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Muscular
In everyday life, many short-lived episodes of spinal pain, particularly lower back pain, result from strains or other injuries to muscles and ligaments. These may be caused by sports injuries or, not uncommonly, an unaccustomed increase in an individual’s physical activity. Viral infections (’flu-like illnesses) are often accompanied by muscular pain, including neck and back pain, referred to medically as myalgia.

Degenerative changes
The spine is made up of individual bones or vertebrae which are joined together by the intervertebral discs, as well as other joints and ligaments, to form a strong but flexible structure (see figure 1 on page 4 of the printed bound booklet or pdf). During middle age and beyond, the commonest cause of spinal pain, besides purely muscular pain, is wear and tear of the intervertebral discs and the associated joints of the spine. These so called degenerative changes are caused by movement, and are therefore more common in the neck (cervical) and in the lower (lumbar) parts of the spine. The region between these areas, the thoracic spine, is splinted by the rib cage and is relatively immobile. Wear and tear affects the joints of the spine in a number of ways. Being biological structures, they respond initially to any form of damage by trying to repair themselves. Unfortunately, whilst nature is able to effect remarkable repairs in many circumstances, the process is not too successful with the joints of the spine. As a result, the regular, healthy structure of youth becomes more irregular with age, as discs bulge, ligaments buckle and bony spurs form. The spinal cord and the nerves issuing from it, which originally ran through smooth canals and channels, may be nipped or compressed by the various irregular surfaces that have developed.

Injuries
People frequently link the start of their back or neck pain to an accident, often one occurring at work, but the sort of accidents that cause this sort of pain are equally likely to occur working in the garden or in the garage at home, or even getting into or out of a car. In many cases a particular movement causes a sudden onset of pain, but it is important to realise that, in most circumstances, the ‘accident’ was merely the trigger which revealed the presence of an existing degenerative problem affecting a segment of the spine. In other words, the accident caused the problem to become symptomatic. In the case of neck pain, for example, people often first experience symptoms when they wake up one morning with a stiff and painful neck.

People sometimes ask whether heavy manual work can accelerate the natural process of degeneration of the spine. This question is difficult to answer with certainty, although the action of repeatedly loading and twisting the lumbar spine may advance degenerative changes in lumbar discs. Weight lifters, for example, are not particularly prone to disc problems, whereas gymnasts are.

One particular injury which can cause a good deal of distress is the so-called ‘whiplash’, or hyper-extension injury of the neck. This most commonly results from rear-impact road traffic accidents. Affected people may experience persisting neck pain, with or without symptoms in the arms, for many months or even years after the accident. Often there is little to be found when the person is examined, and even special investigations and scans may yield negative results. This does not mean that the pain is unreal or imagined and people usually complain of a consistent and recognisable pattern of symptoms.