Back and Neck Pain Clinic

Support for pain, stiffness and everyday movement

Back and neck pain can affect work, sleep, exercise, driving and simple day-to-day activities. Symptoms may begin after a particular movement or injury, but they can also develop gradually without one obvious cause.

A back and neck pain assessment focuses on understanding your symptoms, how you move and how the problem is affecting your routine. Physiotherapy can be used to help manage back and neck pain through movement, exercise, advice and, where appropriate, hands-on treatment.

When physiotherapy may help

An assessment may be useful if you are experiencing:

• Lower or upper back pain
• Neck pain or stiffness
• Pain around the shoulders or shoulder blades
• Difficulty turning or moving your neck
• Pain when sitting or standing for longer periods
• Back pain during bending, lifting or walking
• Symptoms related to work or prolonged desk-based activity
• Reduced movement after an injury
• Recurring episodes of back or neck pain
• Pain that affects sleep or daily activity
• Pain spreading into an arm or leg
• Pins and needles or altered sensation associated with a back or neck problem
• Difficulty returning to exercise after an episode of pain

Physiotherapy is commonly used for musculoskeletal problems including back and neck pain. Some symptoms, particularly those involving significant or worsening neurological changes, may require medical assessment rather than routine physiotherapy alone.

Understanding back and neck pain

Back and neck pain does not always mean that there is a serious injury or damage to the spine. Symptoms can be influenced by joints, muscles and surrounding tissues, as well as activity levels and how the area is being used.

In many cases, there is not one single structure responsible for the symptoms. This is why treatment generally considers movement, strength, activity and function rather than focusing only on the painful area.

For lower back pain, current NICE guidance encourages self-management, continuation of normal activities where possible and exercise as part of treatment.

What happens during your first appointment?

Your first appointment begins with a discussion about your symptoms and how they are affecting you.

The physiotherapist may ask:

• When the pain began
• Whether it started suddenly or gradually
• Where you feel the symptoms
• Whether pain travels into an arm or leg
• Which movements make symptoms better or worse
• How the problem affects sleep, work or exercise
• Whether you have experienced similar episodes before
• Whether there has been a recent injury or accident
• What treatment or investigations you have already had
• What you would like to return to doing

A physical assessment may then look at:

• Back or neck movement
• Joint mobility
• Muscle strength
• Flexibility
• Balance and coordination where relevant
• Walking and general movement
• Movement of the shoulders, hips or limbs where appropriate
• Areas of pain or sensitivity
• Movements related to your work, exercise or daily routine

The purpose of the assessment is to understand how the symptoms behave, identify any limitations that may be relevant and determine an appropriate plan for treatment.

What treatment may include

Treatment depends on your symptoms, assessment findings and current level of activity.

Movement and mobility exercises

Exercises may be used to gradually restore comfortable movement in the back or neck. This can be particularly useful when pain has led to stiffness or avoidance of certain movements.

Exercise and continued movement form an important part of recommended management for many cases of lower back pain.

Strengthening exercises

Treatment may include exercises for the back, neck, shoulders, abdominal muscles, hips or legs depending on the problem.

The aim is to build the physical capacity needed for your normal activities rather than strengthening one isolated area without considering how you move.

Manual therapy

Hands-on techniques such as mobilisation or soft-tissue treatment may sometimes be included to help with movement or short-term symptoms.

For lower back pain, NICE recommends that manual therapy should only be considered as part of a treatment package that also includes exercise, rather than as a treatment on its own.

Advice about activity

You may receive guidance on how to remain active while symptoms settle, including which movements can continue and which activities may temporarily need to be adjusted.

For many episodes of back pain, remaining active and continuing normal activities where possible is recommended rather than prolonged inactivity.

Home exercise programme

You may be given a small number of exercises to complete between appointments. These can be changed as your movement, strength and symptoms improve.

The programme should be realistic enough to fit into your normal routine rather than becoming difficult to maintain.

Lower back pain

Lower back pain is common and can range from a mild ache or stiffness to symptoms that significantly affect movement.

You may notice discomfort during:

• Sitting for long periods
• Getting out of a chair
• Bending or lifting
• Walking
• Standing for longer periods
• Turning in bed
• Exercise or physical work

Physiotherapy may focus on restoring movement, gradually increasing activity and improving strength around the trunk, hips and legs where appropriate.

The treatment approach will depend on how your symptoms behave rather than assuming everyone with lower back pain needs the same exercises.

Neck pain and stiffness

Neck pain may affect movement of the head and can sometimes extend into the shoulders, upper back or arm.

It may develop after a sudden movement or injury, or gradually during periods of reduced activity, repetitive work or prolonged positions. Often there is no single identifiable cause.

Treatment may include:

• Neck movement exercises
• Shoulder and upper-back exercises
• Gradual strengthening
• Advice about work and daily activity
• Manual therapy where appropriate
• A home exercise programme

The aim is usually to help restore comfortable movement and make normal activities easier to manage.

Pain spreading into the arm or leg

Back or neck problems can sometimes involve irritation of a nerve.

With lower back problems, symptoms may travel into the buttock or leg and can sometimes include pins and needles, numbness or weakness. This may be described as sciatica when the sciatic nerve is involved. NICE guidance specifically covers lower back pain both with and without sciatica.

Neck problems may also cause symptoms that travel into the shoulder, arm or hand.

An assessment can help determine whether these symptoms appear suitable for physiotherapy or whether further medical assessment is needed. Progressive weakness, worsening balance or new bladder or bowel changes require urgent medical attention.

Work-related back and neck pain

Symptoms may become noticeable when work involves long periods at a desk, repeated movements, lifting, driving or physically demanding tasks.

The assessment may look at the activities that bring on your symptoms rather than simply advising you to maintain one fixed posture.

Treatment may include strengthening, movement breaks, changes to how certain tasks are performed and ways of gradually improving your tolerance to sitting, standing, lifting or other work activities.

For neck pain, prolonged desk-based positions can be one of several contributing factors, although symptoms are often influenced by more than posture alone.

Movement and confidence

When movement hurts, it is understandable to become more cautious.

You may stop bending, lifting, exercising or turning your neck because you are concerned that the movement will make the problem worse. Over time, avoiding activity can make it more difficult to return to the things you normally do.

Physiotherapy may involve gradually reintroducing movements in a controlled way and building confidence as your body becomes more comfortable with them. Current guidance for lower back pain encourages continued normal activity and appropriate exercise rather than unnecessary avoidance of movement.

Returning to exercise

If back or neck pain has kept you away from exercise, returning does not usually need to happen all at once.

Your programme may begin with comfortable movement and basic strengthening before progressing towards the activities you normally enjoy.

Depending on your goals, this could include:

• Walking
• Running
• Gym training
• Cycling
• Swimming
• Recreational sport
• Physically demanding work

Exercises can be progressed according to your symptoms, strength and ability rather than following a fixed timeline.

Recurring back or neck pain

Some people experience repeated episodes rather than one continuous period of pain.

If symptoms keep returning, the assessment may consider what is happening around each episode. This can include changes in physical activity, work demands, exercise, strength or periods of reduced movement.

Treatment may focus on building a longer-term exercise routine and helping you understand how to respond when symptoms begin to flare up.

The aim is not necessarily to prevent every future episode, but to improve how well you are able to manage symptoms and continue with normal activity.

Do I need a scan?

Not everyone with back or neck pain needs an X-ray or MRI scan.

For lower back pain, NICE recommends that imaging should not routinely be offered in a non-specialist setting unless the result is likely to change how the condition is managed.

Your physiotherapist will consider your symptoms and medical history during the assessment. If there are signs that further investigation or medical review may be appropriate, this can be discussed with you.

When to seek medical advice

Most routine back and neck problems can be assessed without emergency treatment, but some symptoms need more urgent medical attention.

For back pain, NHS guidance advises urgent assessment for symptoms such as severe pain that starts suddenly or worsens quickly, feeling generally unwell alongside the pain, or certain neurological symptoms.

Seek urgent medical advice if back or neck pain is accompanied by symptoms such as:

• New problems controlling the bladder or bowel
• Progressive weakness in an arm or leg
• Significant changes in balance or coordination
• Numbness around the genital or saddle area
• Severe symptoms following significant trauma
• Rapidly worsening symptoms

These symptoms should not simply be managed as routine back or neck pain.

A treatment plan based on your routine

The aim of treatment is different for everyone.

You may want to:

• Sit comfortably through the working day
• Sleep without repeatedly waking because of pain
• Lift or carry more comfortably
• Turn your neck more easily while driving
• Return to exercise
• Walk for longer
• Get back to physical work
• Manage recurring episodes more confidently

Treatment can be built around the movements and activities that are relevant to your life rather than following the same programme for every person.

How many sessions will I need?

The number of physiotherapy sessions varies depending on the nature of the problem, how long symptoms have been present and how they respond to treatment.

Some people may need assessment, advice and a relatively short exercise programme. Others may require a longer period of rehabilitation where symptoms are persistent or physical function has been significantly affected.

Progress should be reviewed during treatment so that exercises and activity levels can be adjusted when needed.