Dealing with Back Pain (Treatment in Singapore)

60-90% of the population will experience back pain in Singapore.  Chances are you or someone you know has suffered from back pain at some point in their life. It can catch you by surprise and drastically limit your mobility and function. 1 in 2 employees took 4-7 days off work for their back pain in the past year. It decreases productivity and one’s quality of life.

However, back pain doesn’t have to be the norm. At the Singapore Sports and Orthopaedic Clinic, our experts can help you bounce back from back pain and prevent future incidents.

What Causes Back Pain?

The back is a complicated structure, consisting of neural networks, the spine, and muscles.

However, everything in the body is connected. Back pain may be caused by a tight muscle, structural abnormalities, neurological issues such as nerve compression, and more.

The spine consists of small bones called vertebrae. In between each bone is a disc. These discs prevent bone-on-bone contact, as well as act as shock-absorbers. Within the spine is the spinal cord. The spinal cord contains the nerves that connect the central nervous system to the rest of the body, allowing your brain to communicate to your muscles and joints to perform certain movements.

Further, muscles connect to various points of the spine and pelvis. The condition of these muscles, such as strength and flexibility, can impact your posture and alignment. If these muscles aren’t functioning properly, back pain may occur.

There are a variety of causes of back pain. Some of the most common causes include a slipped disc, osteoarthritis, poor posture, and tight muscles.

A Slipped Disc

A slipped disc, or herniated disc, is the displacement of the shock absorbing disc in between the spinal vertebrae. It may occur due to twisting or moving incorrectly or due to wear and tear over time. Consequently, it may place pressure on nearby nerves.

‘Sciatica’ is the common term used in conjunction with a slipped disc condition. The disc may place pressure on the sciatic nerve, causing numbness, pain, tingling, and weakness to occur down the legs.

Osteoarthritis

Osteoarthritis is the wearing down of the protective cartilage between bones. In the spine, it is often due to the wearing down of the protective discs. With age, these discs naturally become dehydrated. Some refer to this as ‘degenerative disc disease.’

It frequently occurs in the neck or low back, and may cause varying degrees of pain and functional limitations.

Poor Posture

Your body is made to move a certain way. Further, your joints, muscles, and tissues are optimized for proper posture. Unfortunately, a lot of people lack proper posture.

Today, many people lead fairly sedentary lives. We sit at desks all day, jeopardizing our posture and causing certain muscles to shorten. Flexibility and strength decrease.

When we place our body in unnatural positions, dysfunctions occur. For example, if you are leaning forward all day with your head protruding toward your computer screen, you are placing stress on your neck and shoulder muscles, bones, and tissues.

Bad posture can also lead to added stress on the lower back. The body isn’t made to sit in such positions for prolonged periods. And as much as it tries to adapt, back pain is often inevitable without proper intervention or education.

Tight Muscles

Sitting for long periods may also contribute to tight muscles. The hamstrings, hip flexors, and piriformis muscles may become tense or shortened. Due to their attachment points and locations, these muscles can pull on the pelvis and spine causing pain.

Frequently called ‘Piriformis Syndrome,’ the piriformis muscle may spasm and compress the sciatic nerve creating radiating pain down the legs.

However, sports doctor can educate you and help you overcome these conditions. With proper treatment and care, you can decrease and eliminate your back pain issues.

How is Back Pain Treated in Singapore?

Back pain is treated in a number of ways. It frequently depends on the cause.

Pain relievers, such as over-the-counter NSAIDs, may help decrease initial pain and inflammation. However, it isn’t recommended to use these medications in the long-term. Negative side-effects, including gastrointestinal issues, may occur with chronic use.

Exercise, supervised and provided by a trained professional, can help decrease your risk of back pain and eliminate future injuries. Frequently, back pain in Singapore is caused by inactivity and muscle weakness.

The most common form of rehab exercise for back pain involves the strengthening of the neglected transverse abdominals, or TA. The TA muscles are the deep and lower core muscles. They help support and stabilize the spine and pelvis, acting as a girdle. When this muscle is weak, we try to compensate in other ways. However, this often results in injury and pain, specifically in the low back.

A back pain exercise program will focus on strengthening these abdominal muscles, as well as stretching out shortened or tight muscles. Doing so helps reduce pain and dysfunction of the spine. A basic TA exercise to get you started involves:

  • Lying face up, with your knees bent and your feet planted on the ground.
  • Imagine a tightrope pulling your hip bones together or stopping the flow of urine. You can feel with your fingers in between your hip bones to determine if you are tightening your TA muscle or not. Your stomach should not bulge upward, just tighten.
  • Your low back should remain on the ground or bed. Make sure to keep breathing throughout the exercise. A lot of people tend to hold their breath. However, this is incorrect.
  • Try holding the contraction for 5 seconds to start. Build up to 10 second holds. Perform the exercise 10-12 times and at least 2-3 times per day.

 

Common problematic muscles that may also lead to back pain, include the hamstrings, hip flexors, and piriformis. The hamstrings or hip flexors may become tight, which may pull on the pelvis. In turn, this creates alignment issues. Your lower back may become under stress in this unnatural position. Thus, pain may occur. To correct these issues, your sports doctor will prescribe exercises to stretch out and elongate these muscles. They may also use manual techniques to promote healing and to release muscular tension.

The piriformis, as aforementioned, can spasm and compress the sciatic nerve, causing back pain and radiating pain down the legs. Myofascial release techniques and stretches can help release this small muscle, reducing and preventing future incidences.

In combination with exercise, a manual therapist or sport doctor can perform joint manipulations, traction, myofascial release, and other techniques to help alleviate your pain levels. Each treatment protocol is suited to your particular needs.

In severe cases and where other treatment options fail to work, surgery may be used as a last resort. At the Singapore Sports and Orthopaedic Clinic, our sports doctor are qualified to perform such surgeries. They can prepare you before surgery and help guide recovery post-surgery.

Types of Back Surgery

There are many types of back surgery. Again, it depends on the cause of your back pain as to what kind of surgery you have. Also, surgery is only considered when other interventions have failed to work. The 3 most common surgeries include:

Discectomy: This surgery may be performed when an individual has a slipped disc. The doctors removes the damaged part of the disc.

Laminectomy: Spinal stenosis is the narrowing of the spinal column, which can cause neural issues to arise. In this type of surgery, the lamina portion of the spine is removed to relieve pressure on the spinal cord.

Spinal Fusion: 2 or more vertebrae are fused together in this type of surgery. It limits movement between the 2 vertebrae, reducing pain brought on by the motion of these 2 bones. This is often done in cases where the spine has been damaged or a deformity has occurred.

Your sports doctor will thoroughly explain the surgery prior to. Again, these surgeries are only performed when all other interventions and treatments have been unsuccessful. Frequently, surgery will improve one’s pain levels. However, in some cases, it may not fully fix the problem. Exercises and other treatment protocols can help manage the remaining pain post-surgery.

Orthopaedic Care & Treatment of Back Pain in Singapore

At the Singapore Sports and Orthopaedic Clinic, our injury experts can help you thwart back pain in Singapore and get you back to your regular activities.

Your sport doctor will conduct a thorough assessment. From their assessment, they will come up with an appropriate treatment plan, including exercise, manual techniques, and education. Call or visit our clinic today! Regain back control of your life and rid yourself of back pain for good.

Most Common Cycling Injuries: Prevention

When it comes to a fun way getting in your exercise or even getting from point A to point B, cycling has been the number one way for many years. People of all ages enjoy riding their bikes out on trails, in their neighborhoods and even renting them at the beaches. One problem that comes with this mode of fun and exercise is cycling injuries. Learning how you can prevent these from happening to you will keep you happily cycling for years to come. Check out the common cycling injuries below and a few tips on how to prevent them from happening.

Pain in the Hands or Wrists

Some people experience pain in their hands or wrists after riding. Typically, that is because a lot of people ride with their elbows locked and arms straight out. To prevent that from happening to you, be sure to keep your elbows bent during riding time. This will help your elbows act as shock absorbers for the rest of your arm when you hit bumps or dips along the way.

Pain in the Neck or Back

You might experience neck pain or even back pain after you’ve been riding for a while. Most often times this is due to improper positioning on the bike itself. If you’re handlebars are set at too low of an angle, then you may find yourself rounding your back or bending over to reach them. If you seem to stay in one position for too long this can cause your neck pain to start as well. Be sure to change positions often and get off to stretch while you’re riding for a lengthy period of time.

Pain in the Knees

You may find the most common problem with cycling is the knee pain that can develop. This is mostly due to overuse of your knees. It can result in problems such as cyclists knee, quadriceps tendonitis, or other conditions that are from overuse of the joint. Make sure you give your knees plenty of rest before and after the cycling journey you take. Also shoe wedges can help to relieve the overuse of your knees and thus help prevent your knee pain from coming back.

Head Injuries

Always remember to wear a helmet whenever you are riding to prevent dangerous cycling injuries from happening. Keeping a helmet on at all times will drastically reduce the potential for you to suffer from a head injury during your bike ride.

Keep these tips in mind to help you enjoy cycling and prevent the most common cycling injuries.

Stiff Back – Cause & Relief

Stiffness and pain could occur in the upper back or lower back caused by tension in the muscle tissue. Due to the shortening of muscles, the range of motion is restricted and pain is felt from the muscle spasms and contracture. However, not all back pain and stiffness are caused by tensed muscles. More severe cases could have root problems in the joints, spinal discs and nerves that may require surgery. For mild to moderate stiff back problems, non-surgical methods are sufficient to relief the symptoms.

Causes

Tensed muscles could be caused by trauma, overuse or poor posture. Sharp trauma from a bad fall or an accident can result in an acute muscle strain, as experienced with pain, inflammation and muscle spasms.

An overuse injury is caused by repetitive stresses over time, very often due to sports-related activities. The back is strained from the pressure of the strenuous training or often carrying heavy items, leading to muscle fatigue.

Poor posture is a common but often overlooked cause of stiff back and neck pain. Hunching of shoulders and leaning toward the computer lead to an imbalance strain of muscles. Some muscles are overworked to compensate for muscles not used to support the position. With long periods of time, the constant stress results in pain and stiffness.

Relief

If it is a muscular issue, there are some exercises and tips you can practice every day to relief the symptoms and avoid further strain. Severe cases should however, avoid the exercises unless advised by a doctor or therapist.

The Cobra Stretch:

This basic yoga pose helps to stretch and elongate tensed back muscles. Lie face down and place your palms beneath your shoulders. Keep toes inverted flat and pointing straight, with your stomach tucked in to support your lower back. Then lift your upper body off the floor with your arms and tilt your head back.

Shoulder Rotation:

When doing the shoulder rotation, keep your elbows straight in perpendicular to your body and bring them back aligned to your shoulders. At all times, straighten your back and do the exercise slowly.

Take Short Breaks Regularly:

We tend to sit for the most part of the day and with the sedentary, the muscles stiffen up from the lack of movement. Get up and take a short walk or simply just stretch every 1 to 2 hours of sitting. Make sure that you maintain the correct sitting posture, with your back straight, legs on the floor and head aligned with your shoulders.

4 Misconceptions About Epidural Steroid Injections

Epidural Steroid Injections (ESI) is commonly administered to patients suffering from lower back or leg pain. Lower back pain is due to the inflammation of spinal nerves, causing pain and discomfort to patients as the nerve passage is narrower compared to healthy patients. Corticosteroids are extremely strong pain relief medication that is injected directly into the area of concern, providing immediate relief. However, most patients undergo the procedure with the mentality that they will be “cured” from their lower back pain. This is a misconception of it and in fact, there are many more misconceptions out there about ESI.

ESI is extremely safe

Well, this is a misconception although it is true to a certain extent. Many people think that steroid injections are much safer than oral consumption of steroids. However, this really depends on the medication that is prescribed as the toxicity differs. While oral consumption of medication may cause irritation to the stomach and with the fact that it “travels” a longer distance down, there is a higher risk of allergy. However, ESI are injected directly into the affected area and when something bad occurs, it happens immediately without providing you much reaction time.

Repeated treatments are required for visible results

Many doctors tell their patients that a minimum of 3 ESI is required before they are effective. However, this is the average value comprising data from hundreds of thousands of patients worldwide. In fact, the exact amount of dosage required by each patient is never the same due to the differing genetics of each of us. Some patients get immediate relief after just a single injection while some may need a lot more to see results.

Multiple invasive sites are required

Most of us would have visited the hospital for one reason or another and a high percentage of us have had multiple needles injected into us. ESI are totally different from your usual invasive treatments. Only a single needle is required to be injected as ESI is done under the guidance of an X-Ray machine, providing the doctor with the exact spot to inject.

Immediate pain relief is obtained

While you may get immediate pain relief from the compressing of spinal nerves, you may suffer temporary pain in the form of bruises and tenderness due to the injection. Although the technique is conducted under the guide of an x-ray machine, human error is bound to happen. Bruising and swelling will go away on its own in just a couple of days.

Epidural Steroid Injections have been performed for a long time and it has a track record of being rather safe and successful. Since the procedure is an outpatient one, patients do not need to spend a night in the hospital, making it much more flexible and economical for them.

Spine Surgery: Orthopaedic Surgeon or Neurosurgeon?

In the event that you require spinal surgery to cure your injured back, the first and most important decision you have to make is to choose between an orthopaedic surgeon or a neurosurgeon. The choice of the right surgeon is extremely important and you have to consider factors such as the experience and success rate of the surgeon. So how different are these 2 doctors?

You will first need to understand that both are able to carry out spine surgery. In the past, neurosurgeons were the only ones that could qualify to perform spine surgery. With the evolution in medical techniques, orthopaedic surgeons are well equipped with the knowledge and skills to carry out spine surgeries for patients as well.

Neurosurgeons are medically trained doctors who have completed at least a 4 to 7 years worth of gruelling neurosurgery residency. Neurosurgeons specialise in disorders affecting the nervous system including the brain, spinal cord and nerves. There is however one distinct part that sets them apart from orthopaedic surgeons. Neurosurgeons are the only people who are able to perform surgery that is inside the dura mater of the spine. If the patient has a tumour in the spinal cord, cysts or spinal cord malfunction, only a neurosurgeon is able to perform the surgery for him.

Orthopaedic surgeons on the other hand are medically trained doctors who have completed a 5 years surgical residency focusing on musculoskeletal disorders such as the bones and joints. Most orthopaedic doctors focus on sports injuries and bone disorders. Some orthopaedic surgeons will choose to focus on spinal injuries and they will have to spend additional few years of their time to complete fellowship training on the spine. Other than the few specialised surgeries that only a neurosurgeon can carry out, orthopaedic doctors are able to carry out other spinal surgeries.

When choosing a surgeon to perform spinal surgery for you, the main question is not to decide on whether an orthopaedic surgeon or a neurosurgeon since both are equally adept to perform the surgery. Instead, you should be asking what is his specialisation. Some are specialised in cervical spine surgeries while some are inclined to lumbar disorders. The important questions you would want to ask is how many similar surgeries have they performed to date and what are the success rates. Spinal surgery being a major surgery, you would want a very experienced surgeon to perform it on you.

4 Exercises for Back Pain Relief

Relief from back pain can be obtained from simple back exercises that helps to stretch, loosen and strengthen the back muscles. Our body is designed in a way that the back muscles must work in tandem with the spinal cord and the soft tissues such as the ligaments and tendons. If there are any restriction to the movement, it will cause discomfort and pain for the patient. Back pain is an orthopaedic condition that requires special attention to be given to it. There are some good exercises that can help to provide pain relief and let’s discuss them below.

Myofascial Release

Lie down on a gym mat or on your bed depending on your comfort level as different surfaces will provide different level of pressure. Lay on one side of your body and place an exercise ball beneath it. The ball should be positioned at the muscular region at the side of the spine and slowly place your entire body weight onto the exercise ball. Do not attempt to move about or bounce up and down.

Forward stretch on a chair

Sit down on a chair that does not have any rollers. Place both of your feet firmly on the ground and sit upright. Slowly start to lean forward and stretch towards your toes while keeping your neck in a relaxed position. When you feel tightness in your back, hold in that position for 15 seconds and slowly return to the original position. Repeat this exercise for 10 times and whenever you can throughout the day. This will help to stretch and relax the back muscles.

Knees to chest

Lie down on a soft surface such as a gym mat or on your bed. Maintain a straight posture and slowly bring both of your knees towards your chest. You should be able to feel tightness in your back and hold in that position for 15 seconds. Repeat this exercise for 10 times and whenever you can throughout the day. This will help to stretch and relax the back muscles.

Piriformis stretch

Strong gluteus muscles can help to better support the body’s weight and take some load off the spinal cord. The piriformis muscles is at the buttock region and if the muscles are weak, it can cause pain in the lower back. Lie down on a soft surface and place one leg over the other and pull towards your stomach. You will be able to feel a tightening sensation at the buttock region and hold for 15 seconds. Slowly return to the starting position and change legs. Repeat this exercise for 20 times.

Exercises will help to stretch and strengthen the back muscles to provide pain relief. Most exercises require minimal space and can be performed throughout the day whenever you are free. Do not attempt to stretch beyond your limits and remember not to over exert the injured muscles.

Top 6 White Collar Work Injuries

Work is literally a pain in the body. Don’t you frequently experience pain throughout your body when you return home from work? Studies have concluded that white collar professionals are the ones that have the highest medical claims among all occupations. White collar workers and blue collar workers suffer different pain mainly due to their different job scope. White collar workers sit at their desk the entire day and it does not seem to be hard work at all. However, they often reach home with muscle aches everywhere.

Back pain

Sitting on the chair for prolonged periods can cause a lot of pressure and straining on the back muscles. This is commonly termed as mouse shoulder. You can also experience chronic stiffness in the upper back, lower back and spinal cord. Sitting down for too long will cause the spinal discs to compress and cram up as well as causing inflexibility in the hips which will increase stress levels in the lower back.

Typing injury

Typing injury or repetitive stress injury as its name suggests implies pain in the hands that are caused by repeated typing motions and this will cause even simple daily activities to be almost impossible. This is due to the repeated stresses acting on the tendons and ligaments of the hands. This can cause the ligaments to be inflamed and swell up as a result.

Blurry vision

Staring at the computer screen for the entire will put a lot of strain on the eyes and will leave it dry and tired, eventually leading to blurry vision, headache and eye pain.

Repeated stress disorder

Doing repeated motions every single day in the office can cause muscle overuse and lead to ligament and tendon injuries as well as cause muscle aches.

Neck stiffness

Stiffness of the neck is also another common complaint that many white collar workers have. Due to the prolonged periods of computer usage, the neck is kept in a position unmoved due to the need to view the computer screen. The mistake of setting the monitor height at an incorrect height further aggravates the problem.

Migraines

Many office workers also experience migraines during work and this can ruin a day badly. The exact cause for migraine is still unsure but this is largely due to the prolonged staring at computer screens.

All it takes is just some adjustment to office ergonomics that will lead to a vast improvement in terms of posture and working conditions. Setting the monitor screens at the correct height and the screen brightness to the correct setting can eliminate headaches and even migraines. Sitting upright can reduce chances of back problems.

Complications of Cervical Radiculopathy for Middle-aged Men

Cervical radiculopathy is a medical condition that occurs when a nerve in the spine is irritated due to nerve pinching and it leaves the spine. Nerves located in the spinal cords will leave the spine in all directions and they will travel through the body. Although the nerves are commonly affected only at the spinal region, the impact can be felt from other parts of the body as well. Cervical radiculopathy can be caused by different factors such as ageing as well as injuries. We will be concentrating on cervical radiculopathy for middle aged men in this article.

As we age, our spinal disks will deteriorate and become closer to each other. The body’s natural response is to increase bone forming at the site in order to better support it. However, because of the body’s natural response, it causes the spine to be even stiffer as a result due to the increase amount of bone. These additional bone spurs can also contribute to pinching of the nerves and increase the pressure on the nerves. Osteoarthritis also contributes a significant bit to cervical radiculopathy. Osteoarthritis also causes the body to build more bone spurs at the site in order to better support the back. As a result, these bone spurs will create even more pressure. Imagine a patient suffering from osteoarthritis and who is of a particular age. The amount of pressure acting on the spine will be tremendous! Cervical radiculopathy can also cause certain complications in the body.

Upper body pain

Due to the immense pressure and pinching of nerves in the spine, it will cause pain in the upper body. Nerves are responsible for passing information to the whole body. Pinching of the nerves will cause the nerves to signal to the brain that something is wrong with the upper body and that will result in a natural response in the form of pain from the brain.

Loss of sense of feel

Patients suffering from cervical radiculopathy also suffer from loss of feel in certain parts of their body, particularly in the upper region. This is due to the pinching of the nerves which causes certain bodily function and information to be passed incorrectly and inaccurately. As a rule of thumb, if numbness is felt anywhere in certain parts of the body for prolonged periods of time, it is most likely a nerve injury and medical attention should be sough immediately.

Immediate medical attention should be sought for cervical radiculopathy. If left untreated, it can cause even more serious complications and it will eventually affect the entire body.

Introduction to Decompression of Back

There are many reasons why someone suffers from lower back pain. Common reasons include injuries and ageing. Our spine is naturally protected by the vertebrae and cushioning it are the intervertebral disks. The main function of the intervertebral disks is to cushion any impact or shock experienced by the spinal cord and protects it from any damages. However, sudden huge impact can cause the spine to be damaged despite of the protective measures. Ageing also contribute to a significant percentage of people suffering from back pain mainly due to degeneration of the disks due to wear and tear.

There are many methods to treat back pain. One of the more popular methods is the decompression of back or Spinal Decompression. Spinal Decompression is a non-invasive treatment which means that there is no incision or injections required. It is also non-surgical and it’s relatively cost effective as compared to other methods such as surgery.

Spinal Decompression uses the mechanism of traction which straightens the backbone and relieves pressure in the back. The patient will be lying on the back and motorised traction will help to create negative pressure in the intervertebral disks and that helps to relieve the pain. The spine is gently stretched and this stretching motion will change the position of the spine, allowing them to realign to their normal position. Spinal Decompression also increases oxygen flow to the spine, allowing better exchange of nutrients and increasing healing rate.

Being a non-surgical and non-invasive method, the cost of treatment will be much cheaper as compared to surgery. During surgery, the bulging disks will be trimmed to prevent it from pinching onto the nerves which causes pain. Surgery is expensive and ranges from $20000 to $25000. Surgery is also much more dangerous as compared to Spinal Decompression. The usual cost for each Spinal Decompression treatment ranges from $100 to $200 and patients will usually improve within 20 sessions.

However, Spinal Decompression is not meant for everyone. Patients who are pregnant or suffering from current illnesses such as cancer, osteoporosis, neuro-disorders or cognitive dysfunction are not allowed to undergo Spinal Decompression.

Spinal Decompression is a non-surgical, non-invasive and low risk treatment for back pain which most people are able to undergo. Most doctors will often leave surgery as the last resort as it carries the highest risk amongst all treatment options. As such, there is no harm in giving Spinal Decompression a go.