Lower back and neck pain: treatment without surgery

Lower back and neck pain is most often mechanical: it is caused by strain on a muscle, a ligament, an intervertebral disc or the small joints of the spine, not by a serious disease. Acute lower back pain eases within a few weeks in most cases. The foundation of treatment is moderate movement and exercise, and only a small share of patients needs surgery.

Why does my lower back hurt

The spine is made of vertebrae, the discs between them, small joints, ligaments and muscles. Any of them can cause pain, and often the exact source cannot be pinpointed. That does not mean something was missed: this kind of pain is called non-specific, and it is the most common and the most reassuring type.

Type	Typical picture
Mechanical (non-specific) pain	Stays in the back, changes with movement, often starts after lifting or an awkward movement
Nerve irritation (sciatica)	Pain runs down the leg below the knee, often with numbness or tingling
Narrowing of the spinal canal	The legs tire and ache when walking, and ease when bending forward or sitting
Referred pain	Pain is felt in the back, but its source is elsewhere, for example in the hip joint

In Georgia and neighbouring countries nerve root irritation is often called “radiculitis”. The most common cause is a herniated disc pressing on the nerve. Pain running down the leg along the sciatic nerve is called sciatica.

Lower back pain is often confused with a hip joint problem, and the other way round. I have a separate article on telling the two apart: lower back pain or the hip joint.

Why does my neck hurt

The most common cause of neck pain is long-lasting muscle tension: working at a screen, looking down at a phone, the wrong pillow, stress. This kind of pain stays between the neck and the shoulder blades and often causes headaches too.

If the pain runs down the arm and the fingers go numb, a nerve root in the neck may be irritated. That is exactly why I also examine the neck when someone has shoulder pain: sometimes the shoulder is healthy and the problem lies higher up. I have written about the shoulder separately: shoulder pain.

Osteochondrosis: what the word means

In Georgia lower back pain is often put down to “osteochondrosis”. This term describes age-related changes in the intervertebral discs and vertebrae: the disc loses water and becomes lower, and small bony outgrowths appear at the edge of the vertebra. In English-language medicine the same changes are usually called degenerative disc disease or spondylosis.

The key thing to know: most adults have such changes, including people who have never had back pain. So a change seen on an X-ray or MRI does not in itself explain pain and cannot be a reason for surgery. What matters for treatment is how the pain behaves, whether a nerve is involved and how the person is functioning.

What helps lower back and neck pain

The foundation of treatment is non-surgical, and it often starts at home:

What	What it does
Moderate movement	Speeds recovery; prolonged lying down does the opposite
Exercises	Strengthen the back and abdominal muscles that protect the spine
Physiotherapy	Restores range of motion and teaches correct movement
Heat	Eases muscle spasm
Medication	Reduces pain for a short time so that you can move
Workplace set-up	Reduces prolonged strain: screen at eye level, a good chair, breaks
Injection	In some cases, with nerve root irritation, reduces pain

The biggest change in medicine in recent years is abandoning bed rest. Lower back pain used to be treated with weeks in bed; today we know this slows recovery. Pain is a signal to move moderately, not to stop.

The second important thing is exercise once the acute pain has settled. A strong muscular corset lowers the risk of the pain coming back, and that is the part no tablet can replace. What non-surgical treatment involves in general: treatment options.

When is an MRI needed

In most cases, if there are no warning signs, an MRI is not needed in the first weeks: the image does not change the treatment. An MRI is ordered when:

• weakness in the leg or arm is increasing;
• signs of nerve irritation do not ease despite treatment;
• the warning signs listed below are present;
• an injection or surgery is being considered and a precise picture is needed.

Which investigation shows what, I explain here: X-ray or MRI.

When you should not wait

In these situations see a doctor or seek urgent care without delay:

• problems passing urine or stool, or numbness in the saddle area and inner thighs: this is a sign of pressure on the nerves and cannot wait;
• weakness in one or both legs is increasing quickly, for example the foot has started to drop;
• back pain comes with a fever or unexplained weight loss;
• the pain started after a significant injury, such as a fall or an accident;
• you have had cancer in the past and a new, persistent pain has appeared;
• the pain gets worse at night, at rest, and does not change with position;
• neck pain comes with weakness in both hands or difficulty walking.

When does the spine need a surgeon

Only a small share of lower back and neck pain needs an operation: when pressure on a nerve causes weakness that is getting worse, when there are warning signs, or when severe pain persists for a long time despite proper treatment.

I do not operate on the spine: I perform surgery only on the hip joint. For non-surgical care you can come to a consultation with lower back or neck pain, and if surgery becomes necessary, I refer you to a spine surgeon or a neurosurgeon.

Key points

• Lower back and neck pain is mechanical in most cases and eases within a few weeks.
• Moderate movement works better than lying down; exercise lowers the risk of the pain returning.
• “Osteochondrosis” and disc changes are common on images and do not in themselves explain pain.
• Problems passing urine, numbness in the saddle area and increasing weakness are warning signs.
• Only a small share of cases needs surgery, and then I refer you to a spine surgeon.

On joint pain in general: joint pain. If your lower back or neck has hurt for more than a week, book a consultation.