Back pain and neck pain are responsible for huge personal and societal costs, and are major causes of work disability. Contrary to traditional thinking, neither back pain nor neck pain is a problem that always resolves itself. Recurrences are usual and their course is very variable.

A stepped approach in which the physiotherapist initially takes a history and carries out a physical examination to exclude any potentially serious pathology and identify any particular functional deficits is recommended. Initially, advice providing simple messages of explanation and reassurance will form the basis of a patient education package. Self-management is emphasized throughout. A return to normal activities is also encouraged. For the patient who is not recovering after a few weeks, a short course of physiotherapy intervention may be offered. This should be based on an active management approach, such as exercise therapy. Manual therapy should also be considered. Any passive treatment should only be used if required to relieve pain and assist in helping patients get moving. Specific barriers to recovery need to be explored. Those few patients who have persistent pain and disability that interferes with their daily lives and work need more intensive treatment or a different approach. A multidisciplinary approach may then be optimal, although it is not widely available. Liaison with the workplace and/or social services may be important. Getting all players on side is crucial, especially at this stage.

Many researchers have tried to classify back and neck pain and many different methods have been proposed. The best and most widely accepted method of classification for low back pain is diagnostic triage, where patients are categorized as falling into one of three groups serious spinal pathology, neurological involvement, and non-specific low back pain. Similar categories could apply to neck pain patients.

 The longer patients with back pain are off work, the greater the chances that they will never return to work. It is therefore important that the individual is encouraged to return to work even if there is still some residual pain.  For a small number of patients, more extensive and intensive rehabilitation programmes may be indicated.

This is an abstract from an article originally published in the Oxford Journal of rheumatology

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