Back and neck pain
Most back and neck pain comes from muscles, joints and discs that settle with time and the right movement — and a small number of patterns that need a doctor promptly.
At Poona Orthopaedic Clinic, Kondhwa, Pune — Dr. Atul Keswani and Dr. Harish Keswani.
Back pain is the single commonest reason adults see an orthopaedic doctor, and neck pain is not far behind — long hours at a desk, on a two-wheeler or looking down at a phone see to that. The reassuring fact is that most episodes come from strained muscles, stiff joints or a disc under pressure, and improve over a few weeks with the right advice.
The job of a spine consultation is to separate those everyday causes from the few that need investigation — pain that runs down the leg or arm, numbness or weakness, pain after a fall in an older adult, or pain with fever or weight loss — and to give you a plan that gets you moving again rather than resting for longer than helps.
Common causes
Muscle and ligament strain
The most common cause of a sudden painful back or neck — after lifting, a long journey, an awkward night, or a new exercise. Pain is felt across the lower back or the base of the neck, is worse with movement, and usually eases within one to three weeks.
Disc prolapse ("slipped disc") and sciatica
A disc between two vertebrae bulges and presses on a nerve root. The clue is pain travelling below the knee (sciatica) or down the arm, often with tingling or numbness, and worse with coughing, sneezing or sitting. Most settle over six to twelve weeks without surgery.
Wear-related changes (spondylosis)
Age-related changes in the discs and small facet joints of the spine. Pain is stiff and nagging rather than sharp, worse first thing in the morning and after sitting, and comes and goes over years. Very common after fifty and often manageable with exercise and posture changes.
Spinal stenosis
Narrowing of the spinal canal in older adults. The typical story is heaviness, pain or tingling in both legs on walking that eases on sitting or leaning forward — on a shopping trolley, for example.
Osteoporotic compression fracture
Sudden back pain in an older adult after a minor fall, or no clear injury at all, can be a fracture of a weakened vertebra. It needs an X-ray and a check of bone health rather than painkillers alone.
Pain referred from the hip or elsewhere
Hip arthritis is regularly mistaken for back pain and vice versa; groin pain and difficulty putting on socks point to the hip. Rarely, kidney, abdominal or pelvic problems present as back pain — which is why the examination covers more than the spine.
When to see a doctor
- Back or neck pain that has not improved after two to three weeks of normal activity and simple measures
- Pain spreading into the leg below the knee, or into the arm, especially with tingling or numbness
- Pain that keeps returning, or that is limiting work, sleep or walking distance
- Any back pain after a fall or minor injury in someone over 60, or with known osteoporosis
- Neck pain with headaches, dizziness or pins and needles in the hands
Signs that need urgent care
Do not wait for an appointment if you have any of these — go to an emergency department.
- — Numbness around the buttocks or inner thighs, difficulty passing urine, or loss of bowel or bladder control — go to an emergency department immediately
- — Weakness in a leg or foot (a foot that drags or slaps), or in the hand or arm, that is new or getting worse
- — Severe back pain with fever, unexplained weight loss, or a history of cancer
- — Back or neck pain after a significant fall, road accident or other injury
- — Pain that is constant, unrelieved by any position, and worse at night
What helps in the meantime
- Keep moving — short, frequent walks and normal daily activity recover faster than bed rest, which is no longer advised beyond a day or two
- Heat (a hot water bag or warm shower) for muscular back and neck pain; simple pain relief if it is safe for you
- Set up the desk and the phone at eye level, and take a two-minute break from sitting every half hour
- Lift with the load close to the body and the knees bent, and avoid twisting while carrying
- Begin gentle back and neck mobility and core exercises as the pain allows; a physiotherapist can show you a safe routine
What a consultation involves
A spine consultation at the clinic begins with the story of the pain — where it is, where it travels, what brings it on and what eases it — and an examination of the back or neck, the nerves of the arms and legs, and the hips. Many patients need no imaging at all. An X-ray is arranged when a fracture or wear-related change is suspected, and an MRI only when symptoms suggest a nerve is being compressed or when surgery is being considered. Treatment starts with the simplest effective option: activity advice, physiotherapy, medication for a short period, and targeted injections for nerve-root pain. Surgery is reserved for the small number of patients with persistent nerve compression, progressive weakness, instability or a fracture that needs stabilising, and is discussed with the alternatives and expected recovery set out beforehand.
Questions patients ask
Usually not. Most disc prolapses settle over six to twelve weeks with activity, physiotherapy and medication, and the bulge itself often shrinks on follow-up scans. Surgery is considered when leg or arm pain from a compressed nerve persists despite proper non-surgical treatment, or when there is weakness, or bladder and bowel symptoms, which are an emergency.
Either can treat spine problems; orthopaedic spine surgeons and neurosurgeons both train in spinal surgery. For the great majority of back and neck pain, which is treated without surgery, an orthopaedic spine consultation is the usual first step, and the examination also checks the hips and joints that commonly cause confusingly similar pain.
No. Beyond a day or two of taking it easy, bed rest slows recovery and stiffens the back. Staying as active as the pain allows — walking, light household activity, gentle stretches — is consistently shown to help people recover faster.
Not for most back pain. An MRI shows disc bulges and wear in most adults over forty, including people with no pain at all, so it can mislead unless the examination points to a specific problem. It is useful when there are nerve symptoms that are not settling, when weakness is present, or when surgery is being planned.
What patients say
Experiences with back and neck pain live on the clinic’s Google profile, exactly as patients wrote them — we link to reviews rather than curating them here.
How back and neck pain is treated
Depending on the cause and how far it has progressed, these are the treatments that usually come into the conversation.
Spine care — back pain, slipped disc and sciatica
Spine care in Pune for back pain, neck pain, slipped disc and sciatica — a diagnosis first, non-surgical treatment for the great majority, targeted injections for nerve pain, and spine surgery only for the few who need it.
Read more
Joint injections
Targeted injections used to settle inflammation and pain in a specific joint or tendon, usually to make rehabilitation possible.
Read more
Non-surgical arthritis care
A structured plan to control arthritis pain and keep you active — for the many patients who do not need surgery, or who are not ready for it.
Read moreOther conditions
Living with back and neck pain?
An examination narrows things down quickly. Bring any scans you already have and you will leave knowing what is actually wrong.