What I usually see, explained from start to finish.
Each of these has a page of its own. It is not a medical dictionary summary — it is the explanation I would give to someone sitting in front of me, with the typical pattern, what usually makes it worse, what usually eases it, and what can be expected.
Choose the one that sounds closest. If none of them does, send me a message anyway — not everything fits into four boxes.
The most frequent in my day-to-day practice
"Mechanical obstruction"
Pain that changes place and intensity depending on position, with scans that show nothing decisive. The hypothesis is that something gets caught inside the facet joints — a fragment of cartilage or a fold of the capsule itself. It is the name I use to explain this pattern to my patients — it is not a settled diagnosis, it is a model that describes well what is observed and that points treatment in the right direction.
Something I hear often
“Some days I am fine, others I cannot even put my shoes on. And nothing shows up on the scans.”
Having a herniated disc on a scan and having pain caused by that herniated disc are two different things. When the disc really is irritating the nerve root, the picture has a recognisable shape — and most of these cases improve without surgery.
Something I hear often
“I was told I have a herniated disc and that sooner or later I will have to have surgery.”
The canal the nerves pass through becomes narrower and, in certain positions, leaves less space. The pattern is very characteristic: you walk a certain distance, your legs grow heavy, and relief comes when you sit down or lean forwards.
Something I hear often
“I used to walk right round the park. Now I have to stop twice on the way to the café.”
Surgery solves a specific structural problem, but on its own it does not give back the confidence to move. The work is progressive: recovering range of movement, rebuilding strength, and showing your body, step by step, that movement is safe again.
Something I hear often
“I have no pain any more, but I am afraid to bend down. Nobody told me how far I can go.”
Nothing on this page replaces an assessment by a healthcare professional. And there are situations that are not a matter for physiotherapy at all:
this calls for urgent medical care, the same day.
In the spine, generally
Severe pain that does not ease in any position and that gets worse from one day to the next
Loss of sensation that gets worse from one day to the next, in a leg or an arm
Fever, with no known infection to explain it
Unexplained weight loss — around 10% of your body weight in six months, with no diet or exercise to account for it
When it starts in the lower back
These may indicate cauda equina syndrome.
Numbness or altered sensation across the whole area covered by underwear — genitals, perineum and inner thighs
Losing the ability to hold in urine or stools
Or exactly the opposite: no longer being able to pass urine or open your bowels
Loss of strength in a leg, particularly if it is getting worse
When it starts in the neck
These may indicate cervical myelopathy.
A change in the way you walk that came on suddenly — a feeling of walking as if drunk
Suddenly losing strength or sensation and dropping light objects from your hand
Gradually losing movement in the arm from one day to the next
New clumsiness in fine movements: doing up buttons, writing, picking up coins
In these cases there is only one route: the emergency department.
A medical appointment the same day, as soon as possible, with neurosurgery or spinal orthopaedics.
This is not a matter for physiotherapy, nor for any other healthcare professional.
And it is not a matter of waiting to see whether it improves. Here, time is what weighs most on the outcome: the sooner you are seen by a doctor, the better.
If what you feel does not look like any of these, write to me anyway. The initial conversation is there precisely to work out what is going on with you — and it is free.
