Acute neck pain or "Wry Neck". Chronic neck pain without radiculopathy (neck pain without shoulder or arm pain). Chronic neck pain with radiculopathy resulting from a disc bulge or other structure causing stenosis (associated with arm pain, pins and needles and numbness).
Thoracic and Rib Pain
Kyphosis Scheurmanns Disease Displaced Rib Costochondritis Costovertebral joint pain Costchondral joint pain
Acute lower back pain (less than 6 weeks) that can be attributed to low grade muscle or ligament sprains producing pain and stiffness. Chronic lower back pain without radiculopathy (back pain without leg pain) which can arise from poor postural habits, aberrant movement patterns, maladaptive movement patterns, weakness of the hip extensors and stabilisers and can also be associated with a lack of, or avoidance of exercise. Chronic lower back pain WITH radiculopathy resulting from a disc bulge or other structure causing stenosis (associated with leg pain, sciatica, pins and needles and numbness).
Nerve Pain and Sciatica
Nerve pain can be distinguished into 2 seperate categories, with different treatments for each pathology. 1)Nerve sensitisation - normally associated with a traction injury, inflammation of the nerve sheath, or repetitive over-stretching of the nerve. A nerve sensitisation may cause symptoms like burning, shooting, itchy pain. 2) Nerve compression (radiculopathy) - caused by a physical structure, such as a disc bulge in the spine, or a tight muscle in the limb, compressing the nerve. A compressed nerve cause symptoms like pins and needles, numbness and weakness.
A systematic review conducted in 2014 (Brinjiki et al) found that disc bulges are extremely common in the general population and that there is actually a very poor correlation between pain and the appearance of a disc bulge on MRI. Whilst they can cause pain, they are much more likely to cause referred pain (down the shoulder/arm or leg) than cause spinal pain. If you have been diagnosed with a disc bulge, but are not suffering from any referred pain into the arm or leg, then it is unlikely that the disc is the source of your pain. You would then be classified, according to the diagnostic triage criteria, as having local muscular or joint-related back pain. Disc bulges that do become symptomatic will cause nerve pain and should be treated as a nerve condition (above).
Pelvic and Sacroiliac joint Pain
These conditions generally only affect 2 populations. They are: 1) Pregnant or post-partum women 2) Those suffering from ankylosing spondylitis. It is common for people to complain of their pelvis or hips being "out of place" or "one hip higher than the other". Much research has been conducted in this area and we are confident now that a) it is almost impossible to tell, without a fine slice CT scan if the pelvis has moved out of place and b) the only scenario where this might occur is during or after pregnancy or after significant physical trauma resulting in hospitalisation. We can now readily identify those who actually are suffering from sacroiliac pain and can be treated effectively with bracing (pre and post-natally) or with stretching and strengthening of the pelvic girdle.