Lower Back Pain
Lower Back Pain Clinic
By Neurosurgery Singapore
What is Lower Back Pain?
Most acute lower back pain (LBP) results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain. The pain is more likely to be due to issues with the lumbar disks, nerves, joints or vertebrae. The lower back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the region are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in that area supply sensation and power the muscles in the pelvis, legs, and feet. Many spinal structures, including discs, muscles, ligaments, and others, share a significant overlap in nerve supply. As a result, it can be challenging for the brain to precisely identify the source of pain in the lower back. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not.What are some symptoms of Lower Back Pain?
The main symptom is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs. Sometimes, it may also affect arms and legs. It can last for a short time (acute), a little longer (sub-acute) or a long term (chronic). Some spine condition can cause pain in other parts of the body, depending on which nerves are affected. Minor pain often goes away without treatment, but if it occurs with any of the following symptoms you should see our spine pain doctor:- persistent sharp pain (from back to lower body)
- weight loss
- fever
- inflammation or swelling on the back
- persistent pain, where lying down or resting does not help
- sensation feeling down the legs
- pain that reaches below the knees
- a recent injury, blow or trauma to the back
- urinary incontinence
- difficulty urinating
- fecal incontinence, or loss of control over bowel movements
- numbness around the genitals
- having numbness around the anus
- experiencing numbness around the buttocks
“The kind of pain in lower back that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes it can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, the sensation may run from the buttock down one leg. This is called sciatica.”
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What are the causes of lower back pain?
There are a wide range of factors, including mechanical issues, injuries, medical conditions, aging and lifestyle factors, can cause these. Here are some common causes:
- Muscle Strain or Sprain: Overstretching or tearing of muscles or ligaments in the lower back due to lifting heavy objects, sudden movements, or poor body mechanics.
- Herniated Disc (Slipped Disc): The soft inner material of a spinal disc protrudes through its outer layer and can press on nearby nerves, causing pain and discomfort.
- Degenerative Disc Disease: Wear and tear on the spinal discs over time can lead to reduced cushioning between vertebrae, resulting in pain and stiffness.
- Spinal Stenosis: The narrowing of the spinal canal, which can put pressure on the spinal cord and nerve root, causing pain, numbness, and weakness.
- Osteoarthritis: The breakdown of cartilage in the joints of the spine can lead to pain, inflammation, and reduced range of motion.
- Spondylolisthesis: A condition where one vertebra slips forward over another, often causing nerve compression and lower back pain.
- Sciatica: Compression or irritation of the sciatic nerve, which runs from the lower back down the legs, can cause pain, numbness, and tingling that radiates down the leg.
- Ankylosing Spondylitis: A chronic inflammatory condition that primarily affects the spine, causing pain and stiffness, especially in the lower back.
- Muscle Imbalances: Weak or tight muscles in the back, abdomen, or hips can lead to postural issues and pain in lower back.
- Ligament Sprain: Injuries to the ligaments that support the spine, often due to sudden movements or trauma.
- Fractures: Broken vertebrae, usually caused by osteoporosis, trauma, or conditions that weaken the bones.
- Poor Posture: Slouching, sitting for prolonged periods, or using improper body mechanics can lead to such pain.
It’s important to note that the causes of pain can vary from person to person, and sometimes multiple factors may contribute to the pain.
What types of diagnosis?
Our Spine Specialist will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. A physical exam can also determine if the problem is affecting your range of motion.
Our doctor may also check your reflexes and your responses to certain sensations. This determines if your condition is affecting your nerves.
Imaging tests such as X-rays, CT scans, ultrasounds, and MRIs may be necessary so our Specialist can check for:
- bone problems – alignment and structure
- disc problems – sciatica nerve
- problems with the ligaments and tendons in your back
If our backbone specialist suspects a problem with the strength of the bones in your back, they may order a bone scan or bone density test.
Understanding Lower Back Pain nerve related issues
Thoracic Nerves (T1 – T5)
- Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
- Arm and hand function is usually normal.
- Injuries usually affect the trunk and legs(also known as paraplegia).
Thoracic Nerves (T6 – T12)
- Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
- Usually results in paraplegia
- Normal upper-body movement
- Fair to good ability to control and balance trunk while in the seated position
- Should be able to cough productively (if abdominal muscles are intact)
- Little or no voluntary control of bowel or bladder but can manage on their own with special equipment
Lumbar Nerves (L1 – L3) & (L4 – L5)
- Injuries generally result in some loss of function in the hips and legs.
- Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
- Depending on strength in the legs, may need a wheelchair and may also walk with braces
Sacral Nerves (S1 – S5)
- Injuries generally result in some loss of functioning the hips and legs.
- Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
- Most likely will be able to walk
Possible treatment options?
The treatment depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment. Bed rest isn’t recommended.
Pain Management
Our Back Pain Specialist Doctor might recommend the following:
- Pain relievers. Nonsteroidal anti-inflammatory drugs. For more severe pain, our doctor may prescribe stronger pain medications.
- Muscle relaxants. If condition doesn’t improve with relievers, our doctor might also prescribe a muscle relaxant.
- Topical pain relievers. These are creams, salves or ointments you rub into your skin at the site to relieve lower back pain.
- Antidepressants. Low doses of certain types of antidepressants have been shown to relieve some types of chronic issue independent of their effect on depression.
- Wearable Devices: Devices such as lumbar support belts, posture-correcting braces, and activity trackers can help improve posture, reduce strain on the lower back, and monitor activity levels to prevent exacerbation of pain.
- Injections. If other measures don’t relieve your condition, and if it radiates down your leg, our Spine Specialist may inject an anti-inflammatory medication or numbing medication into the space around your spinal cord (epidural space).
- Diet Management. Some diets are highly inflammatory. Our doctor may advise if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help lessen your back pain by reducing the pressure on your spine.
- Heat and Cold Therapy: Applying heat or cold packs to the affected area can help reduce inflammation and provide temporary relief.
- Posture Improvement: Good posture can help prevent and alleviate pain. Our doctor or physio can guide you to maintain a good posture for different actions.
- Stress Reduction: Stress can contribute to muscle tension and exacerbate lower back pain. Techniques such as deep breathing exercises can help reduce stress and alleviate pain.
Physical therapy and exercise
Our physical therapist at our spine clinic can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain.
As condition improves, the therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. These may include stretches for lower back pain.
These may include:
- Retraining your posture
- Testing the limits of pain tolerance
- Stretching and flexibility exercises
- Aerobic exercises
- Core strengthening
- Deep breathing exercises
Surgical treatments
Few people need surgery. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, spinal surgeries usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn’t responded to other therapy.
