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    Schoen Clinic London, 66 Wigmore Street, London, W1U 2SB

In broad terms, there are three groups of treatment for spinal problems: conservative therapy, injections and surgery.

There are a host of different options within each group but just about all the therapies can be classified into these three groups. You need the right one or ones. For most people, non-surgical or conservative treatments should relieve your symptoms such as the use of painkillers or a combination of bed rest and physical therapy.

Conservative therapy

Conservative therapy itself may be divided into two types: passive and active therapy.

Passive Therapy is when “you lie there and they do things”. This might be rest, time, tablets, heat massage, ultrasound, interferential, or manipulations. It includes the physical therapies of physiotherapy, chiropractic and osteopathy, the meridian-based therapies of acupuncture, acupressure, reflexology, and others such as cranial osteopathy, McTimoney chiropractic therapy, homeopathy, naturopathy, Chinese traditional medicine, stones and crystals. The list is almost endless.

Active Therapy is when “they stand there and you do things”. These exercise based therapies likewise take many forms. Pilates, developed by Joseph Pilates is popular and effective. However, other systems include McKenzie, Keisner, the Alexander technique, yoga in all its forms. They have in common the aim of strengthening and balancing the muscles which control the spine. 

Therapists may give you some active exercises and some passive therapies. The passive therapies are often referred to as “treatments” and the active as “rehabilitation”.

For more information regarding conservative care at The Spine Surgery London, please press here.


Injections may be done for diagnostic or therapeutic reasons. The situation is described in detail in the spinal injections of this site.

Diagnostic injections are performed when we are not sure if an abnormality seen on a scan is the real cause of your symptoms. There are two types; steroid injections and dye injections.

Steroid injections are the commonest. The area we think is causing the problem is injected with a mixture of steroid and local anaesthetic. We then see if you improve or not.

Dye injections are used to see if abnormal areas seen on a scan reproduce the pain. This is a method most commonly used to study discs in a bid to identify if they are causing back pain – please go to discography in our diagnostics section to read more.

Therapeutic injections are more common than diagnostic ones and are of three types: steroid injections, lubricant injections and denervations.

Steroid injections are described above and in the section of the website on spinal injections. They are virtually never used in isolation as they produce only a two to three month window of relief. The window is very useful in allowing more intense rehabilitation to strengthen the spinal muscles and improve posture and flexibility. 

Lubricants. These involve injecting hyaluronase into the small facet joints of the spine. They are relatively uncommon and used mainly to treat chronic neck and back pains where steroid injections and exercise are not providing enough relief. Hyaluronase is the body’s natural joint lubricant and is also found in the slime inside a cactus.

Denervations. These are not often used. It involves burning or freezing the nerves to the painful areas. Most commonly applied to the facet joints - they have the effect of making the joint go numb.


Operationsfor detailed information, please go to either Lumbar Surgery or the Cervical Spine Surgery or the Endoscopic Surgery sections.   

In broad terms they are of two types; those aimed at relieving spinal (neck or back) pain and those aimed at relieving referred limb (arm or leg) pain, otherwise known as brachalgia or sciatica.

Our philosophy is that surgery should always be a last resort and when it is essential the aim should be to restore or maintain movement and whenever possible to use keyhole access. Endoscopic surgery is the ultimate example of keyhole surgery.

In broad terms, surgery for neck or back pain involves major work with significant risks and failure rates. Surgery for leg or arm pain is keyhole if not endoscopic, has low complications rates and routinely works well.

What Treatment should I have?

We are always happy to answer the “what would you do” questions though only after running through all the options. The correct choice involves assessing the symptoms (what you feel and what doesn’t work), the history (how long it has gone on), the physical findings on examination, the test results, the response to treatments already tried and your goals, ambitions, social situation and other health issues.

It should be a decision we very much make together and keep returning to depending on the response. Sometimes it is obvious and the decisions are quickly made – the clinic runs early. Sometimes it is tough, there is a lot to consider, several decisions to make and the process takes a long time – the clinic runs late!

Patients do not come with “I need a microdiscectomy” written on their pyjamas.  We work as a team and have close links to all the other types of specialists involved in caring for spinal problems from clinical psychologists to chiropractors, from orthopaedic surgeons to osteopaths, from rheumatologists to sports physicians, from physiotherapists to Pilates tutors, to Alexander instructors to fitness instructors, to coaches, reflexologists, naturopaths, acupuncturists, pain specialists, hip, knee, shoulder, foot and hand specialists. The aim is to get you what you need and not just what we do ourselves.

Be restless, until you feel we have the decision correct for you.

Who should I see?

As you have seen, the list of possible specialists is almost endless! The commonest question we get asked about surgery is “should I see an orthopaedic or a neurosurgeon”. The real answer is usually either providing they specialise in what you need.

Should I have Surgery?

What surgery should I have?

Should I have a disc replacement or fusion?

*Please come along and see us at The Spine Surgery London and we can answer your questions and work out the best individualised treatment for you.

If you need help!

Contact us