PENN SPINE CENTER

Managing Your
NECK AND BACK PAIN
Resources to Help Keep You in Motion

Your spine serves as a lifeline for the entire human body. It not only allows you to stand
upright, it also is the protection for the spinal cord to deliver movement to the rest of the body.
Every activity during the day relies on the spine to allow you to efficiently and fluidly live the
life you deserve — except when you’re in pain.

If chronic or acute back or neck pain is keeping you from living the life you deserve, the
Penn Spine Center is here to help. Experts from numerous specialties, including neurosurgery,
orthopaedics, physical medicine and rehabilitation, pain management, pain psychology and
physical and occupational therapy, work together to offer a comprehensive approach to treating
your back and neck pain with the most efficient diagnosis and appropriate treatment plan.

This approach to care is designed to get you back to doing what you love the most, from
your first appointment through your recovery.

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Managing Your NECK AND BACK PAIN
Resources to Help Keep You in Motion

Contents
Our Philosophy of Care........................................................................................... 3

Specialists Treating Back and Neck Pain............................................................... 4

What is the Spine?................................................................................................. 5

Understanding Back and Neck Pain....................................................................... 6

Diagnosing Your Back and Neck Pain..................................................................... 9

Treatment Options................................................................................................ 11

Recovery............................................................................................................... 14

Tips for a Healthy Spine....................................................................................... 15

Locations.............................................................................................................. 16

Making an Appointment at the Penn Spine Center............................................... 18

To schedule an appointment, please call 215.615.2587 | 2

 Our Philosophy of Care
Personalized Care for Every Patient
The Penn Spine Center takes a mind and body approach to care. Instead of focusing solely on your condition or
the particular body parts that are causing you pain, our specialists take the time to understand your unique needs
and concerns.

Our ultimate goal is to help you make the best decisions for your lifestyle and activity level. By creating a
customized care plan, we can ensure you recover as quickly as possible.

Seeing the Right Specialist

When you’re experiencing back or neck pain, understanding where to turn for medical care can be confusing.
Should you see a neurosurgeon? What about and orthopaedic surgeon?

Or do you really need to see a physical medicine and rehabilitation or pain management expert to learn about
the treatment options they provide? Maybe activity modification, exercise or physical therapy is all you may
need. Perhaps you would benefit from mind and body skills learned from pain psychologists to regain function.
Choosing incorrectly can mean seeing someone whose treatment approach doesn’t suit you or your pain.

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 Specialists Treating Back and Neck Pain
At the Penn Spine Center, we’ve removed the guesswork to help correctly diagnose and treat your pain. We have
experts form multiple specialties with one common goal — getting you back to the life you deserve. Our team
includes clinicians working together from:

Nonoperative
Physical Medicine and Rehabilitation: Care for patients with chronic back or neck pain using a variety of
treatments including activity modification, exercise, medications, nerve blocks, advanced interventional therapies,
self-management treatments and pain psychology.

Pain Medicine: Care for patients with chronic back or neck pain using a variety of treatments including
medications, nerve blocks, advanced interventional therapies, self-management treatments and pain psychology.

Physical Therapy: Specialize in the development of cardiovascular fitness programs focused on strength,
flexibility, balance and coordination to improve movement and minimize back or neck pain.

Spinal Cord and Nerves

Neurosurgery: Treats injuries and diseases affecting the spinal column with an array of advanced surgical
treatments with an expertise in the relationship of the spinal cord and nerves with other areas of the spinal
column.

Orthopaedic Surgery: Treats injuries and diseases affecting the spinal column with an array of advanced surgical
treatments with an expertise in how the bones, muscles and soft tissues work with each other in the spinal column.

With all these specialists, you can find the answers you want and the treatment you need.

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 What is the Spine?
Your spinal column serves as the pillar to support the body’s weight and to protect the spinal cord. The spine starts
at the base of the skull and stretches downward to the hips. To support the body’s weight and allow for proper
posture, the spine has three natural curves to give it an “S” shape. There are four main components of the spinal
column: bones, spinal cord and nerves, soft tissues and cartilage.

Bones
Bones are the hard material that forms the human skeleton which creates a rigid structure to support, articulate
and protect the other tissues of the body. The spine is formed by 33 bony structures called vertebrae. There are
seven vertebrae in the neck (cervical), twelve vertebrae in the mid-back (thoracic), five vertebrae in the lower back
(lumbar) and five fused vertebrae in the sacrum. In addition, the tailbone (coccyx) is made up of 4 fused vertebrae.

Spinal Cord and Nerves

Traveling through and out of the spinal column are the spinal cord and
existing nerves. The spinal cord connects the brain with the rest of the body.
It resembles a cord as it travels through the neck and mid-back, but spreads
out and resembles a horse’s mane in the lower back (cauda equina). Existing
nerves leave the spinal column between each vertebra to deliver signals from
the brain to various areas of the body.

Soft Tissues
Soft tissues are non-bone tissues that connect or support structures in the
spinal column. Soft tissues include tendons, ligaments and muscles.

Cartilage
Cartilage is the strong, flexible tissue that covers the ends of bones. It is found
between vertebrae (discs) and between the joints of the spine (facets). Unlike
bone and all other connective tissue types, cartilage does not contain blood
vessels. Because of this, it is unable to naturally regenerate.

Wear-and-tear and inflammation of the cartilage can be very painful and limit
your ability to move and function.

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 Understanding Back and Neck Pain
Back and neck pain can be caused by a variety of injuries and conditions. The pain can make it difficult to
perform tasks such as standing, walking and sleeping, among others.

Symptoms and Warning Signs

Aches and pains are a part of daily living. Most times, pain subsides or goes away quickly. If your back or neck
pain does not go away and is accompanied by any of the following, you should see a spine specialist:

»»Lasting muscle pain/stiffness »»Weakness in extremities

»»Shooting or “stabbing” pain »»Loss of bowel or bladder control
»»Pain radiating down arm or leg »»Limited flexibility or range of motion
»»Loss or lessened feeling in extremities »»Deformity of neck or back
Common Back and Neck Conditions
There are many conditions that may be causing your pain. Knowing what some of these are can help eliminate
any surprises during your appointment and prepare you with questions for your spine specialist.

Wear and Tear Conditions

Wear and tear conditions cause the vertebrae and soft tissues of the spine to deteriorate over time. Your spine
may wear down or might become inflamed and in constant pain. While most wear and tear conditions can not
be restored, there are ways to treat the accompanying pain and improve your quality of life.

Common wear and tear spine conditions include:

Degenerative Discs: A very common condition where the disc between vertebrae undergoes a wear and tear
process from use. This causes a loss of normal height between the vertebrae leading to an impingement to
the nerves.

Annular Tear: Another very common condition where the disc’s outer wall tears causing a loss in normal
height between vertebrae leading to an impingement of the existing nerve.

Disc Herniation: Also known as a “slipped disc” or “bulging disc,” this is a very common condition where
part of the disc has moved through a weakened area of the outer wall. This can cause pressure on the spinal
cord or nerves.

Spinal Stenosis: A condition where there is a narrowing of the area through which the spinal cord or
nerves travel. Typically, this is caused by a bulging disc or the thickening of ligaments or bone.

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 Wear and Tear Conditions (continued)
Spondylolisthesis: A condition where a vertebra moves forward out of position compared to the vertebra below
it affecting the natural curve of the back. Typically, this occurs between the lower lumbar vertebrae, but can
happen elsewhere in the spine.

Deformity Conditions
The spine has a natural “S” shaped curve to keep your body balanced and the weight of your upper body evenly
distributed. The causes of spinal deformity can vary from genetics to unknown causes, which tend to be the most
common. A spine deformity can cause other issues outside of just neck and back pain.

Common spinal deformity conditions include:

Osteoporosis: A condition where your bones become brittle due to varying factors affecting the natural bone
building of the body. Osteoporosis can lead to further issues such as fractured vertebra, scoliosis or kyphosis.

Scoliosis: A condition where the natural curvature of the spine is changed by a sideways curve. There is no
definitive cause of scoliosis but hereditary factor and degeneration can play a role. Progression of this curvature
can alter appearance and overall height. If accompanied by neuromuscular disease, scoliosis can cause heart and
lung problems.

Kyphosis: Also known as “Hunchback”, kyphosis is the unnatural, forward curve of the spine.This curvature
typically occurs in the upper back. If accompanied by neuromuscular disease, it can cause breathing
complications.

Traumatic Injuries
Traumatic soft tissue, cartilage and bone injuries of the spinal column often occur during traumatic events such as
a car accident, as well as more common accidents such as a slip and fall or sports-related injury.

Common traumatic spine injuries include:

Vertebral Fracture: An injury that occurs when the bone of the vertebra breaks from extreme impact or when
the internal bone collapses from osteoporosis or tumor, among others.

Spinal Cord Injury: An injury where the spinal cord is severely pinched or damaged as a result of sudden impact
or other injury, causing temporary or permanent paralysis.

Strains and Sprains: An condition where the ligaments, tendons and/or muscles of the spine are overstretched
from undue stress or a sudden impact.

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 Rheumatic Conditions
Rheumatic conditions are autoimmune responses which occur when the body’s immune system mistakes healthy
tissue for harmful substances.

Common rheumatic spine conditions include:

Arthritis: A general term for inflammation and/or wear-and-tear of the joints within the spine. Arthritis can
come in various forms including osteoarthritis, rheumatoid arthritis and spondyloarthritis, among others.

Ankylosing Spondylitis: A specific form of long-term arthritis that mainly affects the vertebrae of the lower
back where they join the hip. This condition is characterized by swelling and inflammation that can lead to the
bones fusing together (autofusion).

Other Conditions
There are several other conditions that can affect your back and neck. Some can be simply a pinched nerve in your
neck or your pain may be caused by a more serious factor such as a tumor.

Other common spine conditions include:

Sciatica: One of the most common forms of back pain, this condition is the pain, weakness, numbness or
tingling caused by an impingement of the nerves in the lower spine that send signals down the leg.

Nerve Impingement: Also known as a pinched nerve, this condition occurs when there is inflammation or
pressure placed on the nerve as it leaves the spinal column.

Failed Back Syndrome: A condition characterized by continued back pain following surgical treatment. The
most common causes are residual disc fragments and foraminal stenosis.

Spinal Tumor: A condition where the vertebra, disc or any other part of the spinal column develops a malignant
(cancerous) or benign (non-cancerous) growth.

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 Diagnosing Your Back and Neck Pain
At the Penn Spine Center, the first step in determining how to treat your back or neck pain is getting an accurate
diagnosis, as quickly as possible.

Correctly identifying the cause of your back or neck pain—the first time—can help you avoid months or even
years of pain and/or disability. It can also give you the chance to start treating your condition before it progresses
and causes further disability.

Diagnosing your back or neck pain requires a physician to take numerous things into account. They will begin by
thoroughly reviewing your medical history and looking for possible causes of your pain, such as strenuous work
conditions, sports activity, repetitive motions and previous injuries. The next step is diagnostic imaging and a
hands-on examination, during which your physician takes a look at the overall picture of you back or neck.

Once the cause of your pain and discomfort has been determined, your care team will create a treatment plan
that’s tailored to both your condition and your personal needs with the goal of improving your overall function.

Common Diagnostic Tests

To better understand the physical extent of your back or neck pain, your physician may recommend various
imaging and diagnostic procedures, including:

X-ray: A painless procedure where X-ray beams are used to create detailed imaging of bones and hard structures
of the spinal column. X-rays can be helpful in diagnosing fractures, tumors, infections and deformities.

Magnetic resonance imaging (MRI): A magnetic field and radio waves are used to create a detailed image
of bone and soft tissue of the spine. MRI images can be helpful in diagnosing infections, tumors and
abnormalities of bone and soft tissue.
(continued on next page)

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 Common Diagnostic Tests (continued)
CT scan (CAT scan): This special X-ray takes detailed images of the spine. CT images detail bones far more than
a standard X-ray.

Electromyography (EMG): A test to assess the health and function of muscles and the nerve cells that control
them. Electrodes are taped to the skin to measure the speed and strength of signals traveling between two
or more points.

Bone Density (DEXA scan): An imaging procedure that evaluates bone density to diagnose osteopenia and
osteoporosis, as well as help determine the likelihood of bone fractures, particularly if other tests such as plain
x-rays, CT scans or MRI do not show it.

Discogram: A test where contrast is injected into the center of discs to determine which disc is generating the
patient’s pain.

Blood tests: Generally used to confirm a suspected diagnosis, especially in cases of arthritis. Blood tests are helpful
after a review of medical history and physical examination are performed and a suspected diagnosis is made.

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 Treatment Options
Just as there are many potential causes of your back and neck pain, there are also numerous options available to
treat each condition, including nonsurgical, minimally invasive and surgical options. Rather than insist on a “one-
size fits all” approach, our clinicians work with you to customize your care plan. To play an active and engaged role
in creating that care plan, it’s important to understand your choices for treating your pain.

NONOPERATIVE

Heat and Ice

If you are experiencing pain in your back or neck following activity, ice can be applied for 20 to 30 minutes at a
time. If the area begins to feel stiff, applying heat is helpful.

Remember, always place a layer of material between the source of ice of heat and the skinto avoid injury.

Pain Medications
Over-the-counter pain relievers, such as acetaminophen (e.g. Tylenol),
ibuprofen (e.g. Advil and Motrin) and topical analgesics (e.g. muscle rubs)
are commonly used to ease back and neck pain. In addition, there are several
prescription medications that a physician may discuss with you based on the
source of pain and previous response to medications. These may include anti-
inflammatory, anti-seizure, certain anti-depressant and opioid medications.
Your physician will discuss the benefits and possible side effect for each.

Physical and Occupational Therapy

Rehabilitative medicine and exercise programs can stretch and strengthen
muscles and soft tissues of back and neck to improve flexibility and
overall support.

Changing the way you perform daily activities can help in alleviating back and
neck pain through limiting the excess strain on the areas. This can be aided
through the use of therapeutics and other apparel and items specially designed
for back and neck pain. In addition, proper posture and correct lifting and
carrying technique can help minimize pain.

(continued on next page)

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 NONOPERATIVE (CONTINUED)

Injections
Some medications can be injected under fluoroscopy (X-ray) and contrast enhancement directly into the neck or
back to treat your pain. These include epidurals, nerve blocks, facet joint blocks and sacroiliac (SI) joint blocks.
Radiofrequency ablation is sometimes recommended and can help with pain control.

Advanced Pain Therapy

Advanced pain therapies such as spinal cord stimulators, radiofrequency nerve ablation, neurolytic nerve injections
and epidural or intrathecal drug delivery pumps may be recommended for certain patients. Your physician will be
able to discuss if any of these treatment options are likely to help your specific condition.

MINIMALLY INVASIVE

Vertebroplasty
Vertobroplasty is an outpatient procedure, meaning a patient returns home the
same day, to treat compression fractures of the spine in which all or part of the
vertebra collapses. Using fluoroscopy, a needle is placed through the skin and
into the bone. Bone cement is injected into the vertebra to relieve pain from
the compression fracture.

Kyphoplasty
Kyphoplasty is an outpatient procedure to treat compression fractures of the
spine, similar to vertebroplasty. Using fluoroscopy, a needle is placed through
the skin and into the bone. Unlike vertebroplasty, kyphoplasty uses a balloon
to restore the height of the vertebra and then bone cement is injected into
the vertebra.

SURGICAL

Microdiscectomy
One of the most common surgeries performed by a spine surgeon, a
microdiscectomy uses a “poke-hole” incision to remove the part of a disc
herniation pushing on the nerve in the lumbar spine. This procedure is
performed with the use of a microscope and small instruments to allow
for minimal disruption to the soft tissues.

(continued on next page)

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 SURGICAL (CONTINUED)

Intervertebral Body Fusion

Commonly referred to as spinal fusion, intervertebral body fusion permanently joins two vertebrae. In this
procedure, the disc is removed and replaced with an implant made from bone, plastic or titanium. Depending on
the approach used by your surgeon, a titanium plate and screws or screws and rods will be used to help create the
fusion between the bones. Spinal fusion is typically done from the front (anterior) for the neck, but can be done
from the front, rear (posterior) or side (lateral) for the lower back.

Deformity Correction
If you have a spine deformity, such as scoliosis, surgery may be recommended to correct the curvature of your
spine. In this procedure, your surgeon will use a combination of manipulation and fusion to adjust the shape of
your spine. Typically, deformity correction requires a larger incision and rods and screws to achieve the correct
alignment.

Motion Preservation
Depending on your diagnosis and post-surgery goals, a motion preservation (or arthroplasty) may be the best
option. In this procedure, your surgeon will remove the disc and replace it with an implant that is designed to allow
full motion rather than fusing the vertebrae together. This procedure can be performed in the neck and lower back.

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 Recovery
Our physicians know that planning for, undergoing and recovering from any operation can be stressful, which is
why they want to hear about your concerns and address them before proceeding with the best surgical option for
you and your back or neck condition.

Rehabilitation with Penn Therapy and Fitness

At the Penn Spine Center, we work with physical and occupational therapists from Penn Therapy and Fitness to
help get you back to the life that you want and deserve. Following treatment for your back or neck pain, therapists
will develop a plan for getting you active and back to being you!

Spinal Cord Injury Support Group

Through our Spinal Cord Injury Support Group, we offer support for individuals living with a spinal cord
injury or dysfunction by providing an interactive forum to share their ideas and experiences. We emphasize
peer relationships, fitness and provide educational opportunities about regaining function and independence.

Family members and caregivers are welcome to attend. Light refreshments are served and free parking is
available at the garage on 17th and South Streets.

For more information, call 215.893.6324.

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 Tips for a Healthy Spine
Cold and Heat Therapy
Ice packs and heating pads can be your best friend when you are struggling with pain in your back and neck.
They can help ease the pain, swelling and inflammation you may be experiencing.

Remember:
»»Never apply heat for more than 20 minutes at a time and always allow skin to return to normal
temperature before re-applying heat
»»Do not apply ice or cold packs directly to the skin, rather wrap them in a towel or other barrier
to protect skin.

Lifting and Carrying

Remember to lift with proper body mechanics when picking up heavy or
awkward items. Avoid bending and twisting when picking up items. Improper
lifting technique can lead to undue stress on the neck or lower back and can
cause reoccurring pain or more serious injury. When carrying heavy items,
make sure that you carry the item as close to your body as possible.

Sleeping
Sleeping with back or neck pain can be painful, but there are ways to
minimize that pain. Some simple ways to do that include:

For neck pain:

»»Perform exercises before bedtime to reduce pain
»»Avoid sleeping on your stomach/belly
»»Try a pillow such as a memory foam pillow to keep you head
in a comfortable position
»»Avoid sleeping on a couch, sofa, car or plane
For back pain:
»»Perform exercises before bedtime to reduce pain
»»Try placing a pillow between your knees while sleeping
Remember, your sleep will improve as your condition improves.

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 Locations

Penn Medicine
Pennsylvania University City
Penn Medicine
Valley Forge
Penn Medicine
Chestnut Hill Hospital of the MARKE
University of Penn Medicine T ST
Pennsylvania Rittenhouse WALNU
T ST
SOUTH
ST
Penn Medicine
Radnor Perelman Center
Pennsylvania
Penn Medicine

ST
for Advanced
Medicine Hospital

BROAD
West Chester

Penn Medicine
Penn Medicine Cherry Hill
Woodbury Heights
Delaware

New Jersey

Click on a location on
the map to view more Penn Medicine
Egg Harbor
information online.

BERWYN EGG HARBOR TOWNSHIP

Penn Medicine Valley Forge Penn Medicine Egg Harbor
1001 Chesterbrook Boulevard 101 Atlantic City International Airport
Berwyn, PA 19312 Egg Harbor Township, NJ 08234

CHERRY HILL PHILADELPHIA

Penn Medicine Cherry Hill Penn Medicine University City
409 Route 70 East 3737 Market Street
Cherry Hill, NJ 08034 Philadelphia, PA 19104

Hospital of the University

CHESTNUT HILL
of Pennsylvania
Penn Medicine Chestnut Hill 3400 Spruce Street
22 East Chestnut Hill Avenue Philadelphia, PA 19104
Philadelphia, PA 19118

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 Locations

Penn Medicine
Pennsylvania University City
Penn Medicine
Valley Forge
Penn Medicine
Chestnut Hill Hospital of the MARKE
University of Penn Medicine T ST
Pennsylvania Rittenhouse WALNU
T ST
SOUTH
ST
Penn Medicine
Radnor Perelman Center
Pennsylvania
Penn Medicine

ST
for Advanced
Medicine Hospital

BROAD
West Chester

Penn Medicine
Penn Medicine Cherry Hill
Woodbury Heights
Delaware

New Jersey

Click on a location on
the map to view more Penn Medicine
Egg Harbor
information online.

PHILADELPHIA RADNOR

Perelman Center Penn Medicine Radnor

for Advanced Medicine 250 King of Prussia Road
3400 Civic Center Boulevard Radnor, PA 19087
Philadelphia, PA 19104
WEST CHESTER
Penn Medicine Rittenhouse
1800 Lombard Street Penn Medicine West Chester
Philadelphia, PA 19146 440 East Marshall Street
West Chester, PA 19380
Pennsylvania Hospital
800 Spruce Street
WOODBURY HEIGHTS
Philadelphia, PA 19107
Penn Medicine Woodbury Heights
235 S. 9th Street 1006 Mantua Pike
Philadelphia, PA 19107 Woodbury Heights, NJ 08097

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 Making an Appointment at
the Penn Spine Center

Don’t let back and neck pain control your life. Call 215.615.2587
to schedule an appointment today with one of our spine specialists.

Preparing for Your Appointment

Educating yourself about your spine condition, how it’s diagnosed and potential treatment options are the first step
in moving beyond your hip pain. Your next move should be to schedule an appointment with a spine expert at the
Penn Spine Center, where we can provide you with a diagnosis, care plan and treatment recommendation.

Prior to your appointment, you may be required to have an MRI or other screenings done. Check when scheduling
on what is required for your appointment with your spine specialist. It may be possible for you to get these tests
done at the same location, prior to meeting with the physician.

To ensure you get the most out of every conversation with your clinical team, it can help to come prepared with
a list of questions. Use the space provided below to write down any questions or concerns you have about your
condition and available treatment options.

Use the space provided below to write down any questions or concerns you have about your condition and
available treatment options.

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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