Sumiko at 62: 4 simple exercises from a physiotherapist to ease back pain

While planning this Physio Fix series, my colleagues and I settled on five common trouble spots for physiotherapists from the Singapore General Hospital (SGH) to tackle: neck, shoulder, back and knee pain, as well as balance.

But would a five-part series overwhelm readers, I wondered. Perhaps we should drop the story on back pain?

A chorus of “nos” greeted me. Everyone has experienced back pain, my colleagues said. It is too common to ignore.

They are right. At any given time, one to three in 10 people worldwide are dealing with back pain, says Associate Professor Dennis Hey, head of orthopaedic surgery at Alexandra Hospital. In an unpublished Singapore study of about 630 adults in 2017, 16 per cent reported having suffered back pain in the past six months.

Despite how intense it can be, most back pain is caused by ordinary, everyday activities. “The most typical cause of back pain in otherwise healthy adults is strain from poor posture and lifestyle habits,” Prof Hey says.

Pain felt at the back can be divided into upper, middle and lower back, corresponding to the three anatomical parts of the spine – upper thoracic, lower thoracic and lumbar spine.

Based on the anatomical differences of the back, the causes of pain can vary. Upper back pain, for instance, may not even originate where you feel it. The problem could lie in the cervical spine, which is where the neck is, even if the discomfort settles between the shoulder blades.

Middle back pain, on the other hand, is less common and warrants closer attention. This part of the back is very stable and less prone to degenerative changes from ageing or strain. Pain here could indicate something more serious, such as an infection or tumor.

Lower back pain is what most of us know all too well. The good news? “It is often a result of musculoskeletal conditions and, unless red-flag features are present, is often benign,” Prof Hey says. In other words, it may hurt, but it is not necessarily dangerous.

Still, there is a difference between a passing ache and something that lingers. Back pain is considered chronic if it lasts beyond three to six months. Most simple strains and sprains, by contrast, tend to settle within six weeks.

If pain persists, two possibilities need to be explored, Prof Hey says. One, the condition is more serious than a normal musculoskeletal strain, or two, the activity that is causing the pain is ongoing, for example, chronic strain from prolonged sitting or lifting heavy loads at work.

“Generally, the longer the pain is present, the less likely it will resolve by itself,” he adds.

This is where many people start to worry – is it a slipped disc? Something wrong with the spine? Certain symptoms should prompt a closer look. If back pain is accompanied by numbness, weakness, or radiating pain down the leg, nerve compression should be considered. New or sudden changes in bladder or bowel habits require immediate attention.

Fever, unexplained weight loss or loss of appetite are warning signs. So is middle back pain in patients at the extreme ends of the age spectrum, such as those under 18 – for whom wear-and-tear of the spine is rare – or over 70, who are more at risk of compression fractures from osteoporosis.

For more common, everyday lower back pain, the kind that follows long hours at a desk, an overenthusiastic workout or heavy lifting, the first steps are simpler.

In the early stages, rest the spine and avoid the activity that triggered the pain. Gentle stretches or a hot pack can help ease muscle spasm. Prof Hey notes that while rest is helpful initially, “prolonged rest is not advisable”. If the condition persists, a doctor may prescribe pain relief and physiotherapy.

As for his top tip on protecting the back, he says: “Prevention is better than cure. A healthy back requires constant motion and stretches to keep muscles toned, joints supple and bones strong. Prolonged, fixed postures in modern lifestyle and occupations stress the spine and result in accelerated degeneration.”

SGH principal physiotherapist Teo Yee Jean says that the most common causes of back pain she sees in patients are related to lifestyle habits and sudden changes in physical activity.

Long hours of sitting and a sedentary lifestyle often contribute to stiffness in the back. Back pain also tends to flare up when people suddenly increase their activity levels, for example, jumping into an intense workout after months of inactivity, or taking on more physical tasks such as grocery runs and heavy spring cleaning during festive periods.

Repetitive loading of the spine in awkward positions, such as bending over to wash dishes or clean the floor, may also strain the back.

Her patients often complain of lower back pain. Ms Teo says this area is most commonly affected because it serves as a fulcrum for many daily movements, especially lifting, bending and twisting.

Back pain affects men and women differently, she notes. Women may be more prone to chronic lower back pain due to generally lower muscle mass, hormonal shifts during the menstrual cycle or menopause, and lifestyle patterns such as repetitive household tasks. Stress can also feed into back pain as anxiety or depression increases muscle tension.

Age plays a role as well. As people age, they may become less physically active, leading to weaker muscles that provide less support for the spine. Weight gain, arthritis and stiffness in spinal joints can also contribute to the condition. “Sometimes, back pain emerges because older adults start compensating for pain or weakness in other parts of the body, like the hips or knees,” Ms Teo says.

Many patients come in fearing the worst. “They worry that back pain will lead to long-term disability,” she says. “I reassure them that most people with back pain improve with time and non-surgical, conservative treatment.”

One of the biggest misconceptions is that movement will make the pain worse. “People are afraid that certain movements, such as bending forward, will worsen the pain,” she says. “Ironically, avoiding movement can make the muscles and joints stiffer and more painful.”

Her advice: keep moving within comfortable limits because the back – like all other parts of the body – responds well to regular, gradual movements and exercise.

Ultimately, preventing back pain comes down to a few everyday habits. “Move regularly throughout the day,” she says. “Even short breaks help.”

Exercise consistently, focusing on strength and endurance, and don’t overlook the basics: good sleep and proper nutrition. All these will support recovery, reduce strain on the spine and help keep the back resilient over time.