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Low Back Pain Management and Treatment

Be Pain Free from Back Pain!

Call us at (65) 6471 2744 or Email to: info@boneclinic.com.sg to schedule for an appointment.

What is Low back pain?

Low back pain can happen to anywhere in your spine, below the ribs and above the legs. The lower back connects the upper and lower body. It bears the most of your body’s weight. Due to this, your back is the most commonly injured compare to the rest of the body and you can easily hurt your back if you life heavy loads, overstretch or twisting. Everyone will have low back pain one time in their life.

What causes Low back pain?

Causes of low back could be injury or degeneration disease.

Cause Low back pain include:

What are the low back pain symptoms?

The symptoms of the low back pain varies with individuals. Some people may feel constant dull or sharp back pain. Some people may feel pain in a small area or a broad area. Some may feel muscle spasms to the back.

Sometimes low back pain can cause symptoms to the legs or thighs, such as pain, numbness, or tingling sensation over the thigh area and sometimes the low back symptoms may extend below the knee to the calf.

Cauda equina syndrome is a rare but serious low back pain problem. This is a condition whereby the nerves at the end of the spinal cord are squeezed. Seek specialist treatment if you feel weakness or numbness in both of your legs or you could not control your bladder or bowel.

Seek specialist treatment if your low back pain does not go away with rest. If you ignore your low back pain, it may result to chronic back pain.

How is low back pain diagnosed?

Our specialist will ask questions about you past medical history. He will examine your spine carefully.

If your low back pain lasted more than four weeks, or if our specialist suspect that you may have more than muscle pain after the examination, he may refer you for an MRI investigation.

How is it treated?

Minor low back pain will improve after resting for a day or two.

Other treatments for your low back pain includes:

  • Physiotherapy – Strengthening to your back muscles.
  • Epidural injection
  • Spinal manipulation
  • Back surgery for disc problem that may lead to nerve problem.

Low Back Pain Video:

How can you prevent low back pain from returning?

If you’ve had low back pain before, the chances of getting low back pain again is higher.

To prevent future low back pain, you can follow these activities:

  • Maintain good posture.
  • Low impact exercise like walk or swim.
  • Avoid wearing high heeled shoes.
  • Sleep on your side.
  • Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
  • Avoid lifting heavy loads.

If you sit or stand for long periods at work:

  • Pay attention to your posture. Sit or stand up straight, with your shoulders back.
  • Make sure your chair has good back support.
  • Take regular breaks to walk around.

If your work involves a lot of bending, reaching, or lifting:

  • Use good techniques for lifting.

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Guide to Low Back Pain

What Is Low Back Pain?

Low back pain is a universal human experience — almost everyone has it at some point. The lower back, which starts below the ribcage, is called the lumbar region. Pain here can be intense and is one of the top causes of missed work. Fortunately, low back pain often gets better on its own. When it doesn’t, there are effective treatments.

Symptoms of Low Back Pain

Symptoms range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. Pain that lasts more than three months is considered chronic. If your pain is not better within 72 hours, you should consult a doctor.

Symptoms That Require Urgent Care

Severe back pain after a fall or injury should be checked out by a health care professional. Other warning signs include a loss of bowel or bladder control, leg weakness, fever, and pain when coughing or urinating. If you have any of these symptoms along with your back pain, contact your doctor.

Muscle Strain or Sciatica?

The kind of back pain that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes back pain can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, pain may run from the buttock down one leg. This is called sciatica.

Back Pain Culprit: Your Job

If your job involves lifting, pulling, or anything that twists the spine, it may contribute to back pain. However, sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or you tend to slouch.

Back Pain Culprit: Your Bag

Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.

Back Pain Culprit: Your Workout

Overdoing it at the gym or golf course is one of the most common causes of overextended muscles leading to low back pain. You’re especially vulnerable if you tend to be inactive during the work week and then spend hours at the gym or softball field on the weekend.

Back Pain Culprit: Your Posture

Mom was right when she said, “Stand up straight!” Your back supports weight best when you don’t slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.

Back Pain Culprit: Herniated Disc

The spine’s vertebrae are cushioned by gel-like discs that are prone to wear and tear from aging or injuries. A weakened disc may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disc and can cause intense pain.

Back Pain Culprit: Chronic Conditions

Several chronic conditions can lead to low back pain.

  • Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.
  • Spondylitis refers to chronic back pain and stiffness due to severe inflammation of the spinal joints.
  • Fibromyalgia causes widespread muscle aches, including back pain.

Who’s at Risk for Low Back Pain?

Most people get their first taste of low back pain in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

  • Being overweight
  • Inactive lifestyle
  • Jobs that require heavy lifting

Diagnosing Low Back Pain

To help your doctor diagnose the source of low back pain, be specific in describing the type of pain, when it started, related symptoms, and any history of chronic conditions. Your doctor may order X-rays, CT or MRI scans to look for damaged bones or discs, or other injuries to the spine.

Home Care for Low Back Pain

Back pain due to muscle strain will usually get better on its own, but you can take steps to make yourself more comfortable. A heating pad or warm baths may provide temporary pain relief.

The Bed Rest Debate

When your back hurts, you may not feel like getting out of bed. But if the problem is muscle strain, doctors recommend returning to your normal activities as soon as possible. Studies suggest that any more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility.

Yoga

If back pain doesn’t go away in three months, there’s evidence that yoga can help. In one recent study, people who took 12 weeks of yoga classes had fewer symptoms of low back pain than people who were given a book about care for back pain. The benefits lasted several months after the classes were finished. The study suggests conventional stretching also works just as well. Make sure your instructor is experienced at teaching people with back pain and will modify postures for you as needed.

Medications

Mild back pain often feels better with over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen. Pain-relieving creams may be helpful for muscle aches. For severe pain or chronic pain, your doctor may recommend prescription medication.

Injections

If simpler therapies and medications aren’t helping, your doctor may recommend injections to the back. One procedure, called a nerve root block, targets irritated nerves. Injections for back pain usually contain steroid medication.

Surgery

If long-lasting back pain is interfering with your daily life, and other treatments have not provided relief, you may be a candidate for surgery. Depending on the cause of your pain, a surgeon may remove a herniated disc, widen the space around the spinal cord, and/or fuse two spinal vertebrae together.

Physical Therapy

If back pain has left you inactive for a long time, a rehabilitation program can help you strengthen your muscles and get back to your daily activities. A physical therapist can guide you through stretches, strength exercises, and low-impact cardio that will help you be fitter without straining your back.

Strengthening the Back

Two types of strength-training moves that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.

Preventing Low Back Pain

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

  • Stay at a healthy weight.
  • Exercise regularly.
  • Lift with your legs, not your back.
  • Make sure your work station position isn’t contributing to your pain.

CURE YOUR BACK PAIN TODAY. CALL US AT +65 64712744 OR EMAIL TO: INFO@BONECLINIC.COM.SG FOR APPOINTMENT

Back Pain Clinic

Are you frustrated with your Lower back pain that is not getting better? Are you experiencing difficulty in standing up after prolong sitting, unable to straighten your back? Feeling numbness to your leg? You are in the right place! We certainly able to help with our innovative and non-invasive (non-surgical) form of treatment. Get your spine check today. Call us at (65) 6471 2744 or Email to: info@boneclinic.com.sg to schedule for an appointment.

Lower back pain is one of the main reasons Singaporean visit their doctor. For adults over 40, it ranks third as a cause for doctor visits, after heart disease and arthritis. Eighty percent of people will have low back pain at some point in their lives. And nearly everyone who has low back pain once will have it again.

Very few people who feel pain in their lower back have a serious medical problem. Ninety percent of people who experience low back pain for the first time get better in two to six weeks. Only rarely do people with low back pain develop chronic back problems.

With these facts in mind, you can be assured that back pain is common, that it usually only causes problems for a short period of time, and that you can take steps to ease symptoms and prevent future problems.

Symptoms of Lower Back Pain:

  • The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back
  • The pain may become worse with activity.
  • Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
  • You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
    • An example of this would be an inability to plantar flex the foot. This means you would be unable to stand on your toes or bring your foot downward. This occurs when the first sacral nerve is compressed or injured.
    • Another example would be the inability to raise your big toe upward. This results when the fifth lumbar nerve is compromised.

Causes of Low Back Pain

Why do I have low back pain?

There are many causes of low back pain. Doctors are not always able to pinpoint the source of a patient’s pain. But our doctor will make every effort to ensure that your symptoms are not from a serious medical cause, such as cancer or a spinal infection.

The vast majority of back problems are a result of wear and tear on the parts of the spine over many years. This process is called degeneration. Over time, the normal process of aging can result in degenerative changes in all parts of the spine.

Injuries to the spine, such as a fracture or injury to the disc, can make the changes happen even faster. There is strong evidence that cigarette smoking also speeds up degeneration of the spine. Scientists have found links among family members, showing that genetics plays a role in how fast these changes occur.

Degeneration

The intervertebral disc changes over time. At first, the disc is spongy and firm. The nucleus in the center of the disc contains a great deal of water. This gives the disc its ability to absorb shock and protect the spine from heavy and repeated forces.

The first change that occurs is that the annulus around the nucleus weakens and begins to develop small cracks and tears. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. The torn annulus can be a source of pain for two reasons. First, there are pain sensors in the outer rim of the annulus. They signal a painful response when the tear reaches the outer edge of the annulus. Second, like injuries to other tissues in the body, a tear in the annulus can cause pain due to inflammation.

With time, the disc begins to lose water, causing it to lose some of its fullness and height. As a result, the vertebrae begin to move closer together.

As the disc continues to degenerate, the space between the vertebrae shrinks. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints.

These degenerative changes in the disc, facet joints, and ligaments cause the spinal segment to become loose and unstable. The extra movement causes even more wear and tear on the spine. As a result, more and larger tears occur in the annulus.

Mechanical and Neurogenic Pain

To best understand the cause of your pain, spine specialists sometimes divide low back pain into two categories:

  • mechanical pain – caused by wear and tear in the parts of lumbar spine.
  • neurogenic pain – occurs when spinal nerves are inflamed, squeezed or pinched.

Spine Conditions

The effects of spine degeneration or back injury can lead to specific spine conditions. These include

  • annular tears
  • internal disc disruption
  • herniated disc
  • facet joint arthritis
  • segmental instability
  • spinal stenosis
  • foraminal stenosis

Symptoms

What are some of the symptoms of low back problems?

Symptoms from low back problems vary. They depend on a person’s condition and which structures are affected. Some of the more common symptoms of low back problems are

  • low back pain
  • pain spreading into the buttocks and thighs
  • pain radiating from the buttock to the foot
  • back stiffness and reduced range of motion
  • muscle weakness in the hip, thigh, leg, or foot
  • sensory changes (numbness, prickling, or tingling) in the leg, foot, or toes

Rarely, symptoms involve changes in bowel or bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder. The pressure may cause symptoms of low back pain, pain running down the back of both legs, and numbness or tingling between the legs in the area you would contact if you were seated on a saddle. The pressure on the nerves can cause a loss of control in the bowels or bladder.

If the pressure isn’t relieved, it can lead to permanent paralysis of the bowels and bladder. This condition is called cauda equina syndrome. Doctors recommend immediate surgery to remove pressure from the nerves.

 

 

Diagnosis

How will my doctor find out what’s causing my problem?

The diagnosis of low back problems begins with a thorough history of your condition. You might be asked to fill out a questionnaire describing your back problems. Our doctor will ask you questions to find out when you first started having problems, what makes your symptoms worse or better, and how the symptoms affect your daily activity. Your answers will help guide the physical examination.

Our doctor will then physically examine the muscles and joints of your low back. It is important that our doctor see how your back is aligned, how it moves, and exactly where it hurts.

Our doctor may do some simple tests to check the function of the nerves. These tests are used to measure the strength in your lower limbs, check your reflexes, and determine whether you have numbness in your legs or feet.

The information from your medical history and physical examination will help our doctor decide which further tests to run. The tests give different types of information.

Radiological Imaging

Radiological imaging tests help your doctor see the anatomy of your spine. There are several kinds of imaging tests that are commonly used.

X-rays

X-rays show problems with bones, such as infection, bone tumors, or fractures. X-rays of the spine also can give your doctor information about how much degeneration has occurred in the spine, such as the amount of space in the neural foramina and between the discs. X-rays are usually the first test ordered before any of the more specialized tests.

MRI Scans

The magnetic resonance imaging (MRI) scan uses magnetic waves to create pictures of the lumbar spine in slices. The MRI scan shows the lumbar spine bones as well as the soft tissue structures such as the discs, joints, and nerves. MRI scans are painless and don’t require needles or dye. The MRI scan has become the most common test to look at the lumbar spine after X-rays have been taken.

Treatment

What can be done to relieve my symptoms?

Ninety percent of people who experience low back pain for the first time get better in two to six weeks without any treatment at all. Patients often do best when encouraged to stay active and to get back to normal activities as soon as possible, even if there is still some pain. The pain may not go away completely. One goal of treatment is to help you find ways to control the pain and allow you to continue to do your normal activities.

Nonsurgical Treatment

Whenever possible, doctors prefer to use treatments other than surgery. The first goal of these nonsurgical treatments is to ease your pain and other symptoms.

Bed Rest

In cases of severe pain, doctors may suggest a short period of bed rest, usually no more than two days. Lying on your back can take pressure off sore discs and nerves. Most doctors advise against strict bed rest and prefer that patients do ordinary activities using pain to gauge how much is too much.

Back Brace

A back support belt is sometimes recommended when back pain first strikes. It can help provide support and lower the pressure inside a problem disc. Patients are encouraged to gradually discontinue wearing the support belt over a period of two to four days. Otherwise, back muscles begin to rely on the belt and start to shrink (atrophy).

Medications

Many different types of medications are typically prescribed to help gain control of the symptoms of low back pain. There is no medication that will cure low back pain. Medications are prescribed to help with sleep disturbances and to help control pain, inflammation, and muscle spasm.

Physical Therapy and Exercise

In addition to other nonsurgical treatments, doctors often ask their patients to work with a physical therapist. Therapy treatments focus on relieving pain, improving back movement, and fostering healthy posture. A therapist can design a rehabilitation program to address a particular condition and to help the patient prevent future problems. There is a great deal of scientific proof that exercise and increased overall fitness reduce the risk of developing back pain and can improve the symptoms of back pain once it begins.

Injections

Spinal injections are used for both treatment and diagnostic purposes. There are several different types of spinal injections that your doctor may suggest.

Some injections are more difficult to perform and require the use of a fluoroscope. A fluoroscope is a special type of X-ray that allows the doctor to see an X-ray picture continuously on a TV screen. The fluoroscope is used to guide the needle into the correct place before the injection is given.

Surgery

Only rarely is lumbar spine surgery scheduled right away. Our doctor may suggest immediate surgery if you are losing control of your bowels and bladder or if your muscles are becoming weaker very rapidly.

For other conditions, doctors prefer to try nonsurgical treatments for a minimum of three months before considering surgery. Most people with back pain tend to get better, not worse. Even people who have degenerative spine changes tend to gradually improve with time. Only one to three percent of patients with degenerative lumbar conditions typically require surgery. Surgery may be suggested when severe pain is not improving.

There are many different operations for back pain. The goal of nearly all spine operations is to remove pressure from the nerves of the spine, stop excessive motion between two or more vertebrae, or both. The type of surgery that is best depends on that patient’s conditions and symptoms.

Laminectomy

The lamina is the covering layer of the bony ring of the spinal canal. It forms a roof-like structure over the back of the spinal column. When the nerves in the spinal canal are being squeezed by a herniated disc or from bone spurs pushing into the canal, a laminectomy removes part or all of the lamina to release pressure on the spinal nerves.

Discectomy

When the intervertebral disc has ruptured, the portion that has ruptured into the spinal canal may put pressure on the nerve roots. This may cause pain, weakness, and numbness that radiates into one or both legs. The operation to remove the portion of the disc that is pressing on the nerve roots is called a discectomy. This operation is performed through an incision in the low back immediately over the disc that has ruptured.

Many spine surgeons now perform discectomy procedures that require only small incisions in the low back (minimally invasive). The advantage of these minimally invasive procedures is less damage to the muscles of the back and a quicker recovery. Many surgeons are now performing minimally invasive discectomy as an outpatient procedure.

Read more about Microdiscectomy or Microdecompression Surgery

Rehabilitation

What should I expect after treatment?

Non-surgical Rehabilitation

For acute back pain, you may be prescribed two to four weeks of physical therapy. You might need to continue therapy for two to four months for chronic back problems. Treatments are designed to ease pain and to improve your mobility, strength, posture, and function. You’ll also learn how to control your symptoms and how to protect your spine for the years ahead.

 

 

 

Read more about Prevention of Lower Back Pain

Read more about Back Problems

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Tips to Manage Low Back Pain at Home

Perhaps you bent the wrong way while lifting something heavy. Or you’re dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four say they’ve had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.

Sometimes it’s clearly serious: You were injured, or you feel numbness, weakness, or tingling in the legs. Call the doctor, of course. But for routine and mild low back pain, here are a few simple tips to try at home.

Spinal Stenosis

Chill it. Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation. “Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes,” she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice — take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.

Keep moving. “Our spines are like the rest of our body — they’re meant to move. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you’re feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you — and your back — more mobile. Just don’t overdo it. There’s no need to run a marathon when your back is sore.

Stay strong. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. “They help you maintain the proper posture and alignment of your spine. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.

Stretch. Don’t sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. Because most of us spend a lot of time bending forward in our jobs, it’s important to stand up and stretch backward throughout the day. Don’t forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.

Think ergonomically. Design your workspace so you don’t have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.

Watch your posture. Slumping makes it harder for your back to support your weight. Be especially careful of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.

Wear low heels. Exchange your four-inch pumps for flats or low heels (less than 1 inch). High heels create a more unstable posture, and increase pressure on your lower spine. According to research, nearly 60% of women who consistently wear high-heeled shoes complain of low back pain.

Kick the habit. Smoking can increase your risk for osteoporosis of the spine and other bone problems. Osteoporosis can lead to compression fractures of the spine. One study found that smokers are about a third more likely to have low back pain compared with nonsmokers.

Watch your weight. Use diet and exercise to keep your weight within a healthy range for your height. Being overweight puts excess stress on your spine.

Try an over-the-counter pain reliever. Anti-inflammatory drugs can help reduce back pain. Be sure to check with your doctor or pharmacist about any interactions over-the-counter pain relievers may have with other medications you are taking. People with a history of certain medical conditions (such as ulcers, kidney disease, and liver disease) should avoid some medicines.

Call your doctor if:

  • Your low back pain doesn’t go away after a few days, and it hurts even when you’re at rest or lying down.
  • You have weakness or numbness in your legs, or you have trouble standing or walking
  • You lose control over your bowels or bladder

These could be signs that you have a nerve problem or another underlying medical condition that needs to be treated.

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Prevent Back Pain with Good Posture

When it comes to posture, your mother did know best. Her reminders to stand up straight and stop slouching were good advice.

Your spine is strong and stable when you practice healthy posture. But when you stoop or slouch, your muscles and ligaments struggle to keep you balanced — which can lead to back pain, headaches and other problems.

A healthy back has three natural curves:

  • An inward or forward curve at the neck (cervical curve)
  • An outward or backward curve at the upper back (thoracic curve)
  • An inward curve at the lower back (lumbar curve)

Good posture helps maintain these natural curves, while poor posture does the opposite — which can stress or pull muscles and cause pain.

When standing, keep these tips in mind:

  • Keep your shoulders back and relaxed.
  • Pull in your abdomen.
  • Keep your feet about hip distance apart.
  • Balance your weight evenly on both feet.
  • Let your hands hang naturally at your sides.

Try not to tilt your head forward, backward or sideways, and make sure your knees are relaxed — not locked.

To test your standing posture, take the wall test. Stand with your head, shoulder blades and buttocks touching a wall, and have your heels about 2 to 4 inches (about 5 to 10 centimeters) away from the wall. Reach back and slide your hand behind the curve in your lower back, with your palm flat against the wall.

Ideally, you’ll feel about one hand’s thickness of space between your back and the wall. If there’s too much space, tighten your abdominal muscles to flatten the curve in your back. If there’s too little space, arch your back so that your hand fits comfortably behind you. Walk away from the wall while maintaining this posture. Keep it up throughout your daily activities.

When seated, keep these tips in mind:

  • Choose a chair that allows you to rest both feet flat on the floor while keeping your knees level with your hips. If necessary, prop up your feet with a footstool or other support.
  • Sit back in your chair. If the chair doesn’t support your lower back’s curve, place a rolled towel or small pillow behind your lower back.
  • Stretch the top of your head toward the ceiling, and tuck your chin in slightly.
  • Keep your upper back and neck comfortably straight.
  • Keep your shoulders relaxed — not elevated, rounded or pulled backward.

To see if you’re keeping your shoulders straight, stand in front of a mirror or ask someone else to evaluate your shoulder position. Aim to keep your shoulders in the same position as shown in the image on the left.

Although good posture should be natural, you might feel wooden or stiff at first if you’ve forgotten the sensation of sitting and standing up straight. The key is to practice good posture all the time. You can make improvements at any age. Stretching and core strengthening exercises can help, too.

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Patient Guide to Lower Back Pain

Lower back pain can be acute or severely painful or can be a long term moderate pain from a chronic back injury.

We explain the differences between acute low back pain and moderate chronic low back and its management.

Often is not possible to completely diagnose the causes of low back pain. Below we also outline the most common diagnosable causes of low back pain, less common causes and other conditions which can cause low back pain.

Acute VS Chronic Low Back Pain

Acute low back pain is severe back pain and usually comes on suddenly caused by a movement such as bending or twisting. Pain in the lower back and buttocks may increase over a couple of hours as inflammation develops. Management of acute low back pain is to reduce pain as quickly as possible by getting the patient into a position of least pain which may be lying on the back, front or side. Whatever is most comfortable is the best and it will be different for each individual. See management of acute low back pain for more detailed information.

Mild or moderate lower back pain is associated with chronic or long term back problems which are usually caused initially by an injury, usually to the joints in the back but over time other structures in particular soft tissue such as muscles contribute to the pain. A range of symptoms include dull aching in the lower back which may come and go, be on one side or across the lower back. There will be reduced range of movement, tenderness at points on the spine, muscle spasms and pain may radiate into the buttocks and hamstrings.

Common Causes of Low Back Pain

Often the exact cause of low back pain is not possible to identify. Symptoms can be vague, come and go and there can be a number of tissues and structures causing the pain. However below are some injuries and conditions that can usually be diagnosed.

SciaticaSciatica or nerve route compression causes pain in the lower back which radiates down into the legs. There are a number of causes by a slipped disc is one of the more common causes.

Facet joint pain or zygapophysial joints as they are also know are synovial joints in the spine which allow movement and help support the spine. Symptoms of facet joint pain include muscle spasm at the side of the spine which pulls the vertibra out of line. Patients will often report a sudden pain when bending over or moving.

Spondylolysis or stress fracture of the pars interarticularis is an overuse injury more common in younger athletes who are involved in sports requiring a lot of bending backwards and rotation of the spine such as javelin throwing, tennis, baseball pitching and fast  bowling in cricket. Symptoms include lower back pain often on one side of the back. Pain is worse during activities requiring backwards bending of the spine or exaggerating the lumbar curve in the spine. Tenderness will be felt over the site of the fracture when pressing in.

Sacroiliac jointSacroiliac joint pain occurs when the joint between the sacrum at the bottom of the spine and the ilium bone of the pelvis is not functioning correctly. It can be locked and not moving freely or it may be that there is too much movement in the joint. Symptoms of sacroiliac joint pain include pain located at either the left or right side of the lower back, not not usually both sides. The pain can vary from a dull ache to a sharp stabbing pain which can radiate into the buttocks. Occasionally sacroiliac joint dysfunction can cause pain in the testicles. Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning is also common.

Muscular trigger points are tiny localized knots in the muscle which cause pain either at the location of the trigger point or referred elsewhere in the back. They are common in the errector spinae muscles which go up either side of the spine and the deep quadratus lumborum muscles either side of the lumbar spine. Deep tissue sports massage techniques are effective for releasing trigger points in the muscles and relieving muscular back pain.

Less Common Causes of Low Back Pain

Spondylolisthesis is most common in children aged between 9 and 14 years old and involves a slipping forward of one of the lumbar vertebra. Spondylolisthesis can vary in severity from a grade one where there may be no symptoms or pain at all and patients are unaware they have the condition to a grade two which may result in low back pain made worse by activity but not radiating into the legs. A grade three injury has greater than 50% forward movement of the vertebra and a grade 4 will be very debilitating with more than 75% movement in the bone.

Spinal canal stenosis is more common in older athletes and involves the spinal canal narrowing causing pressure on the nerves with symptoms of pain and numbness. Sciatic type symptoms may also be present along with weakness of the legs. An X-ray of the spine can confirm the diagnosis.

Fractured vertebra or compression fracture of the spine is a break or fracture of one of the vertebra bones and is usually due to compressive forces. Occurring most frequently in the lower back symptoms include pain at the site of the fracture which may radiate in the hips, buttocks or thighs. Numbness, tingling and weakness may also be experienced and bladder or bowel symptoms from the fracture pressing onto the spinal cord can occur.

Fibromyalgia is a widespread muscular fatigue and pain condition where pain and tenderness is felt throughout the body. Poor sleep patterns are common and the muscles may feel soft and doughy rather than toned and tight. Patients often complain that they ache all over or feel they have overworked the muscles. Irritable bowel syndrome, Dysmenorrhea (cramps or painful menstruation) and chronic headaches are also symptoms of fibromylagia.

Lumbar instability is where part of the spine is unstable or has too much movement. Most low back problems can be relieved by freeing up a hypomobile vertebra or one that has restricted movement, although mobilizing and already mobile joint is not going to be beneficial. In this case the surrounding structures and muscles should be strengthened to support the unstable back. Core strengthening exercises and Pilates exercises for the back are likely to be beneficial. It is possible to have a generally hypomobile spine but with one or two vertebra having restricted mobility. It is important to get an accurate diagnosis and treatment from a back specialist, Osteopath or Chiropractor as the wrong treatment or exercises can have a negative effect.

Other medical conditions and diseases that can have symptoms of lower back pain include rheumatological diseases, gynacologica, gastrointestinal as well as genitourinary problems. If in doubt seek advice from a doctor.

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Patient Education of Back Pain

Back pain is a common complaint. Most people in the Singapore will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work.

On the bright side, you can take measures to prevent or lessen most back pain episodes. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain.

Symptoms of Back Pain:

Symptoms of back pain may include:

  • Muscle ache
  • Shooting or stabbing pain
  • Pain that radiates down your leg
  • Limited flexibility or range of motion of the back
  • Inability to stand up straight

When to see a doctor
Most back pain gradually improves with home treatment and self-care. Although the pain may take several weeks to disappear completely, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

  • Causes new bowel or bladder problems
  • Is associated with pain or throbbing (pulsation) in the abdomen, or fever
  • Follows a fall, blow to your back or other injury

Contact a doctor if your back pain:

  • Is constant or intense, especially at night or when you lie down
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss
  • Occurs with swelling or redness on your back

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.

Causes of Back Pain:

Back pain often develops without a specific cause that your doctor can identify with a test or imaging study. Conditions commonly linked to back pain include:

  • Muscle or ligament strain.Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms.
  • Bulging or ruptured disks. Disks act as cushions between the individual bones (vertebrae) in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. The presence of a bulging or ruptured disk on an X-ray doesn’t automatically equal back pain, though. Disk disease is often found incidentally; many people who don’t have back pain turn out to have bulging or ruptured disks when they undergo spine X-rays for some other reason.
  • Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  • Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain, but generally only if the scoliosis is quite severe.
  • Osteoporosis. Compression fractures of your spine’s vertebrae can occur if your bones become porous and brittle.

Risk Factors of Back Pain:

Anyone can develop back pain, even children and teens. Although excess weight, lack of exercise and improper lifting are often blamed for back pain, research looking at these possible risk factors hasn’t yet provided any clear-cut answers.

One group that does appear to have a greater risk of back pain are people with certain psychological issues, such as depression and anxiety, though the reasons why there’s an increased risk aren’t known.

Test and Diagnosis of Back Pain:

Anyone can develop back pain, even children and teens. Although excess weight, lack of exercise and improper lifting are often blamed for back pain, research looking at these possible risk factors hasn’t yet provided any clear-cut answers.

One group that does appear to have a greater risk of back pain are people with certain psychological issues, such as depression and anxiety, though the reasons why there’s an increased risk aren’t known.

Treatment of Back Pain:

Most back pain gets better with a few weeks of home treatment and careful attention. Over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is OK, but more than a couple of days actually does more harm than good. Continue your daily activities as much as you can tolerate. Light activity, such as walking and daily activities of living, is usually OK. But, if an activity increases your pain, stop doing that activity. If home treatments aren’t working after several weeks, your doctor may suggest stronger medications or other therapies.

Medications
Our doctor is likely to recommend pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs, such as ibuprofen. Both types of medications are effective at relieving back pain. Take these medications as directed by our doctor, because overuse can cause serious side effects. If mild to moderate back pain doesn’t get better with over-the-counter pain relievers, your doctor may also prescribe a muscle relaxant. Muscle relaxants can cause dizziness and may make you very sleepy.

Education
Right now, there’s no commonly accepted program to teach people with back pain how to manage the condition effectively. That means education may be a class, a talk with your doctor, written material or a video. What’s important is that education emphasizes the importance of staying active, reducing stress and worry, and teaching ways to avoid future injury. However, it’s also important for your doctor to explain that your back pain may recur, especially during the first year after the initial episode, but that the same self-care measures will be able to help again.

Physical therapy and exercise
Physical therapy is the cornerstone of back pain treatment. A physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises that may help increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help prevent pain from returning.

Injections
If other measures don’t relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.

In some cases, your doctor may inject numbing medication and cortisone into or near the structures believed to be causing your back pain, such as the facet joints of the vertebrae. Located on the sides, top and bottom of each vertebra, these joints connect the vertebrae to one another and stabilize the spine while still allowing flexibility.

Surgery
Few people ever need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you may benefit from surgical intervention. Otherwise, surgery usually is reserved for pain related to structural anatomical problems that haven’t responded to intensive conservative therapy measures.

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Patient Guide to Back Pain

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Back pain is extremely common – about four in five people are affected at some point in their lifetime. Anyone can get back pain at any age, but it’s most common in people between the ages of 35 and 55, or over.

Your back has many interconnecting structures, including bones, joints, muscles, ligaments and tendons. Its main support structure is the spine, which is made up of 24 separate bones called vertebrae, plus the bones of the sacrum and coccyx. Between the vertebrae are discs that act as shock absorbers and allow your spine to bend. Your spinal cord threads down through the central canal of each vertebra, carrying nerves from your brain to the rest of your body.

It’s often very difficult to know exactly what causes back pain, but it’s usually thought to be related to a strain in one of the interconnecting structures in your back, rather than a nerve problem. Back pain caused by a more serious, underlying condition is rare and you’re unlikely to be affected unless you are very old or very young.

Spinal Stenosis

Symptoms of Low Back Pain

If you have low back pain, you may have tension, soreness or stiffness in your lower back area. This pain is often referred to as ‘non-specific’ back pain and usually improves on its own within a few days.

Back pain may be called either ‘acute’ or ‘chronic’ depending on how long your symptoms last. You may have:

  • acute back pain – lasting less than six weeks
  • sub-acute back pain – lasting six weeks to three months
  • chronic back pain – lasting longer than three months

You should see a doctor as soon as possible if, as well as back pain, you have:

  • a fever (high temperature)
  • redness or swelling on your back
  • pain down your legs and below your knees
  • numbness or weakness in one or both legs or around your buttocks
  • loss of bladder or bowel control (incontinence)
  • constant pain, particularly at night
  • pain that is getting much worse and is spreading up your spine

These symptoms are known as red flags. It’s important to seek medical help for these symptoms to ensure you don’t have a more serious, underlying cause for your back pain.

For most people with back pain, there isn’t any specific, underlying problem or condition that can be identified as the cause of the pain. However, there are a number of factors that can increase your risk of developing back pain, or aggravate it once you have it. These include:

  • standing, sitting or bending down for long periods
  • lifting, carrying, pushing or pulling loads that are too heavy, or going about these tasks in the wrong way
  • having a trip or a fall
  • being stressed or anxious
  • being overweight
  • having poor posture

There may be other, more serious underlying causes of your low back pain, but these are rare. They include:

  • fracture – a crack or break in one of the bones in your back
  • osteoporosis – a condition where bones lose density causing them to become weak, brittle and more likely to break
  • a slipped disc – this is when a disc bulges so far out that it puts pressure on your spinal nerves
  • spinal stenosis – a condition in which the spaces in your spine narrow
  • spondylolithesis – when one of your back bones slips forward and out of position
  • degenerative disc disease – when the discs in your spinal cord gradually become worn down
  • osteoarthritis – a wear-and-tear disease that can particularly affect the joints of your spine
  • rheumatoid arthritis – an inflammatory condition in which your immune system causes inflammation of the lining of your joints and surrounding structures

Low back pain may also be caused by an infection or cancer, but these two causes are very rare.

Diagnosis of back pain

A doctor will usually be able to diagnose low back pain from your symptoms and there will be no need for further tests. If, however, your symptoms don’t improve after a few weeks, or you have some red flag symptoms, he or she may refer you to have:

  • an X-ray
  • a CT scan (a test that uses X-ray equipment and computer software to create pictures of the inside of your body)
  • an MRI scan (a test that uses magnets and radiowaves to produce images of the inside of the body)
  • blood tests

These tests are used to find out if you have a more specific, underlying cause for your back pain.

Please note that availability and use of specific tests may vary from country to country.

Treatment of back pain

If your back pain is non-specific, your doctor will recommend you try self-help measures. Alternatively, he or she may prescribe medicines or refer you for physical therapy if your pain is severe or chronic. If, however, your doctor suspects you have a specific underlying cause, he or she may refer you to have spinal injections. These are used to find out the exact source of, and also to treat, your back pain but aren’t suitable for everyone.

Self-help

There are a number of things you can do to help relieve low back pain.

  • Stay active and continue your daily activities as normally as you can. Bed rest may actually make low back pain worse, so try to limit the time you spend resting to a minimum.
  • Apply hot or cold packs to the affected area. You can buy specially designed hot and cold packs from most pharmacies. If you prefer, you can apply a cold compress, such as ice or a bag of frozen peas, wrapped in a towel. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

Taking an over-the-counter painkiller such as aspirin (acetylsalicylic acid) or paracetamol (acetaminophen), or anti-inflammatory medicine such as ibuprofen is often enough to relieve acute low back pain. You can also use creams, lotions and gels that contain painkillers or anti-inflammatory ingredients. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If your pain is severe or chronic, your doctor may prescribe stronger medicines such as diazepam, morphine or tramadol. However, these aren’t suitable for everyone because they can be addictive and cause side-effects. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Physical therapies

A physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility) may be able to help you design a programme to help you exercise and stretch.

Alternatively, your doctor may refer you for physical therapy such as chiropractic treatment or osteopathy (therapies that are given alongside conventional treatments) to help with your back pain. Treatment can involve exercises, posture advice, massage, and techniques known as spinal mobilisation and spinal manipulation.

Surgery

Back pain, even if it’s chronic, can usually be treated or managed successfully, but about one in 10 people have ongoing problems. Back surgery is really only considered as a last resort if the pain is related to a specific cause.

Complementary therapies

Some people find acupuncture can help relieve low back pain.
Alternatively, you could try a pain-management programme to help you better deal with and manage your symptoms.

You should always talk to a doctor before trying any complementary therapy.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention of back pain

Good back care can greatly reduce your risk of getting low back pain. To look after your back, make sure you:

  • take regular exercise – walking and swimming are particularly beneficial
  • try to keep your stress levels to a minimum
  • bend from your knees and hips, not your back
  • maintain good posture – keep your shoulders back and don’t slouch

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Backache in your Life

If you are like most people, you will have at least one backache in your life. While such pain or discomfort can happen anywhere in your back, the most common area affected is your low back. This is because the low back supports most of your body’s weight.

Many back-related injuries happen at work. But you can change that. There are many things you can do to lower your chances of getting back pain.

Most back problems will get better on their own. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better.

Low back pain may be acute (short-term), lasting less than one month, or chronic (long-term, continuous, ongoing), lasting longer than three months. While getting acute back pain more than once is common, continuous long-term pain is not.

Causes of Back Pain:

You’ll usually first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, or have an injury or accident. But prior to that moment in time, the structures in your back may be losing strength or integrity.

The specific structure in your back responsible for your pain is hardly ever identified. Whether identified or not, there are several possible sources of low back pain:

  • Aortic aneurysm
  • Degeneration of the disks
  • Kidney problems, such as infections or stones
  • Muscle spasm (very tense muscles that remain contracted)
  • Other medical conditions like fibromyalgia
  • Poor alignment of the vertebrae
  • Ruptured or herniated disk
  • Small fractures to the spine from osteoporosis
  • Spinal stenosis(narrowing of the spinal canal)
  • Spine curvatures (like scoliosis or kyphosis) which may be inherited and seen in children or teens
  • Strain or tears to the muscles or ligaments supporting the back

Low back pain from any cause usually involves spasms of the large, supportive muscles alongside the spine. The muscle spasm and stiffness accompanying back pain can feel particularly uncomfortable.

You are at particular risk for low back pain if you:

  • Are over age 30
  • Are pregnant
  • Feel stressed or depressed
  • Have a low pain threshold
  • Have arthritis or osteoporosis
  • Have bad posture
  • Smoke, don’t exercise, or are overweight
  • Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster)

Prevention of Lower Back Pain

Exercise is important for preventing future back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

A complete exercise program should include aerobic activity (like walking, swimming, or riding a stationary bicycle) as well as stretching and strength training.

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

  • If an object is too heavy or awkward, get help.
  • Spread your feet apart to give a wide base of support.
  • Stand as close to the object you are lifting as possible.
  • Bend at your knees, not at your waist.
  • Tighten your stomach muscles as you lift the object up or lower it down.
  • Hold the object as close to your body as you can.
  • Lift using your leg muscles.
  • As you stand up with the object, DO NOT bend forward.
  • DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to take to prevent back pain include:

  • Avoid standing for long periods of time. If you must for your work, try using a stool. Alternate resting each foot on it.
  • DO NOT wear high heels. Use cushioned soles when walking.
  • When sitting for work, especially if using a computer, make sure that your chair has a straight back with adjustable seat and back, armrests, and a swivel seat.
  • Use a stool under your feet while sitting so that your knees are higher than your hips.
  • Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
  • If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don’t lift heavy objects just after a ride.
  • Quit smoking.
  • Lose weight.
  • Learn to relax. Try methods like yoga, tai chi, or massage.

Read more about Low Back Pain

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Back Pain

Most people suffer from mild back pain from time to time and the exact cause of which may be difficult to diagnose. It is usually a sign that one or more muscles, joints, ligaments or discs are over-stretched or twisted by movement of the back in an awkward position. Severe pain may be the result of pressure on nerves from the misalignment of the bones in the back and warrants immediate medical attention.

Low back pain afflicts some 80 % of the adult population some time or other in their lives.

Many episodes of pain last only several hours or a day or two. By and large, 90% of patients should have recovered from their initial attack of pain by 6 weeks from the onset.

Symptoms

Early medical attention is necessary if certain symptoms (“red flags”) are present:

  • Constant pain with no significant relief at rest
  • Aggravated by bending in all directions
  • Localisable severe pain to a single spot on the back
  • Progressively severe pain over days/weeks
  • Persistent nerve pains, pain or sensation of numbness, pins & needles aching in one or both legs
  • Weakness of legs, difficulty in walking, unsteady walking
  • Bladder/bowel problems associated with back pain (difficulty in passing urine – incontinence)
  • General symptoms of poor health, loss of appetite, weight loss, lethargy, fever and chills
  • Previous history of cancer

Treatment

Rest is very crucial for patients with episodic attacks of back pain. Rest here may involve going home and lying down for a few hours, or it may be as simple as keeping the back straight and avoiding further stress to the back in the form of bending, lifting and sitting. In severe attacks, lying down for a day or two may significantly reduce the severity of the pain. If it does not, further bed -rest is not helpful.

Physical therapy is very important in the treatment and prevention of low back pain. In the initial period of acute back pain, combinations of heat, traction, manual treatment, and other techniques may help to rapidly reduce the severity of pain and stiffness. As pain subsides, exercises, to relieve stress and strengthen the back ,are gradually introduced. Regularity of such exercises can help to further reduce the pain, as well as protect the back from unhealthy stress and recurrent attacks of pain.

Different types of medications may be prescribed for different types of back pain.

In acute sciatica or leg pain associated with back disorders, the acute irritation of the nerve may be reduced by taking NSAIDS regularly for a short period of time. NSAIDS are often prescribed purely for pain relief rather than for anti-inflammatory effects. It is based on an as-required basis. These drugs are to be avoided if there is a history of allergy and kidney problems. In most cases, NSAIDS are well-tolerated, though most of them provoke gastric symptoms. The doctor must always be consulted.

Muscle relaxants help to reduce muscle spasm and stiffness that occurs during a pain attack. Sedatives and tranquilisers may be taken at night to ensure a restful sleep.

Ice packs, hot packs or heating lamps, ointments that usually contain methyl -salicylate and medicated plasters of various kinds may help.

30 – 40 % of patients suffer a relapse during the first few months following the attack. It is important to identify the factors that aggravated the pain.

I have severe back pain and sciatica that has not improved even with treatment. What should I do?

X-rays of the low-back should be obtained. Conditions like spondylolisthesis, infection and tumour should be excluded. Sophisticated imaging techniques such as MRI ( magnetic resonance imaging) may be required . MRI scans can show the severity of a prolapsed disc and more importantly , the degree of the nerve compression, if any. Other investigations such as bone scan, CT scans or myelograms may be performed in certain conditions.

Prevention

Recommendations for prevention of low back pain:

  • Try to modify the activity so that it is less likely to strain the back
  • Interrupt a repetitive task frequently by standing and stretching. This helps to reduce the stress on the back from building up to critical levels
  • Exercise programmes must be balanced to exercise all parts of the body, including the back.
  • Exercises should be done frequently in measured doses.

Slipped Disc

As a person gets older, a process called degeneration, the nucleus in the lower few discs of the low back . As a result , the discs are less capable of cushioning the spine , especially during repeated stressful activities. The capsule or annulus can then tear and cause pain. This is known as a slipped disc.

In a slipped disc, the annulus tears with different degrees of severity. Small tears heal quickly. Large tears can cause a small portion of the nucleus herniating through the tear to lie outside the wall of the disc. If this herniation is close to a nerve, intense irritation of the nerve can occur. “Sciatica “or feelings of pain, aching, numbness, “coldness ‘, paraesthesia or pins and needles of the thigh and calf may occur. This can involve one or both legs. Properly performed manual treatment using massage, mobilisation and manipulation may often be helpful in reducing the severity of low back pain.

Most cases recover without the need for surgery. As mentioned earlier, 90 % patients recover within 6 weeks. However a small group of patients have a significant portion of the nucleus that has herniated out of the annulus of the disc to compress the nerve and removal of the herniated fragment of disc will result in more rapid recovery of symptoms than without.

Frequently Asked Questions

Aside from a prolapsed disc, what other causes of recurrent back and leg pains are there?

Spinal canal stenosis and spondylolisthesis are 2 other common causes of recurrent back and leg pains . In older people, a condition termed as lumbar spondylosis, ( the facet joints of the spine can wear out ) can result in episodic back pains. Osteoporosis or softening of the bones can occur in the elderly, resulting in back pains. Patients who have had a previous history of cancer elsewhere, and having persistent back pains, should seek a medical opinion. Less commonly conditions such as rheumatoid arthritis, ankylosing spondylosis and various types of infections can also afflict the spine.

My back is often sore at the end of a day’s work. How can I prevent this?

Modification of activity or the work environment may be required. It is often how the person does that results in unnecessary stress to the back. Such instruction can be provided by the doctor or the therapist , either as an individual or in groups of patients attending “Back Care ” classes.

I am already doing a full day’s work. I also jog and play tennis Why do I need other exercises?

Work, no matter how strenous, is not exercise. In fact, some jobs especially those that involve repeated lifting or bending, or prolonged standing or sitting, add to the stress over the spine. Jogging, racquet games, golf, etc. may be good for general health and fitness but do not significantly exercise or strengthen the back. A balanced programme which includes improving the flexibility and strength of the back will help to prevent recurrent injuries.

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