Pain syndromes and functional disorders

Low back pain (lumbar pain syndrome)

Low back pain is classified by duration as acute, subacute or chronic (lasting longer than 12 weeks). In most patients it is non-specific pain without a single structural cause, arising from dysfunction of the motion segments, muscle imbalance and overload.

The doctor first rules out serious causes (fracture, infection, tumour, inflammatory disease and cauda equina syndrome) and assesses the risk of the pain becoming chronic. In acute low back pain the aim is to stay active, with short-term pain relief and manual therapy; bed rest is not recommended. Chronic low back pain is treated with an active exercise programme, education and, when needed, a multidisciplinary approach.

Cervical syndrome

Cervical syndrome is pain and restricted movement of the cervical spine due to facet joint dysfunction, degenerative disc changes and muscle imbalance, often together with prolonged postural strain. The pain may spread towards the shoulder and shoulder blade, and may be accompanied by headache and a feeling of unsteadiness.

The doctor distinguishes it from cervical radiculopathy and myelopathy, shoulder disorders and inflammatory diseases such as rheumatoid arthritis and polymyalgia rheumatica. Treatment includes pain relief, mobilisation, exercises for the deep neck flexors and scapular stabilisers, and ergonomic measures.

Acute torticollis

A painful spasm of the neck muscles with the head held in a fixed position, most often due to spasm of the levator scapulae or trapezius muscle or acute facet joint dysfunction. Before giving muscle relaxants, blocks or mobilisation, the doctor rules out cervical dystonia and meningeal syndrome and, in children, atlantoaxial rotatory subluxation and Grisel’s syndrome.

Cervicogenic headache and dizziness

One-sided headache or unsteadiness arising from the upper segments of the cervical spine. The doctor distinguishes it from migraine and from neurological and vestibular causes, and treats the source in the neck.

Sacroiliac joint pain

Pain in the lower back and buttock that is often mistaken for disc herniation. Using provocation tests and, if needed, MRI, the doctor distinguishes mechanical dysfunction from inflammatory sacroiliitis, because the two conditions are treated differently.

Pain between the shoulder blades (thoracic syndrome)

Pain in the thoracic spine due to dysfunction of the costovertebral and facet joints or postural strain. Before rehabilitation, the doctor rules out cardiac, pulmonary and gastrointestinal causes.

Myofascial pain syndrome

Regional muscle pain with active trigger points, a taut band and referred pain. The diagnosis is clinical, after radiculopathy and myopathy have been ruled out, and it is treated with physical therapy procedures, local anaesthetic infiltration and stretching.

Piriformis syndrome

Irritation of the sciatic nerve by the piriformis muscle, with pain in the buttock that spreads down the leg and mimics lumbar radiculopathy. The doctor distinguishes it from sciatica, and it is treated with stretching, manual therapy and, if needed, an ultrasound-guided block.

Coccydynia

Pain in the tailbone area, most often after a fall or childbirth, or due to hypermobility of the coccygeal segment. It is treated with offloading when sitting, manual therapy and blocks.

Hypermobility and segmental instability

Increased mobility of spinal segments, either on its own or as part of a hypermobility syndrome (Ehlers-Danlos or Marfan syndrome). The doctor assesses the systemic features, and rehabilitation is based on stabilisation rather than stretching and manipulation.