Back and neck pain is a common problem with two-thirds of the population having neck pain at some point in their lives.
Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.
The head is supported by the lower neck and upper back, and it is these areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.
The history and physical examination is the first step in the evaluation and management of low back pain. Based on this information and specific guidelines, x-rays may be ordered; however, not every patient with low back pain requires x-rays.
The majority of patients will improve with controlled physical activity, physical therapy, nonaddictive non-steroidal anti-inflammatory drugs, and, in appropriate patients, muscle relaxants. Surgical invention is reserved for the patient who has not shown improvement on conservative therapy and has undeniable symptoms and signs (sciatica) associated with a mechanical disorder (herniated disc) that can be corrected by surgical intervention.
Chronic low back pain is a complex disorder that must be managed with a multi-disciplinary approach that addresses the physical, psychologic and socioeconomic aspects of the illness. Fortunately, chronic low back pain affects only a small percentage of patients