Low back pain is one of the most common musculoskeletal ailments that afflict the population. Are you affected by back pain? In Februrary 2000, the Back Society of Singapore conducted a survey of 1,001 adults aged 15 years and above who were randomly selected and interviewed over the telephone.

The Back Survey showed that over the previous six months prior to the survey, 18% or one in five adults had suffered an episode of neck or back pain. Up to 50% of back pain sufferers had experienced an attack at least once a month or more frequently. Of those afflicted, 10% deemed it serious enough to have taken medical leave, 16% had sought help from a doctor and a further 4% had seen a specialist. Only 4% seeks specialist’s advise and that is a serious problem.

The magnitude of the problem is similar to that in other developed nations. In the United States, United Kingdom and Scandinavia, it is known that back and neck pain constitute one of the major causes of physical disability and is responsible for more visits to the doctor than any other medical condition except common cold.

Common conditions that present as backache

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Musculo-ligament strain

Simple back strain is probably the most common cause of low back pain. The pain is usually mild and of limited duration, often improving with very little treatment or spontaneously within several hours or a day. Back strain is commonly seen in office workers who sit for many hours of the day and then develop a sore back after a long day.

Prolapsed intervertebral disc (PID)

Prolapsed intervertebral disc is one of the most common causes of recurrent back pain in adults between the ages of 20 to 50 years. The history is usually long standing. The pain is typically episodic and mechanical in nature, with long pain-free periods in between attacks. In the early stages, the pain may be localised to the back, but as the prolapse becomes progressively more severe, radicular symptoms may arise. Upper lumbar disc prolapses may present as groin discomfort or pain down the anterior thigh. Lower lumbar prolapses are sometimes associated with the typical sciatica in full-blown cases of root impingement, but in mild cases of root irritation, may present as just vague aching discomfort around the lower leg.

Lumbar spondylosis

Lumbar spondylosis describes the syndrome of disc degeneration coupled with loss of disc height, facet osteoarthritis, and osteophyte formation. The pain associated with lumbar spondylosis is typically facetal in nature, which is worsened on extension of the spine. Spondylotic pain tends to be chronic and may occur even on daily basis. The pain is typically worse in the mornings, and after prolonged standing or walking.

Spinal canal stenosis

Spinal canal stenosis is a condition in which part or all of the entire spinal canal stenosed. Symptomatic stenosis typically occurs in patients in the fifth to seventh decades of life. Degenerative spondylolisthesis has been found to be four times more common in women. Most patients report a long history of intermittent back pain with progressively leg symptoms, which are typically worsened by walking or standing and relieved by sitting or squatting. This is referred to as neurogenic claudication.

Isthmic spondylolisthesis

Isthimic spondylolisthesis occurs in approximately 5% of the population. Patients typically present with a long history of musculo-ligamentous strain, which eventually develops in many cases to eventual sciatica or neurogenic claudication as a result of progression of the spondylolisthesis.

Miscellaneous

There are of course many other causes of back pain, including ankylosing sponylitis, metastatic spine disease from cancers such as colon, breast and lung; primary tumours both benign and malignant; and spine infections such as tuberculosis. In such cases, the back pain tends to be more constant and progressive, and may be associated with other systemic symptoms.

Red flags

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Certain symptoms are “red flags” and when present, early medical attention is advised.

• Back pain that is constant rather than episodic, with no significant relief even at rest
• Back pain that is aggravated by bending in all directions, rather than worsen in mainly one direction of movement
• Severe pain localisable to a single spot or focus on the back
• Pain that is progressively severe over days or weeks
• Back pain associated with persistent “nerve pains”, ie, pains or sensations of numbness, pins and needles, aching in one or both legs, that do not go away even with rest or treatment
• Symptoms of weakness of the legs, difficulty in walking, unsteady walking
• Symptoms of bladder or bowel problems that are associated with the back pain, such as difficulty in passing urine, or incontinence

Specialist Orthopaedic Surgeon – Dr. Kevin Yip Featured in Channel NewsAsia:

The magnitude of the problem is similar to that in other developed nations. In the United States, United Kingdom and Scandinavia, it is known that back and neck pain constitute one of the major causes of physical disability and is responsible for more visits to the doctor than any other medical condition except for the common cold.

Common Conditions that Present as Backache

• Musculo-ligamentous strain
• Prolapsed intervertebral disc (PID), Channel NewsAsia Featuring Dr. Kevin Yip
• Lumbar spondylosis
• Spinal canal stenosis
• Isthmic spondylolisthesis

Symptoms of Lower Back Pain

• Muscle ache
• Shooting or stabbing pain
• Pain that radiates down your leg
• Limited flexibility or range of motion of your back
• Inability to stand straight