Low back pain is one of the most common pain disorders today. It is a chronic condition characterized by a persistent dull or sharp pain per the lower back. It afflicts 80% of the adult population some time or other in their lives.

Ms Karen Koh, Senior Principal Physiotherapist from the Department of Physiotherapy and Dr Benedict Peng, Visiting Consultant from the Department of Orthopaedic Surgery at Singapore General Hospital, give detailed answers to your questions.

Question by vincenttan

Dear Doctor I am 28 years old. Six months ago I started having severe cramps in my left leg and back, which kept me in bed for one whole weeks. Eventually the cramps disappeared but I was left with constant numbness and tingling in my left calf and foot. X-rays confirmed a problem with my sciatic nerve. Can you tell me what to do to relieve the constant ache and numbness in my calf and foot? Also, my lower back has been weak and I am unable to resume a regular exercise program. Can i still play basketball?

Vincent :(

Answered by Dr. Benedict Peng, Singapore General Hospital

Based on your description, it is possible that you have a pinched nerve (nerve compression). Conservative treatment will consist of physiotherapy and pain-killers. Exercises that strengthen your abdominal and lower back muscles are helpful. You can still play basketball, but you should stop if it causes you pain or do it in moderation. If your symptoms persist, you should consult a doctor. Further investigations such MRI scans may help elucidate the condition.

Question by sieweng55

Dear Sir, my colleague is 56 years old and she is suffering from severe back pain for the past 3 years. According to her MRI report, there is a bruised on her spine from C2 to C7, and damage on the spinal cord. She had consulted the local doctors, and took pills regularly. She also tried massaging and physiotherapy, but it didn’t help.

Should my colleague go for a surgery? Is it safe to have a surgery at the age of 56? Kindly advise.

Answered by Dr. Benedict Peng, Singapore General Hospital

It is difficult to determine if your colleague needs surgery based on MRI report alone. Based on the report, if there is spinal cord damage, she should be seen by a Spine Specialist to check her signs and symptoms and interpret her MRI scans accordingly. If she requires surgery, the specialist will be able to advise. Before proceeding with surgery, investigations will be performed to determine if she is fit for operation.

Question by miki

My sister-in-law is pregnant. She is currently in her second trimester and she complains of too much back pain. What could be the reason for the back pain she is facing? Is this back pain so serious that it should be treated by medication or this is common during the pregnancy?

Answered by Dr. Benedict Peng, Singapore General Hospital

About 80% of pregnant women have back pain. The expanding uterus shifts the weight of the body and stretches and weakens the abdominal muscles, changing the posture and putting strain on the back.

The increased weight also means the muscles have to work harder and the joints are also stressed. Also hormonal changes during pregnancy loosen the joints and ligaments causing pain on movement, standing and sitting for long periods. Appropriate rest, standard back exercises and medication can help with the pain.

Question by gloria_nicki

Dear Doc, My mum has been experiencing a sharp throbbing pain on the her back lately ( pain experience sharp when she is sitting down). During the last month checkup with the doctor, he recommend that she underwent a surgery. At the same time, we brought her to seek alternative opinion from a chiroprator, who suggest that she might not need a surgery. We are pretty confused now since the two opinion is different. What is your opinion ? Thanks

Answered by Dr. Benedict Peng, Singapore General Hospital

There are many causes for back pain and whether your mother needs surgery depends on the cause and her clinical presentation. If her symptoms persist despite chiropractic treatment, she should see a Spine Specialist.

Question by strongfitmacho

Hi Doctor, I have been quite active in sports and never really have any back problems. However, after a basketball game 2 months back, i start to suffer from intense back pain which restricted my movement. I can barely sit down without a sharp pain.

I went to a chinese sinseh but it doesn't really help. The pain persisted for the next 3 weeks till i went to see a chiropractor. After 3 sessions of 'twisting' , the pain gradually subsided and i am pain free now. ( touch wood ) I have 3 questions

1. Isit just a minor muscle sprain whereby time will aid in the healing? By the time i went to see the chiropractor, i have already sustained the injury for 3 weeks. Which means to say that even without the chiropractor's help, i am already on the road to self healing and recovery.
2. Will this injury affect the discs "Jelly' and once this damage is done, it is irreversible other than surgery?
3. Does Glucosomine/Chondroitin play a part to reduce the pain? What can i do so that by the time i am 60, i don't wake up with all the cracking sounds and feeling pain all over? Thank you!!!

Answered by Dr. Benedict Peng, Singapore General Hospital

1. Most back pain that occur after strenuous activities are due to muscle sprains and these usually get better. Rest, pain-killers, physiotherapy and chiropractic manipulation can help alleviate the pain.
2. Disc degeneration is a natural process. Strenous activities or injuries to the discs can predispose to disc degeneration. Not all disc degeneration requires surgery. Most are treated conservatively.
3. There is no real evidence that glucosamine/chondroitin will reduce back pain. Back pain may come from the muscles, discs, joints and ligaments. Glucosamine/chondroitin is only useful for joints. Regular exercises especially those that strengthen the abdominal muscles and low back muscles, keeping a healthy diet to maintain an appropriate weight and avoiding smoking can help.

Question by dohreimee

My husband has been complaining abt low back pain. Not sure if it's due to slipped disc. He exercises regularly and runs at least once a week. I'm concerned that this may aggrevate the situation. What's the best or safest form of exercise for someone with back pain? I heard that stretching exercises are impt as warm up but what type and how? tks

Answered by Ms Karen Koh, Singapore General Hospital

Swimming or water based exercises such as aqua aerobics are generally a safer form of exercise for someone with low back pain. The buoyancy of the water does not load the joints and discs of the back as compared to weight bearing exercise such as running.

Stretches performed as a form of warm up prior to exercises are usually targeted at muscles which will be used during the course of the exercises. Each stretch should be performed to the point when tightness is experienced in the muscle and held for 10 seconds and repeated 3-5 times. No pain should be felt during the stretch.

Question by pearlynwan

I just hurt my back last week ( which might be cause by lifting of heavy stuffs), but it is not painful enough to see a doctor. I've read that my pain might be caused by a sprain in the muscle.

Can i continue with my daily exercise routine, especially swimming ? I am worried that it might worsen my situation since i am letting the body heal itself.

Answered by Ms Karen Koh, Singapore General Hospital

A mild muscle strain will usually resolve without the need for any intervention. If you are able to continue with your daily activities or exercise without experiencing a worsening of the pain during or after the session, it should be relatively safe for you to continue. However, if the pain from your muscle strain worsens or persists after 1 month, you should seek medical attention.

Question by prettybaby

My husband had a mild slipped disc many years ago. He was told his condition at that time didn't require surgery. However, he continued to have relapse at least once every year, where he feels pain in the lower back and his muscles went into spasms. On some occasions, he had to stay in bed for days.

1. What can he do to improve his condition and to make sure he doesn't suffer relapses?
2. Will Pilates help?
3. Should he see a chiropractor on a regular basis? He already seeing a physiotherapist regularly.
4. What kind of exercises are good for him and what kind should he avoid?
5. Why do some people get back pain or slipped disc while others don't?

Answered by Ms Karen Koh, Singapore General Hospital

1. ​​Good mobility of joints and optimal strength and muscle control are important and can be maintained through regular exercise. It is also essential to maintain good posture, avoid sustained postures for prolonged periods of time and apply proper techniques when performing any forms of lifting or other heavy tasks. These will help to minimize the likelihood of a relapse.
2. Exercises which improve the mobility of joints and increase the control and strength of muscles would generally help. Exercises which load the back excessively and/or repetitively should be avoided.
3. Both physiotherapists and chiropractors are health care professionals who provide care for patients with low back pain. The approaches and rationale behind treatment techniques may be different and patients choose who they seek treatment from depending on their own beliefs and response to the different approaches.
4. There are some studies which suggest that there may be genetic factors predisposing certain people to low back pain more than others. However, our daily activities and the postures that we keep significantly impact the amount of stress and strains our back is subjected. The combination of our genetic make-up and our daily loading of our back will determine the likelihood of one developing back pain.

Ref: W09