Written by Dr Ray SH NgIn my current practice, the most common musculoskeletal problem I encounter is back pain.
Lower back pain is certainly the major cause followed by the upper back or neck area and then the middle part of the spine.
Most of the time, patients experience lower back pain not from a single major event but usually from an innocuous situation. For instance, they would tell me about feeling a bit stiff in the lower back for several weeks earlier. This would lead up to a time most recently where they reported lifting up a baby or bending down to pick up a grocery bag and suddenly feeling severe pain out of nowhere. What tends to happen is that due to a series of repetitive micro-traumas, we may not realise that the muscles of the back are being strained or getting inflamed. At some point, a fairly minor trigger can tip us over the pain threshold giving rise to a “sudden onset” of severe pain.
This might have occurred due to repetitive excessive loading of the back due to an imbalance of the muscles around the lower back and pelvis. Some of the patients I see back pain due to the following reasons:
- Postural problems in the office at work or at home.
- Using heavyweights that they have not developed the strength to use in the gym and not getting properly warmed up beforehand. It is important to do stretching exercises post-exercise to reduce the risk of the muscles getting tight which can lead to back pain.
- Being overweight - those people with a large waist circumference ie carrying too much fat around the belly were more likely to strain their lower back.
It would be helpful to assess the person with postural issues and determine how to resolve this as this might help to correct the patient's problem in the long term.
However, prescribing the appropriate painkillers or muscle relaxants could also be useful especially if the patient finds it hard to sleep at night.
The patient could be assessed for their posture alignment and also checked for more serious problems such as a disc herniation. The discs are pads between the bony parts of the spine which allows flexibility of the back. If there is excessive pressure on the pads, this may cause a herniation of the disc pressing onto the spinal nerve. The patient may experience feelings of numbness, pain or loss of power in the legs if the nerve compression is severe enough.
In such a situation, the doctor may decide to arrange an MRI scan and depending on the result, determine whether a course of:
- Biomechanical readjustment of the pelvis
- Gentle muscle massage or spinal manipulation with physiotherapy, chiropractic or osteopathy
- Surgical intervention in severe cases would be required
Overall, it would be better to stay physically active to prevent lower back pain.
Zdziarski (2015) stated that being overweight and leading a sedentary lifestyle produced a vicious circle of further weight gain, fear of moving and worsening pain severity. Wasser (2017) found that specific activities such as weight training, aquatic exercises ie moving against resistance in the water and Pilates-based exercises helped reduce back pain and improved overall quality of life.
Common questions on backpain:
When I get back pain, should I stay in bed and not move at all?
Malmivaara (1995) found in the New England Journal of Medicine that relying on bed rest delayed recovery from back pain. It was better to attempt normal activity as far as possible and keep moving as tolerated. This made sense in terms of reducing muscle stiffness which otherwise exacerbate the back pain.
What is sciatica?
This is a condition whereby you may experience lower back pain alongside pain travelling down one leg. This may move down the buttock, the back of the leg below the knee and possibly reach the toes.
It is due to the sciatic nerve being compressed which travels down from the spine and all the way down the leg.
This may settle down if the symptoms are mild but in more severe cases, it would be appropriate to see the doctor determine if further investigations such as an MRI is needed to check if the disc is pushing on the nerve.
Should I consider wearing a back brace if I have back pain?
It is not recommended to wear a back brace when you first present with back pain as this can lead to increased muscle stiffness and exacerbate the muscle spasms triggering further back pain.
1. Malmivaara, A. et al. The treatment of acute low back pain -- bed rest, exercises, or ordinary activity? (1995) N Engl J Med. ;332(6):351-355.
2. Wasser, J. et al (2017). Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals. PM & R, 9(2), 181-192.
3. Zdziarski LA, Wasser JG, Vincent HK. (2015) Chronic pain management in the obese patient: A focused review of key challenges and potential exercise solutions. J Pain Res;8:63-77