Overview of Back and Neck Pain
Back and neck pain are two of the most common health problems experienced across the globe. They can be caused by any number of things, from muscle strain to more serious conditions such as a herniated disc, degenerative disc disease or even a fracture. This pain impairs many daily activities and can lead to increased stress, as people feel that they are unable to perform the simplest tasks. Furthermore, the pain can lead to irritability, depression, decreased job performance and missed work. In less common cases, back and neck pain can be a sign of a more serious or potentially life-threatening condition. This is why it is so important to seek treatment for chronic back and neck pain. Pain related to the lower back often originates from the disc space between the L1 and S1 vertebrae, or from the joints in that region. The L1 to S1 vertebrae makes up the motion segment of the low back, and a herniation or degeneration of the discs in this space can cause pain. Pain can come from the back to the legs and thighs. It is also common that lower back pain is associated with muscle imbalances in the pelvis or the muscles between the low and upper back. Pain originating from areas around the lumbar spine often cause pain when bending forward or backward. In more serious cases, it can be difficult to walk or stand.
Causes of Back and Neck Pain
Back and neck pain is a common condition suffered by Singaporeans. It may affect any age group, but generally, it is more frequent in the people between 30 and 60 years of age. It may be an ongoing recurrence of a longstanding condition or it may occur as a sudden and severe onset following a specific incident or movement. This can affect your ability to concentrate at work and function normally at home. The causes of back pain are numerous but roughly fall into either a sudden (traumatic) or a sustained overstress injuries. For both types the structures usually affected are the discs, a ligament or a muscle. Usually back and neck pain is not due to a serious disease and the exact cause of the pain is often unknown. This is not usually important as the pain usually settles with simple appropriate treatment. An accurate diagnosis is not always possible and is not usually required.
Common Symptoms of Back and Neck Pain
Stiffness can be general, widespread, or localized to one area. Muscle tightness and restriction in the normal range of motion of the joint is typical of stiffness. Stiffness and reduced range of motion are more often noted after waking up in the morning or after periods of inactivity. A common problem is back pain and more specifically lateral thigh and leg pain. This is an umbrella term used to encompass symptoms of numbness, tingling, pins and needles, or weakness. Usually, the knee and ankle jerk reflexes are diminished. This is often caused by nerve compression at the lower lumbar or L3 or L4 level. This painful symptom requires immediate medical assessment.
Pain can be anywhere from a dull constant ache to a sudden, sharp pain. Pain can be in one part of the body such as the back on the left side, or it can be in another location of your body such as low back, shoulder pain, or neck pain. It can also be exhibited as traveling or radiating pain on part of your body. Widespread pain can occur with conditions such as fibromyalgia and is typically described as moderately severe pain involving areas on both sides of the body, above and below the waist.
Importance of Seeking Treatment
Finding the causes of back and neck pain can be like finding a needle in a haystack. The severity of damage and pain to the back or neck does not always correlate to the degree of injury, and often identifying the cause can be difficult, leaving the sufferer more frustrated than when they began. These confusions can lead to despair and, according to the Australian Spinal Research Foundation, “people asked to rate their general practitioner for providing information on their back said they would give them a C minus,” indicating dissatisfaction with the way back pain is handled by health professionals and understanding of the condition by the sufferer. Yet, identifying the cause in even the simplest terms such as “I have a slipped disc” can often open doors to curing the problem. A study conducted in Singapore found that most patients were less likely to seek treatment or lost confidence in their treatment if they were still uncertain about the cause after seeking their healthcare practitioner. Millions of people miss work each year due to back and neck pain, but the true scope of how much back pain costs is hidden in more hidden factors. Back pain is often a cause of changes in occupations or early retirement, itself being a massive economic burden when combined with treatment costs. An evidence review conducted by the medical journal Spine, which analyzed a variety of studies on the cost of low back pain, categorized costs into direct medical costs and indirect costs including loss of income, compensation, and productivity. The data was then adjusted for inflation and converted to 2016 U.S. dollars, which found the combined economic impact of low back pain to range between $84.8 billion and $624.8 billion. Pricing to individual patients was even more alarming, showing that private health insurance and out-of-pocket costs ranged between $669 and $2773 in 2006, only set to increase in recent years due to higher demand for treatments and increasing wages in healthcare. This provides a harsh reality that costs to treating back pain can easily exceed the cost of prevention, in which some cases prevention is no longer an option.
Best Treatment Options for Neck Pain
If results from treatments aimed at the cause of the neck pain are discouraging or there is no real cause that can be identified, then treatments aimed at relieving symptoms may be the only option. This could include consulting with primary care doctors or specialists such as neurologists. They can provide you with information on what types of medications (prescription or over-the-counter) may help dull the neck pain in order to make it more manageable. Sometimes neurologists will send patients to physical therapy or rehabilitation. For some, the final hope may be some form of surgical treatment assuming that there are no more treatment options aimed at resolving the cause of the neck pain.
The best treatment for neck pain is more focused on the cause of the neck pain rather than the neck pain symptoms themselves. This would be to attempt treatments aimed at resolving the cause of the neck pain. In some instances, these treatments may make the pain seem worse initially as the body has to readjust to the changes being made. But sometimes the end result is an improvement to the neck pain. An individual would need to speak to a doctor to figure out what the cause of their neck pain is and what treatments are available for this cause.
Physical therapy and rehabilitation: Neck pain can often be debilitating and occasionally lead to pain in the arms or headaches. If there is a chance that a person could recover from the condition causing the neck pain, then there is always the possibility that the neck pain will resolve. Although the pain may not go away completely, there is still a possibility that a person can live functional and productive lives despite the pain. The goals of treatment are to find the cause of the neck pain and then to treat this cause with the hopes that the neck pain will improve. In order to reach these goals, there may be a trial of a few different treatment options.
Physical Therapy and Rehabilitation
Cervical disc disease, disc herniation, and neck strain can be difficult problems to manage. Neck and arm pain can be quite debilitating. For those patients who do not wish to use medications or who continue to have discomfort related to neck or arm pain for several weeks, an evaluation of physical therapy or rehabilitation should be considered. A therapist can work on posture education, ergonomic issues for work, and the use of traction. Neck discomfort often improves with specific exercises to strengthen the neck muscles. Similarly, arm discomfort will improve with specific exercises to improve strength and alleviate numbness or tingling. These exercises may be supervised and performed during multiple sessions in the therapist’s clinic. In order to improve strength and flexibility, endurance training requires a longer-term exercise program supervised by the therapist. This may involve the use of cardiovascular training equipment such as a treadmill or elliptical runner. A therapist may also recommend the use of an at-home traction device or a TENS unit to alleviate arm pain.
Medications for Pain Management
It is important to state here that all medications have potential side effects and drug interactions, and it is essential to discuss the risks and benefits with a doctor and to always read the information provided with the medication. Specific advice should be obtained for those with peptic ulcers, asthma, high blood pressure, kidney disease, heart failure, previous strokes, and those who have allergies to aspirin or NSAIDs. Any medication should be taken strictly within the recommended dosage and frequency. Always consult a doctor when changing the dose or type of medication.
Taking medication is one of the most consistent ways to control and manage neck pain. There are several types of medications available which are effective for a range of painful conditions. The vast majority of people with neck pain will not need strong painkillers and respond well to simple analgesics such as paracetamol. Effective pain control will also allow the patient to continue with exercise and rehabilitation programmes. For more severe neck pain, the initial use of a fast-acting analgesic is beneficial to gain rapid control of the pain. This can be achieved with a non-steroidal anti-inflammatory drug (NSAID) which can also help to reduce any inflammation present. It is generally advisable to take medication regularly for a specific period rather than just taking it when the pain is very bad.
Non-Invasive Treatments like Chiropractic Care
It is important to explore all possible options to find relief. Getting down the cause of neck pain is the first step to finding the most effective treatment. This must be done with the help of a qualified health professional. If the cause is known, avoid any treatment that is not substantiated with scientific evidence. For instance, there is little point in trying invasive treatment that carries a high risk of significant side effects. Under the category of neck pain with recent onset, the best treatment is advice to stay active, education, self-management, and analgesics or NSAIDs. These should all be used in conjunction with each other. There is scientific evidence that manual therapy and the use of a collar may be beneficial for those with recent onset whiplash in providing short-term relief from symptoms, but these treatments are not widely available. Ice and/or heat application have not been researched for recent onset neck pain, so there is no evidence either way for the effectiveness of these treatments.
Surgical Interventions for Severe Cases
Microdiscectomy is a surgical procedure recommended for severe and chronic neck pain, if the pain is into the arm and a specific root (nerve) in which the patient can feel tingling, numbness, and weakness does not improve. The disc material causing the pressure is removed to relieve the pain from the nerve. This procedure is often recommended if the pain is severe and has not resolved after a period of 4-6 weeks. The procedure is often successful and may alleviate the pain immediately. Anterior Cervical Discectomy and Fusion is a more extensive operation for a cervical herniated disc causing neck pain or arm pain. In addition to the disc material being removed, a cervical fusion is performed to stop the motion at the segment of the spine causing pain. ACDF involves an incision in the front of the neck and after the disc is removed, a graft is inserted to fuse the vertebrae. This procedure may be considered for those suffering severe arm pain and weakness that is not relieved by non-operative treatments. Posterior Cervical Laminoforaminotomy is a similar procedure to anterior cervical discectomy, but is performed on the back of the neck and often used for a herniated disc that is impinging on a nerve root which is only causing severe arm pain and no neck pain. Finally, Cervical Artificial Disc Replacement is a relatively new procedure offered to patients. A cervical disc is used to replace the intervertebral disc and the goal of this technology is to maintain motion at the level of the spine. This procedure is currently only recommended on specific patients and age groups. These procedures and the decision to proceed with surgery depend on many factors and your orthopaedic surgeon can help to guide you to the best treatment.
Singapore’s Leading Back and Neck Pain Treatment Centers
Center A is well known for its non-surgical approach to various musculoskeletal conditions, including back and neck pain. There is a wide range of treatment options available at this center including occupational therapy, physiotherapy, psychological services, medication, injection therapy, and complementary medicine. Patients will first be assessed by a musculoskeletal specialist to diagnose the cause of their back or neck pain before he/she is referred to the appropriate therapist or allied health professional. A unique service at this center is the combined clinic where the patient is able to see both a pain specialist and an allied health professional on the same day at the same place to facilitate an interdisciplinary approach to treatment. This center is suitable for patients who prefer a non-surgical approach to their back or neck pain or those who are unsure of what treatment is best for their condition. This is because there is no obligation for patients to undergo any form of invasive procedure and the risks and benefits of each treatment option will be discussed with the patient who will have an active part in the decision-making process. This center is also involved in pain research and education and has strong links with the local and international medical community.
You can find a wide range of treatment options for your back and neck pain with Singapore’s increased focus on this sub-specialty. Some of the pain specialists are overseas-trained, while others have many years of experience dealing with back and neck pain in the local and regional setting. We describe two such centers which have either a unique approach and specialists known for their expertise in the field.
Center A: Specializing in Non-Surgical Approaches
Located in the vibrant Central Business District, Center A has made a name for itself with its 8 locations island-wide, making it one of the most accessible back and neck pain treatment centers. It specializes in non-surgical methods, setting itself apart from the majority of pain treatment centers in Singapore. Apart from its effective methods of pain relief, it has the advantage of cutting costs to make the process much more affordable. Being the largest provider of non-surgical treatment, this center has treated more than 200,000 patients to date for a wide range of conditions, making it the go-to place for those seeking alternatives to surgery. This is the place where Min, with a protruding disc in his lower back, sought treatment. Fearing surgery, he was worried nothing could be done. But after several sessions of a relatively new treatment called Intradiscal Electrothermal Therapy (IDET), he found relief and can now lead an active lifestyle without any hindrance to his back. This center offers a wide range of treatments from pain medications, injections, and physiotherapy. But it is most notably effective for conditions like slipped discs, sciatica, and spinal stenosis. These conditions are notorious for being difficult and surgery is often seen as the last resort. However, many patients have avoided surgery with the variety of treatments offered at this center.
Center B: Expertise in Minimally Invasive Procedures
Minimally invasive procedures offer a safer, quicker, and easier recovery, less pain and trauma to the body, and are often more cost-effective in the long term compared to conventional surgery. This is particularly useful for the elderly, patients with multiple medical problems, and some with occupations that require hard physical work. Mindful that expert skills and experience are needed for such procedures to be done effectively, a team of experienced surgeons have been trained in some of the best centers in the world in minimally invasive procedures for the spine. These include muscle-sparing microdiscectomies for lumbar disc prolapse, complex stabilization and fusion surgery using state-of-the-art interbody fusion techniques and instrumentation, percutaneous techniques (inserting long screws through the skin without large incisions), endoscopic and microendoscopic procedures. One very recent development is the use of navigation technology, which allows complex surgery to be done with minimally invasive techniques under image guidance. This increases the accuracy and safety of such procedures and will reduce the risk of converting to an open procedure to check for misplaced screws and instrumentation. Currently, only a handful of surgeons in Singapore are familiar with this technology. This exceedingly delicate and complex surgery demands a high level of technical skill and an understanding of the three-dimensional anatomy of the spine. This is then balanced with a cautious approach, always weighing the benefits of surgery in relation to the risk profile for the patient.
Tips for Preventing and Managing Back and Neck Pain
A healthy diet and active lifestyle are important, not only for preventing back pain, but for overall health and well-being. Being overweight or obese can significantly increase the load on the spine and can result in structural damage. Both poor nutrition and high body fat can lead to increased risk of hypertension, diabetes, and heart disease, all of which can lead to back pain and impaired function. High impact sports can cause trauma and injury to the spine. Regular exercise should be a combination of cardiovascular exercise, strengthening, and flexibility. Low impact activities such as walking, swimming, or using an elliptical machine are great forms of cardiovascular exercise. Yoga and pilates are excellent for flexibility and strengthening, and aqua-aerobics is a great form of exercise for people with back pain. Choosing activities that you enjoy and are convenient for you will help you maintain regular exercise as a lifetime habit.
Regular relaxation and general exercise are a great way to help manage stress. Yoga is an excellent form of relaxation and exercise that can be beneficial in managing and preventing back pain. Daily stretching will help maintain normal joint function as well. Stress can create muscle tension in the back, which can cause pain, muscle tightness, and increased risk of muscle injury. By identifying the source of your stress and reducing it, you can reduce the risk of future back pain.
Proper posture and body mechanics are essential to preventing back and neck pain. A chair should have a straight back or low-back support. You should sit with your back against the back of the chair. A small pillow at the low back can be used for extra support. Your knees should be at the same level or higher than your hips. Use your abdominal muscles to help support your body when sitting or standing for long periods. If your job involves standing for long periods, you should change positions frequently with your weight evenly distributed on both feet. Continuous standing on one foot or on the same leg can develop muscle imbalances, leading to back pain.
Maintaining Proper Posture and Ergonomics
Thighs: Try to keep the angle between the thighs and the trunk as open as possible. This usually involves raising the seat height. Use a seat with a sufficient depth to allow clearance between the front edge of the seat and the back of the knees.
Legs: Keep the knees and hips level. The use of a footrest may help to attain this posture more comfortably.
Feet: It should be possible to alternate between two sitting postures, one with the feet flat on the floor and the other with the feet supported on a footrest. Avoid sitting on the legs and feet.
When sitting, the following tips can help to establish a good sitting posture: Eyes: Keep the head in a neutral position, make sure the eyes are level with the top of the computer monitor. If not, adjust the seat height. The use of a document holder is helpful.
Regular Exercise and Stretching
Regular exercise is important considering people living sedentary lives are being prone to back pain, a prevailing phenomenon in developed nations where a sizable portion of the populations are sitting in front of computers in offices. While engaging in physical activities might give you the initial discomfort, it is important for recovery from chronic back problems and helps to prevent recurrence of the pain. For those with existing pain, they should attempt light activities such as walking and swimming before progressing to more strenuous exercises. Yoga is also a good alternative because it focuses on flexibility and core muscle strength, which is important for back health. Failure to engage in regular physical activities will result in gradual decline of the body’s functional abilities. A joint that is not moved will eventually lose its function and they will be forfeited by the body in terms of energy. What this means is that the body will not waste energy maintaining the function of the joint and use it for other more demanding biological processes. This is a detrimental state of body equilibrium as inactivity of the joint will lead to further pathologies and pain.
Stress Management Techniques
Developing an awareness of how stress affects your neck and back, recognizing situations which cause stress, and learning to control stress are the most important elements in preventing and managing problems. Stress produces a physiological response in your body which can make your pain and tension more intense. Become aware of your stress: how does it affect you physically and mentally? Whether your stress is caused by sudden crises or by the constant pressure of repetitive tasks, it is important to recognize the symptoms and effects of stress. Many people are unaware that their feelings of anger, irritability, depression, and apathy, as well as headaches, excessive worry, insomnia, and fatigue can all be symptoms of stress. Knowing what situations cause your stress is the first step in managing it. Keep a stress diary to record events and your reactions. See if you can identify patterns in your stress levels and note the events which preceded or contributed to stress. By recording your stress you may find that it is not as unmanageable or unpredictable as it seems. Any form of relaxation or rest can be beneficial for reducing stress. Spend time doing activities you enjoy. Whether it is a hobby, listening to music, or reading a book, your aim is to feel temporarily removed from life’s demands. Try to arrange a regular time for relaxation in your day. Perhaps you can allocate ten minutes every few hours, or an hour at the end of the day. Remember that relaxation is not only a break from work, but also a state of mind. Try to minimize environmental and mental distractions. Another simple way to reduce stress is by ensuring that you get enough sleep. A tired mind has increased difficulty in coping with stress.
Healthy Lifestyle Habits for Spine Health
Overview of Back and Neck Pain
Back and neck pain are two of the most common health problems experienced across the globe. They can be caused by any number of things, from muscle strain to more serious conditions such as a herniated disc, degenerative disc disease or even a fracture. This pain impairs many daily activities and can lead to increased stress, as people feel that they are unable to perform the simplest tasks. Furthermore, the pain can lead to irritability, depression, decreased job performance and missed work. In less common cases, back and neck pain can be a sign of a more serious or potentially life-threatening condition. This is why it is so important to seek treatment for chronic back and neck pain. Pain related to the lower back often originates from the disc space between the L1 and S1 vertebrae, or from the joints in that region. The L1 to S1 vertebrae makes up the motion segment of the low back, and a herniation or degeneration of the discs in this space can cause pain. Pain can come from the back to the legs and thighs. It is also common that lower back pain is associated with muscle imbalances in the pelvis or the muscles between the low and upper back. Pain originating from areas around the lumbar spine often cause pain when bending forward or backward. In more serious cases, it can be difficult to walk or stand.
Causes of Back and Neck Pain
Back and neck pain is a common condition suffered by Singaporeans. It may affect any age group, but generally, it is more frequent in the people between 30 and 60 years of age. It may be an ongoing recurrence of a longstanding condition or it may occur as a sudden and severe onset following a specific incident or movement. This can affect your ability to concentrate at work and function normally at home. The causes of back pain are numerous but roughly fall into either a sudden (traumatic) or a sustained overstress injuries. For both types the structures usually affected are the discs, a ligament or a muscle. Usually back and neck pain is not due to a serious disease and the exact cause of the pain is often unknown. This is not usually important as the pain usually settles with simple appropriate treatment. An accurate diagnosis is not always possible and is not usually required.
Common Symptoms of Back and Neck Pain
Stiffness can be general, widespread, or localized to one area. Muscle tightness and restriction in the normal range of motion of the joint is typical of stiffness. Stiffness and reduced range of motion are more often noted after waking up in the morning or after periods of inactivity. A common problem is back pain and more specifically lateral thigh and leg pain. This is an umbrella term used to encompass symptoms of numbness, tingling, pins and needles, or weakness. Usually, the knee and ankle jerk reflexes are diminished. This is often caused by nerve compression at the lower lumbar or L3 or L4 level. This painful symptom requires immediate medical assessment.
Pain can be anywhere from a dull constant ache to a sudden, sharp pain. Pain can be in one part of the body such as the back on the left side, or it can be in another location of your body such as low back, shoulder pain, or neck pain. It can also be exhibited as traveling or radiating pain on part of your body. Widespread pain can occur with conditions such as fibromyalgia and is typically described as moderately severe pain involving areas on both sides of the body, above and below the waist.
Importance of Seeking Treatment
Finding the causes of back and neck pain can be like finding a needle in a haystack. The severity of damage and pain to the back or neck does not always correlate to the degree of injury, and often identifying the cause can be difficult, leaving the sufferer more frustrated than when they began. These confusions can lead to despair and, according to the Australian Spinal Research Foundation, “people asked to rate their general practitioner for providing information on their back said they would give them a C minus,” indicating dissatisfaction with the way back pain is handled by health professionals and understanding of the condition by the sufferer. Yet, identifying the cause in even the simplest terms such as “I have a slipped disc” can often open doors to curing the problem. A study conducted in Singapore found that most patients were less likely to seek treatment or lost confidence in their treatment if they were still uncertain about the cause after seeking their healthcare practitioner. Millions of people miss work each year due to back and neck pain, but the true scope of how much back pain costs is hidden in more hidden factors. Back pain is often a cause of changes in occupations or early retirement, itself being a massive economic burden when combined with treatment costs. An evidence review conducted by the medical journal Spine, which analyzed a variety of studies on the cost of low back pain, categorized costs into direct medical costs and indirect costs including loss of income, compensation, and productivity. The data was then adjusted for inflation and converted to 2016 U.S. dollars, which found the combined economic impact of low back pain to range between $84.8 billion and $624.8 billion. Pricing to individual patients was even more alarming, showing that private health insurance and out-of-pocket costs ranged between $669 and $2773 in 2006, only set to increase in recent years due to higher demand for treatments and increasing wages in healthcare. This provides a harsh reality that costs to treating back pain can easily exceed the cost of prevention, in which some cases prevention is no longer an option.
Best Treatment Options for Neck Pain
If results from treatments aimed at the cause of the neck pain are discouraging or there is no real cause that can be identified, then treatments aimed at relieving symptoms may be the only option. This could include consulting with primary care doctors or specialists such as neurologists. They can provide you with information on what types of medications (prescription or over-the-counter) may help dull the neck pain in order to make it more manageable. Sometimes neurologists will send patients to physical therapy or rehabilitation. For some, the final hope may be some form of surgical treatment assuming that there are no more treatment options aimed at resolving the cause of the neck pain.
The best treatment for neck pain is more focused on the cause of the neck pain rather than the neck pain symptoms themselves. This would be to attempt treatments aimed at resolving the cause of the neck pain. In some instances, these treatments may make the pain seem worse initially as the body has to readjust to the changes being made. But sometimes the end result is an improvement to the neck pain. An individual would need to speak to a doctor to figure out what the cause of their neck pain is and what treatments are available for this cause.
Physical therapy and rehabilitation: Neck pain can often be debilitating and occasionally lead to pain in the arms or headaches. If there is a chance that a person could recover from the condition causing the neck pain, then there is always the possibility that the neck pain will resolve. Although the pain may not go away completely, there is still a possibility that a person can live functional and productive lives despite the pain. The goals of treatment are to find the cause of the neck pain and then to treat this cause with the hopes that the neck pain will improve. In order to reach these goals, there may be a trial of a few different treatment options.
Physical Therapy and Rehabilitation
Cervical disc disease, disc herniation, and neck strain can be difficult problems to manage. Neck and arm pain can be quite debilitating. For those patients who do not wish to use medications or who continue to have discomfort related to neck or arm pain for several weeks, an evaluation of physical therapy or rehabilitation should be considered. A therapist can work on posture education, ergonomic issues for work, and the use of traction. Neck discomfort often improves with specific exercises to strengthen the neck muscles. Similarly, arm discomfort will improve with specific exercises to improve strength and alleviate numbness or tingling. These exercises may be supervised and performed during multiple sessions in the therapist’s clinic. In order to improve strength and flexibility, endurance training requires a longer-term exercise program supervised by the therapist. This may involve the use of cardiovascular training equipment such as a treadmill or elliptical runner. A therapist may also recommend the use of an at-home traction device or a TENS unit to alleviate arm pain.
Medications for Pain Management
It is important to state here that all medications have potential side effects and drug interactions, and it is essential to discuss the risks and benefits with a doctor and to always read the information provided with the medication. Specific advice should be obtained for those with peptic ulcers, asthma, high blood pressure, kidney disease, heart failure, previous strokes, and those who have allergies to aspirin or NSAIDs. Any medication should be taken strictly within the recommended dosage and frequency. Always consult a doctor when changing the dose or type of medication.
Taking medication is one of the most consistent ways to control and manage neck pain. There are several types of medications available which are effective for a range of painful conditions. The vast majority of people with neck pain will not need strong painkillers and respond well to simple analgesics such as paracetamol. Effective pain control will also allow the patient to continue with exercise and rehabilitation programmes. For more severe neck pain, the initial use of a fast-acting analgesic is beneficial to gain rapid control of the pain. This can be achieved with a non-steroidal anti-inflammatory drug (NSAID) which can also help to reduce any inflammation present. It is generally advisable to take medication regularly for a specific period rather than just taking it when the pain is very bad.
Non-Invasive Treatments like Chiropractic Care
It is important to explore all possible options to find relief. Getting down the cause of neck pain is the first step to finding the most effective treatment. This must be done with the help of a qualified health professional. If the cause is known, avoid any treatment that is not substantiated with scientific evidence. For instance, there is little point in trying invasive treatment that carries a high risk of significant side effects. Under the category of neck pain with recent onset, the best treatment is advice to stay active, education, self-management, and analgesics or NSAIDs. These should all be used in conjunction with each other. There is scientific evidence that manual therapy and the use of a collar may be beneficial for those with recent onset whiplash in providing short-term relief from symptoms, but these treatments are not widely available. Ice and/or heat application have not been researched for recent onset neck pain, so there is no evidence either way for the effectiveness of these treatments.
Surgical Interventions for Severe Cases
Microdiscectomy is a surgical procedure recommended for severe and chronic neck pain, if the pain is into the arm and a specific root (nerve) in which the patient can feel tingling, numbness, and weakness does not improve. The disc material causing the pressure is removed to relieve the pain from the nerve. This procedure is often recommended if the pain is severe and has not resolved after a period of 4-6 weeks. The procedure is often successful and may alleviate the pain immediately. Anterior Cervical Discectomy and Fusion is a more extensive operation for a cervical herniated disc causing neck pain or arm pain. In addition to the disc material being removed, a cervical fusion is performed to stop the motion at the segment of the spine causing pain. ACDF involves an incision in the front of the neck and after the disc is removed, a graft is inserted to fuse the vertebrae. This procedure may be considered for those suffering severe arm pain and weakness that is not relieved by non-operative treatments. Posterior Cervical Laminoforaminotomy is a similar procedure to anterior cervical discectomy, but is performed on the back of the neck and often used for a herniated disc that is impinging on a nerve root which is only causing severe arm pain and no neck pain. Finally, Cervical Artificial Disc Replacement is a relatively new procedure offered to patients. A cervical disc is used to replace the intervertebral disc and the goal of this technology is to maintain motion at the level of the spine. This procedure is currently only recommended on specific patients and age groups. These procedures and the decision to proceed with surgery depend on many factors and your orthopaedic surgeon can help to guide you to the best treatment.
Singapore’s Leading Back and Neck Pain Treatment Centers
Center A is well known for its non-surgical approach to various musculoskeletal conditions, including back and neck pain. There is a wide range of treatment options available at this center including occupational therapy, physiotherapy, psychological services, medication, injection therapy, and complementary medicine. Patients will first be assessed by a musculoskeletal specialist to diagnose the cause of their back or neck pain before he/she is referred to the appropriate therapist or allied health professional. A unique service at this center is the combined clinic where the patient is able to see both a pain specialist and an allied health professional on the same day at the same place to facilitate an interdisciplinary approach to treatment. This center is suitable for patients who prefer a non-surgical approach to their back or neck pain or those who are unsure of what treatment is best for their condition. This is because there is no obligation for patients to undergo any form of invasive procedure and the risks and benefits of each treatment option will be discussed with the patient who will have an active part in the decision-making process. This center is also involved in pain research and education and has strong links with the local and international medical community.
You can find a wide range of treatment options for your back and neck pain with Singapore’s increased focus on this sub-specialty. Some of the pain specialists are overseas-trained, while others have many years of experience dealing with back and neck pain in the local and regional setting. We describe two such centers which have either a unique approach and specialists known for their expertise in the field.
Center A: Specializing in Non-Surgical Approaches
Located in the vibrant Central Business District, Center A has made a name for itself with its 8 locations island-wide, making it one of the most accessible back and neck pain treatment centers. It specializes in non-surgical methods, setting itself apart from the majority of pain treatment centers in Singapore. Apart from its effective methods of pain relief, it has the advantage of cutting costs to make the process much more affordable. Being the largest provider of non-surgical treatment, this center has treated more than 200,000 patients to date for a wide range of conditions, making it the go-to place for those seeking alternatives to surgery. This is the place where Min, with a protruding disc in his lower back, sought treatment. Fearing surgery, he was worried nothing could be done. But after several sessions of a relatively new treatment called Intradiscal Electrothermal Therapy (IDET), he found relief and can now lead an active lifestyle without any hindrance to his back. This center offers a wide range of treatments from pain medications, injections, and physiotherapy. But it is most notably effective for conditions like slipped discs, sciatica, and spinal stenosis. These conditions are notorious for being difficult and surgery is often seen as the last resort. However, many patients have avoided surgery with the variety of treatments offered at this center.
Center B: Expertise in Minimally Invasive Procedures
Minimally invasive procedures offer a safer, quicker, and easier recovery, less pain and trauma to the body, and are often more cost-effective in the long term compared to conventional surgery. This is particularly useful for the elderly, patients with multiple medical problems, and some with occupations that require hard physical work. Mindful that expert skills and experience are needed for such procedures to be done effectively, a team of experienced surgeons have been trained in some of the best centers in the world in minimally invasive procedures for the spine. These include muscle-sparing microdiscectomies for lumbar disc prolapse, complex stabilization and fusion surgery using state-of-the-art interbody fusion techniques and instrumentation, percutaneous techniques (inserting long screws through the skin without large incisions), endoscopic and microendoscopic procedures. One very recent development is the use of navigation technology, which allows complex surgery to be done with minimally invasive techniques under image guidance. This increases the accuracy and safety of such procedures and will reduce the risk of converting to an open procedure to check for misplaced screws and instrumentation. Currently, only a handful of surgeons in Singapore are familiar with this technology. This exceedingly delicate and complex surgery demands a high level of technical skill and an understanding of the three-dimensional anatomy of the spine. This is then balanced with a cautious approach, always weighing the benefits of surgery in relation to the risk profile for the patient.
Tips for Preventing and Managing Back and Neck Pain
A healthy diet and active lifestyle are important, not only for preventing back pain, but for overall health and well-being. Being overweight or obese can significantly increase the load on the spine and can result in structural damage. Both poor nutrition and high body fat can lead to increased risk of hypertension, diabetes, and heart disease, all of which can lead to back pain and impaired function. High impact sports can cause trauma and injury to the spine. Regular exercise should be a combination of cardiovascular exercise, strengthening, and flexibility. Low impact activities such as walking, swimming, or using an elliptical machine are great forms of cardiovascular exercise. Yoga and pilates are excellent for flexibility and strengthening, and aqua-aerobics is a great form of exercise for people with back pain. Choosing activities that you enjoy and are convenient for you will help you maintain regular exercise as a lifetime habit.
Regular relaxation and general exercise are a great way to help manage stress. Yoga is an excellent form of relaxation and exercise that can be beneficial in managing and preventing back pain. Daily stretching will help maintain normal joint function as well. Stress can create muscle tension in the back, which can cause pain, muscle tightness, and increased risk of muscle injury. By identifying the source of your stress and reducing it, you can reduce the risk of future back pain.
Proper posture and body mechanics are essential to preventing back and neck pain. A chair should have a straight back or low-back support. You should sit with your back against the back of the chair. A small pillow at the low back can be used for extra support. Your knees should be at the same level or higher than your hips. Use your abdominal muscles to help support your body when sitting or standing for long periods. If your job involves standing for long periods, you should change positions frequently with your weight evenly distributed on both feet. Continuous standing on one foot or on the same leg can develop muscle imbalances, leading to back pain.
Maintaining Proper Posture and Ergonomics
Thighs: Try to keep the angle between the thighs and the trunk as open as possible. This usually involves raising the seat height. Use a seat with a sufficient depth to allow clearance between the front edge of the seat and the back of the knees.
Legs: Keep the knees and hips level. The use of a footrest may help to attain this posture more comfortably.
Feet: It should be possible to alternate between two sitting postures, one with the feet flat on the floor and the other with the feet supported on a footrest. Avoid sitting on the legs and feet.
When sitting, the following tips can help to establish a good sitting posture: Eyes: Keep the head in a neutral position, make sure the eyes are level with the top of the computer monitor. If not, adjust the seat height. The use of a document holder is helpful.
Regular Exercise and Stretching
Regular exercise is important considering people living sedentary lives are being prone to back pain, a prevailing phenomenon in developed nations where a sizable portion of the populations are sitting in front of computers in offices. While engaging in physical activities might give you the initial discomfort, it is important for recovery from chronic back problems and helps to prevent recurrence of the pain. For those with existing pain, they should attempt light activities such as walking and swimming before progressing to more strenuous exercises. Yoga is also a good alternative because it focuses on flexibility and core muscle strength, which is important for back health. Failure to engage in regular physical activities will result in gradual decline of the body’s functional abilities. A joint that is not moved will eventually lose its function and they will be forfeited by the body in terms of energy. What this means is that the body will not waste energy maintaining the function of the joint and use it for other more demanding biological processes. This is a detrimental state of body equilibrium as inactivity of the joint will lead to further pathologies and pain.
Stress Management Techniques
Developing an awareness of how stress affects your neck and back, recognizing situations which cause stress, and learning to control stress are the most important elements in preventing and managing problems. Stress produces a physiological response in your body which can make your pain and tension more intense. Become aware of your stress: how does it affect you physically and mentally? Whether your stress is caused by sudden crises or by the constant pressure of repetitive tasks, it is important to recognize the symptoms and effects of stress. Many people are unaware that their feelings of anger, irritability, depression, and apathy, as well as headaches, excessive worry, insomnia, and fatigue can all be symptoms of stress. Knowing what situations cause your stress is the first step in managing it. Keep a stress diary to record events and your reactions. See if you can identify patterns in your stress levels and note the events which preceded or contributed to stress. By recording your stress you may find that it is not as unmanageable or unpredictable as it seems. Any form of relaxation or rest can be beneficial for reducing stress. Spend time doing activities you enjoy. Whether it is a hobby, listening to music, or reading a book, your aim is to feel temporarily removed from life’s demands. Try to arrange a regular time for relaxation in your day. Perhaps you can allocate ten minutes every few hours, or an hour at the end of the day. Remember that relaxation is not only a break from work, but also a state of mind. Try to minimize environmental and mental distractions. Another simple way to reduce stress is by ensuring that you get enough sleep. A tired mind has increased difficulty in coping with stress.
Healthy Lifestyle Habits for Spine Health
Stop smoking. Most people know smoking has serious health risks, but many are unaware it is a risk factor for back pain. A study published in Human Brain Mapping found a direct correlation between tobacco use and back pain. This correlation is even present in adolescents; a study in the Journal of Bone and Joint Surgery found adolescents who smoke are more likely to have back pain than their non-smoking counterparts. Take quitting steps today for a healthier future for your back and your overall health.
As you age, taking care of your spine might be more important than you think. Spinal problems and a bad back can be painful, annoying, and debilitating, and your quality of life is seriously compromised when you experience pain every time you try to stand up or sit down. Much of your daily discomfort is due to the effects of the gravitational force on your spine as it, combined with age-related changes, can result in back pain, neck pain, arm and leg pain, as well as weakness and numbness. When you take a proactive approach to spinal health, you can improve all aspects of our life and reduce the risk for back, neck, and spinal-related pain and discomfort. Here are some proactive steps to maintain spinal health.
Stop smoking. Most people know smoking has serious health risks, but many are unaware it is a risk factor for back pain. A study published in Human Brain Mapping found a direct correlation between tobacco use and back pain. This correlation is even present in adolescents; a study in the Journal of Bone and Joint Surgery found adolescents who smoke are more likely to have back pain than their non-smoking counterparts. Take quitting steps today for a healthier future for your back and your overall health.
As you age, taking care of your spine might be more important than you think. Spinal problems and a bad back can be painful, annoying, and debilitating, and your quality of life is seriously compromised when you experience pain every time you try to stand up or sit down. Much of your daily discomfort is due to the effects of the gravitational force on your spine as it, combined with age-related changes, can result in back pain, neck pain, arm and leg pain, as well as weakness and numbness. When you take a proactive approach to spinal health, you can improve all aspects of our life and reduce the risk for back, neck, and spinal-related pain and discomfort. Here are some proactive steps to maintain spinal health.
