Lower Back Pain

Patient Education Spine Conditions Lower Back Pain

 Stop your Back Pain today. Effective Treatment, Non Surgery. Discuss with our Spine Specialist for the Diagnosis, Treatment and Prognosis of your Back Pain. Call us +65 97731458 to schedule for an appointment.

Low back pain refers to pain that you feel in your lower back. You may also have back stiffness, decreased movement of the lower back, and difficulty standing straight.

Acute back pain can last for a few days to a few weeks.

Causes of Low Back Pain

Most people will have at least one backache in their life. Although this 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. There are many things you can do to lower your chances of getting 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.

Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments.

Lower Back Pain

Causes of sudden low back pain include:

  • Compression fractures to the spine from osteoporosis
  • Cancer involving the spine
  • Fracture of the spinal cord
  • Muscle spasm (very tense muscles)
  • Ruptured or herniated disk
  • Sciatica
  • 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 may also be due to:

  • An abnormal aortic aneurysm that is leaking
  • Arthritis conditions, such as osteoarthritis, psoriatic arthritis, and rheumatoid arthritis
  • Infection of the spine (osteomyelitis, diskitis, abscess)
  • Kidney infection or kidney stones
  • Problems related to pregnancy
  • Medical conditions that affect the female reproductive organs, including endometriosis, ovarian cysts,ovarian cancer, or uterine fibroids

Symptoms of Low Back Pain

You may feel a variety of symptoms if you’ve hurt your back. You may have a tingling or burning sensation, a dull achy feeling, or sharp pain. Depending on the cause and severity, you also may have weakness in your legs or feet.

Low back pain can vary widely. The pain may be mild, or it can be so severe that you are unable to move.

Depending on the cause of your back pain, you may also have pain in your leg, hip, or the bottom of your foot.

Diagnosis of Low Back Pain

When you first see your health care provider, you will be asked questions about your back pain, including how often it occurs and how severe it is.

Your health care provider will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. Most of the time, back pain will get better using these approaches.

During the physical exam, your health care provider will try to pinpoint the location of the pain and figure out how it affects your movement.

Most people with back pain improve or recover within 4 – 6 weeks. Therefore, your health care provider will probably not order any tests during the first visit unless you have certain symptoms.

Tests that might be ordered include:

  • CT scan of the lower spine
  • MRI of the lower spine
  • X-ray

Treatment of Lower Back Pain

Minor low back pain will improve after resting for a day or two.

Other treatments for your low back pain includes:

  • Anti-inflammatory and Muscle Relaxant Medicines
  • Back Support
  • Physiotherapy. Strengthening to your back muscles
  • Epidural injection
  • Spinal manipulation
  • Back surgery for disc problem that may lead to nerve problem

When to see a Spine Specialist

Consult a Spine Specialist right away if you have:

  • Back pain after a severe blow or fall
  • Burning with urination or blood in your urine
  • History of cancer
  • Loss of control over urine or stool (incontinence)
  • Pain traveling down your legs below the knee
  • Pain that is worse when you lie down or that wakes you up at night
  • Redness or swelling on the back or spine
  • Severe pain that does not allow you to get comfortable
  • Unexplained fever with back pain
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis

Prevention of Lower Back Pain

Exercise is important for preventing back pain. Through exercise you can:

  • Improve your posture
  • Strengthen your back and improve flexibility
  • Lose weight
  • Avoid falls

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 you 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 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 prevent back pain include:

  • Avoid standing for long periods of time. If you must stand 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 an 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.
  • Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.

Read more about SPINE AND ORTHOPAEDIC CENTRE SINGAPORE

 Stop your Back Pain today. Effective Treatment, Non Surgery. Discuss with our Spine Specialist for the Diagnosis, Treatment and Prognosis of your Back Pain. Call us +65 97731458 to schedule for an appointment.

Spondylolisthesis

Patient Education Spine Conditions Lower Back Pain
What is Spondylolisthesis?

Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra. Forward slippage of one vertebra on another is referred to as anterolisthesis, while backward slippage is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of the spine as well as a narrowing of the spinal canal (central spinal stenosis) or compression of the exiting nerve roots (foraminal stenosis).

What are the Causes of Spondylolisthesis?

There are five major types of lumbar spondylolisthesis.

  1. Dysplastic spondylolisthesis: Dysplastic spondylolisthesis is caused by a defect in the formation of part of the vertebra called the facet that allows it to slip forward. This is a condition that a patient is born with (congenital).
  2. Isthmic spondylolisthesis: In Isthmic spondylolisthesis, there is a defect in a portion of the vertebra called the pars interarticularis. If there is a defect without a slip, the patient has spondylolysis. Isthmic spondylolisthesis can be caused by repetitive trauma and is more common in athletes exposed to hyperextension motions including gymnasts, and football linemen.
  3. Degenerative spondylolisthesis: Degenerative spondylolisthesis occurs due to arthritic changes in the joints of the vertebrae due to cartilage degeneration. Degenerative spondylolisthesis is more common in older patients.
  4. Traumatic spondylolisthesis: Traumatic spondylolisthesis is due to direct trauma or injury to the vertebrae. This can be caused by a fracture of the pedicle, lamina or facet joints that allows the front portion of the vertebra to slip forward with respect to the back portion of the vertebra.
  5. Pathologic spondylolisthesis: Pathologic spondylolisthesis is caused by a defect in the bone caused by abnormal bone, such as from a tumor.

What are the Risk Factors of Spondylolisthesis?

Risk factors for spondylolisthesis include a family history of back problems. Other risk factors include a history of repetitive trauma or hyperextension of the lower back or lumbar spine. Athletes such as gymnasts, weight lifters, and football linemen who have large forces applied to the spine during extension are at greater risk for developing isthmic spondylolisthesis.

What are the symptoms of Spondylolisthesis?

The most common symptom of spondylolisthesis is lower back pain. This is often worse after exercise especially with extension of the lumbar spine. Other symptoms include tightness of the hamstrings and decreased range of motion of the lower back. Some patients can develop pain, numbness, tingling or weakness in the legs due to nerve compression. Severe compression of the nerves can cause loss of control of bowel or bladder function, or cauda equina syndrome.

How is Spondylolisthesis diagnosed?

In most cases it is not possible to see visible signs of spondylolisthesis by examining a patient. Patients typically have complaints of pain in the back with intermittent pain to the legs. Spondylolisthesis can often cause muscle spasms, or tightness in the hamstrings.

Spondylolisthesis is easily identified using plain radiographs. A lateral X-ray (from the side) will show if one of the vertebra has slipped forward compared to the adjacent vertebrae. Spondylolisthesis is graded according the percentage of slip of the vertebra compared to the neighboring vertebra.

  1. Grade I is a slip of up to 25%,
  2. grade II is between 26%-50%,
  3. grade III is between 51%-75%,
  4. grade IV is between 76% and 100%, and
  5. Grade V, or spondyloptosis occurs when the vertebra has completely fallen off the next vertebra.

If the patient has complaints of pain, numbness, tingling or weakness in the legs, additional studies may be ordered. These symptoms could be caused by stenosis or narrowing of the space for the nerve roots to the legs. A CT scan or MRI scan can help identify compression of the nerves associated with spondylolisthesis. Occasionally, a PET scan can help determine if the bone at the site of the defect is active. This can play a role in treatment options for spondylolisthesis as described below.

What is the treatment of Spondylolisthesis?

The initial treatment for spondylolisthesis is conservative and based on the symptoms.

  • A short period of rest or avoiding activities such as lifting and bending and athletics may help reduce symptoms.
  • Physical therapy can help to increase range of motion of the lumbar spine and hamstrings as well as strengthen the core abdominal muscles.
  • Anti-inflammatory medications can help reduce pain by decreasing the inflammation of the muscles and nerves.
  • Patients with pain, numbness and tingling in the legs may benefit from an epidural injection.
  • Patients with isthmic spondylolisthesis may benefit from a hyperextension brace. This extends the lumbar spine bringing the two portions of the bone at the defect closer together and may allow for healing to occur.

For patients whose symptoms fail to improve with conservative treatment surgery may be an option. The type of surgery is based on the type of spondylolisthesis. Patients with isthmic spondylolisthesis may benefit from a repair of the defective portion of the vertebra, or a pars repair. If an MRI scan or PET scan shows that the bone is active at the site of the defect it is more likely to heal with a pars repair. This involves removing any scar tissue from the defect and placing some bone graft in the area followed by placement of screws across the defect.

If there are symptoms in the legs the surgery may include a decompression to create more room for the exiting nerve roots. This is often combined with a fusion that may be performed either with or without screws to hold the bone together. In some cases the vertebrae are moved back to the normal position prior to performing the fusion, and in others the vertebrae are fused where they are after the slip. There is some increased risk of injury to the nerve with moving the vertebra back to the normal position.

Can Spondylolisthesis be prevented?

Spondylolisthesis cannot be completely prevented. Certain activities such as gymnastics, weight-lifting and football are known to increase the stress on the vertebrae and increase the risk of developing spondylolisthesis.

What are the complications of Spondylolisthesis?

Complications of spondylolisthesis include chronic pain in the lower back or legs, as well as numbness, tingling or weakness in the legs. Severe compression of the nerve can cause problems with bowel or bladder control, but this is very uncommon.

What is the prognosis for Spondylolisthesis?

The prognosis for patients with spondylolisthesis is good. In most cases patients respond well to a conservative treatment plan. For those with continued severe symptoms, surgery can help alleviate the leg symptoms by creating more space for the nerve roots. The back pain can be helped through a lumbar fusion.

Herniated Disc / Slipped Disc

Patient Education Spine Conditions Lower Back Pain

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What is Herniated Disc / Slipped Disc?

Your spinal column is made of up 26 bones (vertebrae) that are cushioned by disks. The discs protect the bones by absorbing the shocks from daily activities like walking, lifting, and twisting.

Each disc has two parts a soft, gelatinous inner portion and a tough outer ring. Injury or weakness can cause the inner portion of the disc to protrude through the outer ring. This is known as a slipped or herniated disc. This causes pain and discomfort. If the slipped disc compresses one of your spinal nerves, you may also experience numbness and pain along the affected nerve. In severe instances, you may require surgery to remove or repair the slipped disc.

Slip Disc

What are the symptoms of Herniated Disc / Slipped Disc?

You can have a slipped disc in any part of your spine, from your neck to your lower back. The lower back is the most common area for slipped discs. Your spinal column is an intricate network of nerves and blood vessels. A slipped disc can place extra pressure on the nerves and muscles around it.

Symptoms of a slipped disc include:

  • pain and numbness, most commonly on one side of the body
  • pain that extends to your arms or legs
  • pain that worsens at night
  • pain that worsens after standing or sitting
  • pain when walking short distances
  • unexplained muscle weakness
  • tingling, aching, or burning sensations in the affected area

The types of pain can vary from person to person. Please consult a Spine Specialist if your pain results in numbness or tingling that affects your ability to control your muscles.

What causes Herniated Disc / Slipped Disc?
A slipped disc occurs when the outer ring becomes weak or torn and allows the inner portion to slip out. This can happen with age. Certain motions may also cause a slipped disk. A disc can slip out of place while you are twisting or turning to lift an object. Lifting a very large, heavy object can place great strain on the lower back, resulting in a slipped disc. If you have a very physically demanding job that requires a lot of lifting, you may be at increased risk for slipped discs.
Overweight individuals are also at increased risk for a slipped disc because their discs must support the additional weight. Weak muscles and a sedentary lifestyle may also contribute to development of a slipped disc.
People who are 35 to 45 years old are more likely to have a slipped disc. This is because your discs begin to lose some of their protective water content as you age. As a result, they can slip more easily out of place. They are more common in men than women.

What are the effect of the Herniated Disc / Slipped Disc?

An untreated, severe slipped disc can lead to permanent nerve damage. In very rare cases, a slipped disc can cut off nerve impulses to the cauda equina nerves in your lower back and legs. If this occurs, you may lose bowel or bladder control.

Another long-term complication is known as saddle anesthesia. In these cases, the slipped disc compresses nerves and that causes you to lose sensation in your inner thighs, the back of your legs, and around your rectum.

While a slipped disc’s symptoms may improve, they also can worsen. If you cannot perform the activities you once could, it is time to see a spine specialist.

How are Herniated Disc / Slipped Disc diagnosed?

Our spine specialist will first perform a physical exam. He will be looking for the source of your pain and discomfort. This will involve checking your nerve function and muscle strength, and whether you feel pain when moving or touching the affected area. Our spine specialist also will ask you about your medical history and your symptoms. He will be interested in when you first felt symptoms and what activities cause your pain to worsen.

Imaging tests can help the Doctor view the bones and muscles of your spine and identify any damaged areas. Examples of imaging scans include:

  • X-rays
  • CT scans
  • MRI scans

Our spine specialist can combine all these pieces of information to determine what is causing your pain, weakness, or discomfort.

How are Herniated Disc / Slipped Disc treated?

Treatments for a slipped disc range from conservative to surgical. The treatment typically depends on the level of discomfort you are experiencing and how far the disc has slipped out of place.

Most patients can relieve slipped disc pain using an exercise program that stretches and strengthens the back and surrounding muscles. A physical therapist may recommend exercises that can strengthen your back while reducing your pain.

Taking some anti-inflammatory medicines and avoiding heavy lifting and painful positions can also help.

While it may be tempting to refrain from all physical activity while you are experiencing the pain/discomfort of a slipped disc, this can lead to muscle and joint stiffness. Instead, try to remain as active as possible through stretching or low-impact activities such as walking.

If your slipped disc pain does not respond to over-the-counter treatments, our spine specialist may prescribe stronger medications. These include:

  • muscle relaxers to relieve muscle spasms
  • narcotics to relieve pain
  • nerve pain medications like gabapentin or duloxetine

Our spine specialist may recommend surgery if your symptoms do not subside in six weeks or if your slipped disc is affecting your muscle function. Our surgeon may simply remove the damaged or protruding portion of the disc without removing the entire disc. This is called a microdiscectomy.

In more severe cases, our surgeon may replace the disc with an artificial one or remove the disc and fuse your vertebrae together. This procedure, called a laminectomy, adds stability to your spinal column.

Is it possible to prevent a Herniated Disc / Slipped Disc?

It may not be possible to prevent a slipped disc, but you can take steps to reduce your risk of developing a slipped disc. Those steps include:

  • Use safe lifting techniques: Bend and lift from your knees, not your waist.
  • Maintain a healthy weight.
  • Do not remain seated for long periods; get up and stretch periodically.
  • Do exercises to strengthen the muscles in your back, legs, and abdomen.

What is the prognosis for someone with a Herniated Disc / Slipped Disc?

Most people with a slipped disc will respond well to conservative treatment. Within six weeks their pain and discomfort will gradually lessen.

Stop your Back Pain today. Effective Treatment, Non Surgery. Discuss with our Spine Specialist for the Diagnosis, Treatment and Prognosis of your Slipped Disc. Call us +65 97731458 to schedule for an appointment.

Lower Back Strain

The most common low back injuries are strains, in which lower back muscles or tendons are stretched or torn.

What is Low Back Strain?

The back is made up of bones (vertebrae) of the spinal column, disks between these bones, the spinal cord (which contains nerves), and muscles, tendons, and ligaments. Muscles in the back and belly (abdomen) help support the spine. The lower back (lumbar spine) supports most of the body weight and helps with moving, twisting, and bending. The most common low back injuries are strains, in which lower back muscles or tendons are stretched or torn. Tendons are tough bands of tissues connecting muscles and bones. Anyone can have a low back strain. Athletes, especially football players and gymnasts, are more likely to strain in practice than during competition.

What causes Low Back Strain?

Causes include activities that stress the lower back, such as stretching, bending, improper lifting, too much pulling (weight-lifting), or twisting (basketball, baseball, golf). Playing sports without stretching or warming up back muscles can lead to strains. Other causes are poor conditioning, obesity, smoking, coughing hard, emotional stress, falling, and trauma.

What are Symptoms or Low Back Strain?

Symptoms include sudden lower back pain that becomes worse with activities (bending, stretching, coughing, sneezing). Painful and stiff back, painful buttocks and legs, and lower back spasms are others.

How is Low Back Strain diagnosed?

Diagnosis result from taking a medical history, doing a physical, and maybe doing x-ray studies. Computed tomography (CT) or magnetic resonanse imaging (MRI) may be done if clearer pictures of bones, nerves, or disks between the bones are needed.

A study using electric current, called electromyography (EMG), helps diagnose muscle problems and may be done.

How is Low Back Strain treated?

Treatment involves rest, ice, heat, medicines, and physiotherapy. People should rest for a day or two, but then light physical activity should be started. Apply heat to the back but only after 2 to 3 days of using ice first, after the swelling has gone. Electric heating pads, hot water bottles, or soaking in a hot bath would work. Medicines include muscle relaxants and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain. Physical therapy and exercises can help strengthen muscles in the abdomen and can stretch and strengthen lower back muscles during and after healing.