What do TCM practitioners, Orthopaedic surgeons, Sport medicine doctors, physiotherapists and chiropractors have in common? That's right, they all see Singaporeans with back pain.
Back pain treatment is a multi-million dollar industry in Singapore - clearly, the problem afflicts many of us. It's no wonder that tons of marketing money is poured into targeting back pain sufferers.
For example, I'm sure you'll have noticed advertisements in heartland malls and across the internet, with promises along the lines of:
- Best kept secrets for healing bad backs naturally
- FREE spine check up - book now as appointments are limited
- FREE $99 gift bag if you call up to book today!
Back pain by itself can be a complex problem to treat, often with multi-factorial causes – it doesn't help when dubious claims like that appear all over your Facebook Feed.
In this post, I'll give you an objective and evidenced-based account of all the back pain treatments in Singapore, and what actually works - so that you can stop wasting your time and money.
It's a long read (1979 words) because I believe that providing you with all the answers in one place is the best way for you to sift through all the misinformation about back pain.
First up, what are the most common causes of back pain?
There's a popular saying amongst doctors - common things happens commonly. If you see a bird in Singapore, it's likely to be a sparrow, not a kingfisher.
The most common cause of back pain I see in patients is back strain. How this happens is that they accidentally pull their back muscle due to incorrect posture or lifting. Back strain should resolve in a few days time with proper rest and icing.
What about the causes for lower back pain?
Lower back pain affects virtually everyone at some point in life. A BMJ study found lower back pain to be the the number one cause of disability worldwide, affecting 83 million people globally.
Your spine is made up of a series of bones stacked onto each other. These bones are cushioned by disks, which protect your bones by absorbing the shocks from daily activities like walking and lifting.
As you age, the discs in your back start to dry up. This is further exacerbated by poor posture, which can translate to lower back pain with time.
If you find that your back pain doesn't go away in a few days, or if the pain is too excruciating, then it might not just be a simple "strain" or result of wear and tear anymore.
Chronic back pain is defined as back pain that's lasted more than 3 months. It also means that your back pain has lasted 10 times longer than a simple muscle strain.
At this point, you should definitely get checked by a doctor if you haven't done so yet - you might have a slipped disc, a pinched nerve, or even a nasty cancerous growth in your spine.
How do I know if my back pain is due to a slipped disc?
You may have a slipped disc if you feel an electric current-like sensation shooting down the foot from your back, or if you experience pain, numbness, or tingling on one side of your body.
The "disc" in question is a cushion-like structure in between your spine bones. When they are damaged, the cushion-like material slips out, and can cause severe irritation of the big nerves in your legs, as well as an electric current-like sensation (sciatica).
When should you be worried about back pain?
There are several “red flags” symptoms that doctors always look out for:
- Severe pain that prevents you from sleeping, or wakes you up from sleep
- Unexplained loss of weight and loss of appetite
- Severe weakness of one leg or both legs that prevents you from walking properly
- Loss of control of bladder/bowel movements (you wet yourself or pooped yourself without knowing)
- If the pain lasts for 3 months or longer
- If the pain is so severe that you can’t even move or wake up from bed
All these symptoms spell trouble, and may be due to abnormal growths - any delay in treatment could result in devastating disability.
This is why you should NEVER seek out a chiropractor if you are experiencing back pain for the first time - this often leads to critical delays in potentially life-saving treatment.
Sadly, I've seen all too many patients who went to chiropractors when they started experiencing back pain, and missed the golden window for receiving early diagnoses for treatable cancers.
Who do doctors go to when we have back pain ourselves?
Here are the health professionals that doctors turn to ourselves, or refer our patients/friends/family to for back pain:
- Sport Medicine doctor
- Orthopaedic surgeon
Occasionally, when the pain is of a very chronic and debilitating nature that doesn't respond to any other treatment, we may also refer you to see a Pain Specialist.
Rest assured that there's not a single medical professional in Singapore who goes to a chiropractor for back pain, or who will send you to one. Their purported claims for "spinal adjustments" to treat medical conditions lack any scientific evidence or physiological reasoning.
It's for this reason that chiropractors are NOT regulated by MOH in Singapore, because they are simply not health professionals.
There are also well-documented dangers with the spinal adjustment treatment that chiropractors offer - studies have reported multiple cases of stroke and death from spinal manipulation.
"But my friend swears that chiropractic works for back pain!"
Amongst patients, I often liken what chiropractors do to a massage -
Do you feel better immediately after the massage? Probably.
Does it solve the problem? No.
If you feel less pain after a chiropractic visit, it’s usually due purely to either a placebo effect, and/or a temporary release of endorphins.
Inevitably but surely, the back pain will return. If it doesn’t, you'd have had the same outcome without any care in the first place - in the same way that a flu recovers by itself with good rest. You'd have been better of staying home, and watching Netflix.
Any claims that chiropractors can "readjust" your misaligned spine (over 10 sessions) to cure back pain is simply BS. Maybe in an alternate Star Wars Universe where the “Force” is real, and chiropractors are all Jedi masters - only then, could they conceivably realign your spine by using the “Force”. Unfortunately, Jedi Masters they are not.
How is back pain diagnosed?
I'd say that the most important thing in successfully getting rid of back pain is to get the correct diagnosis first. Doctors determine this from:
- A thorough clinical history
- A detailed physical examination
- X-Rays/MRI scan/blood tests as necessary.
To be sure, there are cases where the exact cause of back pain can never be pinpointed, even though abnormalities may be seen on X-Ray or MRI. This is because studies have shown that people can have worn-out discs in their back, yet experience no back pain.
However, what a medical doctor WILL do for you is to comb through all your symptoms and investigate thoroughly to make sure that we leave no stones unturned - we won’t miss any opportunity to get you better.
So please bear with us while we appear to interrogate you by asking a trillion questions on your first visit. We are only doing our due diligence to deliver the best care possible.
What are some easy self-help measures for back pain?
The best road to full recovery involves rest, physical rehabilitation and progressive resistance exercises.
- Interrupt any repetitive task you perform by taking every opportunity you can to stand and stretch. This helps to reduce the stress on your back.
- Exercise regularly to strengthen all parts of your body, including your back.
What are the best back pain treatments in Singapore?
The best back pain treatment is one that's tailored to the cause of your back pain, your current condition, and your lifestyle requirements.
Accordingly, the 3 mainstays of back pain treatment administered by doctors are:
1. Physiotherapy. A properly tailored and supervised physiotherapy programme will help to reduce back pain in most. Treatment normally begins with traction and heat therapy, followed by exercise programmes to improve the strength and stamina of your back and spinal muscles. Regularly performing these exercises will help to prevent back pain from recurring.
2. Medications can help to relieve back pain, reduce inflammation, and decrease muscle spasm. Examples include NSAIDS and muscle relaxants.
3. Spinal injections. There are various types of spinal injections, which include:
- Epidural injections, which consist of a steroid and painkiller. They work by reducing pain and inflammation around affected areas.
- Nerve blocks are injections of medication near the nerves. They help to reduce nerve and joint inflammation, and also prevents excessive stimulation of injured nerves.
Does surgery work for back pain?
You must be thinking - As an orthopaedic surgeon, I'm going to encourage everyone to have surgery for back pain, right?
Nope. I always use surgery as a LAST RESORT. Surgery only helps in certain cases when we've tried but failed all other treatment modalities (medication, physical therapy and physiotherapy).
Of course, there are some specific instances when surgery will be offered straight away. These are usually reserved for severe and threatening medical conditions, such as back pain due to:
- Severe spinal column fractures
- Spinal joint dislocation
- Severe compression of the spinal cord causing progressive loss of nerve functions
- Eroded spinal column structures caused by cancerous growth
"But I don't want surgery, and nothing else has worked for my back pain!"
In patients with chronic back pain who do not want surgery, there are other limited medical interventions to help reduce your pain.
- Radiofrequency ablation, which helps to reduce chronic back pain by destroying the nerve that causes pain. It's normally reserved for patients with degenerative joint disease like arthritis.
- Spinal cord stimulation. This is an implantable device that offers pain relief by stimulating the spinal cord electrically to block pain transmission. It does not eliminate the source of pain.
To sum up, if you take nothing else away from this post, I hope that you at least understand the importance of finding out the real cause behind your back pain, rather than allowing a chiropractor to attribute it on your spine being misaligned.
I've seen too many cases where the critical diagnosis has been delayed or missed. It's too late by the time they reach us - either the nerve is already irreversibly damaged, or in the worst case scenario, the cancer has spread too much for any treatment.
Lest I end on a sombre note, I'd like to add that in patients with back pain who do seek proper medical treatment, 90% percent of people eventually get better in 2 – 6 weeks, without the need for any invasive treatment at all.
Dr Henry Chan is an orthopaedic surgeon practising at Mount Elizabeth Hospital. Dr Chan specialises in the management of adult and child fractures and trauma, general orthopaedic injuries, sports injuries of the ligament and meniscus, and degenerative spine conditions including prolapsed intervertebral discs (slipped discs). In his free time, he enjoys singing Karaoke.