a discectomy. “This is when we remove a small portion of spinal elements to access and remove the herniated disc fragment in order to open up the spinal canal,” Dr. Crasto explains.
Fusion surgery
Fusion surgery often uses screws and rods to stabilize the bones. “The screws and rods act like a clamp to hold the bones in place while they mature and fuse together,” Dr. Crasto says. Fusion surgery may also involve placing a spacer between the vertebral bones after removing the intervening disc.
Conditions that may require fusion surgery include:
Cervical and lumbar stenosis
Cervical herniated discs
Spinal instability (spondylolisthesis)
Cervical and lumbar degenerative disc disease
“Sometimes, in order to fully decompress the nerve roots, it requires extensive resection of the normal architecture of the spine,” Dr. Crasto says. “When that’s the case, we treat stenosis with decompression and fusion surgery at the same time.”
Deformity correction surgery
“We often combine deformity correction surgery with fusion and decompression,” Dr. Crasto says. “This is when we’re really trying to move the bones before fusing them together.” Several conditions may require deformity correction surgery:
What happens during post-op physical therapy?
After surgery, physical therapy can help restore mobility and function. “During the education in our physical therapy sessions, we’ll talk about navigating your day-to-day life under your surgeon’s precautions,” Jordan says. These precautions might include:
Avoiding bending, lifting, twisting, or prolonged sitting
Lifting, pushing, or pulling weight restrictions
Wearing a brace
Everyone’s post-op journey is different. “The progression with physical therapy depends on the protocol and the surgery performed,” Jordan explains. “The goals are to first protect the area for healing, then gradually increase strength so you can get back to your normal activities.”
It’s important to remember that returning to activities is gradual. “We usually start with lower-impact, aerobic activities like walking and then stationary biking, before progressing to more repetitive rotations like running or golf,” Jordan says.
“But ultimately, with post-op physical therapy, our goals are driven by your goals and your prior level of function before surgery,” Jordan states, “We just want to help you get back to what you were doing before.”