Spine & Back Care
Back Pain, Neck Pain, Sciatica & Spondylosis
A comprehensive, evidence-based guide to understanding and treating spinal conditions. Written by Dr. Dharam Pandey, integrating 25+ years of orthopaedic and spine rehabilitation experience.
"Most spine conditions respond to conservative care — surgery is rarely the first option."
Understanding Your Spine
The spine is a complex structure of bones, discs, nerves, and muscles. Understanding its design helps make sense of your pain.
🔍 Spinal Segments
Key Structures:
- • Vertebrae: Bony building blocks
- • Discs: Shock-absorbing cushions between vertebrae
- • Nerves: Spinal cord and nerve roots
- • Facet joints: Guide movement between vertebrae
- • Muscles & ligaments: Provide support and movement
The spine has three natural curves that work together to absorb shock and maintain balance. When these curves are altered (poor posture), stress increases on discs, joints, and muscles.
Most back pain is mechanical — related to how the spine moves and functions — not due to serious disease.
Low Back Pain
The leading cause of disability worldwide. Most back pain is mechanical and responds well to physiotherapy.
- Muscle strain or ligament sprain
- Facet joint irritation
- Disc irritation (not herniation)
- Usually central pain, no leg symptoms
- Degenerative changes
- Poor movement patterns
- Deconditioning
- Central sensitization
Exercise therapy, manual therapy, and education are first-line treatments. Bed rest is NOT recommended — gentle movement is better.
Neck Pain
Increasingly common in the digital age. "Tech neck" from prolonged device use is a modern epidemic.
📱 Common Causes
- • Poor posture: Forward head posture, rounded shoulders
- • Muscle tension: Stress, poor ergonomics
- • Facet joint irritation: From repetitive or sustained positions
- • Disc issues: Less common than in low back
Every inch of forward head posture doubles the load on your neck.
Sciatica & Radicular Pain
Pain that travels down the leg — a sign that a nerve root is irritated, often by a disc or narrowing.
🔴 Symptoms
- ⚡ Shooting, electric pain down leg
- ⚡ Numbness or tingling in specific areas
- ⚡ Weakness in specific muscles
- ⚡ Pain worse with sitting, coughing, sneezing
🟢 Common Causes
- • Disc herniation: Disc material presses on nerve
- • Spinal stenosis: Narrowing of spinal canal
- • Spondylolisthesis: Vertebra slips forward
- • Piriformis syndrome: Muscle irritates sciatic nerve
"Sciatica doesn't automatically mean surgery. Most disc herniations resorb over time, and directional preference exercises can centralize pain — moving it from the leg back to the back, which is a good sign."
Spondylosis: Spinal Arthritis
Spondylosis is the natural aging process of the spine — degeneration of discs and joints. It's common, and doesn't always cause pain.
Disc Degeneration
Discs lose water content, become thinner, less flexible. This is normal aging — like grey hair.
Bone Spurs
Body tries to stabilize joints by forming extra bone. Can sometimes narrow spaces where nerves exit.
Facet Joint Arthritis
Cartilage in the small joints wears down, causing stiffness and pain with extension/rotation.
Many people with "severe" degeneration on MRI have no pain. And many with "normal" scans have severe pain. The scan is a tool, not a diagnosis. Treatment is based on YOU, not your images.
Directional Preference
Most spine pain has a direction that makes it better (centralizes pain) and a direction that makes it worse (peripheralizes pain). Finding YOUR direction is key.
⚠️ Important: Find your direction with a trained physiotherapist — doing the wrong direction can worsen symptoms.
Essential Spine Exercises
These are examples. The right exercise depends on YOUR directional preference and condition.
- Pain during exercise should centralize (move toward spine) — if it peripheralizes (moves into limb), STOP
- Avoid sharp, stabbing pain
- Start slowly, progress gradually
- Consistency beats intensity
Red Flags: When to Seek Immediate Care
Most spine pain is mechanical and safe to treat with physiotherapy. But some symptoms require urgent medical attention.
Spine-Friendly Ergonomics
How you sit, stand, lift, and sleep matters. Small changes can make a big difference.
Spine Care FAQ
Free Resources for Spine Health
Our spine specialists have 25+ years of experience treating all spinal conditions. We're here to help you move better and live pain-free.
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