Spinal Physiotherapy

A holistic approach requires a broad range of skills.

Pain from the neck, chest and back make up a huge percentage of the people we see. This is not surprising when we know that low back pain and neck pain are two of the leading causes of disability in the world. The problems originating in the spine can be numerous as it is a common source of referred pain. Spinal physiotherapy includes treatment from the top to the bottom (literally!).

Neck Pain (Cervical Spine)

The neck commonly refers pain to:

  • the head – cervicogenic headaches. These are most often on one side, but can co-exist with tension headaches and migraine and the neck can be a contributing trigger to these other types of headache.
  • arms and fingers – nerves irritated in the neck will refer pain anywhere in the arms. Nerve pain can be really distressing due to the quality of it. It is not uncommon for patients to believe that the pain is coming from the arm and in doing so , make attempts to stretch the arm to get relief. This obviously will be ineffective if the problem is coming from the neck. If a nerve is being compressed this will cause pins and needles and/ or numbness in the arm. This can also occur from a compression in the arm itself though. A detailed assessment of your neurological function will determine where the problem is coming from. If the nerve is being compressive or irritated in the neck, manual therapy delivered in a way to relieve compression can be effective in reducing the pain and disability. Often patients need additional medication from their GPs to help them through the recovery process. We often liaise with GPs to keep them informed of our findings.
  • chest and shoulder blade – it is very common for patients to feel the pain into the shoulder blade region and do all sorts to try to resolve the pain through rubbing with a tennis ball or again stretching the upper back and shoulder. Treatment directed to the neck, if the problem is here usually resolves the pain.

Mid back pain (Thoracic Spine)

Chest and upper back pain can be very distressing as it can interfere with your breathing or the location can cause you to think it is coming from your heart or a broken rib. Obviously, we recommend that if you suspect you might be getting cardiac pain, you should seek immediate medical care.

  • mid back – pain between the shoulder blades is common
  • chest and abdomen pain -pain can spread from the mid back around into the chest or even the upper abdomen


Middle back pain can be from postural causes or twisting and lifting awkwardly when you are not used to it. This can give quite sharp pain in the chest and interfere with your breathing. The muscles in the back and the little joints are often sources of pain that can be eased with local manipulation or soft tissue massage. Trying to remain active is the goal, and some local treatment may be helpful in assisting you back to activity.

Lower back pain (Lumbar spine and Pelvis)

Low back pain is by far the most common area we see within the clinic and there is a lot of misinformation around spinal pain and low back pain that can actually make the problem much worse.

  • lower back- pain often across the an area at belt level
  • buttock pain- pain into one or both buttcoks
  • leg pain- pain descending a leg/s towards the foot

Common myths about low back pain

For instance, the following beliefs are really common but are not true:

  • Is low back pain is caused by bad posture? – possibly, but not in the way you think! – adopting upright active postures is not necessarily helpful. Although posture will have an impact on your pain, the current approach is to encourage relaxed comfortable postures. If your pain feels better in a more relaxed slouched position, why wouldnt you adopt this?


  • Is low back pain is cause by me aging? – No! – Elderly people get low back pain, but so do younger people and in fact the most common time for people to get low back pain is in their middle age. The drivers are unclear, but life stresses are often cited as a potential driver.


  • Is my spinal pain is caused by something being out of place? – No – This is a marketing ploy used to entice people to get their necks and backs manipulated because they are told they have poor alignment. Joints don’t go out of position, and the clicks from manipulation are not the vertebra going back into position. This is just gas forming in the joint, like when you crack your knuckles. Manipulation can be very helpful in restoring range of motion, but it does come with more risk. Restrictions in movement are more likely to be as a result of local spasms or joint restrictions, which improve with softer forms of treatment too. Also having your neck cracked will not improve your lower back pain. This type of treatment is unnecessary and exposes you to more risk of serious accidents.


  • Is low back pain is caused by a weak core? – No! – contrary to what your pilates teacher will tell you, having a weak core does not cause back pain. (There are still lots of benefits to doing pilates, so dont stop if you enjoy it!). In fact, people that have persistent or recurrent low back pain have more core activity than people that dont get pain. Tensing your belly all the time tenses your back muscles too (that’s the point of ‘stability’ -rigidity), but your spine is designed to move, but pain makes us all more tense and less likely to move freely. So your sore muscles naturally switch on to guard your movement. But often this guarding response can be unhelpful and can actually be part of the problem. So, relaxing and moving you back, while staying relaxed is often the goal. This is not always easy though and needs proper coaching.


  • Is it dangerous to bend my back? – No, not even when lifting! Again, our spines are designed to bend, and lifting with a rounded back is not dangerous. In fact it has been shown to be a more efficient way to move and lift. You still want to  bend your knees and hips, but lifting in a more natural way can again be very liberating and reduce your pain. Clearly if you are unsure about this, please check with us. If lifting with a rounded back increases your pain, this might be what is best for you!


  • I have disc bulges and all sorts on my scan, this must be the cause of my pain? – Not necessarily! Disc bulges and even prolapses are not necessarily painful. In fact disc bulges, degenerative facet joints, disc prolapses are commonly seen in people that dont experience pain. The can cause problems though when they press on the spinal nerves and interfere with its function.


  • My pain is really bad, so there must be something really bad going on! – Probably not – Serious causes do occur, but they are fortunately rare- see below. The intensity of pain is not actually a reliable indicator of the severity of tissue damage. It is very common to have severe pain in the absence of any tissue damage or visible pathology. In fact, it is really common for the pain to come on without any obvious injury at all.  The pain you feel is influenced by your mood, emotions, thoughts and sleep state to name a few. Which is why we take account of all these things when assessing you. Often the pain comes on at times of high stress. A deeper understanding of pain and what is means has been shown to be very empowering when it comes to getting over pain related problems.

So, what should you do about spinal pain?

Try to remain relatively active (walking, low level activity), take pain medication if you need it, you can use heat to ease the pain if that feels good, and gently stretch. There are often other contributors to back pain – eg stiff hip, sedentary lifestyle, stress, so establishing the drivers for the problem will be picked up during a thorough examination. Seeing a good physiotherapist is recommended by the HSE and the NHS. Fortunately, that is something we definitely have. Then it is a process of building back to the level of activity you want to achieve. Building strength and mobility through gradually exposing you to more and more load. We would then act as coach and rehab therapist to build you back to fitness.

Note: spinal pain of a serious cause does exist, and we all need to be aware of the signs and symptoms, but it is rare. If you have these symptoms you need to go to the hospital for immediate care. These red flags can be a sign of more serious pathology:

  • constant severe pain as a result of a fall or trauma – especially if associated with pins and needles or numbness
  • an inability to pass urine, or a change in your urinary function, such that you have more difficulty passing urine.
  • a loss of bladder or bowel control – incontinence
  • pins and needles in both legs
  • tripping or falling for no reason
  • a loss of sensation or pins and needles in your groin or saddle area – genitals or buttocks.
  • chest pain

Undergoing a thorough examination to establish the location of the problem and the cause is critical to getting a good outcome. This is often difficult to do yourself.  We are all highly trained in the pattern recognition and techniques required to make an accurate diagnosis possible.

Try to keep yourself mobile, and doing gentle stretching can be really helpful. Most problems are not serious and do resolve.

If you have any questions or would like to book an appointment at one of our Edinburgh physiotherapy clinics, contact us.

Cool ‘Techie’ Stuff

We are able to use certain technologies to determine loading patterns which might be contributing to the strain on tissues. These include the Biodex Isokinetic machine, video analysis, bike fit, running assessments, gait analysis to name a few. These novel approaches can give valuable information on the cause of a person’s pain.

Assessments and Measures of Improvement

There are clearly lots of things to consider on your road to recovery and there are lots of potential things to measure. This can help inform us as to how you are progressing. Patient assessments may be from self reported questionnaires, range of motion, muscle strength, agility, dexterity or general function. Your physio may look to perform these assessments at various stages of your recovery. These assessments can be quite simple to perform and can be good for you to monitor your own progress. They may be a bit more technical, like the isokinetic strength testing on the biodex.

If you are looking for help to feel better, you can contact us to make an appointment at one of our four Edinburgh Physiotherapy clinics or to discuss any questions you might have.