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Low Back Pain

Understanding Low Back Pain

Low back pain is one of the most common pain disorders. It is a chronic condition characterised by a persistent pain in the lower back. 80% of the adult population suffers low back pain at some point in their lives.

Your back is a complex and delicate structure that is made up of a combination of bones, muscles, nerves and joints. Therefore, it does not take a significant injury or damage to disrupt the normal workings of the back and trigger an episode of back pain.

Low back pain can be classified according to how long the symptoms last. For example:

  • acute back pain - the pain does not last longer than six weeks
  • chronic back pain - the pain lasts for more than six weeks


The most common symptom of backache is pain, tension or stiffness in the lower back. The lower back, between the bottom of the ribs and the top of the legs, is usually affected. Other symptoms of backache include:

  • muscle spasms - involuntary tightening and relaxing of your muscles
  • pain that travels from your lower back down your buttocks and into your legs - this is usually a sign of sciatica
  • a reduced range of motion in any actions that involve your back - for example, you may find it difficult or painful to bend over to pick things up

There are a number of warning signs, known as 'red flags', which may indicate that your back pain is actually caused by a more serious condition. These include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • inflammation or swelling of the back
  • constant back pain that does not ease after lying down or resting
  • pain that travels to your chest, or pain that is high up in your back
  • pain down your legs and below the knees
  • a recent trauma or injury to your back
  • loss of bladder control
  • inability to pass urine
  • loss of bowel control
  • numbness around your genitals, buttocks or back passage


As we age, our bone strength, muscle elasticity and tone tend to decrease. The spinal discs begin to lose fluid and flexibility, which then decreases their ability to cushion the spine.

Back pain can be triggered by everyday activities at home and at work, or by poor posture. For example, back pain can occur as a result of:

  • bending awkwardly
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • standing or bending down for long periods
  • twisting
  • coughing
  • sneezing
  • muscle tension
  • over-stretching
  • driving in a hunched position
  • driving for long periods without taking a break

Occasional episodes of back pain can occur as a result of the normal ageing process of the spine, which can temporarily disrupt the normal function of your back. You may sometimes wake up with back pain and have no idea what has caused it.

The risk factors for low back pain include:

  • being 20 to 50 years of age - most cases of backache affect young and middle-aged adults
  • being overweight or obese - extra body weight places more strain on the bones, muscles and joints of your spine
  • smoking - it is uncertain as to whether this is a result of tobacco smoke damaging the tissue of the back or due to the fact that smokers tend to have unhealthier lifestyles than non-smokers (or it could possibly be a combination of both)
  • the long-term use of medications that are known to weaken bones, such as corticosteroids
  • stress - it is thought that people who are under stress may unknowingly tense the muscles in their back, which could trigger an episode of back pain


Your doctor will be able to diagnose low back pain by learning your symptoms together with examination. There is usually no need for tests, such as X-rays or Magnetic Resonance Imaging (MRI) scans. Your doctor will only refer you for an X-ray or MRI scan if you have associated symptoms that suggest that you may have a more serious condition, such as loss of bladder control or unexplained weight loss.

Back-related conditions that can be diagnosed using an MRI scan include:

  • cancer of the spine
  • infection
  • fracture
  • ankylosing spondylitis - a chronic (long-term) condition that causes pain and inflammation of the joints and the tissues around them
  • cauda equina syndrome - a rare and serious condition where nerves inside the spine are compressed, leading to a loss of bladder and bowel function


  • Rest - You may need to restrict your activities or have bed rest in the first 1-2 days and resume your activity level gradually.
  • Medications - The doctor may prescribe some analgesics and muscle relaxant to help relieve the pain.
  • Physical Therapy - Perform flexibility and strengthening exercise at least twice a day, focusing on the muscles at the back, stomach and hip. Hot or cold therapy is used to relax the muscles. It is a short term pain relief method.
  • Surgical Management - Surgery is seldom required unless you are experiencing any of the following symptoms: - Bladder or bowel dysfunction - Lower limb numbness/ weakness - Persistent pain despite therapy


Low back pain can be prevented through lifestyle modifications:

  • Maintain good body postures at all times.
  • Maintain healthy weight range.
  • Use proper body mechanics/ lifting techniques. Avoid bending at waist level.
  • Modify workplace/space (workplace ergonomics) to reduce back strain.
  • Exercise regularly. Proper exercise can help to strengthen and increase flexibility of back muscles and help to increase bone density. Swimming, brisk walking and cycling are good examples of exercises for back pain sufferers.
  • Stop smoking.
  • Avoid staying in the same position for a prolonged period of time.
  • Sleep on a firm mattress. It helps to protect the spinal curvature. Try to sleep on the sides, with knees bent and a pillow between them. If you prefer to lie on your back, place a pillow under your knees.


Find out more information from:

Singapore Health Services
Singapore General Hospital
Health Xchange
National Institute of Neurological Disorders and Stroke
NHS Choices


1. How common is back pain?

Back pain is a very common condition and can affect adults of all ages. It is estimated that one in five people will visit their GP / doctor in any given year because of back pain. 80% of adults will experience at least one episode of back pain at some point in their life.

2. Do you have any quick tips to a healthier back?

  • Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support.
  • Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.
  • Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.
  • Don't try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.
  • Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.

3. What are the things I need to prepare when seeing my doctor for my low back pain?

  • Write down any symptoms you've been having, and for how long.
  • Write down key personal information, including any mental or emotional stressors in your life.
  • Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
  • Note any recent injuries that may have damaged your back.
  • Bring a family member or friend along, if possible. The person accompanying you may remember you may remember something that you missed or forgot.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

4. What are some of the questions I need to ask my doctor during consultation?

  • What is the most likely cause of my back pain?
  • Are there any other possible causes?
  • Do I need any diagnostic tests?
  • What treatment approach do you recommend?
  • If you're recommending medications, what are the possible side effects?
  • For how long will I need to be treated?
  • Are there any restrictions that I need to follow?
  • What other self-care measures should I be taking?
  • Is there anything else I can do to help prevent a recurrence of back pain?

This article is reproduced with the permission from Agency for Integrated Care (AIC) and Singapore Sliver Pages.

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