Osteoarthritis of the spine (spondylosis): symptoms, causes and treatment

Osteoarthritis is the most common type of arthritis in the UK, according to the NHS. It develops when the protective cartilage on the ends of bones breaks down, leading to pain, stiffness, swelling and problems moving the joint, and sometimes bony growths. The spine contains many small joints, along with the soft discs between the vertebrae, and all of these can show wear.

When the neck is affected the term used by the NHS is cervical spondylosis, which it describes as wear and tear to the bones of the spine and the soft cushions of tissue (discs) in the neck. The same kind of change can occur in the lower back. Arthritis UK, the UK arthritis charity, makes the same link: it says osteoarthritis in the spine is referred to as spondylosis.

It is useful to know that such changes are very common. The NHS calls cervical spondylosis a normal part of ageing and says many people have no symptoms, which is why a scan that shows "arthritis" does not by itself explain a person's pain.

The main symptoms of osteoarthritis, the NHS says, are joint pain and stiffness and problems moving the joint, and some people also have swelling, tenderness or a grating or crackling sound. Severity varies greatly from person to person, and symptoms can be mild and come and go or more continuous and limiting.

• Neck and shoulder pain or stiffness that can come and go.

• Headaches that often start at the back of the neck.

• Lower back pain and stiffness that usually improves within a few weeks, but can last longer or keep coming back, as the NHS describes for back pain generally.

• Pain that gets worse the more the joints are used, with morning stiffness that lasts less than 30 minutes, which the NHS lists among the features that make a GP suspect osteoarthritis.

The NHS says the exact cause of osteoarthritis is not known, but several things are thought to increase the risk: joint injury, other conditions that have damaged a joint, increasing age, family history, obesity and being a woman. For cervical spondylosis it adds that you may be more likely to get it at any age if you have previously had a neck injury or have a family history of the condition.

The NHS advises that you cannot prevent osteoarthritis altogether but may reduce the risk by avoiding injury and living a healthy lifestyle: doing at least 150 minutes of moderate aerobic activity a week plus strength exercises on 2 or more days, maintaining good posture, taking regular breaks if you work at a desk, and losing weight if you are overweight.

A GP will ask about your symptoms and examine you. For the neck, the NHS says a health professional will examine the neck and shoulders, may test your reflexes and watch you walk, and may arrange X-rays or scans depending on your symptoms. For osteoarthritis generally it says further tests are not usually necessary, but may be used to rule out other causes such as rheumatoid arthritis or a fracture.

This matters in the spine, because not all back pain is wear and tear. The NHS lists a slipped disc, sciatica and ankylosing spondylitis as medical conditions that can cause back pain, and very rarely a broken bone, cancer or an infection. It advises seeing a GP if back pain is not improving after a few weeks of home treatment, is worse at night or does not improve with rest, has caused unexplained weight loss, or comes with a lump or change in the shape of the back.

For mild symptoms the NHS suggests regular exercise, losing weight if you are overweight, suitable footwear and devices that reduce strain on joints. For back pain it says to stay active, continue daily activities and avoid staying in bed for long periods. It lists anti-inflammatory medicine such as ibuprofen (which may not be suitable for everyone), ice or heat packs wrapped in a tea towel, and exercises and stretches.

For neck symptoms the NHS suggests gentle neck exercises, improving posture and painkillers such as paracetamol and ibuprofen, and says a pharmacist may recommend stronger painkillers. A muscle relaxant or other medicine may be prescribed if pain has come and gone for a long time. It says treatment usually takes a few weeks to work, although pain and stiffness can come back.

If symptoms do not improve, other options the NHS lists for persistent back pain include group exercise sessions and physiotherapy, manual therapy, cognitive behavioural therapy to help you cope with the pain, and in some cases of long-term lower back pain a procedure to seal off some of the nerves. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for physiotherapy without a GP referral.

Surgery is uncommon. For the neck the NHS says it is only considered if a nerve is being pinched (cervical radiculopathy) or there is a problem with the spinal cord (cervical myelopathy), and that it may stop symptoms getting worse but is not always a cure. NHS physiotherapy waiting times can be long, and some people choose private physiotherapy, which can be found through the Chartered Society of Physiotherapy.

The NHS says to call 999 or go to A&E if back pain comes with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or anus, changes in bladder or bowel function, chest pain, or began after a serious accident. Ask for an urgent GP appointment or call 111 if you feel hot, cold, shivery or generally unwell, or if the pain is severe, starts suddenly or is getting worse quickly.

For neck problems, the NHS says to seek urgent advice for severe neck pain that starts suddenly or is getting worse quickly, heaviness or weakness in the arms or legs, or pins and needles in an arm with neck pain. Call 999 for new problems walking, loss of bladder or bowel control, or sudden lack of co-ordination.