Orthopaedic Surgeon Dr. Kevin Yip

What is arthroscopic knee surgery (keyhole surgery)?

It is usually a day case surgical procedure in which the inside of the knee is examined with a camera inserted through small cuts in the skin (usually one cut on each side of the knee cap). In most cases, performing the corrective surgery at the same time can solve the problem. In some cases further operation may be required.

Orthopaedic Surgeon Dr. Kevin Yip
Orthopaedic Surgeon Dr. Kevin Yip

When should I have an arthroscopy?

In the majority of cases, surgery for torn ACL (Anterior Cruciate Ligament), torn meniscus, removal of a loose piece of bone, biopsy and articular cartilage lesions can be performed using special instruments. The advantage of arthroscopic surgery over conventional surgery is less pain and usually quicker recovery.

Investigation required before surgery

At times, clinical examination would be sufficient to identify the problem. However, sometimes we may need to do some investigation to ascertain the root cause.

  • a magnetic scan (MRI) to ascertain the problem affecting the knee.
  • an x-ray of the knee joint may be needed.
  • in some cases a simple blood test and ECG (tracing of heart) may be required.
Back Pain During Pregnancy

The majority of musculoskeletal problems that arise during pregnancy can be prevented and treated with physiotherapy. Individualised physical therapy programs have been found to be more effective than group sessions for the reduction of pain and sick leave caused by back pain in pregnancy. Individualised session’s should include exercise therapy, postural training/advice, and ergonomics recommended once weekly over a 5 week period.

The 2003 joint statement of the Society of Obstetrician and and Gynaecologists (SOGC) and the Canadian Society of Exercise Physiology (CSEP) regarding exercise during pregnancy recommended resistance exercise in addition to aerobic exercise for pregnant women. “Women and their care providers should consider the risks of not participating in exercise activities during pregnancy, including loss of muscular and cardiovascular fitness, excessive maternal weight gain, higher risk of gestational diabetes or pregnancy-induced hypertension, development of varicose veins and deep vein thrombosis, a higher incidence of physical complaints such as dyspnea or low back pain and poor psychological adjustment to the physical changes of pregnancy.” (Wolfe et al 2003).

Back Pain During Pregnancy
Back Pain During Pregnancy

Pregnancy related problems that benefit with physiotherapy & exercises

The most common are musculoskeletal problems like back & pelvic girdle pain (approx. 50% prevalence in pregnancy [Britt et al 2004], thoracic pain and nerve compression syndromes (e.g. carpal tunnel, ulnar nerve neuritis, de Quervain’s tenosynovitis).

Pelvic girdle pain and back pain

According to Artal et al (2008) most of the musculoskeletal problems that pregnant women experience are related to the altered postures. Whilst it may not be possible to stop this process from occuring, it is possible to minimise these maladaptive postures. With posture advice and strengthening of the core muscles, the weakened structural integrity can be somewhat restored. This helps reduce or eliminate many of the common discomforts associated with pregnancy and improve postpartum recovery, particularly those associated with back problems (Artat et al 2008, Hammer et al 2000).

Nerve pathologies

Exercises to mobilise the nerves within nervous system can also be advised for women with nerve compression.

How does the doctor assess whether physiotherapy suits me?

Our doctor who specialise in back pain issues associated with pregnancy can recommend exercises for pregnant and post-partum women after an assessment which generally consists of an analysis of the following:

  • Joint mobility and symmetry
  • Muscle imbalances and strengths
  • Neurological evaluation
  • Evaluation of functional limitations
Physiotherapy treatment techniques in addition to exercise commonly include:
  • Pain management
  • Techniques to aid joint and soft tissue flexibility
  • Recommendations for sleeping and resting postitions
  • Posture correction and ergonomic advice
  • Postpartum rehabilitation

Call +65 64712674 for an appointment today to solve your back pain and enjoy pregnancy!

Back Pain During Pregnancy

Lower Back Pain During Pregnancy

Back Pain During Pregnancy
Back Pain During Pregnancy

Back pain or discomfort is common during pregnancy and should be expected to some degree by most women. Back pain may be experienced during any point of your pregnancy; however, it most commonly occurs later in the pregnancy as the weight of the baby increases. Back pain can disrupt your daily routine or interfere with a good night of sleep. The good news is there are steps you can take to manage the back pain that you experience.

How Common is Back Pain During Pregnancy?

You are not alone if you are experiencing back pain during your pregnancy. The prevalence varies with reports, showing between 50 to 70 percent of all pregnant women having back pain.

What Causes Back Pain During Pregnancy?

Back pain during pregnancy is related to a number of factors. Some women begin to experience lower back pain with the onset of pregnancy.  Women who are most at risk for back pain are those who are overweight or had back pain prior to pregnancy. Here is a list of potential causes of back pain or discomfort during pregnancy:

  • Increase of hormones – hormones released during pregnancy allow ligaments in the pelvic area to soften and the joints to become looser in preparation for the birthing process of your baby; this shift in joints and loosening of ligaments may affect the support your back normally experiences
  • Center of gravity – your center of gravity will gradually move forward as your uterus and baby grow, which causes your posture to change
  • Additional weight – your developing pregnancy and baby create additional weight that your back must support
  • Posture or position – poor posture, excessive standing, and bending over can trigger or escalate the pain you experience in your back
  • Stress – stress usually finds the weak spot in the body, and because of the changes in your pelvic area, you may experience an increase in back pain during stressful periods of your pregnancy

How can you prevent or minimize back pain during pregnancy?

Back pain may not be prevented completely, but there are things that you can do to reduce the severity or frequency. Here are a few steps you can take to help reduce the back pain you are experiencing:

  • Use exercises that we taught you that support and help strengthen the back and abdomen
  • Squat to pick up something versus bending over
  • Avoid high heels and other shoes that do not provide adequate support
  • Avoid sleeping on your back
  • Wear a support belt under your lower abdomen
  • Get plenty of rest. Elevating your feet is also good for your back

How can you treat back pain during pregnancy?

There are a number of things you can do to treat back pain during pregnancy. Some of the steps you take to avoid back pain may also be used to treat current back pain. Here are some other common interventions:

  • Ice or heat
  • Braces or support devices
  • Sleep on your left side and use a support pillow under your knees
  • Medications used to treat inflammation

When to contact your health care provider?

You want to contact us if you are experiencing any of the following:

  • Severe back pain
  • Increasingly severe or abrupt-onset of back pain

Your Next Steps:

  • Begin an approved exercise program to support your back and abdomen
  • Set aside a couple of times a day where you can take a nap or get off your feet
  • Purchase a support belt
  • Purchase a sleep aid pillow
Lower Back Pain

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

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.


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

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

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

Back pain that lasts from a few days to a few weeks is considered acute. Pain that lasts for three months or longer is considered chronic.

When to see our doctor

  • Back pain is constant or intense, with no relief even at rest
  • Back pain is worse by bending in one direction
  • Severe pain is focus on a single spot or on the back
  • Numbness, pins and needles, aching in one or both legs, that do not go away 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
  • Whenever back pain is associated with general symptoms of poor health, eg, loss of appetite and weight, lethargy, fever and chills
  • You fell and blow to your back or other injury

Also, see our doctor if you start having back pain for the first time after age 50, or if you have a history of osteoporosis.