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Spinal Stenosis

Are you suffering from Spinal Stenosis? Having lower back pain with leg pain and numbness? You are at the right place. Get professional opinion and treatment on your Spinal Stenosis. Call us for appointment today. Tel: +65 64712744 or SMS to: +65 92357641 (24 Hours Hotline).

There are two types of spinal stenosis: lumbar stenosis and cervical stenosis. While lumbar spinal stenosis is more common, cervical spinal stenosis is often more dangerous because it involves compression of the spinal cord, as explained below in more detail.

Lumbar Spinal Stenosis VS Cervical Spinal Stenosis

  • In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of sciatica — tingling, weakness or numbness that radiates from the low back and into the buttocks and legs – especially with activity.
  • Spinal stenosis pain in the neck (cervical spinal stenosis) can be far more dangerous by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms, including major body weakness or even paralysis. Such severe spinal stenosis symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine.

In rare cases, lumbar stenosis can go no further than to produce severe persistent disabling pain and even weakness in the legs. Most cases of stenosis in the lumbar spine, however, have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting.

Spinal Stenosis

Spinal Stenosis in Older Patients

Spinal stenosis is related to degeneration in the spine and usually will become significant in the 5th decade of life and extend throughout every subsequent age group. Most patients first visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with significant activity limitations, such as leg pain and/or difficulty with walking.

Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of spinal stenosis occur in the lumbar spine (low back), which is called lumbar spinal stenosis, and most will affect the sciatic nerve which runs along the back of the leg. When this happens, it is commonly called sciatica.

Common Symptom of Spinal Stenosis

Leg pain with walking (claudication) can be caused by either arterial circulatory insufficiency (vascular claudication) or from spinal stenosis (neurogenic or pseudo-claudication). Leg pain from either condition will go away with rest, but with spinal stenosis the patient usually has to sit down for a few minutes to ease the leg and often low back pain, whereas leg pain from vascular claudication will go away if the patient simply stops walking.

Although occasionally the leg pain and stenosis symptoms will come on acutely, they generally develop over the course of several years. The longer a patient with spinal stenosis stands or walks, the worse the leg pain will get.

Common Treatment of Spinal Stenosis

Depending on the severity of symptoms, spinal stenosis can often be managed through non-surgical treatments.

The three most common non-surgical spinal stenosis treatments include:

  • Exercise
  • Activity modification
  • Epidural injections

Fortunately, spinal stenosis surgery outcomes for decompression can be among the most rewarding surgical methods used on the spine (second only to removal of some herniated discs). Generally patients do well after decompression surgery and are able to increase their activity following recovery from spinal stenosis surgery. Many patients have a better walking tolerance following back surgery for spinal stenosis.

Are you suffering from Spinal Stenosis? Having lower back pain with leg pain and numbness? You are at the right place. Get professional opinion and treatment on your Spinal Stenosis. Call us for appointment today. Tel: +65 64712744 or SMS to: +65 92357641 (24 Hours Hotline).

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.

Cure Your Back Pain Today! Call us at +65 6471 2744 or SMS to +65 9235 7641 for an appointment

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.

Cure Your Back Pain Today! Call us for Appointment today +65 6471 2744 (24 Hours) or SMS to: +65 92357641.

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

STOP YOUR BACK PAIN TODAY! CALL +65 6471 2744 or Email to info@boneclinic.com.sg for appointment

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.

STOP your Back Pain today! Call +65 6471 2744 or Email to: info@boneclinic.com.sg for Appointment

Guided Injection (Epidural) for Lower Back Pain

A lumbar epidural injection is a safe and effective minimally invasive treatment for the treatment of certain types of low back pain.  This type of spinal injection reduces nerve inflammation, calms symptoms, aids healing and, provides the physician with important diagnostic information.

The procedure involves injecting a corticosteroid into the epidural space.  A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective at reducing inflammation. Sometimes a narcotic is injected to increase pain relief. The epidural space is between the protective membrane (dura mater) that covers the spinal cord and the bony spinal canal. After medication is injected, it flows and coats the nerve roots.

Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.

Many spinal problems cause low back and leg pain (sciatica).

Basics about Lumbar Spinal Nerves

There are 5 pair of spinal nerves In the lumbar spine. Each pair of nerves provides sensation and function to specific parts of the body. The spinal nerve pairs are numbered to correspond with the adjacent vertebral level. The nerve roots at L1 exit at the left and right between the first and second lumbar vertebrae (L1-L2).  L5 exits between the last lumbar vertebra and the sacrum (L5-S1).
Each pair of nerve roots exit the spinal column and branch out into the body forming the peripheral (outer) nervous system.  These nerves innervate the lower part (below the waist) of the body and enable movement (motor function) and feeling (sensory function). Dermatones are skin areas innervated by spinal nerve roots. Physicians use dermatomal patterns to help diagnose the location of certain spinal problems based on where the patient reports pain or weakness.
Based on symptoms, medical history, physical and neurological examination, and imaging study findings (x-ray, MRI), the physician can determine the spinal nerve root(s) associated with pain and other symptoms.

Patient Procedure Preparation

Some types of medications have to be stopped several days before the procedure.  Certain medications increase the risk for bleeding.  The physician may ask the patient to stop pain medication, including anti-inflammatory drugs to determine the full effectiveness of the lumbar epidural injection.

Possible Risks and Complications

Any medical procedure poses risks or possible complications. Although rare, possible risks or complications include bleeding, infection, nerve injury, and allergic reaction to medication.  Furthermore, the injection may increase pain and cause tenderness at the injection site.  The physician discusses all potential risks and complications with the patient well in advance of the procedure date.

What to Expect: The Procedure and After

The procedure is performed in a sterile setting.  After checking into the facility, the patient changes into a hospital gown and lies on the treatment bed, and an intravenous line is started through which medications are administered.  Relaxing medication is given; complete sedation is not necessary.

In the procedure room, the patient is positioned face down with a cushion placed under the abdomen.  This keeps the spine in a flexed position and the patient comfortable.  The skin area is cleansed using a sterile solution.  Local anesthetic is injected to numb the injection site.

Fluoroscopic imaging equipment called a C-arm is positioned over the patient.  During the procedure fluoroscopy captures x-rays in real time and displays the images on a monitor. Under fluoroscopic guidance, the physician inserts the needle and injects a small amount of contrast (dye) to verify needle placement.  Next, an anesthetic and corticosteroid is injected into the epidural space.  Pain may temporarily increase during the injection. The physician asks the patient for feedback during the procedure and makes the patient as comfortable as possible. When the injection is over, the injection site is covered with a small bandage.

A lumbar epidural injection treatment may involve one or more injections. The procedure takes about 15-minutes. After the procedure, the patient is moved into the recovery area where the nurse monitors vital signs.  Soon, the patient is discharged with written home care instructions.

Some patients experience discomfort after the procedure for two or three days. This is normal and does not necessarily mean the corticosteroid is not taking effect. Typically, the physician’s office will call the next day to follow up. Some physicians recommend that patients keep a daily record of pain levels and symptoms following a lumbar injection to provide the medical team with information that could guide further treatment.

Conclusion

Lumbar spinal injections have provided significant pain relief to many people with moderate to severe low back pain. Not everyone is an appropriate candidate for this procedure, and prospective patients should discuss risks and benefits with their physicians.

For more Information, please call +65 6471 2744 or Email to: info@boneclinic.com.sg