Neck and back pain.
What are the underlying causes?
Find out more about neck or back pain and the underlying causes.
Neurosurgeon Brisbane
Neck and back pain key points
- In most cases (over 90%) neck or back pain is due to muscular spasms (often in younger people) and spinal arthritis (often in older people).
- In some cases the pain is due to infection, a fractured bone, ruptured disc, or cancer.
- The key to treatment is to work out what the underlying cause is.
- When your pain is caused by infection, cancer, a fracture or ruptured disc, surgery is often required.
- When you have a condition called spondylolisthesis, then surgery is an effective treatment.
- In the majority of cases, however, surgery for neck or back pain is not required, nor recommended.
Neck and back pain Brisbane
What is it?
Over 90% of neck or back pain is due to either arthritis in the spine or muscular spasms and cramps.
When someone describes their back “locking up” or feeling tight, this is usually a spasm of the deepest group of muscles in the back, which on average are about 5-7 cm under the skin. They are much deeper than you would imagine.
Arthritis is more common in older people and muscular pain is more common in younger people.
A lot of people get frustrated at this so-called ‘musculoskeletal” diagnosis. But it is not a ‘get-out-jail-card’ or ‘cop-out’ diagnosis for the surgeon making the assessment; it is a real phenomenon that is responsible for the majority of neck and back pain. And it can be difficult to get quick relief.
Spinal surgeon Brisbane
The key is not to have unnecessary surgery for this common condition.
In older people, arthritis pain comes from inflammation in the facet joints. Facet joints are little joints at the back of the spine. There are 2 for every level in the spine, one on the right and one on the left. In fact, the joints in the spine at each level form a tripod. At the front is the big joint where the spinal disc sits. From here there is a prong at the back where there are two smaller facet joints jut out, one to the right and one to the left. Facet pain is very common and responds very well to steroid injections or radiofrequency ablation.
Younger people tend to get more muscular pain. They can also get pain from the spinal disc. When someone feels their back ‘locks up’ that is due to the deep layer of muscles in the back. These muscles are about 5-7 cm below the surface; they are a long way under the skin and are very strong in younger people. Back stiffness in young people is also due to this strong muscle mass tightening up.
The same occurs in the neck. In fact, it is quite common for all the muscles that connect the neck to the spine and shoulders to tighten up. This is felt as pain and tension in the back of the neck, shoulders and into the back of the head.
The two most common causes of all this muscular mayhem in younger people is an asymmetry between the right and left-sided muscles (often seen in active people where one body part becomes dominant from overuse) and weakness of the posterior kinetic chain.
Neck pain symptoms | Back pain symptoms | Brisbane
What are the symptoms?
Typically neck pain is felt somewhere in the back of the neck and often felt radiating into the back of the head, or into the shoulders.
Back pain can either be central in the lower back, or on either (or both sides) and often radiates into the buttock and hip region.
It is very common. Almost everyone experiences either back or neck pain at some point.
Almost always it is not dangerous. It is just a matter of how much it affects your quality of life. For most people it passes. For some people it persists long enough to really erode quality of life.
Neck pain causes | Back pain causes | Brisbane
What causes it? Did I do something to cause it?
The two most common causes are wear and tear changes (also called arthic changes) and trauma. The most common causes of trauma are work related incidents or road accidents.
Back or neck pain is usually due to wear and tear or some accident. This is not genetic. Some family blood lines have better overall genetics in their spine (stronger bones and muscles and better geometry to the spine), but there is no medical genetic condition that causes the common back or neck complaints.
Neck pain treatment | Back pain treatment | Brisbane
How is it treated?
The key to treatment is to work out what the underlying cause is. This is actually much harder than it sounds. Even after a comprehensive discussion, examination, and review of all the scans it is sometimes not clear what exactly is causing the neck or back pain. We often suspect it’s a facet joint or disc or muscle, but finding which facet joint, disc or muscle is the challenge.
This is very different to nerve pain down the arms or legs where it is often quite easy to work out exactly which nerve is causing the pain.
If the exact cause can’t be identified, the next best step is to rule out the nasty causes of back and neck pain. This can be fairly easily done with a series of questions, examination and modern scans.
This way cancer, infection and fractures and ruptured discs can be ruled out. Once they have, and the spine has been deemed ‘safe to use’ then sending the patient down physiotherapy or pilates pathways is usually the best option.
Spinal surgeon Brisbane
Neck and back pain surgery Brisbane
Do I need surgery?
Surgery for back or neck pain is rarely ever required. The only time it is required is if the pain is due to cancer, infection, a fracture or ruptured disc. There is one exception and that is the condition spondylolisthesis. If the surgeon can confirm that it is the cause of the pain, then this condition responds very well to surgery.
Beyond this, the days of long-segment spinal fusions for back and neck pain are rapidly coming to an end on account of the severe side effects of these historical operations. It is not recommended by today’s more modern surgeons. A well-tailored pilates, physiotherapy or pharmacotherapy program are much more effective in the long run.
Dr Alex Koeman, Spinal surgeon Brisbane
Does the treatment work?
Surgery can be successful for the treatment of pain due to cancer, infection, fractures, ruptured discs or spondylolisthesis.
For facet or muscular pain, or general arthritis surgery has a very low success rate.
Spinal surgeon Brisbane
However, in 6-12 months down the track, there will be a very high likelihood that the symptoms will return to the same level, or worse, and the surgery will start to cause long-term complications.
It is for this reason that a well-trained expert will not recommend surgery for your neck or back pain outside the reasons listed above. It generally does not work and will only make you worse in the long run.
As a patient with back or neck pain, this information is presented to refocus your sights on the long term management, not a short term fix with long term disastrous complications.
Everyone is different. But the sooner a pilates or physiotherapy program is commenced, the sooner you will start to see some improvement.
Pilates and physiotherapy are safe.
The other possible treatment is a steroid injection. I very commonly recommend this for back or neck pain. Steroid injections are very safe. You can have them done multiple times without concern. In fact, it is almost always required to have at least two injections to get the best result. Steroid injected is very different from a steroid tablet. A tablet once swallowed goes to the whole body via the bloodstream and can cause side effects as a result. An injection, however, stays only in the joint and does not spread to other parts of the body. It is not dangerous to the joint and will not weaken it or the ligaments.
Most of the time, yes. My main role is to rule out nasty causes of the neck or back pain, and any mechanical causes that would respond exceptionally well to surgery (despite the bad press, there are some causes of back pain that respond very well to surgery and can quickly return you to your previous quality of life).
This depends on what is the cause in the first place, you, your age, your overall symptoms and your scan results. I am happy to take you through all of this to advise you regarding this.
In most cases, yes.
Neck and back pain specialist Brisbane
What should I do now?
Back or neck pain is incredibly complex. It requires a thorough assessment and examination of you and your symptoms, and review of all your scans. I am happy to organise all the necessary scans and full assessment of your pain. If you would like this assessment then please contact my team.
Ready to make an appointment?
Ramsay Specialist Centre
Suite 325
Newdegate St
Greenslopes QLD 4120
