Insights + interviews

In Conversation with Principal Physiotherapist, Calvin Sim

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We interview Mr Calvin Sim, the Principal Physiotherapist at Physio Connectionz, to share more about lower back pain and its causes.

As the Principal Musculoskeletal Physiotherapist at Sports and Orthopaedic Rehabilitation Centre, Physio Connectionz, Calvin Sim (CS) has vast experience in managing musculoskeletal injuries arising from sports to problems arising from sedentary lifestyles.

Lower back pain is a common problem among many Singaporeans due to our lifestyle and office jobs. To gain more insight on the topic, we got Calvin to share more about lower back pain and its causes, as well as some possible treatments.

AA: Hi Calvin, firstly, could you tell us more about lower back pain and how common it is among Singaporeans?

CS: Numerous researches have suggested that lower back pain is the number one cause of non-systemic medical leave across the globe. It is also reported that everyone would experience at least one episode of lower back pain in their lifetime, with 80 percent having recurring lower back pain. In Singapore, the Ministry of Health (MOH) did a Burden of Disease Study in 2010 and found that lower back pain is ranked the 3rd most common musculoskeletal injuries, right after osteoarthritis and rheummatoid arthritis.

AA: Which group of people are more susceptible to suffering from lower back pain and why? (Eg. Age group, gender etc)

CS: In the MOH study, lower back pain was reported to hit in the population as young as 15 years old, with the highest number of sufferers aged between 30 to 40 years old, and 50 to 55 years old. Lower back pain was also found to affect women more than males.

In the 50 to 55 age group, disc degeneration is generally the main cause of lower back pain. As for the 30 to 40 age group, one possible explanation for  the increase in lower back pain is the change in activity level. The 30- to 40-year-olds tend to be seated for long periods of time at work during weekdays and switch to being excessively active with either exercises or activities over the weekend. This causes an increase in stress on the back muscles, thus causing ache and pains arising from muscle tightness or strains.

AA: What are some of the top causes for lower back pain in Singapore?

CS: One of the biggest causes of lower back pain in the general population is posture. A lot of people tend to stand either in a very erect posture or in a very slouched posture. This puts a lot of unnecessary stress on both the muscles in the lower back as well as the joints in the lumbar spine, which would cause degeneration of the disc and joints in the lower back, thus causing us to feel pain. Prolonged sitting in an inappropriate posture can also give rise to lower back pain as it puts the lower back muscles on a prolonged stretch, causing the muscles to be strained and therefore weak.

AA: Many may tend to ignore the symptoms of lower back pain and think of it as merely a condition that comes with age. When is it time to seek medical help for it and will the pain ever go away completely?

CS: As most back pains go off in about a few days with ample rest and over-the-counter medications such as panadol, neurofen, as well as deep heat rubs, we normally think that the problem is solved. However, the lack of pain need not mean that the problem is resolved. Lower back pains tend to recur as we have not addressed the root of the problem. As a result, the recurrence would be more frequent and the duration would last longer.

In my opinion, for a mild lower back pain, if it does not resolve within two to three days of rest, or if you have had at least two episodes of lower back pain within a few months, it is best to seek professional medical help. However, if one has a moderate degree of pain, it is best to seek treatment as soon as possible.

AA: What are some treatments typically used to help those suffering from lower back pain?

CS: Common treatments used for lower back pain sufferers are heat treatment, interferential current, TENS, and lumbar traction which may be used to decrease the amount of pain. Depending on the physiotherapist’s assessment of the cause of pain, joint mobilisation and/or deep tissue mobilisation may also be employed if a joint stiffness or muscle tightness is the cause. Some physiotherapists who have completed advanced training may manipulate the joints if deemed necessary as there are risks associated with joint manipulations. The risk and benefits of this treatment should be discussed with the patient before administration.

These treatments are generally used as a short-term, immediate relief of pain. However, the main way to prevent recurrence of lower back pain is through exercises. The physiotherapist would prescribe an exercise programme that would be specially catered to your condition, so as to address the root cause of the problem. The poor posture could be a result of stiffness in the joints or tightness in one’s muscles. The exercises prescribed should be closely adhered to and you should continue to do the exercises on a regular basis, even when the condition has improved.

AA: How would products such as 3M’s Futuro Slim Silhouette Back Support help when it comes to managing lower back pain on a daily basis?

CS: The Futuro Slim Silhouette Back Support is designed to mimic the role of the Transverses Abdominis, which is the main core muscle supporting the spine. So when one experiences an acute episode of lower back pain, using the back support would help reduce the pain by supporting the spinal structures and allowing time for the muscle to heal and recover.

Using the support for a few days would usually help alleviate the pain. However, if the pain persists beyond two weeks even after donning a back support, I highly recommend seeking professional assessment and advice from a doctor or physiotherapist. I wouldn’t recommend long-term usage of any kind of support if you have not gotten your problem properly assessed as the prolonged usage of braces has been found to cause further weakness of the muscles.

AA: Are there certain exercises you would recommend to help manage lower back pain?

CS: Swimming freestyle is the main exercise I would recommend to all my patients suffering from lower back pain as it is a good total body workout and also helps to strengthen the core muscles. Pilates is also another good form of exercise to help manage lower back pain but it is very important to get a good instructor to supervise you properly while you perform it.



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