Back Pain

Back pain is a common problem which nearly all of us will experience it as some point. Back pain can be distressing affecting usual activities, however the problem is rarely structural. Physiotherapy can help manage pain, via manual therapy, acupuncture and exercise. An important focus is on strengthening exercises to help support the spine.

Back & Neck pain

A common area of pain is the spine, particularly the back and neck. We provide expert assessment and management of back and neck pain, helping restore full pain-free movement and function.

Back pain can be frightening and debilitating, and can lead to time off work. It may follow an awkward lift, DIY or repetitive movements, gardening or sport. Other times it may be provoked with a seemingly innocuous movement –  eg reaching to the floor, or turning at your desk. Back and neck pain may result from prolonged sitting, eg at the computer. Static postures (often in positions that are less than ideal) are poorly tolerated, as spines (indeed muscles and joints in general) prefer to move.

Underlying sources of pain are typically the joints and muscles (mechanical dysfunction), and when there is pain the muscles will often work to protect the spine. These muscles may then become pain generators themselves. There may be pain with an acute disc tear, or with a disc bulge that puts pressure on a spinal nerve. Interestingly, degenerative changes do not always cause pain although, if there is inflammation associated with this, pain may result. Normally there is a combination of causes, and our physiotherapists will use a variety of techniques to target these.

The spine is an inherently strong structure with many small joints between the vertebrae, ligaments, muscles and discs. It provides protection for the spinal cord, and allows the nerve roots to exit and form the peripheral nerves of the body. It is well designed for movement but not for prolonged stresses or sudden forces. In many cases it is the muscles, ligaments and connective tissue that cause mechanical problems and result in pain, it is often not the disc at all.

Discs are tough structures sitting between each vertebra and form part of the spinal column. They act as shock absorbers, but occasionally can tear or some of the substance can protrude out of the spinal column into the space where the nerves lie. The portion of the disc may irritate or put pressure on the nerve, or inflammatory chemicals may also cause nerve irritation. Symptoms include pain in the back or referred into the buttock or leg, stiffness in the spine. Occasionally  in the legs there may be pins and needles or numbness, and even weakness.

Nerves travel throughout the entire body from the spinal cord from each level of the spine. If nerves are involved there may be pins and needles or numbness in the arms, legs or head. Nerves can be irritated at the spine itself, or at points through the body where they interface with structures such as muscles and bones.

Pain can be heightened by factors such as fear, beliefs and emotions. The brain can interpret signals from the injured area differently depending on its state. The brain may continue to read higher levels of pain or more persistent pain despite tissue healing.

Our physiotherapists will assess your symptoms, including previous history, taking account of factors that may be contributing to your pain experience.  Your treatment plan will include management of these factors, with the aim of restoring function and improving your quality of life.

Treatment may include manual therapy to the soft tissues and joints, and possibly acupuncture. You will be advised regarding activities, postures and function for recovery and beyond, and given specific exercises to help restore mobility and muscle control of the spine.  Throughout the recovery process exercises will progress to challenge your spine and help improve its resilience.

We may recommend continuing exercise that suits you such as pilates, yoga, walking or swimming aiming for self help and management.

Download the back pain information and exercise sheet

Download the neck pain information and exercise sheet

This is provided as general information only and is not intended to be relied upon as medical advice.


This refers to the acceleration–deceleration mechanism of energy transfer to the neck (typically resulting from rear or side impact motor vehicle collisions, but the same mechanism may occur in sports and other activities).  The result is a degree of strain to bones, discs, muscles, nerves and tendons of the neck - any of which can be sources of pain.

Whiplash symptoms may present immediately, or more commonly hours, days, or even weeks after injury. Symptoms may include tenderness, pain or stiffness in the neck, jaw, shoulders or arms. More unusually dizziness, headache, loss of feeling in an arm or hand, nausea and vomiting may occur.

Keeping moving and resuming as normal function as as possible is recommended. Physiotherapy assessment will identify the structures affected and treatment may include hands on treatment and targeted exercises to help to restore full pain-free function.

This is provided as general information only and is not intended to be relied upon as medical advice.

T4 syndrome

Upper Thoracic Spine Syndrome

Typical symptoms are pain and stiffness of the upper thoracic region. Other symptoms may include diffuse arm pain, headaches, neck pain, and hand or forearm pain or pins and needles. Symptoms can be worse at night.

Causes include sustained periods of sitting or bending with the arms in front of you (think: laptops/driving/needlework). This may be new or increased activity in this position. Lack of movement affects not only muscles and joints but the local blood supply (hence reduced oxygen to nerves, muscles and joints).

A thorough assessment will identify if the thoracic spine is the cause. Treatment will usually involve mobilisation of the thoracic area, perhaps nerve mobilisation, along with postural advice, stretches and strengthening.

Regular exercise such as yoga or pilates can help prevent recurrence by keeping the area more mobile.

This is provided as general information only and is not intended to be relied upon as medical advice.


This is a term that refers to any pain in the leg stemming from the spine. Typically it may mean nerve pain due to pressure or irritation, and the pain may follow a very specific route (possibly due to a disc protruding,  or any narrowing of the space where the nerve sits). Pain may also refer more generally into the legs from the joints or muscles in the back or pelvis.

A detailed history of your symptoms along with assessment of the spine and pelvis will help to identify which structures are at fault, and what treatment is indicated. Reducing pressure on affected structures through manual therapy and exercise is often the early focus of treatment, then progressing exercise including building strength into functional movements.

Where needed we will advise on referral for imaging or specialist opinion.