Back pain is one of the most common afflictions of modern society. 60-90% of adults will experience back pain at some point in time in their lives. The risk of back pain is highest amongst males, and in those who perform manual labour.

In the world we currently live in, where working from home has become a reality for some of us, the lack of walking, combined with prolonged sitting in front of computers has led to a different pandemic of sorts, one of back pain.

When working from home, one frequently does not engage in much exercise. Coupled with easy access to a pantry, this leads to weight gain and net muscle loss. This muscle loss means that we are more likely to suffer from insidious damage to the back.

Prolonged sitting also increases forces going through the lowest part of the spine, making injury much more likely. 

How does back pain occur?

In broad terms, back pain can either be related to injury or not. Back pain caused by injury means that the back pain is caused by an accident such as a motor vehicular accident, or a fall. When one thinks of back pain, this is likely the situation we think of first.

It is far more common, however, that back pain arises without an actual accident. We term this sort of back pain as atraumatic. The simple act of overreaching from an object, bending over to pick up something, or even sneezing can cause back pain.

In some patients, back pain may be the result of infection or tumours growing in the spine. This is especially true if there is unexplained weight loss, or fever. 

What are the sources of back pain?

There are 3 major components of back pain, and your back pain is usually of a combination of these 3 sources:

• Muscular back pain is due to overwork of the numerous muscles of the lower back. Strains and tears of these muscles cause an aching, cramping type of back pain.
• Discal pain comes from the intervertebral disc, a cartilaginous structure between 2 bones of the spinal column. A tear in the outer fibres (annulus fibrosus) of the disc results in sharp pain, and puts a patient at risk of a disk protrusion.

• Facet joint pain is caused by pain arising from joints in the spine, which are known as facet joints. These sometimes can wear out, and can cause both back pain and pain in the buttock region.

Symptoms related to back pain

• Buttock pain is usually related to back pain, because it is frequently referred to as pain from worn out facet joints in the spine. Referred pain means that pain occurs in a part of the body that is not actually injured due to shared nerves with another body part.
  • Buttock pain is not always caused by back pain, it can sometimes arise due to muscle strains of the buttock muscles.

• Shooting pain down the leg is most commonly caused by narrowing of the nerve passages in the spine. This can be the result of disc damage or osteoarthritis of the facet joints (wearing out of the joint). The narrowing causes pinching of the nerves in the spinal column and results in pain.
  • This pain is frequently described as electric pain, or lightning pain down the back of the leg, beyond the calves and to the foot. It is known as sciatica or radicular pain.

• Leg or foot numbness and weakness is caused by pinching of the nerves as mentioned previously. Besides causing pain, the nerves also bring sensation from the legs to the brain (numbness) and allow you to move your legs, feet and toes (weakness). Therefore, any pinching of the nerves in the spine can also cause numbness and weakness.
  • The pinching of the nerves can sometimes be so severe that patients may experience severe numbness in the foot (walking on cotton) or severe weakness in the lower leg muscles resulting in the foot dropping (foot-drop).

• Leg cramps can also sometimes happen in patients with back pain, especially if the condition causing back pain also results in severe narrowing of the spinal canal (space the nerves from the spinal cord travels in).
  • This results in crampy leg pain, which usually occurs after a fixed distance of walking, and which is relieved by sitting down.

• Tingling/burning/insect crawling sensations can result from pinching of the nerves within the spinal canal. This condition is known as paraesthesia.

• Loss of bowel and bladder control can also occur in very severe cases of disc injury, where the disc protrudes out (disc prolapse) and presses on the nerves controlling bladder and bowel control. This is a rare condition which is known as cauda equina

How will my back pain be worked up?

Here at our centre, we will first conduct a medical interview where we will explore the symptoms and causes of your back pain. This is followed by a focused examination on the back and associated areas to detect any signs of back disorder.

This is usually followed by either back X-rays and or an MRI scan of the back to further delineate the underlying cause of your back pain. Based on the available information, we will then present to you our diagnosis of the condition and discuss treatment methods.

A list of conditions that cause back pain can be found here.

Treatment of back pain

Treatment of back pain is usually undertaken by the treatment of the underlying condition. We provide a full suite of options for surgical and non-surgical treatment of back pain, and work with a curated team of professionals to manage your back condition.

Treatments may include:

• Medications for back, buttock and leg pain
• Lifestyle modification advice to help you cope with back pain
• Back and core muscle physiotherapy to strengthen your back and improve function while relieving pain
• Pain procedures to treat the underlying causes of back pain
• Surgery to release pinched nerves and stabilise worn out spines

References:

Related Articles by Dr Yong Ren

• Understanding Back Pain: Causes, Symptoms, and Treatment Options
• Don't Delay: Advice on Managing Pain
• When to Worry About Back Pain: Understanding the Signs and Symptoms"
• Comprehensive Guide to Lower Back and Buttock Pain Management