Overview of Lower Back Pain
Causes can be due to overactivity like repetitive heavy lifting, an acute trauma from sports, a slip or fall, or even just standing still in one position too long can initiate this type of pain. Alternatively, a lack of activity can also lead to pain cause the muscles and joint to weaken, creating an excessive amount of stress on the bones. Any structural abnormalities such as a previous injury, or an overly significant difference in leg length can also cultivate pain. In addition to this, if high levels of your everyday stress and/or depression vitamin as well as any general sedentary period, hate to say it smokers? and overweight people are also at far greater risk of developing pain. Regardless of the cause, the end result is a contest between the body’s attempt to incapacitate the injured structures to protect an area from further injury, and to create enough stability to support essential functions of the lower back, all the whilst maintaining an adequate level of mobility. This explains why pain can vary from severe and disabling to mild and nagging, and can be classified as either acute or chronic.
Lower back pain may be debilitating. It can severely impair an individual’s mobility and flexibility. The flexibility of the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord, as well as the nerves, the muscles of the low back, abdomen, and pelvis all work in coordination to produce motion, to support the body’s weight and to somehow still have enough stability to also protect vital internal organs. On top of that, the lower back is also the major region of weight bearing in the body. Now do you follow so far? You don’t have to possess a degree in biomedicine to understand why there are so many different possible causes of lower back pain.
Causes of Lower Back Pain
Lower back pain happens when the muscles in the lower back are overly stretched or torn. One of the common causes of lower back pain is poor posture. Poor posture comes from overextending the back in activities like slouching in a chair, prolonged standing with a hyperextended back or an extreme forward-backward motion of the spine. When poor posture is the cause of the pain, it is often due to the fact that the joints are constantly pressured and stressing the surrounding muscles. Injury is also a common cause of lower back pain. The damage to the muscles and the discs in the back are a result of any form of sudden impact such as sports injury, car accidents, and slip and falls. Sudden impacts can cause the muscles or the ligaments to be pulled to cause a muscle strain or cause damage to the discs in the back. Another cause for lower back pain is a condition called sciatica. Sciatica is a result of the inflammation of the sciatic nerve. The sciatic nerve is the longest nerve in the human body and it runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at the feet. If the sciatic nerve becomes inflamed, it can cause pain that shoots all the way from the lower back to one or both legs. This can be accompanied by numbness in the legs and a tingling sensation. Lastly, there are other conditions that can cause inflammation to the back which will result in lower back pain. These conditions include different forms of arthritis, abnormal curvature of the spine, and cancer.
Symptoms of Lower Back Pain
The area of back pain is likely to encompass the entire lower back but may also focus on one side or the other. The pain could also move or radiate down the back, the front, or the side of the leg. This spreading may be indicative of a path being irritated or impinged by the disc or the pinching of a nerve. If the facet joints become affected, joint pain is typically felt around the waistline and/or across the hips. An indication of relief from the leg pain while walking on hands and knees (flexed posture) is generally a sign that there is a herniated disc impinging on a nerve. Additional symptoms involving leg pain, such as weakness, feeling of pins and needles, or tingling, can be indicative of a more serious injury to a nerve but are not specifically indicative of what type of injury is present.
One of the main indicators, most commonly reported by all lower back pain sufferers, is pain. This pain is usually mechanical in nature (see number 2 below) or nonspecific back pain. It’s not intense and comes and goes. It usually originates from an injury, tension, or stress on the lower back. Sometimes, the pain switches on very quickly, and there is a specific incident involving a fall or injury. In more severe injuries, the symptoms may not appear straight away. Whether it’s intense or not, onset of pain can cause mild to severe disability to lower back pain. Pain that becomes chronic can also lead to depression and anxiety.
Impact of Lower Back Pain on Daily Life
Lower back pain can dramatically and negatively affect everything you do during your waking hours. If lower back pain is depriving you of a good sleep, this just makes the problem worse as a lack of sleep can make your back pain feel even more severe. It’s a vicious cycle. You need a certain amount of sleep to help your back heal, yet your back pain is preventing you from getting the sleep you need. Back pain can affect your mood and can lead to a state of depression. Very often, when people have a prolonged episode of back pain, they are unable to partake in activities or have to take time off work. This can result in loss of confidence and self-esteem due to financial and social implications. Lack of social activity and hobbies can lead to a sense of isolation, and people with chronic pain can feel that they are no longer useful. This can be the biggest obstacle in the way of recovery from chronic pain and can delay the rehabilitation process. Finally, lower back pain can impinge on cognitive function. Research has shown that there can be a decrease in short-term and working memory due to inhibition from pain. This can affect decision making and can sour relations with others, worsening the emotional effects of back pain.
Chiropractic Treatment for Lower Back Pain
Should I see a chiropractor for lower back pain? Chiropractic is a treatment where a specialist uses their hands to help relieve problems with the bones, muscles, and joints. It’s a type of complementary and alternative medicine. The word chiropractic comes from a Greek word which means treatment by hand. The main treatment involves manual therapy: a chiropractor will use their hands to treat your back muscles and move your joints into the correct position. They may also use other treatments such as acupuncture or ultrasound. An initial chiropractic consultation is very similar to that of a standard medical consultation. You will be asked about your medical history, medication, and any past injuries to your back. You may also be asked to undertake some general health tests. If your back problem is not likely to be helped by chiropractic manipulation, you may be referred to your GP or a specialist for further tests or to receive different treatment. There is some evidence to suggest that chiropractic is effective in the treatment of lower back pain. The National Institute for Health and Care Excellence (NICE) provides guidelines for the treatment of lower back pain that recommend manual therapy, which is manipulation using the hands. Although it has been questioned whether chiropractic is actually cost-effective as a treatment for lower back pain compared to other treatment offered by GPs or in hospitals. There is no criteria to suggest that people who have more severe back pain will respond better to chiropractic treatment than those with milder pain.
What is Chiropractic Treatment?
Chiropractors use hands-on spinal manipulation and other alternative treatments. The theory is that proper alignment of the body’s musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication. Manipulation is used to restore mobility to joints restricted by tissue injury caused by a traumatic event, such as falling, or repetitive stress, such as sitting without proper back support. A chiropractic adjustment typically involves forceful manipulation of the joint into the restricted range to overall improve the range and quality of motion of the joint. You may hear a popping noise of gas being released from the joint, similar to the release of a knuckle. Chiropractic mobilizations are low force manipulation with the aim to increase the range and quality of movement within the joint. These are particularly useful during the early stages of recovery and in elderly patients with degenerative changes in their spine.
Effectiveness of Chiropractic Treatment for Lower Back Pain
Chiropractic care is a popular form of treatment for acute and chronic lower back pain. Spinal manipulative therapy (SMT) is the form of treatment most associated with chiropractors. It involves the use of the hands to manipulate the spine, with the aim of reducing pain and restoring mobility to the joints. Research has shown this to be effective in the treatment of acute lower back pain. A study undertaken by the Medical Research Council comparing chiropractic treatment and hospital outpatient treatment for managing lower back pain found chiropractic treatment to be more effective and cheaper than hospital outpatient treatment. SMT is believed to have an effect on the way the brain processes information from the painful area, downplaying its importance in signaling pain and spasm. This is a theory of how SMT alleviates pain, but despite this being a widely held belief, it is still not yet proven. The use of SMT has been shown to be of benefit especially to those with uncomplicated or mechanical lower back pain, which is pain that arises from the joints and is marked by poor mobility and little change in position of the painful area. Mechanical pain is the most common type of lower back pain, and it is believed that the use of SMT is less likely to be beneficial to those with a radicular syndrome, which is pain that radiates down the leg due to nerve root irritation and is often accompanied by an increase in pain as well as muscle spasm. In general, research would suggest chiropractic treatment to be more effective in the treatment of acute lower back pain compared to chronic pain.
Risks and Considerations of Chiropractic Treatment
Chiropractic treatment is widely used for chronic pain, including lower back pain. The Spine Center suggests that 22% of people seeing a chiropractor saw them for back pain. Usually, treatment by a chiropractor is safe and effective. However, because the treatment involves the use of the hands, it does carry some risk. Spinal manipulation is probably the most common technique that comes to mind when you think of chiropractic treatment. The chiropractor locates a joint that has become restricted, and it is this restriction which is usually the cause of pain. Inflammation and pain cause the joint to become less mobile. By applying a controlled force, the chiropractor can mobilize the joint and increase its range of motion. When the joint is realigned in this way, an audible crack can be heard. This noise is the exact same as the noise you hear when you “crack” your knuckles. The noise is simply created by bubbles of gas in the fluid of the joint being released. A recent study explains the risks of spinal manipulation. 28 patients were seen after spinal manipulation and were assessed to see if SMT was causal, contributory, or unrelated to their adverse effects. In most of the cases, adverse effects were at the very least contributory to the presenting symptom. The problems given were usually musculoskeletal in nature or headaches. However, in some severe cases, there were symptoms due to neurological deficits and other reported problems. In this small number of patients, adverse effects were causal to the serious presenting problem, in three cases considered to be severe.
Finding a Qualified Chiropractor in Singapore
As chiropractic treatment varies widely between different practitioners and may be effective for some and not for others, it is important to find a chiropractor who has a good reputation and can be trusted. It is advisable to ask around and get recommendations from family and friends, as personal opinions and experiences count for a lot. Another thing to consider is the number of treatments and the package that a chiropractor may try to sign a patient up for. If a chiropractor is suggesting that a patient come 3 times a week over a month, it may be wise to get a second opinion. As well, some chiropractors in Singapore try to sign large packages to insurance companies, so treatment will be encouraged whether it is needed or not. A more reputable chiropractor would suggest a pay per visit schedule, and would not insist on any treatment which the patient feels uncomfortable with. When looking for a chiropractor in Singapore, you should always look for one that has been registered with the Chiropractic Association of Singapore; they may be known as a member of the Association of Chiropractic Singapore, or a MASC (Member of the Association of Chiropractic). This ensures that the chiropractor is well qualified and has obtained a degree from a reputable university. However, even this is not foolproof, as some chiropractors may have qualified from different countries a long time ago before the association was made and may not have kept up to date with their skills and knowledge in the profession. An easy and sufficient way to assess whether a chiropractor is competent and to be trusted in Singapore is to see whether he is registered with the Ministry of Health in Singapore under the Traditional Chinese Medicine Practitioners Act (TCMPA). By being registered, it ensures that the chiropractor has met requirements for practice, has no criminal records and is competent in his field. By now, one can see that with the availability of government regulation resources now, that it is quite easy to find a good and trustworthy chiropractor in Singapore.
Other Treatment Options for Lower Back Pain
What is the best treatment for lower back pain? Physical therapy and exercise are also important to strengthen the musculature in the lower back in order to help resolve chronic back pain. Multiple studies have shown that exercise and increased fitness are an effective way to eliminate and prevent back pain. A decompression training course will advise on the correct exercises aimed at relieving the condition and preventing back pain from occurring in the future. This can be done at home or at a physiotherapist-supervised session. Aerobic exercises such as walking, swimming, or fitness classes can be useful in mobilizing spinal structures, reducing disability, and relieving pain. Use of specific strengthening exercises (e.g., lumbar and core strengthening) and flexibility techniques may also be useful to sustain back pain relief. Effects of reducing core fat by diet and regular exercise contribute to preventing structural abnormalities in the lumbar spine and therefore reducing future back pain episodes. Failure to keep active can result in flexibility and muscle tone loss, which has also been attributed to chronic low back pain. Because of fear of pain or re-injury, the avoidance of activity is commonly observed in chronic back pain patients. It is important that the patient stays active and receives a comprehensive pain management program. It is also important that the patient learns to understand and self-manage their condition. This can be achieved via patient education and/or a cognitive behavioral therapy course.
Physical Therapy and Exercise
The spinal column and its surrounding muscles and tendons are best supported by increased flexibility and strength of adjacent body parts. Tension and stress can be factors leading to muscle pain. By learning exercises you can do at home, coupled with periodic visits to a professional physical therapist, you can learn to lift, sit and move with less stress to your back. Exercise to relieve low back pain can strongly be recommended; the exercise should not be too heavy at the initial stage, heavy exercise can worsen the low back pain. After committing to regular lower back exercises, now is a good time to make exercise part of your daily activity. Consider getting full workouts in swimming and using exercise machines. Physical therapy includes muscle release, and in the gradual strengthening of the abdominal core muscles our physiotherapists at physiomed regularly mix in some segment of clinical Pilates. Pilates is a form of exercise where we have our patients take active control of the movement. Through this, they are able to regain control and strength of muscles that they usually poorly activate. This segment of exercise is especially useful for lower back conditions.
Medications for Lower Back Pain
NSAIDs are also a good choice for non-specific acute lower back pain. NSAIDs are a type of analgesic (pain reliever) and have been found to be an effective treatment for acute lower back pain. They also reduce inflammation, which may be a contributing factor to the pain you are experiencing. The reduction of inflammation and pain can increase your mobility in the short term, allowing you to move around more and help speed up recovery time. If not prescribed by your doctor, most NSAIDs can be purchased over the counter and are fairly inexpensive. Always take NSAIDs with food to avoid stomach irritation, and if you are prone to stomach ulcers or have cardiovascular disease, be sure to check with your healthcare provider before taking NSAIDs.
Your doctor may prescribe pain relievers to help ease discomfort and allow you to get on with your daily activities. But sometimes these medications have side effects. If you experience discomfort due to tingling, burning, or numbness, your doctor may prescribe tricyclic antidepressants or anticonvulsants. This medication type does require a prescription and has been found to relieve some types of chronic back pain, including pain resulting from nerve damage. There are a variety of over-the-counter and prescription medications to relieve back pain. Always consult your healthcare provider before taking medication for pain relief.
Alternative Therapies for Lower Back Pain
– Chiropractic Treatment: Manipulation is the primary treatment of chiropractors. Manipulation involves a process in which a trained chiropractor uses his or her hands or a small instrument to apply a controlled sudden force to a spinal joint. The goal of this procedure, also known as spinal adjustment, is to improve spinal motion and improve your body’s physical function. Some methods during which chiropractic treatment is thought to benefit lower back pain include: – Activating the body’s self-healing abilities: Spinal manipulation is thought to stimulate a person’s parasympathetic nervous system, which may stimulate the release of endorphins, which are the body’s natural painkillers. – Providing a new direction for pain: By altering the position and function of spinal joints, it is thought that the pain signals from the joint itself are interrupted, thus relieving the pain experienced in that region.
Many patients with lower back pain are interested in trying alternative treatments. Common types of alternative or complementary therapy that may be beneficial for managing lower back pain include:
Surgical Intervention for Lower Back Pain
The decision to undergo surgical treatment for chronic lower back pain is usually made under extreme duress, with mediation of emotional factors playing a significant role. When the patient’s pain is intolerable despite adequate trial of comprehensive non-surgical treatments, when severe and progressive neurological deficits are present or are getting worse, and when there is significant difficulty in controlling bladder and bowel functions, surgery may be a consideration. And when the anatomic diagnosis (which is strongly advocated prior to consideration of surgery) is clearly defined, surgical outcomes are more predictable and the reasons to consider surgery more consistent. Careful patient selection is an important aspect of deciding whether to proceed for surgical intervention of chronic lower back pain. The type of surgical procedure will vary with the diagnosis. Surgery may be a lumbar laminectomy and discectomy for a slipped disc, or a spinal fusion for spondylolisthesis with chronic lower back pain. Artificial disc replacement is relatively new and will have specific indications. All surgical interventions have potential risks and benefits, and an informed decision-making process after consultation with the lower back pain specialist is important. Step-wise progression of symptoms or acute neurological worsening may be absolute or relative indications for surgical intervention. High-quality evidence-based clinical practice guidelines are available to help assist in decision-making for surgical intervention for chronic lower back pain, and case-by-case application with awareness of their limitations will be necessary.
Choosing the Best Treatment for Lower Back Pain in Singapore
If the cause of lower back pain is less specific, nonsurgical methods are usually the best course of action.
Spinal fusion has been traditionally used to treat many lower back conditions; it is a procedure where the spine is fused. This treatment is quite invasive and a long recovery period is required. Another more modern option is arthroplasty, where the problematic intervertebral disc is removed and replaced with an artificial disc. This method retains mobility of the spine and decreases the chance of problems occurring at adjacent levels of the spine, which can occur in fusion. Both these surgical methods have good success rates for the relief of chronic lower back pain.
Treatment methods for lower back pain are vast and varied, and both medical and surgical options are available. The severity and cause of the lower back pain will dictate the most suitable treatment method. If the pain is the result of a specific cause such as a prolapsed intervertebral disc – you have tried nonsurgical treatment methods for six weeks and the pain is still severe enough to interfere with daily activities – surgery may be an option.
When selecting the best treatment for lower back pain in Singapore, you will need to consider the following: – The cause and severity of your lower back pain – Potential side effects of the treatment – Doctor’s expertise and availability – Success rate of the treatment.
Factors to Consider in Treatment Selection
This should be considered as you would want a treatment to target the specific tissue involved to provide quicker pain relief and improved function. For instance, if the diagnosis is a lumbar posterior joint sprain, the most tissue specific treatment is likely to be a manual therapy technique to the affected joint. Joints can be treated effectively using mobilization and manipulation techniques where research supports their ability to reduce specific joint pain with increased patient function. If the same injury was treated with a more non-specific approach such as an ultrasound or TENS, the patient is going to feel little change in their symptoms and will likely become disillusioned and doubtful in treatment effectiveness.
How tissue specific is the treatment?
Once a diagnosis has been made that a specific tissue is involved in the low back pain, the doctor will be able to proceed with consideration for the best treatment approach. This can vary from tissue to tissue and, of course, can depend on the severity of the pain and acute injury to more chronic and persisting conditions. Overall, the following factors should be considered in the treatment selection.
Personalized Approach to Lower Back Pain Treatment
For people with chronic or recurrent low back pain many of the treatments on offer are of questionable value. Treatment may be associated with only modest effects, or have effects that are only short-lived. Some treatments carry significant risks or costs, and others still are offered based simply on the conventional wisdom, personal experience, or persuasive sales pitch of a practitioner. The reality of this situation is not an acceptable one and there is much that can be done to improve it. A logical starting point is to provide an approach to back pain treatment that best matches the care that is provided to the needs of the individual patient, this is where personalized treatment comes in.
There are many treatments available to back pain sufferers, even those suffering from the same or similar diagnoses may find that their experiences of, and the responses to, their conditions are very different. There is also little guidance for practitioners on which treatments are best suited to which patients, and so in reality treatment is often a hit-and-miss process often involving a number of different approaches some more successful than others. So how is a patient to know what will work best for them? How can they avoid the time and money spent on failed treatments? How can they ensure that they are receiving the most effective treatment for their condition?
Personalized treatment has been the buzzword on everyone’s lips in recent years. It is a term used in different ways and it affects various dimensions of care. Whether it’s ensuring a more person centred service, a treatment planned and delivered in full partnership with the patient, or tailoring a treatment so that it best meets the needs of the individual person. All its connotations boils down to providing a service that is best suited to the individual.
Integrative Approaches to Lower Back Pain Management
Conventional therapies include self-care, medical consultation, and surgery. There are a wide variety of self-care actions that can alleviate back pain. These include hot and cold packs, paid muscle and joint pain relief, massage, back pain-specific exercise, and over-the-counter medication. If professional advice is required, consultation with a general practitioner (GP), rheumatologist, or orthopedic surgeon may occur. This might lead to more invasive treatments such as corticosteroid injections for pain relief or surgery. A common belief is that conventional treatments are safer with more evidence of effectiveness compared to CAM therapies. However, adverse effects and complications are not uncommon in conventional treatments. Overall, conventional treatment is very much dependent on the severity of back pain and diagnosis. There are situations where conventional treatments would not be a suitable option, e.g., surgery being too high a risk or an ineffective outcome.
In integrative back pain management, both conventional and CAM therapies have evidence of effectiveness in alleviating back pain. Each treatment has its pros and cons, and suitability varies among individuals.
Integrative medicine is a holistic approach in the management of diseases. It encompasses the combination of both conventional treatment with complementary and alternative medicine therapies (CAM). Best evidence-based practices are applied from both conventional and CAM treatments. It is patient-centered and empowers the patient by taking a more active role in their healthcare.
