Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Back Pain

The most common site of back pain is the lower back or lumbar region. The lower back bears the weight of the upper body plus any weight that is carrying. It also twists and bends more than the upper back. The following factors can increase the risk for back problems:

1. Ageing. Discs begin gradual deterioration by age 30
2. Sedentary lifestyle. Lack of exercise leads to muscle inflexibility; weak back & stomach muscles and obesity.
3. Poor posture
4. Obesity
5. Genetic factors
6. Work that stresses the back
7. Improper body mechanics
8. Pregnancy
9. Smoking
10.Psychological factors

Evaluation of back pain includes medical history; thorough physical examination and imaging study or blood tests.

– X-rays show bone alignment and the presence of degenerative joint disease, tumors, infection or injury in some cases.
– Magnetic resonance imaging (MRI) reveals conditions involving the soft tissues e.g. herniated discs or detect non-spinal causes of back pain, including infection and cancer.

Bone scan detects bone tumors or compression fractures caused by osteoporosis.

Electrodiagnostic studies can confirm nerve compression caused by herniated discs or stenosis.

Blood and urine samples may be used to test for infections or arthritis.

You can prevent back problems with the following measures:

– Get regular aerobic exercise (e.g. swimming). Exercise increases back and abdominal muscle strength and flexibility, which helps support and align your back, and minimizes back injury. Flexibility in the hips and upper legs allows for correct pelvic bone alignment.
– Choose an exercise level suited to your fitness level, and do gentle warm-up stretches before and after exercising.
– Use proper body mechanics:

* . Standing. Maintain a neutral pelvic position, and avoid rounding your back. Avoid hunching your shoulders and tensing your neck. Wear comfortable and low-heeled shoes.
* . Sitting. Use a seat with good lower back support. Keep your knees and hips level.
* . Lifting. Hold the load close to your body, keep your back straight and bend at the knees. Let your legs take most of the strain. Avoid lifting and twisting simultaneously.

– Lose weight. If you are more than 10 percent over your ideal body weight, lose weight through healthy diet and aerobic exercise.
– Sprains, strains and minor injuries, usually after lifting a heavy object or making an abrupt movement.
A strain or tear to the muscles, tendons or ligaments.

Herniated disc.

Facet joint problems and osteoarthritis.

Other causes: abscesses, blood clots and tumors and can result from problems in other organs such as gastric ulcers, kidney problems, pancreatitis, inflammatory bowel disease, pregnancy, menstruation and ovarian cysts. In older people, low back pain may be a sign of Paget’s disease or Parkinson’s disease.

Eighty to 90 percent of back pain resolves within six weeks. Treatments include


Medications can reduce muscle and joint inflammation

Alternating heat and cold application can help relieve sore and inflamed back muscles. Immediately after back pain starts up, try applying ice compresses several times a day, up to 20 minutes each time. After spasms and acute pain subside, apply heat for up to 20 minutes to help loosen tight muscles.

Back braces, corsets and belts can relieve strain and support your back temporarily
– Lie down in a comfortable position at the onset of back pain. When the pain lessens:
. try to get moving again as soon as possible and increase your activity levels gradually
. try not to stay in one position or do any activity for more than 30 minutes at a time
. avoid lifting, bending or twisting until you have been pain-free for a few days
.
avoid the activity which caused the pain

Healthy sleep is important in recovery. Try lying in a fetal position with a pillow between your knees, or lying on your back with a pillow under your knees. Avoid caffeine and try having a warm bath before bedtime.

Corticosteroid injections for more severe back pain.
– Physical therapy may include:
. Heat and cold applications
.
Massage

Hydrotherapy and exercises in swimming pool.

Exercise. Once the pain subsides, exercise to improve muscle strength, flexibility and posture.

Relaxation can loosen tense muscles and ease pain

Transcutaneous electrical nerve stimulation

Only 2% of back pain investigation results in a back operation. Surgery is indicated for unrelenting pain or progressive muscle weakness caused by nerve compression, or incontinence. Laminectomy aims to relieve sciatica by removing bone spurs or disc fragments that protrude into the spinal canal or press on nerve roots. Fusion involves joining two vertebrae with a metal implant and bone graft to eliminate painful movement.

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