Where the pain is matters
“Back pain” covers three quite different regions, and they tend to fail in different ways.
- Lower back. The most common by a distance, and the region that carries the most load. Covered in detail on our low back pain page.
- Mid back (thoracic). Often stiffness rather than sharp pain, frequently related to sustained desk posture, and a common hidden driver of neck and shoulder problems. When the mid back stops rotating, the neck and shoulder do more than their share.
- Upper back and between the shoulder blades. Commonly a combination of thoracic joint restriction and the muscular load of holding the head forward for hours a day.
Why it often is not where you think
The spot that hurts is frequently the structure that has been compensating, not the one that stopped working.
A stiff mid back asks the low back and the neck to make up the difference. A hip that does not extend asks the lumbar spine to. Neither compensation hurts at first: it just quietly loads a structure beyond what it is built for, until that structure complains. Treat only the complaining structure and you get relief, then recurrence.
That is why the examination looks at the whole spine and how it moves as a chain, rather than at the sore segment alone.
Seek urgent medical care if you have
Loss of bladder or bowel control, numbness around the groin or inner thighs, progressive limb weakness, severe pain after significant trauma, or back pain with unexplained weight loss, fever, or night pain that does not change with position.
How we assess it
A first visit takes about 30 minutes: a full history, a physical examination of movement and load through the whole spine, and relevant neurological and orthopaedic testing. Then a clear explanation of what we found and what we would recommend — including whether we are the right people to help.
Where the picture is unclear or the findings warrant it, we have digital imaging on-site, including objective range of motion measurement so progress can be compared against a number rather than a memory.
What care might involve
Usually a combination of adjustment to restore lost movement and rehabilitation to change the loading pattern. Depending on the presentation it may also include cold laser therapy, or a course of spinal decompression. Not everyone needs all of it: most people need one or two.
Related
If pain is travelling into a leg see sciatica; if into an arm, see neck pain. For disc-related presentations see disc herniation and bulging discs. For desk-driven strain see posture correction.