(65) 64712744|info@boneclinic.com.sg

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.

STOP YOUR BACK PAIN TODAY. CALL US AT 6471 2744 OR EMAIL TO: INFO@BONECLINIC.COM.SG TO SCHEDULE FOR AN APPOINTMENT

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