Our spine (also known as vertebral column) consists of 33 vertebrae but the five sacral and four coccygeal vertebrae are fused together, so taken as one each (so total 26 vertebrae). The spine helps us to move and bend. It protects the spinal cord which transmits signal from our organs to brain and vice versa. Spine helps to maintain the posture; without spine you would not be able to stand erect!!! The spine is divided into five segments. 1) 7 Cervical- (C1 to C7)- these vertebrae help in neck movements. It supports the weight of the head. 2) 12 Thoracic- (T1 to T12)- Vertebrae of the thoracic region have limited movement and provide support to the rib cage. 3) 5 Lumbar- (L1 to L5)- Lumbar vertebrae support the weight of the body. 4) 1 Sacrum- The five sacral vertebrae are fused together to form sacrum. It helps in transmitting weight from spine to lower limbs. 5) 1 Coccygeal- The four bones of the coccyx region fuse together to form the tail bone. The vertebrae are separated from each other by an intervertebral disc between them. Discs act as shock absorbers and are exposed to continuous wear and tear due to routine activities, improper posture, travelling etc. The discs provide flexibility to spine. The central portion of disc has gel like material (Nucleus pulposus) surrounded by tough structure(annulus) which if breaks cause gel to leak (annular tear) near the nerves leading to swelling around the nerves and sciatica like symptoms. Annular tear can also cause back pain which aggravates with sitting. Each vertebra is connected to adjacent vertebra by a pair of joints known as facet joints. These joints are prone for degeneration(spondylosis) or injury like any other joints in the body. Patients with facetal pain present with pain in lower back which aggravates with getting up from sitting position, walking downhills. Sometimes the pain gets referred to buttocks and thighs but rarely below the knee. If the degeneration affects joints in neck region, patients experience neck pain which aggravates with simple routine activities which involve neck extension like gargling. Proper alignment of vertebrae is crucial for proper functioning of spine. If one vertebra is shifted in front or back as compared to lower vertebra, the condition is known as spondylolisthesis. It puts pressure on nerves leading to pain, tingling and numbness in legs or arms depending on the location. The cavity formed by the central portion of each vertebra forms the spinal canal. It accommodates the spinal cord and provides protection. There are various ligaments, which help in the movement and holding vertebrae together. Injury or wrong posture can sprain the ligaments leading to neck pain or back pain. Most important structure which provides support to spinal column are the muscles which run from neck to back. Muscles are final common expressors of pain - be it disc, ligament, nerve or facet joints. So, while treatment of back pain, ultrasound guided dry needling forms the mainstay of multimodal treatment along with epidural injection, facet injection, medial branch block, sacroiliac joint injection, radiofrequency ablation etc.