Your spine or neck/back muscles are stiff, resulting in pain when moved sharply or quickly. Whenever anything jarring happens to your body (e.g., making a Strength or Dexterity saving throw, taking damage), you need to succeed on a DC 8 + (IE) × 2 Constitution saving throw. Failure results in taking one level of exhaustion until you take a short rest. This stiffness limits your head and neck movement, so you have a −(IE) penalty on all Wisdom (Perception) checks involving vision against Dexterity (Stealth).

Real-world Examples

Spinal Fusion, Arthritis, Herniated Disc, Sciatica

Assistive Options

Applied heat or cold may help, as can a 1-minute massage. A character with back or neck stiffness will likely have determined what works for them. The player and GM should decide what works effectively, and using such a method will reduce the IE by 1 for 1d6 hours. Spending (IE) hours per day (15 minutes at a time spread throughout the day) stretching the stiff muscles will reduce the IE by 1 until the next stretching session is due. A back brace gives a +2 bonus to the Constitution saving throw from jarring pain. Spending one hour swimming or bathing in warm flowing water will reduce the IE by 1 for 2d6 hours.

Magical Assistance

Applying magical healing specifically to the point of pain without restoring hp will reduce the IE by 2 for 1d4 hours.

My spine doesn’t quite align, and everything is squinty, but don’t underestimate me. Although everything from the ribcage down is 10% dysfunctional, everything above works, and it’s the 90% functional that gets me into trouble!

– Dorian

Your spine has openings, exposing the neural tissue within, leaving you vulnerable to a variety of conditions and, at IE 4, Infection. You have −(IE) to Constitution saving throws against disease. You have (IE) of these related traits: Spine Difference, Muscle Control & Gait Difference, Body Rash, Sleep Disruptions, Diverse Face Shape, Skeletal Flexibility, Head and Neck Pain, or Incontinence. You have a heightened awareness of your own body and can predict internal changes. This gives you a +(IE) bonus to saving throws against magic that alters your body shape or internal function such as the Polymorph spell or Werewolf, and when recurring Pain or other physical traits manifest, a successful DC 10 passive Wisdom (Perception) check will alert you to its onset 1d20 minutes in advance.

Real-world Examples

Spina Bifida

Assistive Options

Spinal surgery is too dangerous in most fantasy world settings, so no mundane options help, although many of the related traits benefit from mobility aids and other options.

Magical Assistance

Magic that helps cure disease can help against frequent infections. Consult the related traits for additional assistance.

You have ridges, plates, or spikes running the entire length of your spine, each (IE) inches long. You can use these to make an unarmed attack causing 1d(IE) damage, either piercing or slashing damage, depending on the shape of the ridge. You cannot fit into magical armor, and a normal suit of armor costs +20 percent to allow openings that do not reduce the armor’s integrity.

Real-world Examples

This is a fantasy trait with no real-world analog.

Assistive Options

These cannot be trimmed as they have blood vessels running through them. No mundane assistive options exist.

Magical Assistance

A Seeming spell or similar magical effect is necessary to mask the protrusions.

You experience chronic pain in your head or neck. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. In the presence of bright light or loud noise, you make the roll with disadvantage. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage.

Real-world Examples

Hemicrania Continua, Migraines, Cervicogenic Headaches, Postural Orthostatic Tachycardia Syndrome

Assistive Options

Laying down or avoiding bright light or loud noises can help you feel better but does not eliminate the game mechanic.

Magical Assistance

A healing spell can target the head or neck and reduce the IE by 2 for 1 hour instead of regaining hp.

Your neck is (IE) feet longer than the typical range for your ancestry. This allows you to see over some obstacles, but because the neck and spine are vulnerable, you take (IE) extra damage from bludgeoning and slashing damage. You also have a −(IE) penalty to attempts at disguise or blending into a crowd.

Real-world Examples

This is a fantasy trait and has no real-world analog, although the Kayan people of Myanmar wear heavy brass rings or coils that, from childhood onward, push the shoulders down, giving the appearance of a long neck, and can be uncomfortable when removed.

Assistive Options

A custom cloak can attempt to disguise this condition with an opposed Charisma (Deception) check made with disadvantage and a −(IE) penalty.

Magical Assistance

Spells like Seeming can attempt to temporarily mask this condition, but it does not eliminate the damage penalties.

You have a tumor or lump on your neck with a diameter of (IE) inches. This causes difficulty breathing and swallowing, causing a −(IE) on all Constitution checks involving physical endurance.

Real-world Examples

Tumor, Goiter, Cyst, Hodgkin’s disease

Assistive Options

No mundane assistance helps with this, and surgery to remove the lump, because of the vital blood vessels in the neck, requires a successful DC 20 + (IE) Wisdom (Medicine) check, failure resulting in death.

Magical Assistance

A Minor Illusion spell can temporarily hide the visibility of the lump but not its physical effects.

Your spine curves, causing you difficulty and pain to straighten it directly upright, if at all. This gives you a −(IE) penalty on all Dexterity (Acrobatics) checks and Strength (Athletics) checks to jump. (Roll 1d12 for the direction of the curve, 12 being straight forward, then clockwise around.)

Real-world Examples

Scoliosis, Kyphosis, Lordosis

Assistive Options

A brace is helpful to prevent curvature from getting worse, although braces can be painful, and some choose to have their back assume whatever position it would naturally move into.

• Armor Class 10
• Hit Points 1
• Speed 10 ft., burrow 10 ft., climb 10 ft., swim 10 ft.

• Skills Stealth +2
• Senses darkvision 30 ft., passive Perception 8
• Languages —
• Challenge 0 (10 XP)

Actions

Tongue Bite. The louse crawls into the mouth of an unconscious humanoid on a successful Dexterity (Stealth) check with advantage against the target's passive Wisdom (Perception). It then secretes a poison which numbs the mouth on a failed DC 10 Constitution save. The numbing takes 1 minute to take effect, at which point the louse begins to consume the tongue by swallowing it whole and digesting it with acid, which takes 1 hour. If anyone notices the louse before the end of this process, it can be removed with a successful contested Strength check. If the discovery was made within the first 9 minutes of consumption, the target will be unable to speak until after a long rest but will experience no ill effects beyond that. If the discovery is made 10–60 minutes after consumption, the target will permanently experience the effects of Minimal Tongue with an IE equal to the number of minutes ÷ 20 rounding up.

If the louse is removed after 10 minutes, a DC 10 Wisdom (Medicine) check will be needed to stop the bleeding, or the target will lose 1 hp per round until dead.

At the end of the hour, the louse has attached itself to the nervous system through the nerves in the mouth, and any attempt to remove it short of a Greater Restoration or Wish spell will kill the host.

Once attached, the louse responds to neural commands and acts like a tongue with a Speech Impediment (difficulty pronouncing labial sounds due to trying to hide the louse, but you must succeed on a Charisma (Performance) check against the passive perception of anyone they talk to within 10 feet to conceal it or experience disadvantage on all Charisma checks with those aware of the louse.

A tongue louse lays 10 eggs every week along with a foul-tasting liquid, prompting the host to want to spit it out. These eggs will hatch in 7 days and begin to seek hosts.

Your tongue is outside the shape typical for your ancestry. Choose or roll on the following table. While most of these have their own benefits, they are not conducive to speech, so unless otherwise noted, this gives you a −(IE) penalty on all speech-related ability checks, saving throws, and attack rolls, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.

• Extended. Your tongue is much longer than is typical for your ancestry, (IE) feet. This allows you to eat insects from a colony, like ants or termites, for which you have a preference.
• Forked. Your tongue is long, thin, and forked, giving you an improved sense of smell; you can easily detect the direction smells are coming from by flicking your tongue in and out of your mouth. This gives you advantage on Wisdom (Perception) checks involving smell, but because many people fear snakes, you have disadvantage on Charisma (Persuasion) checks. A forked tongue has no IE. You have disadvantage on all speech-related Charisma checks and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls. When learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.
• Minimal. Your tongue is smaller than expected for your ancestry or (IE 4) missing. This also gives you −(IE) on Wisdom (Perception) checks related to taste.
• Prehensile. Your tongue is attached to the front of your mouth, and you can use it to grab items up to your height away and pull them to yourself as an action. Your tongue has a Strength equal to 1/2 your Strength attribute, rounding up, and can grab items and move them toward or away from you. A prehensile tongue has no IE. You have disadvantage on all speech-related Charisma checks, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.
• Proboscis. Your tongue is hollow, enabling you to drink through it like a straw. You are unable to consume solid food and have no teeth. A proboscis has no IE. You have disadvantage on all speech-related Charisma checks, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.
• Symbiotic. Your tongue was eaten by a Tongue Louse, and it now functions as your tongue in a parasitic symbiosis. Symbiotic Tongue has no IE, and you have disadvantage on all speech-related Charisma checks, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.

• Vampiric: Your tongue is hollow, and your teeth form a circle at the end of it like a lamprey. You prefer to drink liquids, especially blood, but can also consume soft foods. You can use your tongue to make an unarmed attack, causing 2 (1d4) piercing damage, and on a successful hit, you attach yourself to the victim. Once attached, you need not roll to hit and automatically cause 2 (1d4) damage. Vampiric tongue has no IE. You have disadvantage on all speech-related Charisma checks, and you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls. When learning a new spell with a verbal component, it takes twice as long to copy it into your spellbook as usual.

Real-world Examples

Macroglossia, Kawasaki Disease, Fissured Tongue, Cymothoa Exigua

Assistive Options

Besides a mask to cover the mouth, you may benefit from learning a sign language, which can be exchanged for any language or proficiency.