Back pain is an extremely common complaint. 90% of the adult population would have experienced back pain at some point in their lives and approximately half of these people would have experienced recurrent back pain.

Many conditions give rise to back pain. The most common source of pain is related to the encountered causes include disorders of abdominal oragans (pancreatitis, kidney stones or infection), blood vessels injuries (aortic dissection) and infections affecting nerves (shingles). Despite investigations, some cases of back pain have not attributable cause. The good news is that, no matter what the cause of the pain is, the majority of back pain resolves spontaneously within six to eight weeks.

Spine Anatomy Top ViewCauses of Back Pain

The following are common causes of back pain related to the spine and surrounding structures.

Degenerated lumbar disc

A lumbar disc is the soft tissue found between each vertebra. It is responsible for spinal stability, mobility and absorption of shock transmitted through the spine. 80% of the composition of a normal disc is water. This gives it a springy consistency and allows for normal function. When a disc undergoes degeneration, it loses some of its water content. As a consequence of this, the disc loses its thickness and bulges at its periphery. This bulging irritates nerves found at the edge of the disc, giving rise to back pain. This pain can radiate down to the buttocks and is aggravated by prolonged sitting, one would tend to slouch and this flexes the spine, increasing the pressure on the disc. This further irritates the nerve, thus worsening the pain in the back and buttocks (discogenic back pain).

Herniated lumbar disc (slipped disc)

Herniated Disc

A herniated lumbar disc occurs when the central jelly-like part of the disc (nucleus pulposus) bulges through a fissure in the outer capsule (annulus fibrosis) of the disc. This herniation often causes pressure on the nerves supplying the lower limbs resulting in leg pain, in addition to back pain. There can also be lower limb weakness and numbness due to impairment of nerve function secondary to compression. Occasionally, the herniated disc can cause compression of the nerves supplying the bowel and bladder resulting in incontinence (cauda equina syndrome). This is an emergency condition which requires urgent surgery. If there is a delay in the treatmetn of cauda equina syndrome, incontinence can be permanent.

Spinal Stenosis

Spinal stenosis is characterised by back pain associated with leg pain after walking for a certain distance. This phenomenon is known as neurogenic claudication. The walking distance achievable is predictable and the leg pain can also be predictably relieved by sitting down but not by standing still. This condition is caused by narrowing of opening of the spine through which the nerves supplying the lower limbs exit. The narrowing is often due to arthritis of the small joints of the spine (facet joints) which results in enlargement of the joints from growth of bone spurs (osteophytes). The narrowing is also contributed by bulging, degenerate discs.

Myofascial pain

This is pain originating from the muscles and supporting soft tissues surrounding the skeletal portion of the spine. It is characterised by tenderness over localised areas  on the back (trigger points). Pain is typically relieved by stretching the involved muscle group or by trigger point release (massage) or injection.

Spinal Fractures, Infections and Tumours

While uncommon, these are particularly sinister causes of back pain associated with poor outcomes if not detected and treated early.

When to Seek Treatment

These are factors that may point towards a condition that requires urgent treatment such as a fracture, infection or tumour (“red flags”).

  • Recent trauma such as a fall from a height or motorcycle accident.
  • Recent mild trauma in an individual above the age 50 such as a fall onto the buttocks.
  • History of prolonged steroid use.
  • Someone with a history of osteoporosis.
  • Any person above the age of 70 due to increased risk of cancer, infection and non-spinal cause of back pain.
  • Previous history of cancer.
  • History of recent infection.
  • Temperature over 38.5 degrees Celsius associated with back pain.
  • Intravenous drug use.
  • Back pain worse at rest which is associated with infections and tumours.
  • Recent unexplained weight loss.

Other characteristics of pain which warrant urgent medical attention include –

  • Prolonged back pain.
  • Back pain associated with acute onset weakness or numbness of the lower limbs or lower limb pain.
  • Back pain associated with incontinence.

Assessment and Treatment

A doctor’s assessment of back pain includes obtaining a history regarding the pain, associated symptoms and conditions. This is followed by an examination of the back and nerve function of the lower limbs.

If a spinal condition for back pain is suspected, a X-ray will be performed. A MRI scan may also be requested for if there is any impairment of nerve function or presence of any “red flags”.

The majority of back pain is treated with rest, medications and physical therapy. In very selected conditions, surgery is necessary.

Back Pain Specialist

Dr Mathew Tung

Dr Mathew Tung Neurosurgeon

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Brief Outline of Cervical Spondylosis

Cervical spondylosis is a chronic degeneration of the vertebrae of the neck (cervical spine) and the intervertebral cushions or discs. Bone spurs, or osteophytes, are bony projections that form along joints and are often associated with arthritis. Such spurs themselves can rub against nearby nerves or occasionally on the spinal cord causing pain and limitations in joint motion. The degeneration results from wear on the bones of the cervical spine over time.

Anatomy and physiology

Cervical Spondylosis

Aging and repetitive stress can cause discs of the spine to become drier and less elastic. Such degeneration may cause discs to bulge or in some cases, rupture. When the surrounding ligaments bevome less flexible, the vertebrae develop bone spurs – new areas of bone growth along the margins of existing bones.

Cause of Cervical Spondylosis

Repetitive wear on cervical vertebrae. Excessive and improper weight lifting. Bulging or herniated cervical disc.

Signs and symptoms

Neck pain radiating to shoulders and arms. Loss of balance. Headaches radiating to the back of the head.

Complications if left cervical spondylosis unattended

Cervical spondylosis is a common cause of spinal cord dysfunction in older adults. If the condition isn’t treated, the injury may progress and become permanent. Bone spurs or herniated discs can impinge and put pressure on the roots of one or more nerves of the spinal cord in the neck, producing tingling, burning, weakness or numbness in the arms or hands. Displaced spurs can also float in the system, periodically interfering with joints.

Treatment for cervical spondylosis

Non-Surgical Methods:

Rare and severe cases may require surgery.

Rehabilitation and prevention

Less serious cases of cervical spondylosis respond to exercises with physical therapist, aimed at strengthening and stretching neck muscles. Low-impact aerobic exercises including walking or swimming may also help. While age-related spondylosis may be difficult to prevent, minimising high impact activity, engaging in upper body training and attention to posture may help avoid the injury.

Long-term prognosis

Mild cases of cervical spondylosis respond well after immobilisation of the injury and appropriate physical therapy. More serious cases may require injections of anti-inflammatory agents between the vertebral facet joints or in some cases, surgery to remove bone spurs, particularly if they have broken off from larger sections of bone to become loose bodies.
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Treatment for pinched nerve

Cause of pinched nerve

Herniated disc pressing on a nerve. Irritation of the nerve due to repetitive stress. Bone spurs or degenerating vertebrae impinging on a nerve.

Brief Outline of Pinched Nerve to the neck

Nerves controlling the shoulder, arm and hand originate within the spinal cord in the neck. Inflammation or compression of one of these structures is known as a pinched nerve or cervical radiculitis, and results in pain, weakness, and loss of movement. Herniation of the cervical discs – often caused by repetitive stress – can impinge on the cervical nerves, also causing the injury.

Anatomy and physiology

Cervical radiculitis occurs when a disc from one of the seven cervical vertebrae making up the upper spine presses against the spinal nerves connecting to the spinal cord. Such nerves branch to numerous areas of the body, and symptoms may radiate from the source along the nerve to areas where the nerve travels. Depending on the affected disc impinging on the cervical nerve, pain may occur in the arm, chest, neck, or shoulders.

Prolapsed Intervertebral Disc

Signs and symptoms of pinched nerve

Pain, weakness, and loss of movement in the neck. Numb fingers. Weak muscles in the arms and chest.

Complications if left unattended

Inflammation and pain associated with pinched nerves may continue or worsen, should the source of the injury not be addressed. The nerve may become permanently damaged through continued pressure and stress, and the condition may point to other (potentially serious) underlying injuries to the vertebrae or spinal cord.

Rehabilitation and prevention

Given proper treatment, the prognosis for cervical radiculitis is generally good. Mild cases usually respond to physical therapy in conjunction with medications such as NSAIDs. Following healing, a program of physical therapy and flexibility / strengthening exercises can help restore to your usual self. Attention to proper technique, particularly during weight training/weight lifting can help prevent pinched nerve injury.

Long-term prognosis

Most cervical pinched nerve injuries resolve themselves without serious medical intervention. More serious or prolonged cases may require surgery to relieve compression of the nerve root.
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Brief Outline of Cervical Nerve Stretch Syndrome

Cervical nerve stretch syndrome, also sometimes referred to as a burner syndrome, results from the stretching (or compression) of the brachial plexus a complex of nerves in the lower neck and shoulder area. The injury is common in contact sports including hockey, football, wrestling, and rugby. Sports injuries to the brachial plexus are characterised by a burning sensation that radiates down an upper extremity. Symptoms may last anywhere from two minutes to two weeks.

Anatomy and physiology

Brachial Plexus

The brachial plexus are nerves originating in the brain. They exit the cervical vertebrae, extending to peripheral structures including muscles and organs, (to which they transmit motor and sensory nerve impulses). A series of cervical nerve roots within the brachial plexus send fibres to the shoulder and trapezius muscle, the deltoid muscle and distal radius, the elbow and the fingers.

Cause of the Cervical Nerve Stretch Syndrome

Blow to the head or shoulder, especially in a football tackle. Ear to shoulder bending with rotation (compression of cervical nerves). Hyperextension of the neck.

Signs and symptoms

Severe, burning pain, radiating from the neck to the arm and/or fingers. Parasthesia or numbness, tingling, pricking, burning, or creeping sensation of the skin. Muscle weakness.

Complications if left unattended

Burning and stinging symptoms will persist and often worsen. Further damage to the peripheral nerves can result should the injury be ignored. Symptoms may also indicate spinal cord injury, with potentially serious complications.

Treatment for Cervical Nerve Stretch Syndrome

  • Physiotherapy
  • Oral Medications

Rehabilitation and prevention

Rehabilitation for cervical nerve stretch syndrome usually entails physical therapy. Following a healing phase, such therapy seeks to improve cervical range of motion and to strengthen cervical muscles, with particular attention to the muscles supporting the injured brachial plexus nerve. Proper protective gear, appropriate technique and upper-extremity strength training can help prevent the injury.

Long-term prognosis

Prognosis for the injury is generally good, though some athletes develop chronic form of the condition and a high rate of recurrence has also been noted. In rare cases, nerve injury requires microsurgery to repair nerve damage.
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Scoliosis is a problem with the curve in your spine. Some curves in your spine are normal. But a few people have spines that make a large curve from side to side in the shape of the letter “S” or the letter “C.” If this curve is severe, it can cause pain and make breathing difficult.

The good news is that most cases of scoliosis are mild. If found early, they can usually be prevented from getting worse.

Scoliosis Bending Down


What causes scoliosis?

Scoliosis usually starts in childhood. Scoliosis that is severe enough to need treatment is most common in girls.

A curve in the spine may get worse as your child grows, so it is important to find any problem early.

In most cases, the cause of scoliosis is not known. This is called idiopathic scoliosis. It develops mostly in children and teens and appears to be related to several things, including genetics, as it often runs in families.

There are two types of scoliosis: nonstructural and structural.

Nonstructural (functional) scoliosis

Nonstructural (functional) scoliosis involves a curve in the spine, without rotation, that is reversible because it is caused by a condition such as:

  • Pain or a muscle spasm.
  • A difference in leg length.

Structural scoliosis

Structural scoliosis involves a curve in the spine, with rotation, that is irreversible and is usually caused by an unknown factor (idiopathic) or a disease or condition such as:

  • Disorders that were present at birth (congenital), such as spina bifida, in which the spinal canal does not close properly; or a disorder that affects the formation of bones. These curves can be harder to correct. They often get worse as the child grows, especially during the teen years.
  • Nerve or muscle disorders, such as cerebral palsy, Marfan’s syndrome, or muscular dystrophy.
  • Injuries.
  • Infections.
  • Tumors.

In adults, scoliosis may result from changes in the spine due to aging (degenerative changes). These degenerative changes may be caused by osteoarthritis.

What are the symptoms?

Scoliosis most often causes no symptoms in your child until the spinal curve becomes large. You might notice these early signs:

  • Your child has one shoulder or hip that looks higher than the other.
  • Your child’s head does not look centered over the body.
  • Your child has one shoulder blade that sticks out more than the other.
  • Your child’s waistline is flat on one side, or the ribs look higher on one side when your child bends forward at the waist.

In adults, scoliosis may cause back pain and trouble breathing.

How is scoliosis diagnosed?

The doctor will check to see if your child’s back or ribs are even. If the doctor finds that one side is higher than the other, your child may need an X-ray so the spinal curve can be measured.

Scoliosis is most serious in young children who are still growing. A curve in the spine may get worse as your child grows. So many experts believe screening your child for scoliosis is important so that any curve in the spine can be found early and watched closely.

How is Scoliosis treated?

Mild cases of scoliosis usually do not need treatment. Your doctor will check the curve of your child’s spine every 4 to 6 months. If the curve gets worse, your child may need to wear a brace until he or she has finished growing. In severe cases, or if bracing doesn’t help, your child may need to have surgery.

Scoliosis and its treatment can be a severe strain on your child. Wearing a brace can feel and look odd. It also limits your child’s activity. Your child needs your support and understanding to get through treatments successfully.

What increases the risk of scoliosis?

Your child may be more likely to have scoliosis if someone in your family has had it and if your child is a girl. Other things that increase the chance of scoliosis include:

  • One of the bones in your child’s spine has moved forward out of place compared to the rest of the spine.
  • Your child’s arms or legs are missing or are abnormally short.
  • Your child has other problems with tissue growth that happened before birth.

When To Call a Doctor

Call your doctor to have your child evaluated for scoliosis if:

  • You observe a curve in your child’s spine.
  • You notice that something about your child’s posture looks unusual, such as ribs that stick out, one shoulder that is higher than the other, one hip that is higher than the other, or an uneven waistline.
  • You observe that your child’s clothes don’t fit properly or that his or her hems don’t hang evenly.
  • A school screening program recommends that your child see a doctor.

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