Understanding Lower Back Strain
Another cause of lower back pain is a muscle strain. This can result from a sudden trauma such as a car accident or from lifting a heavy object. Sometimes the cause is elusive. Strains can occur when the muscle is over-tired or if there has been a long-standing muscle spasm around the lower back.
When the disc is damaged, the soft center can bulge or rupture through the tough outer layer. This is what is described as a herniated disc. If the herniated disc is not pressing on a nerve, the patient may suffer no symptoms. If the herniated disc is pressing on a nerve, there may be back pain, along with pain in the leg.
Your lower back is comprised of numerous structures including muscles, ligaments, tendons, and bones. The vertebrae in your spine are cushioned by gel-like discs, and these discs are actually comprised of an extremely tough outer layer with a softer gel-like center. The discs are susceptible to injury, and they can become damaged from heavy lifting, twisting of the spine, or even from a violent sneeze or cough.
Causes of lower back strain
Strained lower backs can occur for many reasons. The lower back supports most of the body’s weight, so injuries or strains are quite common. Some of the top causes for lower back strain are: – Exercising too hard or doing physical work: This can cause the muscles or ligaments to stretch too much or too fast. – Throwing your body out of balance: This could be anything from carrying a heavy object to one side, to an accidental fall, to one leg being slightly shorter than the other. – Lifting, pushing, or pulling heavy objects: This can put too much stress on the back, causing the muscles or ligaments to be injured. – Emotional stress, tension or too little sleep: This may cause some people to unconsciously tighten their back muscles, often leading to back strain. – Abrupt movement or overuse: Athletes often get lower back strains from any sudden or forceful movements in their upper body, or twisting the upper part of their body while their spine is stationary. This can also happen to anyone doing other types of abrupt movements, perhaps from a car accident or similar sudden jolt. – Aging and inactivity: Lack of exercise and too much sitting is bad for just about every part of the body, the back is no exception to this. Inactivity can weaken the back, and weaken the body overall, making the back more susceptible to injury.
Symptoms of lower back strain
Dull, aching pain. Increased pain with movement of the lower back. Pain in the lower back that is increased after prolonged activities. The above mentioned are some of the symptoms experienced by individuals with lower back strain. These symptoms occur most frequently in individuals who have suffered a specific event that has caused injury to the lower back. Although, the event might be a relatively simple movement such as bending to tie a shoe, or picking something up. These seemingly simple tasks can cause over-stretching of the ligaments in the lower back leading to a great deal of pain and discomfort. In more severe injuries, the individual may not be able to stand up straight. Pain or muscle spasms in the lower back often cause even simple movements to result in increased pain. And finally, individuals with lower back pain will often try to overprotect the area in an attempt to avoid further injury. This may result in increased stiffness of the back muscles.
Diagnosis of lower back strain
X-rays. These provide information about the quality of the bone and whether or not there are bony overgrowths (spurs) that are pressing on a nerve. X-rays provide clear pictures of dense structures, such as the bones. X-rays can be helpful to diagnose the cause of lower back pain, such as to find the infection, tumor, and bony damage. However, only 15% of lower back pain can be diagnosed through the X-ray result. Therefore, it is not routine for lower back pain. X-rays will not be taken if the patient is a woman and there is a possibility of pregnancy because the X-ray is dangerous for the baby.
Several diagnostic procedures to look for the cause of pain include:
Diagnosis of lower back pain Patient history and symptoms are often the best guide to the cause of your lower back pain. In many cases, the doctor can take a history and make a diagnosis based on the patient’s description of the pain and how it affects movement, he said.
Shingles and its Impact on Lower Back Pain
An acute, painful viral condition caused by the chicken pox virus, herpes zoster, also known as shingles, is a debilitating condition predominantly seen in the elderly. The natural history of the herpes zoster is a single occurrence in a lifetime. Shingles occur due to the reactivation of the chicken pox virus in the dorsal root ganglion. Known or suspected triggers that cause reactivation of the virus are immunosuppression, psychological stress and trauma. The virus then travels down the sensory nerves and involves the skin. This is characterized by pain and a band of blisters in a dermatome pattern that do not cross the midline. 2-4 days prior to the rash, there is a prodromal phase of severe burning or aching pain in the involved dermatome. This acute pain and skin involvement often alarms patients to seek treatment. Treatment of the actual herpes zoster with pharmacological agents is somewhat time dependent and patients are often frustrated if they are not able to obtain treatment within the first 72 hours, therefore therapy for the actual shingles should be initiated by the primary care team ASAP. Herpes zoster affects 1 in every 3 people and can cause severe complications in the elderly, therefore there is now a vaccine available that has shown to decrease the occurrence of shingles in the elderly by 50%.
Overview of shingles
Shingles is a disease that affects the nerves and the skin supplied by the affected nerves. The name herpes zoster is from Latin: herpes, meaning ‘to creep’, and zoster, meaning ‘girdle’ or ‘belt’. The affected area often feels itchy or tingly, and it is usually very sensitive to changes in temperature. This discomfort can be severe and is usually the first symptom. After a few days, a rash appears as a band or patch of raised dots on the side of the trunk or face. This is a sign that the virus has reactivated, and it is usually when the pain becomes more severe. In the days and weeks that follow, a crust forms over the blisters, then they slowly heal.
Shingles is a painful rash which usually develops on one side of the body, often the back. The rash forms in a band-like pattern and may wrap around the entire torso. Shingles is caused by the same virus that causes chickenpox. After a person has had chickenpox, the virus lies dormant in the nervous system and can reactivate years later, causing shingles. It is not known what reactivates the virus.
Connection between shingles and lower back pain
A recent study found to suggest that this condition quadruples the chance of an individual experiencing an episode of lower back pain and that this risk may persist for many years after the initial occurrence of shingles and lower back pain. It is believed that this may be due to the degradation of nervous systems in elders caused by the virus. At that time, back pains were not severe enough, but reoccurs and worsens with time. Another possible condition arising from shingles is chronic radicular pain, through the migration of varicella-zoster virus to the dorsal root ganglion, and reactivation. It is believed that it may cause leg or arm pain long after the shingles outbreak with pains moving into the specific dermatomal area. Despite these findings, there is still much uncertainty about how shingles is able to cause these painful conditions.
Herpes zoster is the virus that causes shingles and it is part of the herpes family of viruses. The first contact with herpes zoster will result in chickenpox, which may have occurred during childhood. The virus remains dormant in the nerve roots and may reactivate later in life, producing shingles. This unique virus has been linked to various neurological and musculoskeletal complications. While much remains to be discovered about the pathophysiology and its impacts on nerve and musculoskeletal function, research has provided evidence of its links to various painful conditions. The herpes zoster virus causes inflammation of the affected nerve and the production of small blisters in the region. Shingles eruption usually occurs in a single dermatome and on one side of the body.
Effects of shingles on the lower back
The shingles episode has characteristic features, and it is important to be able to differentiate it from other causes of LBP. The pain which precedes the rash by a few days is often described as ‘burning’, ‘sharp’, or ‘like electric shocks’, and is associated with paraesthesia or hyperaesthesia in the affected dermatome. This is in contrast to the dull, aching pain of mechanical LBP. The pain in shingles can be extremely severe and associated with cutaneous allodynia. It is not uncommon for the pain to be misdiagnosed as visceral or renal pain. Constitutional upset with fever and malaise is often severe with zoster, and in the elderly, there may be a delay in diagnosis as the rash may be sparse or non-existent. The skin is the most commonly affected organ with herpes zoster, and the presence of the rash aids diagnosis. The rash is often preceded for 2-4 days by neuralgic pain and paraesthesia, and the appearance of vesicles on an erythematous base in a unilateral dermatomal distribution is characteristic. In uncomplicated shingles, the rash resolves, and the pain and other symptoms abate. Complete resolution of the lesions occurs in >90% of immunocompetent individuals within a 3-4 week period.
Treating shingles-related lower back pain
Although the effectiveness of medications and anesthetic injections in reducing or eliminating shingles-related pain remains largely unexplored, some patients with zoster myelitis or postherpetic neuralgia have been treated with epidural methylprednisolone with reported success. A patient with zoster myelitis resulting in severe lower back pain and paraparesis had complete resolution of his pain and partial recovery of his motor deficit after a 3-day course of IV acyclovir and 80 mg of oral prednisone daily for 6 days. Subsequently, there has been no return of his pain and he has been maintained with oral prednisone at slowly tapering doses, and has had no adverse effects from prednisone other than mild dyspepsia. A controlled study is required to determine the optimal use of methylprednisolone or prednisone for postherpetic myelopathy or radiculitis. An immunocompromised patient with zoster involving his right L1-2 and L2-3 dermatomes and severe radicular pain and multiple vesicles in clusters on an erythematous base over his L1-L3 paraspinal areas had complete resolution of his pain and skin lesions after 10 days of treatment with 60 mg of oral prednisone daily and normal areas of skin and mucous membrane covered (Learner, PM. 135). A case of right L1-2 zoster in a renal transplant patient, resulting in pain and paraparesis, was treated with a short course of IV acyclovir and oral prednisone with improvement of his pain (Morales, G. 22). Although anecdotal, these reports suggest a potential benefit from systemic glucocorticoids in severe cases of herpes zoster, and well-designed studies should be pursued.
Treatment Options for Lower Back Strain and Shingles-Related Lower Back Pain in Singapore
There are quite a few things that someone can do for lower back strain treatment or shingles. The result may be different between each individual. Basically, the treatment for both conditions is similar since the cause of the pain is in the same spot. The treatment options are pain management and medication, exercises, alternative therapies, and surgery. For mild shingles or lower back pain, medication and pain management can be done by taking over-the-counter pain relievers such as aspirin or ibuprofen. Paracetamol can be taken to reduce the discomfort caused by shingles. Unfortunately, there are no specific treatments to cure shingles, but by taking antiviral medications, it can shorten the duration of the disease and prevent complications. For severe shingles-related pain, there is a possibility to inject corticosteroids to the painful area or to take strong narcotic pain medication through prescription, although this kind of treatment is not recommended for long-term use. Anti-epileptic medication and tricyclic antidepressants can be considered by the shingles sufferer since the medication can relieve the pain and repair the damaged nerve. The same with a lower back pain sufferer, if the pain does not go away after 4 weeks, or in the very first instance if the pain is severe and acute, a health professional will evaluate the possibility of injection treatment to relieve the pain. For medication or any active intervention, consultation with a physician is necessary. A good physician can provide a clear explanation of the treatment options and their implications and help the patient to decide which way to go according to their condition. Normally, they will assess the amount of discomfort and its impact on the patient and make considerations about the risks of intervention, possible adverse effects, and costs of the treatment compared with the potential benefit. Any decision should be made jointly between the patient and their doctor.
Medication and pain management
Nonsteroidal anti-inflammatory drugs (NSAIDs) are an option for pain relief in the treatment of acute and chronic lower back pain. They have shown to reduce pain levels and increase function. There is little difference between NSAIDs for lower back pain in terms of effects and different types have been compared with results demonstrating no significant superiority of one form over another. Side effects can limit the dose and duration that these medications can be taken. Paracetamol is recommended as first-line treatment for lower back pain, although trial evidence suggesting a benefit of its use is limited. Its best effects are seen in the relief of pain associated with inflammatory or arthritic pathology. Opioids are effective for acute or subacute severe lower back pain, causing a reduction in pain but a risk of addiction and high dependence. They have drawbacks in terms of cost and a perceived lack of effectiveness in the relief of chronic noncancer pain. They are generally not recommended for high-level spinal cord compression or cauda equina syndrome due to a potential for exacerbating constipation and further neurological impairment. Medication should be agreed upon by the analgesic ladder with regular review as to continuation. Local steroid injections have shown a favorable effect on chronic lower back pain but are not recommended as routine therapy and the exact site and substance to inject is unclear.
The pharmacological management of lower back pain focuses on the use of analgesics, taken on a regular basis or intermittently, to relieve or reduce pain. The use of an analgesic ladder has been suggested in the treatment of cancer pain. Furthermore, there are several varieties of medications available for the relief of chronic pain. These should be used with care as some have serious unwanted side effects and this use can detract from simple analgesia and can be detrimental to the person suffering with pain. Data is also limited on the effectiveness of chronic medication use in chronic nonspecific back pain.
Physical therapy and exercises
Patients with lower back pain from both shingles and lower back strain are encouraged to start moving as soon as the pain has decreased to a discomfort level. There are many options for physical therapy, but a light program of exercise and stretching, involving the hips and the muscles of the lower back and legs is generally the best way to start. It should be guided by a professional physical therapist and be relatively progressive. The therapist will assist the patient in determining which exercises will benefit them the most. If the patient is unable to function independently, exercises can be done passively or with assistance. Patients are encouraged to continue with exercises at home. Long-term conditioning with aerobic exercises (e.g. bicycling, swimming) is beneficial for improving the functional capacity and decreasing the pain for those with chronic lower back problems. The primary focus should be the exercise and the emotional satisfaction from increased fitness, rather than becoming preoccupied with attainment of a specific heart rate. In patients with chronic conditions or in the elderly, aquatic therapy or light aerobic exercises may be more suitable due to the lesser impact forces on the spine and the support provided by water. These exercises are geared towards improving the overall physical fitness, endurance, and well-being of an individual. Although it is advisable to avoid any activities that significantly aggravate the pain, recent studies have refuted previous advice for those with lower back pain to avoid activities and bed rest, recommending that they should continue with their normal activities and be reassured that discomfort does not necessarily equate to damage.
Alternative therapies for pain relief
Herbal medicine is viewed as a less aggressive approach compared to pharmaceutical treatments and is the consumption of plant-based pills and extracts in an attempt to improve overall health. It is believed that this form of medicine is gentler on the body; however, the efficacy of it is mainly based on the quality of the product and the condition being treated. Step-by-step Life (2004) states that due to lack of conclusive scientific evidence, it is difficult to say with confidence whether herbal medicines are effective or not for CLBP. This is echoed by the words of Duncan and Suter (2006) who mention how there is limited evidence to either support or refute the use of herbal medicine.
Acupuncture is thought to be an effective treatment, as the traditional Chinese belief is that the body is powered by universal life energy, or qi, which travels along lines of energy, or meridians. Pain is thought to be a blockage of qi’s movement, and acupuncture is said to stimulate the movement of qi and remove blockages by inserting ultra-fine needles into specific acupoints. This then triggers the nervous system to release chemicals in the muscles, spinal cord, and brain, which in turn will either change the ways pain is perceived or the body’s response to it.
Duncan and Suter (2006) address several therapies tailored for CLBP sufferers, i.e. Complementary and Alternative Medicine (CAM) such as acupuncture, herbal medicine, spinal manipulation, massage, movement therapy, and yoga. These approaches are deemed suitable for the vast majority of sufferers, as many patients may have already tried pharmaceutical and surgical treatments with minimal success.
Surgical interventions for severe cases
Surgical interventions provide relief for patients with chronic lower back pain, but there is little evidence to support that surgery is more effective than the other treatment options. There are different types of surgery to treat lower back pain: – Decompression surgery (laminotomy, discectomy, and microdiscectomy) is performed to relieve the pressure on a nerve caused by a herniated disc. When a herniated disc is compressing the nerve, the removal of the piece of the disc that is fragmenting the nerve usually provides patients with pain relief in the lower extremities and/or the lower back. – Fusion surgery is primarily used to treat spondylolisthesis. It will stop the motion of the area where the spine has slipped, relieving the associated leg pain as the nerve is no longer being compressed. This is achieved by placing bone between the two affected vertebrae. The bone acts as a bridge between the two vertebrae, creating a fusion of the two vertebrae into one solid piece. – Artificial disc replacement involves removing a damaged intervertebral disc and replacing it with a new, artificial one. This treatment is still relatively new, and the long-term benefits are still being researched.
Importance of seeking professional help
Seeing a healthcare provider is important for all patients, especially those with intense pain that is not improving. The benefits of seeing a healthcare provider include a thorough history and examination done to determine the cause of your pain and the best course of action to take. This may include referral for more tests or a consultation with other healthcare providers. A healthcare provider can also provide you with advice regarding activity and work restrictions. Education on how to best take care of your back and prevent further injury is very important, which can be provided by a nurse or physical therapist. Patients seeking alternative therapies should also seek advice from a medical professional to ensure safety and limit further damage. This section will cover various healthcare providers to help guide you in the direction you feel is best suited for you.
Singapore’s Healthcare System and Resources for Lower Back Pain
When you review the contents of “Effective Treatment for Lower Back Strain and Shingles-Related Lower Back Pain in Singapore”, you will get a better idea of the healthcare system in Singapore and the resources that are available in treating lower back pain. This will help you to make the best possible choice of treatments to obtain the most immediate, long-lasting, and convenient relief from your lower back pain. To fully understand the healthcare system in Singapore, you need to understand the fact that Singapore has “a mixed healthcare system that comprises a mixture of public and private healthcare”. There is a comprehensive network of medical clinics and hospitals providing primary and specialist care, and medications are very affordable compared with many other first-world countries.
Overview of Singapore’s healthcare system
In 2000, Singapore launched the “Health 2010” masterplan with an objective to develop a patient-focused and healthcare system organised around clinical specialties. This being the case, it has brought about further healthcare reform with the advent of new healthcare clusters, each assigning focus to different clinical specialties. Singapore’s public healthcare system is mainly funded by the Ministry of Health (MOH). In a quick appraisal of a patient’s experience in the polyclinic and a public hospital, a subsidised fee for services provided is permitted by the patient through means testing. EDURE has since collaborated with the MOH to develop Singapore’s healthcare manpower and education infrastructure to both further capabilities for higher patient care, and better patient care. Access to physiotherapy treatment for lower back pain in the public sector is mainly via referral in the restructured or public hospitals. With an increasing amount of hospital beds being dedicated to acute care, private community hospitals and nursing homes, there is in effect, less emphasis and resource provided to rehabilitative care in the public sector. Overall, the general focus on physiotherapy in the public sector is geared mainly toward patients who are acute in nature. Step-down or sub-acute patients who would benefit from rehabilitative physiotherapy may find that there are fewer resources available to them. An example would be an elderly patient with chronic lower back pain, seeking to improve his mobility and functional capabilities. He may find that there are no resources to tap into in the public sector and may have to resort to using his medisave at a highly subsidised rate in the private sector.
Accessibility to specialized clinics and hospitals
Accessibility to specialized clinics and hospitals. Patients with lower back pain in Singapore generally seek treatment from private specialists or allied health professionals such as chiropractors, physiotherapists, and TCM practitioners, rather than from public hospitals or Western trained medical doctors. Most individuals rely on word of mouth or self-referral to access these services, although some are referred by western doctors. Wait times vary depending on the individual services and doctors but can range from immediately to a few days. Although accessibility is good, cost is a barrier as treatment costs in the private sector can be quite high and allied health services are not currently covered under Medisave. There are some notable exceptions where individuals seek care from public hospitals and doctors. Patients with more serious lower back conditions such as chronic pain, spinal stenosis, or disc problems may be assessed and managed by a rheumatologist, neurologist, or orthopedic surgeon at a restructured hospital. Those with work injuries may seek care at the Singapore General Hospital, Changi General Hospital, or Tan Tock Seng Hospital in the hope of receiving subsidized treatments and medications under a specialist’s care at the polyclinic or specialist outpatient clinic. This may help to ease the financial burden of treatment.
Support groups and resources for individuals with lower back pain
As a person living in Singapore who has lower back pain, you can find help with your condition. To determine the kind of help you need, remember it is important to get a proper medical diagnosis. For very specific advice, you should ask your family doctor, who can refer you to a specialist as required. This article aims to provide basic information on some of the treatment and rehabilitation options for the most common causes of lower back pain. However, it is not a substitute for medical advice. If you have lower back pain, you are not alone. At some point in their lives, about 80% of Singaporeans are affected by back pain. So with such a high prevalence, does this mean that it’s normal and nothing can be done? The answer is no. Although some degree of degeneration in the spinal structures is inevitable with aging, evidence strongly supports the idea that specific treatment helps to effectively resolve episodes of back pain. Complete resolution of an episode prevents future episodes from occurring, thus breaking a vicious cycle of pain and further degeneration. This is why it is important to seek the most effective treatment.
