Sciatica is nerve pain down the leg from a compressed or inflamed nerve in the back. Similarly, arm pain can arise from the neck. It can be associated with signs of nerve damage such as numbness or weakness. It is most commonly due to a disc herniation but can be due to degeneration or occasionally a more serious spinal problem. Nerve pain needs specific treatment depending on the diagnosis and can include injections or surgery. It is important that nerve pain be diagnosed promptly and correctly so that the right treatment can be started quickly to avoid long term problems.
Back pain is the most common cause of disability but is often poorly understood and treated. It is usually not serious and settles quickly but can sometimes be due to a more significant underlying problem and go on for many months. It is important to carefully assess the problem with a history and physical examination and in many cases, a scan. Once the condition is diagnosed, an appropriate comprehensive treatment plan can be developed in order to improve the pain and restore function as quickly as possible. Neck pain is less common but benefits from the same co-ordinated approach.
Back and neck injuries can occur at work, from sport or with simple daily activities such as bending, lifting or twisting. They usually result in muscle or ligament strains, but can sometimes lead to more serious trauma including stress fractures and more serious vertebral fractures. Assessment needs to take into account the type of injury, the nature of the pain and the findings on examination and imaging. Treatment usually involves a short period of rest followed by hands on treatment and a graduated exercise program but sometimes needs more specialised care including bracing or surgery.
There are many specific disorders of the spine that need individualised care. These include lumbar conditions such as pars defects, isthmic spondylolisthesis, scoliosis, spinal stenosis, disc degeneration and degenerative spondylolisthesis, and cervical conditions such as radiculopathy and myelopathy. Each of these is different and requires expertise to diagnose them and ensure the correct treatment is undertaken. Most of these conditions will benefit from appropriate co-ordinated rehabilitation, and even if specialised pain procedures or surgery are ultimately required, rehabilitation is an essential part of the recovery process.
