Welcome to the Spine and Neck Service

The spine service forms part of a range of services provided by the Sussex MSK Partnership. It is a service provided by clinicians called Advanced Practitioners. These are physiotherapists or osteopaths with specialist knowledge and skills in caring for patients with spine conditions. The aim of the service is to provide patients with a high quality service that is based in a community setting, such as a GP surgery.

What is the spinal service?

The spine service forms part of a range of services provided by the Sussex MSK Partnership. It is a service provided by clinicians called Advanced Practitioners. These are physiotherapists with specialist knowledge and skills in caring for patients with spine conditions. The aim of the service is to provide patients with a high quality service that is based in a community setting, such as a GP surgery.

Getting ready for my appointment

To help you prepare for your appointment we have collected some general information on our FAQ’s page.  This will help you understand what to expect from your appointment and how best to prepare.

Where are the clinics located?

To find a full list of our clinic locations please see locations page

Getting in Touch

If you need to speak to one of our team about an appointment or referral, please see the contact page for more details.

Neck and Back Pain - Overview

Pain in the neck or back, also known as spinal pain is very common. About 80% of people will experience spinal pain at some point in their lives. For the vast majority of people, their pain is not serious and will normally settle naturally over 2-12 weeks.

This section of our website aims to...

- Explain the causes of spinal pain

- Inform you what you can do to help yourself

- Help you understand when to seek help for your pain

- Inform you about some of the medical options for managing your pain

In addition to the useful information about the spine that we have included on this page, you can also download our helpful information leaflets, and learn more about pain with educational videos (below).

NHS Choices also has a useful interactive guide on back pain



What is my spine?

The spine is a flexible column of bones (called vertebra) that run from your skull to your pelvis. This is a very strong structure, it allows your body to bend and twist, and provides protection to the spinal cord and nerves.

What does my spine look like?

spine diagram

The spine is divided into several sections, the neck (cervical spine), middle back (thoracic spine), lower back (lumbar spine), back of the pelvis (sacrum), and tail bone (coccyx).

Between each of the vertebra in your spine are pads of tough connective tissue (intervertebral discs) that cushion your spine, absorb shock and allow movement. The joints of the spine (facet joints), which allow the spine to perform a wide range of movements are formed where the vertebra sit on top of one another.

Through the middle of your spine is a tunnel, called the spinal canal, through which the spinal cord runs. The spinal cord is part of the central nervous system, and refers to a bundle of nerves that runs from your brain through your spine. Its main function is to relay information to and from the brain, and allows the brain to control the body.

The rest of your body is connected to your spinal cord by nerves that leave the spine through holes in the side of the spine (intervertebral foramen). These nerves travel all over the body and tell different parts of our body how to behave, such as the muscles in our arms and legs, genitals and anus.

The spine is connected by thick connective tissue called ligaments that provide support and muscles that make the spine very strong.

Facts about back pain

Back pain is common and normally improves within a few weeks or months. Although back pain can be limiting, in most cases the pain isn’t serious and will usually get better over time. There are a lot of beliefs about back pain out there that are not true and could actually make the situation worse. This section identifies and challenges common misconceptions about back and neck pain, and could reduce your risk of long term pain.

‘If I hurt my spine, will I suffer with pain from now on?’

In 85% of the cases, the pain is not related to serious damage to the spine. Only a very small number of people will develop long term persistent pain. This kind of pain is usually related to factors other than damage, such as anxiety, depression and avoiding normal movement behaviours.

‘If I have back pain, should I stay in bed and rest?’

Avoiding activity may help to reduce pain in the first few days of having spinal pain, exactly like you would avoid walking on your foot, if you had an ankle sprain by twisting it awkwardly (such as stepping of a curb). However, people who rest excessively and take steps to avoid all activity are actually at greater risk of developing a long term pain problem. Research shows that undertaking gentle movement and returning to normal activity in fact speeds up recovery. You should therefore try to move little and often and increase this gradually each day, depending on your pain.

‘Will moving my spine will make my situation worse?'

It is common that people fear movements such as twisting and bending when in pain, however it is essential to keep moving. Avoidance of movement and use of devices such as back braces has the potential for the back to become more sensitive to movement and can make your pain worse in the long term. Gentle movement actually helps to desensitise the spine and will help you recover more quickly.

‘Is my pain a sign that I have damaged my spine?

Pain and tissue damage rarely relate. Surprising as it may seem, the amount of pain you feel does not relate very well to the extent of an injury. For example, there is a very poor relationship between tissue damage seen on an MRI scan and pain. In fact, studies have shown that ‘abnormalities’ are really common. Around 90% of people will have an abnormality on an MRI scan, this could include disc bulges and pressure on nerves, yet most people will not experience any symptoms at all. The amount of pain you experience is actually dependent upon factors such as mood, fear, fitness, stress and coping style. This is good news, because if you have positive coping behaviours and attitudes towards pain, you will be likely to get better more quickly.

‘Is something out of place?’

Well-meaning practitioners will often advise that pain in the neck or back is the result of something being out of place, and will try to ‘correct’ this with manipulations or moving parts of your body around. Unfortunately there is little to no evidence, that the pain that you feel is because a joint in your spine or pelvis being out of place. As humans we tend to be dominant with one side of the body, and are not symmetrical. Therefore it is actually quite normal that there will be difference in the shape and position of joints on either side of our bodies. Research using MRI scans has shown that manipulations do not change the position of joints in the spine. However you can feel better after having had a manipulation, but this is not because something has been ‘put back in place’. The mechanism why we feel better are still poorly understood and is an ongoing research topic and debate in the literature. We do know that active treatment strategies such as coping and giving you a sense of control really help in reducing pain and avoid long term chronicity.

‘Have I slipped a disc in my spine?’

The term slipped disc refers to cushion or disc that that separates the bones in your spine pressing on a nerve. This can cause either arm or leg pain. This term 'slipped disc' is in fact very misleading as the discs are not capable of slipping. The discs in your spine are actually held in place by very strong connective tissue, and are in them selves’ very tough structures. They do not pop in and out of place.

It is possible for the discs in your spine to develop bulges or protrusions that have the potential to cause nerve irritation. However, it is quite common that even when nerves in the spine are compressed by a disc, they do not cause any symptoms whatsoever. Therefore, the management of someone with pain in the spine that refers into the arm or leg will be dependant upon the extent to which daily function and sleep are affected. Whether there is any weakness or other concerning signs. It is this combination of factors combined with a physical examination that will determine whether an MRI scan is required. You can read more about concerning symptoms to watch out for by going to ‘What do I need to watch out for?’

The term slipped disc is also unhelpful as it can instil a fear of movement in some people. In fact, the best way to manage nerve irritation is through regular gentle movement and exercise and pain relief. MRI studies show that even when a disc has developed a bulge or protrusion, the body is capable of healing this. The vast majority of people with nerve pain in either the arm or leg will naturally get better over a period of 13 weeks as the size of the bulge or protrusion shrinks.  Therefore, most people will not need to have either injections or surgery.

Do I need a scan or X-ray or scan for my pain?’

In most cases scans and X-rays are not needed, and contrary to common belief, will not show you a cause of your pain. Most people will have normal ‘age related changes’ also known as ‘wear and tear’ on an MRI scan. This process occurs over many years, like wrinkles on our skin. In fact, up to 80% of individuals over the age of 60 will have visible signs on an X-ray and MRI such as disc bulges, however for most people, these changes do not cause any symptoms. A thorough clinical examination is able to identify the majority of problems, only in a small number of specific cases is a scan required.

‘When is a scan helpful?’

An MRI scan is the gold standard for getting an internal view of the bodies’ structure. MRI scans don’t involve x-rays and are very safe, although they are quite noisy and some people find them claustrophobic. X-rays only provide limited information about the bones in your spine (vertebra) and these are rarely affected and are therefore not routinely arranged.

An MRI scan (magnetic resonance image) may be helpful if arm or leg pain due to nerve irritation does not settle, their is concern about the cause of someone's pain, or if an intervention like an injection or operation is being considered.

MRI scans are not normally required in the early stages of either arm or leg pain that is being caused by nerve irritation in the spine. This is because pain is expected to improve by itself over a period of 6 weeks to 3 months.

MRI scans are very sensitive and will detect almost all serious spine problems such as cancer, infection, or pressure on the spinal cord or spinal nerves. They will also comment on minor abnormalities that are not important, or related to your symptoms. Although these words can sound concerning, they are nothing to worry about.

‘Do I need an operation to cure my pain?’

Surgery is only required in certain and specific situations. For most people surgery will not cure their pain, and in fact when compared with physiotherapy, surgery is no more effective than a conservative approach. Surgery for long term back pain is considered high risk and tends to have very poor results. The vast majority of people with neck and back pain can manage their problem by staying active and addressing the individual factors related to their pain. Only if very specific problems are found, such as nerve compression, stenosis causing spinal cord compression or fractures would surgery considered a viable option.

 

What can I do to help myself to get better?

Getting the balance right

When you have back pain it is important to keep a balance between rest and activity. Research shows, those people who excessively avoid or are fearful of movement and activity are much more at risk of developing long term pain problems. In the short term, it’s okay to adapt any movements that might be causing you pain or make it worse. However try to remain active within your pain limits and you should recover more quickly.

Remain positive

Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive as this can help you recover faster. Low mood, stress and anxiety are all known to increase pain and are shown to negatively influence recovery.

Taking steps to identify and manage factors that contribute to pain, such as stress and being proactive with self-care reduces long term pain and disability.

Exercises

Exercising with pain may seem daunting, but it is one of the most important elements of managing spinal pain. Undertaking gentle activity to improve your flexibility, strength and fitness will help you recover quicker.

If your pain increases when doing activities, stop and rest for a bit. When your back pain feels better, try to resume doing your exercises/activities to stay strong and mobile.

Using a warm heat pack on your spine before exercising makes you feel more comfortable. It is important to perform your exercises regularly. You may find the exercises uncomfortable at first, this is normal. Use the pacing principles to judge how much exercise you should start with, and to increase your exercise over time. It is better to do a few exercises several times a day rather than all at once.

At home / work

Here are some tips to help you day to day

Pacing is a strategy to increase activity without increasing your symptoms. It involves spacing activities throughout the day in a manner that helps to avoid aggravation of pain.

Take regular breaks from your desk, driving or any activity where your spine is held in the same position for a long period of time. Correcting your posture may feel awkward at first because your body has become so used to sitting and standing in a particular way.

A supporting pillow may help some people when sleeping.

Limit your screen time.  Don’t spend too much time looking at tablets or mobile phones as it is likely you will hold your spine in the same position for a long time.  Try using a stand for them or place them on a table.

Pain Killers

Over the counter painkillers may be helpful.  If you have any questions or concerns about this then speak with your pharmacist or General Practitioner (GP) who will be able to give you expert advice. If you experience severe nerve pain in your arm or leg, go and discuss nerve pain modifying drugs with your GP.

Posture

There is no evidence that slouched postures contribute to back and neck pain. However we do know that staying in one posture for too long will put strain on your back or neck. Therefore take steps to change your posture regularly by adapting your seating position and getting up.

Sleep

It is important that you have good sleep hygiene and thus a regular sleep pattern. Taking steps to reduce stress, and using techniques such as relaxation and mindfulness, can help you to better manage your symptoms and sleep. Research has shown that lack of sleep will “wind up” your nervous system (a bit like turning up the amplifier) causing you to feel more pain.

Lifestyle

Positive lifestyle changes such as gentle regular activity, exercise, stopping smoking, improved sleeping patterns and addressing contributing factors such as stress can significantly impact upon the amount of pain you experience, and the amount this limits you in daily life.

Although being overweight is not directly a risk factor for developing pain, leading an inactive and sedentary lifestyle can increase the risk of long term pain in the spine. Weight loss does have numerous health benefits such as reducing the risk of lifestyle related cancers, type II diabetes, high blood pressure, and other cardiovascular problems such as heart attack and stroke.

Finally, smoking can make you feel more pain as the release of harmful chemicals into our bodies slows healing and makes nerves more sensitive to pain. Smoking also increases the level of stress hormones, which also increases nerve sensitivity.  To find out more about local service that can help you become more active, manage stress, lose weight and stop smoking, click here

What do I need to watch out for?

Most cases of spinal pain are not serious. However, on very rare occasions, there are certain symptoms that could be a sign of something more serious, that need to be checked urgently.

If you have recently or suddenly developed any of the following:

  - A change or loss of control of your bladder function

  - Loss of bowel control

- Altered sensation around your genitals or back passage

- Loss of sexual function

- Pins and needles or numbness in both legs or weakness or incoordination in the legs that affects your walking

 

Should you experience any combination of the symptoms above then you should attend your nearest A&E for further assessment or call NHS 111

You will need to seek medical advice if you:

- Have a history of cancer within the last 5 years

  - Any unexplained weight loss (more than 5% of your body weight in the last 6 months)

  - Are feeling generally unwell/fever

- Have recently become unsteady on your feet

Any combination of these symptoms could mean you have an underlying serious illness therefore make an urgent appointment with your GP to further discuss these

When do I need to see someone about my back pain?

Most cases of spinal pain get better on their own or with simple self-help treatments.

You should see a medical professional if:

- Your pain is severe

- You have tingling or numbness in your hands, feet, arms or legs

- Your limbs feel cold / or you experience odd sensations

- You have had an obvious injury such as a fall or other trauma

- You have had spine or pain radiating into the limb for longer than 6 weeks

- You have experienced recent unexplained weight loss (more than 5% of your body weight in the last 6 months)

Useful Videos

The following videos have been carefully selected by our clinical staff to help you improve your understanding of pain and how it can be managed. Each video has been put together by an expert. They are informative, easy to understand and contain the best information available.

What do physiotherapists advise for managing low back pain?

Understanding pain in less than 5 minutes

What is the single best thing we can do for our health?

Understanding low back pain with Dr Mike Evans

Useful Resources

PAIN-ED is a great source of health information and patient stories which highlight ways of managing persistent back pain




 

Helpful Leaflets

Here are some leaflets to help you manage your condition, these have been reviewed and approved by our clinical staff to be the best information for patients.

To find out more about Rheumatology problems that can affect the spine click here.