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Specialist Orthopaedic Doctors

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Back Pain Injections

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Fluoroscopically Guided Digital X-Ray Injections

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Spinal Manipulation

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Exercise & Rehabilitation Programmes for the Young...

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...and the Not So Young


'Spinal manipulation' is a term used to describe a range of manual therapy techniques applied to the spine. The most common usage relates to a High Velocity Low Amplitude (HVLA) thrust, where the practitioner applies a rapid thrust or impulse. Practitioners perform spinal manipulation by using their hands or a device to apply controlled force to a joint in the spine, moving it just beyond the normal range of motion. Sometimes you may hear a 'click', just like when people 'crack' their knuckles. The aim of the treatment is to relieve pain and improve physical function by regaining normal range of motion and inducing a beneficial neurophysiological effect. Manipulation is not usually intended to be a stand-alone treatment; it tends to be used in conjunction with other techniques within a treatment session.

Spinal manipulation can be performed on any area of the back, from the neck down to the pelvis. Similar techniques can even be used on the ribs. Low back pain is a common condition, for which spinal manipulation is among one of the techniques used in attempts to relieve pain and improve functioning. However, manipulation may be incorporated into a treatment programme for other problems, such as facet lock, facet irritation, disc irritation, trapped nerves, cervicogenic headaches, rib and thoracic spine dysfunctions, sacroiliac dysfunctions and postural related problems. Advanced knowledge and skill in the use of this technique requires training, practice and the development of palpatory skills.

Healthcare professionals such as Osteopaths, Chiropractors, Physiotherapists and some conventional medical doctors are able to practice spinal manipulative techniques. All Osteopaths and Chiropractors and some Physiotherapists learn this technique as part of their initial training. Other therapists are able to learn this skill by completing a postgraduate course in manipulative/manual therapy. Spinal manipulation is relatively safe when performed by a trained and licensed practitioner. The most common side effects experienced include: discomfort in the treated area, headaches or tiredness. These effects are temporary and usually dissipate in 1 to 2 days.


back-pain-3Once the cause of your pain has been assessed and diagnosed, a number of different treatments are on offer depending on your condition and its cause. These treatments range from manual therapy, exercise and Pilates programmes to the latest in fluoroscopically (digital X-ray machine) guided spinal injections. These injections are provided by our team of sports and musculoskeletal physicians and specialist pain management anaesthetists.

If your condition requires manual therapy we have a wide range of  therapists including Physiotherapists, Osteopaths and Chiropractors. Many of our practitioners are dually qualified in the use of Acupuncture and can use it as part of your treatment.

The cause of your back or joint pain may be related to how you stand or run. Our on-site Podiatrist can undertake a biomechanical assessment of your gait and stance to determine whether this is the case. If necessary she will provide you with orthotics (inserts for your shoes) which will help to correct your posture, thus reducing abnormal loads on your back and other joints.

The Clinic prides itself on its integrated approach to the treatment of back and joint pain and believes that having many types of practitioners all working together under one roof with the common aim of reducing your pain as quickly as possible is the key to successful outcomes. One of the many strengths of the Clinic is the vast experience available in so many different treatment specialities. As an addition to physical treatments, we are pleased to offer access to a Psychologist who can help manage the stress that may be worsening your pain.

The Clinic is at the 'cutting edge' of a treatment called Prolotherapy for back pain. This involves a series of injections into the ligaments of the spine to help strengthen them. The injections are performed under fluoroscopic guidance for greater accuracy. Following this type of treatment, a number of top sportsmen and women have made full recoveries from injury and gone on to represent their countries at football, rugby, rowing, cricket and many other sports.

Causes of Back & Neck Pain

  • Overuse and Over-activity injuries (e,g, from gardening or unusual activity)
  • Wear and Tear (osteoarthritis) of spinal (facet) joints
  • Trauma and Sports injuries
  • Wear and tear to intervertebral discs
  • Slipped or herniated intervertebral disc
  • Whiplash, typically as a result of motoring accidents
  • Standing, sitting or bending down for long periods
  • Strains from lifting, carrying, pushing or pulling loads that are too heavy.

Back pain can be made worse by:

  • Other illnesses or disease
  • Being overweight
  • Poor core stability and posture
  • Low mood, depression and anxiety


There may be other causes of your low back pain, these include:

An Osteoporotic or Fragility Fracture caused by low bone density. This is more common in women after the menopause or people who have used high dose steroids for long periods. Diseases such as hypothyroidism can put you more at risk.

Spinal Stenosis occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves.When intervertebral disks collapse and osteoarthritis develops, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth - called spurs - can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

When intervertebral disks collapse and osteoarthritis develops, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth - called spurs - can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal. This very painful condition often presents after you have walked for a set distance and the pain settles with rest. The distance is usually very repeatable and may be associated with a feeling of weakness in the legs. This condition may benefit from an epidural injection but some cases require surgery to deal with the symptoms.

Slipped or herniated discs occur when the jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or damaged, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain. Because a herniated disk in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is sciatica. Treatment of this may be by manual therapies or by injection therapies you will be able to discuss this with your doctor. A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

Spondylolithesis occurs when changes from ageing and general wear and tear make it hard for your joints and ligaments to keep your spine in the proper position. The vertebrae move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves or compress the small joints at the back of the spine (facet joints). This causes back pain which is made worse with extension (leaning backwards) and may lead to back spasms.

Degenerative disc disease - when the discs in your spinal cord gradually become worn down

Rheumatoid arthritis - an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures