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.

Ref: H24