Low Back Pain
Low back pain is is one of the most common conditions that patients seek healthcare services for. Low back pain can be caused and exacerbated by a multitude of factors, including muscle dysfunction, pinched nerves, inactivity, repetitive motion, herniated discs, spinal stenosis, osteoarthritis, etc.
Physical Examination of Low Back Pain
We take a comprehensive history and perform a thorough examination, to establish:
- Are the symptoms mechanical, traumatic (falls and accidents which necessitate investigations) or visceral (arising from organs or causes that necessitate a medical referral)?
- Most cases of low back pain even if it feels severe initially, will subside within a few weeks. However, low back pain is known to be recurrent. Some predictors of recurrent low back back includes core muscle dysfunction, poor fitness, and job dissatisfaction.
- If mechanical, what are likely structures that cause the pain, and the directional tendencies for ease and irritation, and plan for therapy (e.g. manual therapy to relieve pain and facilitate movement)?
- Prognosis and discharge planning – symptoms that are not overly irritable, without neurological involvement, and ability and confidence to restore self-initiated movement, tend to produce a favourable outcome.
Treatment Options
As low back pain is caused and affected by many factors. No one treatment techniques address all of them. An individualised and evidence-based approach is needed taking into account current symptoms, irritability, existing wear-and-tear, job or activity requirements, etc. Some of the treatment options include:
Manual Therapy
Spinal manipulation has been shown to be effective for acute mechanical low back pain. Our physiotherapists and chiropractors are skilled practitioners of spinal manipulation.
Acupuncture
We use acupuncture as an primary or adjunct therapy to help relieve acute muscle guarding and prepare for other techniques such as spinal manipulation. All physiotherapists and chiropractors are certified and experienced in either acupuncture or dry needling.
Therapeutic Exercises
Therapeutic exercises can be broadly divided into two categories: Specific exercises to help address dysfunctions, e.g. McKenzie exercises to treat discogenic pain or core exercises to optimise motor control; or general exercises to improve or maintain cardiorespiratory fitness and minimise disuse deconditioning. Exercise prescription is both a science and art – it takes experience to utilise scientific knowledge to reduce symptoms and improve function based on the patient’s individual needs and circumstances.
Self-care
For many people with acute low back pain, self-care measures such as temporary rest, over-the-counter pain medications, and gentle stretching and activity can be effective in relieving symptoms. It is also essential to address lifestyle factors and practices that contribute to low back pain, such as physical inactivity.
Preventing Low Back Pain
Here are some of the measures to minimise the impact of low back pain:
Physical exercise: Regular physical activity can significantly reduce the risk of low back pain, with a 25-40% lower risk observed in individuals who exercise regularly.
Move well, stay well: There is not one good sitting posture, standing posture or lifting posture. Much of the prior assumptions on “perfect” lifting, sitting and standing work postures have been debunked. Movement helps reactivate core and trunk muscles and restore blood flow, and also redistribute load and forces in the back and trunk
Weight control: Being overweight or obese is a significant risk factor for low back pain, with a 16-25% higher risk observed in individuals with a BMI of 25 or higher.