Dr Chua Soo Yong
With most people today spending hours of their day sitting in front of the computer, back pain has become increasingly common. Perhaps the sedentary nature of the population means that people are less fit and therefore weaker in their back. Perhaps it is due to poor posture as they pound away at the keyboard during the day. With it being so common, how can a person know what exactly their back pain means?
Back pain can mean many things. A back sprain, for example, means that the muscles around the back are 'pulled'. In this case, you would feel a tight sensation in the muscles around the spine, and pain when trying to twist or bend the back. Back sprains are relatively simple, and can be treated by putting a cold compress around the affected area and resting.
Other causes of back pain, however, are not as innocent.
A slipped disc, which is a common back injury, can be caused by poor posture when lifting heavy objects. "This results in a herniation of your disc – the soft tissue that act as a cushion between your spinal vertebrae bones," says Dr Chua Soo Yong, an orthopaedic surgeon currently practising at Mount Elizabeth Hospital. "The disc then protrudes from its usual position and presses on the nerves in your spine, causing pain." A slipped disc is not uncommon, the US National Library of Medicine (NLM) estimates that 1 – 2% of all people will suffer back pain as a result of a slipped disc at some point in their lives, while up to 50% of all people will have a certain degree of slipped disc that is asymptomatic, meaning there are no symptoms, and does not cause pain.
Spinal stenosis is another common back problem that people do not know about. Unlike slipped discs, which are often caused by trauma such as falls or poor lifting, spinal stenosis is a condition that develops slowly. "Spinal stenosis is the medical condition where there is a narrowing of the spinal canal, which is where your spinal nerves reside. This can be caused by old age, either when the back ligaments thicken or when there are bone spurs or arthritis developing on your vertebrae," Dr Chua explains. When the spinal canal narrows, the pressure on the spinal nerve roots increase, which can cause pain, numbness and even weakness in the legs.
Unlike the muscle soreness and pain that a sprained back will give you, back injuries such as slipped discs often cause a type of pain known as sciatica. This is when there is a pain or tingling sensation down the back of the leg, and the pain becomes worse when sitting or standing up. Sciatica is one of the clearest signs of a serious back problem, because it means that your back injury is affecting the nerves that travel down your spine into your lower limbs.
As you can see, not all back pain is equal, and it can sometimes be difficult to differentiate between a simple problem and a serious one. The general rule of thumb for someone suffering from a back problem is to rest and ice the affected area. If the problem improves and does not come back, then it is most likely a simple muscular injury. "If, however, the problem persists, or the pain starts to affect the limbs, then there is a chance you are experiencing symptoms of a serious injury," Dr Chua says. "In this case, it is best for you to consult an orthopaedic spine specialist, who can employ detailed scans such as magnetic resonance imaging (MRI) scans to get a better picture of your condition.”
Those of you who find that you are suffering from a chronic problem such as herniated discs or spinal stenosis do not have to be overly worried, especially if the problem is diagnosed early. The majority of people suffering from back problems do not require surgery. Most of the time, a combination of medication that reduces the inflammation in the nerves and physiotherapy to correct poor posture is enough to keep your problem in check.
Back injuries that are not treated can have grave consequences. According to the NLM, if a slipped disc that continues to cause pain is not treated for more than 6 weeks, it becomes increasingly unlikely for non-surgical treatment to be effective. In these cases, the sciatica pain can result in a loss of mobility in the patient. For severe cases of spinal stenosis, lack of treatment can lead to incontinence and even paralysis.
If you do require surgery, it might be less traumatic than you think. Technological advancements mean that many spine problems today can be treated using minimally invasive techniques, where small cuts are employed to insert surgical tools. Minimally invasive back surgeries tend to cause less trauma to the body, which means that recovery is faster. Dr Chua says, "There are even procedures such as disc nucleoplasty for herniated discs, where a special slim radiofrequency needle is inserted into the back to remove the protruded part of the disc, thus removing the pressure on the spinal cord." A study published in the Pain Physician Journal shows that up to 84% of patients who received disc nucleoplasty reported a significant reduction in pain, and only 4% of all patients suffered from complications.
Remember, not all back injuries require surgery, but if you really do need to go under the knife, early treatment means a better chance of a full recovery. A study published in the medical journal Spine reported that early spine surgery for spinal stenosis patients had a clear benefit within the short-term compared to those who decided to forgo surgery for conservative treatment. One thing to note is that 27% of those who decided to forgo surgery eventually had to undergo surgery due to lack of improvement in their symptoms.
The best person to consult for your back pain is an orthopaedic spine specialist. This is especially the case if symptoms of your back pain has been plaguing you for a long time. "Not only is the specialist able to order the correct and detailed scans to better diagnose your problem, he is also able to provide advice on the best course of treatment for your problem," explains Dr Chua.
If you suffer from back pain, make an appointment to see an orthopaedic specialist directly. There is no reason to suffer silently and risk the problem getting worse.