Mechanical and degenerative back pain

What do “mechanical” and “degenerative” mean?

“Mechanical” means that pain is affected by movement, posture or physical load. “Degenerative” means the ordinary age-related changes seen in the discs and small joints of the spine. Neither term gives one certain cause for the pain.

Disc wear, bulges and changes in the small facet joints become more common with age. They are also seen in many people who have no pain. A scan can support an assessment, but it cannot reliably identify the painful structure by appearance alone.

Back pain or sciatica?

Back-dominant pain is felt mainly in the lower back, although it can spread into the buttock or thigh. Sciatica usually travels farther down the leg because a nerve leaving the spine is irritated. It may come with tingling, numbness or weakness. Some people have both types of pain.

Assessment and scans

The consultation considers when the pain began, where it spreads, what movements affect it, and how it changes sleep, work and everyday life. The examination helps separate common back pain from sciatica and from problems that need a different type of care.

NICE advises that most people do not need an early scan. A scan is most useful when its result could change treatment. An injection or operation should not be recommended simply because a report describes an abnormality.

What treatment may help?

Most care begins with a clear explanation, support to keep moving and exercise chosen around the person’s needs. Hands-on treatment can sometimes help, but is usually most useful as part of a wider exercise programme. When pain has lasted a long time, treatment may also include help with confidence, sleep and the understandable fear of making the back worse.

Medicines need an individual discussion about likely benefit and possible harm. Strong painkillers are generally not a good long-term answer for back pain.

NICE advises against routine spinal injections for low-back pain, but that does not mean every injection is without value. In the right person, an injection may help answer where pain is coming from and may give temporary relief that makes movement and rehabilitation easier.

Medial branch blocks are often described to patients as facet-joint injections. A small amount of local anaesthetic is placed around the tiny nerves carrying feeling from the facet joints at the back of the spine. If pain improves clearly for a short time, a longer-lasting heat treatment to those nerves—called radiofrequency denervation—may be worth considering.

This option is considered for carefully selected people with persistent, localised back pain after other non-surgical care has not worked. The amount and duration of benefit vary.

When might a surgical opinion help?

Spinal fusion or disc replacement is not a routine answer to back pain without a clear cause. Referral to a surgical colleague may be helpful when there is a specific problem that an operation might treat—for example pressure on a nerve, an unstable or unusually shaped spine, a fracture, or concern about inflammation, infection or a tumour.