Dr David Mak, Associate Consultant with the Department of Neurosurgery at National Neuroscience Institute(NNI), a member of the SingHealth group, answers your questions on preventing and managing lower back pain.

This As​k The Specialist forum has closed. Thank you for participating.​ Scroll down to see all questions and answers submitted for this forum.

Lower back pain is a common condition and affects up to 90% of adults in Singapore at some point in their lives. 

The most common cause of lower back pain is pulled muscles in the back – this is usually short-term and gets better on its own with warm or cold compresses and regular pain medication within one to two weeks.

However, other causes of lower back pain may include damage to the spine due to a slipped disc, injuries or ‘wear and tear’.  These can cause chronic pain that gets worse over time. If left untreated, they can result in difficulties walking and interfere with daily activities.

The good news is that lower back pain can often be prevented and managed through lifestyle modifications, physiotherapy and medications.

Don't put up with lower back pain! If you are unsure about how to prevent or manage lower back pain, ask our specialist now in this limited-time forum!

About Dr David Mak

Dr David Mak is an Associate Consultant with the Department of Neurosurgery. He has deep interest in surgical interventions and wearable robotics for spine conditions. He is also committed to advancing medical knowledge and inspiring next generation of medical professionals through insightful and dedicated teaching.


Questions and answers on lower back pain

1. Question by Adam

Hi doctor,

I'm suffering from back pain and spinal problem long years, how to treat this?

Answer by Dr David Mak

Hi Adam,

There are many causes of back pain, from common causes like muscular strain, to degeneration (wear and tear) related, deformity related, or in some rare occasion, back pain could also be caused by underlying spinal lesion. 

I suggest that you visit your family doctor who will have an understanding of your medical history and do some basic investigations to evaluate your back and spine problems. He/she will refer you to a specialist if necessary for further tests and treatments.

2. Question by Jedaiah

Hi Dr,

Understand that lower back pain is caused by pulled muscles in the back.

What are the reasons that could cause the pulling of muscles, as well as what are the things that we can do to help prevent/reduce this from occurring?

Answer by Dr David Mak

Hi Jedaiah,

Yes, you are right - pulled muscles, or muscle strain, is one of the common causes of lower back pain in our population.

Muscle strain, or sometimes, muscle stiffness could be related to the following conditions (just to name a few):

  • Repetitive stress and strain – either from acute trauma (eg a direct blow on the back from accidents / injuries), posture related (eg prolonged standing and/or bending of the back during work), exercises (muscle fatigue and in some cases – incorrect techniques during certain exercises)

  • Degenerative spine (ageing related) – commonly this may predispose to lower back pain from degeneration of different parts of the spine

  • Deformity of the spine – for example – scoliosis or kyphosis of the spine may result in long standing back pain, and causes could be congenital or acquired

  • Medical conditions – for example – infection or underlying lesions (growth – tumour) may also result in back pain although these are not the most common causes

It is important to treat underlying causes once the source of back pain is identified. As you can see there are a wide variety of causes for back pain.

Muscle strain could be treated first from reducing any potential trigger activities, and some patients may require a short duration of simple analgesia (pain killers). Physiotherapy and some therapeutic exercises will be useful as well. If back pain remains persistent despite these measures, it would be good to see your family doctor for an assessment, and if needed, he/she will refer you to a specialist.

3. Question by May

Dear Dr Mak,

I experienced pain on my lower back (left side) and the pain spread to my left glutes and leg. I also feel numbness on my left foot on and off, especially when standing up. The pain is especially uncomfortable in the afternoon till night time.

I am an avid runner but have alternate between running, walking, cross training (elliptical, swimming) since I experience the pain in my left glutes, leg 2 months ago.

Any advice on pain management?

Answer by Dr David Mak

Hi May,

Pain is the body’s way of telling you that something is wrong. There are several possible causes for your pain and numbness, e.g.  wear and tear of the spine (ageing), muscle strain, nerve irritation, commonly caused by slipped disc or bone spurs, or even joint related (knees, hips, sacro-iliac joints for example), and it is difficult to advise without knowing more about your condition. I would recommend that you see your family doctor who can refer you to a specialist for a further assessment.

You may try to cut down on exercises that may potentially increase the workload of the spine and large joints, e.g., running, while non-competitive swimming is likely tolerable. You may also consider a short duration of simple over-the-counter painkillers and see if that will reduce the exacerbation of your symptoms.

4. Question by Zakir

Hi Dr,

I’m suffering lower back pain due ageing and degenerative changes. How can I improve it?

Answer by Dr David Mak

Hi Zakir, while I always tell my patients that no one is capable of reversing ageing, however, we are able to treat symptoms of lower back pain.

Many patients respond well to over-the-counter painkillers and physiotherapy – usually focusing on core strengthening and range of movement (ROM) exercises. Please see your family doctor for an assessment and referral to a physiotherapist or specialist if necessary.

5. Question by ngkk

Hi Dr,

I'm in my late 50s and started having backaches in my early 50s. Is it a common sign that people above 50s will get this back problem and if indeed the case, why? Thanks.

Answer by Dr David Mak

Hi ngkk,

Backaches are common in most age groups, common causes in your age group are:

  • Degenerative related (ageing – wear and tear)

  • Deformity related (could be underlying long standing deformity of the spinal column)

  • Related to other medical conditions

And most commonly, long standing back pain could be a result of repetitive stress and strain of the spinal column and its ‘soft tissue’ components (eg spinal muscles, joints and ligaments), and this could be postural related e.g. caused by prolonged sitting or standing during work), or activities related (eg exercises that may predispose to backaches).

There are many possible causes for backaches. Please see your family doctor for an assessment and they can advise on whether a specialist referral is necessary.

6. Question by yen goh

Hi Dr,

I have a past episodes that I woke up suddenly with severe Lower back pain or around the glutes area that I can't get down from bed. In one episode, subsequently in consecutive few days I have difficulty wearing my pants or bend my waist. It results in severe pain when I try to do so.

This episode has happened after my period. I would like to ask can hormonal changes affect the lower back, or can it be related to fibroids that I have? I took painkillers and muscle relaxant and it get well in 1 to 2 weeks’ time.

Answer by Dr David Mak

Hi Yen Goh,

Hormonal changes may play a part in contributing to backaches. I have also seen patients who came to my clinic with back-pain, and eventually we have found out that the underlying cause is due to uterine fibroids.

If you are already seeing a specialist for your fibroids, please discuss your pain with them at your next appointment if your appointment date is soon. Your specialist will be able to advise if the pain is related and refer you to a spine specialist if necessary. 

If you do not see a specialist for your fibroids and/or your appointment is not soon, I would recommend you discuss your symptoms with your family doctor as the pain is affecting your daily life. The pain that you have described could also be related to degenerative spine (ageing – wear and tear), and your family doctor can refer you to a spine specialist or for physiotherapy if necessary.

7. Question by Dav

Dear Doctor,

I am over 50 years old and recently encountered 2 pretty serious lower back pains.  One happened in June 2023 while the other Feb 2024.

The first incident happened during a company game overseas where it required me to be in a gunnysack hopping from one end to the other, that was when after a few hops, I twisted my lower back muscles and that immediate lightning-like shocks hurt my back badly.  I wasn’t able to walk normally and certain postures could make the pain got worse.  This pain lasted me for a few weeks, nothing much was done other than popping pain killers and applying cream to soothe the pain.

The second incident happened when I was trying to load a flowerpot to my car back seats.  I believed the wrong posture had resulted me in getting a sudden sharp pain on my lower left back muscles unexpectedly.  This was worse than the first encounter and it took me whole lot of effort to slowly get into my driving seat.  I could even feel the pain when stepping on the paddles.  I had problem getting up from my bed subsequently, let alone be able to walk in my house without holding on to something stable along the way.  Despite applying warm/cold pads frequently, took the strongest pain killers I could find, it took me longer to recover for this time round.

Now I am really afraid that this incident may happen to me again.  Before that I did my back exercise to strengthen my lower back muscles every night but looks like it didn’t help me at all, hence I have given up on this.

I hope to get your good advice in any way to prevent this from happening again or any right exercise, diet I should strictly follow to gain back my confidence as well as to have a healthy BACK for life!

Thank you in advance.

Answer by Dr David Mak

Hi Dav,

It sounds like the para-spinal muscle (commonly referred as our back muscles – those that helps our spinal column to maintain our postures) strain is the most likely cause of the back-pain you described. Another possible cause is compression fracture of the spine, characterised by cracks in the spinal bone. This can lead to pain as well. It is therefore advisable for you to see a family doctor, who may do an X-ray to assess if there's any spinal fracture. The types of treatment you will receive depends on the findings on physical examination and X-ray.

Most importantly, let’s not forget that we should protect our back too, for example, adequate warm up / stretches before exercises. Always remember to bend your knees and hip down together while carrying heavy loads.

8. Question by Mr Ong

Hi Dr Mak,

I’m 65-year-old diabetic and had a cervical neuroplasty surgery last Apr. I’ve had the lower back pain for more than 5 years, on and off.

Mostly the back pain comes after I wake up and goes away after a few hours rest on the couch. No pain down my legs. Just the lower back and this prevents me from standing straight, like difficulty wearing trousers and socks.

My mattress is 12” thick firm foam type. I tried putting a pillow under my knees but doesn’t help. I normally sleep on my side.

Taking Anarex and panadol didn’t help either.  I’ve also tried physiotherapy and TCM tui na. No help. I’m afraid it will get worse with age. Sometimes difficult to get out of bed.

Do I need to consider a surgery? Thanks.

Answer by Dr David Mak

Hi Mr. Ong,

There are a few possible causes of lower back pain that you have described. While most commonly the pain generator is likely from the lower (lumbar) spine, it is equally important to investigate properly to make sure there are no concurrent pathologies in the hip, sacro-iliac (pelvis) joints that may result with similar complaints / symptoms.

If you are still seeing your surgeon who did your cervical neuroplasty, please share your symptoms with him/her at your next review appointment.

Depending on the root cause of the pain after proper evaluation (e.g. imaging), typically treatment begins with more conservative measures – for example, therapeutic physiotherapy exercises, pain killers.

Interventions may be considered if symptoms persist or worsen, for example, injections (nerve root injections, trigger point injections etc.), and surgery is usually the last resort of all treatment.

9. Question by Joyce

Dear Dr

I’ve had lower back pain 24/7 ever since I gave birth to my youngest child in 1995. He is my 4th child.

In 1998, I was diagnosed with SLE and till today I attribute my back pain with my lupus because by then I am in pain all over my body most of the time.

Is there any way you can help relieve at least this pain?

Answer by Dr David Mak

Hi Joyce,

You are right, SLE is known to affect joints of our body and hence some patients with SLE may experience long standing back-pain.

The specialist whom you see for your SLE will have a good understanding of how the condition is affecting your whole body. Do discuss your back pain with them at your next review appointment and they can advise whether you would benefit from seeing a spine specialist to check for spinal column instability, as a long standing underlying inflammatory condition such as SLE may weaken the joints of the spine.

10. Question by Michael

Dear Dr Mak, my questions are:

  • What causes back pain?

  • What can be done immediately to manage pain when pain occurs?

  • How to prevent back pain from occurring constantly?

Thank you.

Answer by Dr David Mak

Dear Michael,

There are many causes of back-pain, and the more common causes are:

  • Degenerative related (ageing – wear and tear)

  • Deformity related (could be underlying long standing deformity of the spinal column)

  • Related to other co-existing medical conditions

Most commonly, back-pain could be a result of repetitive stress and strain of the spinal column and its ‘soft tissue’ components (eg spinal muscles, joints and ligaments), and this could be postural related (prolonged sitting or standing during work), or activities related (eg exercises that may predispose to backaches).

Pain killers can be useful for short term relief of sudden exacerbation of back-pain depending on the underlying cause.

Physiotherapy assessment and therapeutic exercises may also help to reduce the chance of back-pain recurrence.

Most importantly, let’s not forget that we should protect our back too, for example, adequate warm up / stretches before exercises. I always recommend my patients to consider bending their knees and hip down together while carrying heavy loads.

As there are many possible causes for backaches. If you experience recurrent back-pain, do see your family doctor for an assessment and they can advise if a referral to a spine specialist is necessary.

11. Question by Debbie

Hi Dr Mak,

I have been having lower back pain every time I sit on the bed for more than 20 minutes since late last year. Every time I stand up from the bed, I realise that I cannot straighten my back immediately and there is an ache at my lower back.

What could be the cause? I am 52 this year and I am very concerned. I went to Polyclinic for an X-ray on 26 December 2023. Although there are no fractures, I still experience aches whenever I sit too long on the bed. Thank you for your advice.

Answer by Dr David Mak

Hi Debbie, do you experience similar back pain when you sit on a chair? I wonder if the back-ache that you’ve described could be related to your posture when you are sitting on the bed

Another issue to take note is whether the mattress is too soft that may not provide a good solid support while you are sitting up on it. These are common causes for back-aches too.

None-the-less I would still advise you to see your polyclinic doctor who can refer you to a spine specialist for a thorough examination and evaluation of your recurrent back symptoms.

12. Question by Debbie

Hi Dr Mak,

I am a 74 year-old lady and have just did my TKR in end August 24. The knee is still stiff though I am on a weekly Physio programme since my discharge from hospital. The stiffness affects my gait and it in turn aggravates my lower left back pain.

The latter has been ongoing for many years and doctors have diagnosed it as age degeneration with a slight curvature to the right. Physio doesn't help much and the pain can be so intense at times that I need to sit down or lie down and stretch. I have been taught some physio techniques by a Sports Physio Therapist but it has to be done by someone. Please advise.

Answer by Dr David Mak

Hi Margaret,

It is not uncommon for patients to have concurrent issues with their knees and back – both due to wear and tear. After the TKR surgery, you may tend to focus more on the back pain as now the knee is not affecting you as much as before.

If your back pain is recurrent, and still affects you even though you have been through physiotherapy exercises for the back, I would advise you to share your back symptoms with the specialist who did your TKR surgery at your next review appointment or to speak to your family doctor. They can refer you to a spine specialist, for a thorough examination and evaluation of your symptoms, as there are various causes of back pain.

13. Question by Beng Khoon

Hi Dr,

I have been suffering from lower back pain for over two years. The pain is worsening when I sit or squat down for some 30 mins and stand up from the sitting or squatting position.

I have been doing physio exercises but the pain seems not improving.

What should I do to improve my situation?

Answer by Dr David Mak

Dear Beng Khoon,

Lower back pain is a common condition that affects many in our population. While there are many causes of lower back pain, treatment typically begins with conservative measures like physiotherapy exercises - stretching, range of movement exercises of the back to offload the stiff muscles and joints. A trial of simple off-the-counter analgesia (painkillers) may also help.

If you have tried physio-exercises and pain does not improve, I would advise that you see your family doctor who can refer you to a spine specialist for a thorough evaluation of the longstanding lower back pain that you are experiencing.

14. Question by Beeny

Dear Dr,

My wife having lower back pain for years. Seeing many doctors and TCM treatment. The condition never improves. She is now 75 years old.

Every night I had to apply Chinese medication oil on her back. Every day she cannot walk straight and bend forward while walking. What can I do now?

Answer by Dr David Mak

Hi Benny, I am sorry to hear that your wife is suffering from lower back pain for many years and it appears that the symptoms are affecting her lifestyle too.

For her age group, there are many possible causes of lower back pain. From your description, her lower back pain could potentially be caused by a spinal deformity from ageing (wear and tear).

I would advise you to bring her to your family doctor for a check-up and referral to a spine specialist for a thorough review, examination and imaging of her long-standing lower back pain.

15. Question by Wong SH

Hi Dr Mak,

I had herniated intervertebral disc when I was younger but did not seek professional treatment. The pain usually subsided after 3 weeks.

Now, some 30 years later, the pain comes back on and off at L4/L5 even though I did nothing to aggravate it. Last recurrence was CNY 2024 till now.

Checked with orthopaedics at TTSH but they said at this age (74 years old) my bones are too brittle to put in metal brackets and screws to support my spine.

a) What can I do to remove the pain when it recurs

b) What can I do to prevent the recurrences?

Answer by Dr David Mak

Thank you for the message, to answer your questions:

a) What can I do to remove the pain when it recurs?

Physiotherapy exercises – for example, lower back stretching, range-of-movement exercises – may help temporarily ease[PME(1]  the stiff spinal muscles, joints of the back and help with the pain. Off-the-counter analgesia may help with the symptoms too. Lifestyle changes may help as well, for example, try not to carry heavy loads and avoid strenuous exercises that involve straining the axial / back muscles.

b) What can I do to prevent the recurrences?

As mentioned above, lifestyle changes and adjustments may help preventing aggravation of symptoms. If your symptoms are persistent or recurrent, I advise that you see your family doctor for a check-up and referral to a spine specialist for further treatment and management of your pain.

16. Question by Walter

Dear Dr,

When sitting and lying down I have chronic back pain. It started a few years ago after a few days fasting. I went to chiropractic who popped the back and stretched it many times, but it doesn’t help.

I do play sports like Padel and futsal and I walk a lot during which I have no pain at all. It’s just annoying as I have a desk job and my feet hurt too much if I have a standing desk. I’m 58 by the way and expect to live quite a bit longer.

I do take tramadol for knee pain (at night and rest) but that doesn’t do anything for the back pain. So far I have not found a pain killer that actually helps and I’d rather do without.

I am also still very flexible so I’m not too worried about that.

Hope you have some suggestions, or I can have it checked somewhere.

Answer by Dr David Mak

Hi Walter, I am glad to know that you are actively doing sports regularly. From your description, I have a few suggestions that may help with your back pain.

First of all, with regard to foot pain from prolonged standing at work, it is not uncommon to see patients with flat-feet suffering from secondary back-pain. Do consider an in-sole support for the shoes you wear to work. A podiatrist will be able to assess your feet and recommend suitable insoles.

There is a possibility of knee pain as a result from frequent straining at sports. You may consider physiotherapy therapeutic exercises for the knee. A temporary break from playing futsal for a few weeks may also help.

Physiotherapy exercises for lower back pain such as lower back stretching and range-of-movement exercises may temporarily off-load the stiff spinal muscles, joints of the back to help with the pain.

Off-the-counter analgesia (painkiller) may help with the symptoms too. Lifestyle changes may help as well. For example, try not to carry heavy loads and avoid strenuous exercises that may strain the axial / back muscles.

However, if your symptoms are persistent or recurrent, I would advise you to see your family doctor for a check-up and referral to a spine specialist if required, for further assessment and evaluation (including imaging) of your symptoms.

17. Question by Walter

Dear Dr. David Mak, 

I have prolapsed disc at L4 and L5 since 30 years ago. I have undergone 3 surgeries over the years with the most recent keyhole surgery being 10 years ago.

So far, there is still manageable pain and weakness at my lower pain.

Is there any electro pulse device that is available to repair the weak muscles, reduce pain or induce muscle strengthening to support the damaged compressed disc that is prone to spasm. Thank you.

Answer by Dr David Mak

Hi Winstorn,

There is a possibility that the affected discs are fairly degenerated by now from prior disc prolapse and surgeries.

Majority of our body’s axial load goes through the front of the lumbar spine (the disc and main body of the spinal segment), however if for example, the discs are degenerated - the overall ability of the spine to support axial loading is not as effective as before, and in exchange the back components of the spine (the ligaments, muscles, joints) may have to work harder to achieve this. When this happens, patients  experience back pain.

Physiotherapy exercises for lower back pain – for example, lower back stretching, range-of-movement exercises – may help temporarily off-load the stiff spinal muscles, joints of the back and help with the pain. Off-the-counter analgesia may help with the symptoms too. Lifestyle changes may help as well, for example, try not to carry heavy loads and avoid strenuous exercises that involves straining the axial / back muscles. If you have to perform such actions, do practise proper lifting habits to protect your back and spine.

However, if your symptoms are persistent or recurrent, I would advise you to see your family doctor for a check-up and referral to a spine specialist if required for a review and evaluation (imaging) of the symptoms.

18. Question by Douglas

Hi Dr David Mak,

I have suffered for low back pain for many years due to scoliosis and lumbar deterioration.

I have consulted private doctor and they have advised my for radiofrequency ablation and nucleoplasty. The costs for this treatment are too expensive for private hospital and he also advised me to consultant government hospital in order to have subsidised rate.

Hope you can advise the procedure in order to get consultation in government hospital.

Answer by Dr David Mak

Hi Douglas,

Thank you for your question. For subsidised specialist care, patients need to be referred to public hospitals by a polyclinic doctor.

For more information on the level of subsidy available for inpatient and outpatient care at public hospitals, please click here.

19. Question by Douglas

Dear Dr,

I'm a 65-year-old female with chronic lower back and leg paint for the last 10 years.

Recently, it got worst. I feel sharp sudden pain at the lower back on the spot next to the spine. My legs are painful, I only can walk on level ground. Going up or down stairs is very painful.

I tried taking Ibuprofen 400mg daily for 7 days, stop when I felt dizzy on 2 occasions. During that week, my leg pain was gone and I could walk comfortably.

After 1 week the pain came back. I took Ibuprofen 200 mg for 2 days, the pain is bearable. The pain comes back 6 days later.

Question: Should I take Ibuprofen once every week to manage the pain? Or should I take Ibuprofen every day till the pain recovers?

Thank you so much if you could answer my query.

Answer by Dr David Mak

Hi Regina,

It seems that your back pain symptoms are affecting your quality of life. While ibuprofen may provide temporary relief of your symptoms, it is not advisable to take this medication regularly for a prolonged duration due to the potential side effects (may affect the stomach and kidneys).

I would strongly recommend that you see your family doctor for a check-up and discuss a referral to a spine specialist for a thorough examination and evaluation (imaging) to find out the cause of the recurrent symptoms and get treatment accordingly. While the leg pain that you have described is most likely related to the back, there is also a possibility that these are two independent problems.

For the time being I would recommend you take ibuprofen as required if there is exacerbation of the symptoms.

20. Question by Koon Ann

医生你好,

2016年开颈脊手術減壓, 2023年颈脊及腰脊MRI 报告正常, 腰及雙脚非常酸痛無力,走路慢不能挺直而且走久更趨向前 ,麻痺及疼痛從髖部兩邊至大小腿內外側,膝蓋关节及腳踝关节非常酸脹。 服用神經科医生開的 Baclofen 10mg / Pregabalin 75mg 不見成效。請問属於什麽病症,什么原因造成,可有其他治療。謝謝!

Answer by Dr David Mak

Hi Koon Ann,

It is reassuring to know that your cervical and lumbar MRIs in 2023 were reported as normal. Although there are many potential causes, the symptoms that you have described could possibly be related to a loss of sagittal balance (the natural position of the head in relation to the pelvis) of the spine. 

This could also explain why analgesia does not help too much with the symptoms. A loss of sagittal balance is typically not evaluated by the MRI scans either. I would advise you to see your family doctor for a check-up and referral to a spine specialist (if required) for a thorough examination, evaluation, and further imaging of your condition.

21. Question by George

Hi Dr,

About 7 years ago I had a muscular back pull and went to NUH and physio. It healed but over the years the back pain keeps coming back even if I lifted a chair in the wrong position. I rub muscular cream each time the pain comes and it goes off after a week.

Need advice on what type of exercise would strengthen the back. Thank You and have a nice day!

Answer by Dr David Mak

Hi George,

Physiotherapists will be able to advise you on exercises for the lumbar spine (lower back). These include lower back stretching and range-of-movement exercises that may help temporarily ease the stiff spinal muscles, joints of the back and eventually reduce the frequency of recurrent back pain.

A trial of core strengthening exercises may also help reduce the chance of worsening back pain in the future.

Simple off-the-counter analgesia may help to manage and prevent worsening back pain.

Lifestyle changes may help as well, for example, try not to carry heavy loads and avoid strenuous exercises that involves straining the axial / back muscles.

However, if your symptoms are persistent or recurrent, I would advise you to see your family doctor for a check-up and referral to a spine specialist if required for further evaluation of your symptoms.

Ref: H24