Lower Back Pain

Lower back pain is a common and often disruptive condition that affects people across all age groups. Whether it begins gradually or comes on suddenly, it can interfere with movement, sleep, work, and overall well-being. While some episodes are mild and resolve quickly, others can become persistent or recur over time, greatly affecting one’s quality of life and limiting daily activities.

The experience of lower back pain can vary from person to person. For some, it’s a dull ache that lingers throughout the day; for others, it can be sharp, intense, or radiate down the legs. In many cases, it is linked to strain, poor posture, or age-related changes in the spine.

What causes lower back pain?

Lower back pain can be a symptom of anything from conditions involving the bones, joints, discs, muscles, ligaments, or nerves in the lumbar spine. In many cases, the pain is mechanical in nature, resulting from strain or degeneration of the spinal structures. In others, it may be linked to inflammation, nerve irritation, or referred pain from internal organs. Understanding your back pain’s root cause is the first step to getting effective treatment.

Common causes include:

Muscle and ligament strain — overuse, sudden awkward movements, or poor posture can lead to small tears in muscles or ligaments, triggering pain and stiffness. This is one of the most frequent causes of acute lower back pain, particularly among those with sedentary lifestyles or jobs requiring repetitive bending or lifting.
Degenerative disc disease — the intervertebral discs, which act as shock absorbers between the vertebrae, gradually lose hydration and elasticity with age. This degeneration can lead to reduced disc height, instability, and pain.
Herniated or prolapsed discs — when the inner gel-like core of a disc pushes through a tear in the outer layer, it can press on nearby spinal nerves, causing localised pain or nerve symptoms like numbness, tingling, or weakness (commonly known as sciatica when affecting the lower limbs).
Facet joint arthritis — the small joints at the back of the spine (facet joints) can become inflamed or arthritic over time, which contributes to chronic back pain (link to service page) and stiffness, especially with movement.
Spinal stenosis — narrowing of the spinal canal can compress the spinal cord or nerves, leading to back pain, leg pain, and difficulty walking. It tends to occur more frequently in older adults.
Spondylolisthesis — this condition involves one vertebra slipping forward over the one below it, often due to age-related wear or a defect in the bony structure. It can lead to instability and nerve compression.
Sacroiliac joint dysfunction — the sacroiliac joints, located at the base of the spine where it connects to the pelvis, can become inflamed or misaligned, causing lower back and buttock pain.
Poor biomechanics and posture — slouched sitting, prolonged standing, or uneven weight-bearing due to weak core muscles or leg length differences can contribute to ongoing strain and discomfort in the lower back.
Underlying medical conditions — although less common, conditions such as infections, kidney stones, endometriosis, osteoporosis, or tumours can cause referred or structural lower back pain and should be ruled out in persistent or unusual cases.

Identifying the exact source of pain is not always straightforward, as multiple structures may be involved. A detailed clinical assessment and, when necessary, targeted imaging help determine the most likely cause and guide treatment.

What are the symptoms of lower back pain?

Lower back pain can present as a dull ache, sharp “zapping” sensation, persistent, or radiating pain.

Common symptoms include:

Localised pain in the lower back — this is the most typical symptom. The pain may be constant or intermittent and is often described as aching, throbbing, or stiff. It may worsen with certain movements, such as bending, lifting, or prolonged sitting.
Pain that radiates to the hips, buttocks, or thighs — sometimes, pain originating in the lower back spreads to nearby areas. This may occur due to muscular involvement or inflammation of adjacent joints and ligaments.
Sciatica (nerve pain radiating down the leg) — when a spinal nerve is compressed or irritated, such as by a herniated disc, it can cause sharp, shooting pain that travels down the buttock and leg, typically on one side. This may be accompanied by tingling, numbness, or weakness.
Stiffness and restricted movement — many people with lower back pain find it difficult to bend, twist, or stand up straight. Stiffness is often worse in the morning or after prolonged inactivity.
Muscle spasms — in some cases, the muscles in the lower back may tighten involuntarily, leading to sudden, cramping pain and reduced mobility.
Pain that improves or worsens with position — some types of back pain are posture-dependent. For instance, spinal stenosis may cause discomfort when standing or walking that eases with sitting or leaning forward.
Chronic or recurrent pain — pain that persists for more than 12 weeks or that comes and goes over months may indicate an underlying degenerative or structural issue.

When should I be concerned about lower back pain?

While most cases of lower back pain are not serious, certain symptoms may suggest a more urgent medical issue. These include:

Pain following a significant injury (such as a fall or car accident)
Pain accompanied by unexplained weight loss or fever
Numbness in the groin or saddle area
Loss of bladder or bowel control
Progressive weakness in the legs

These signs may point to a neurological emergency, such as cauda equina syndrome, or other serious conditions requiring prompt evaluation.

Who is at risk of lower back pain in Singapore?

Lower back pain is common across all age groups in Singapore, but certain individuals are more likely to develop it due to their occupation, lifestyle, or health status. Groups at higher risk include:

Office workers and sedentary professionals — prolonged sitting at desks, often without proper ergonomic support, can lead to postural strain and muscle imbalances. Over time, this may contribute to stiffness, disc issues, and chronic lower back pain.
Healthcare workers, cleaners, and manual labourers — jobs that require repeated lifting, bending, pushing, or carrying heavy loads increase the likelihood of muscle strain and joint wear. Poor lifting technique can also raise the risk of disc injury.
Delivery riders and professional drivers — spending long hours on motorbikes or in vehicles can compress the lower spine, especially if seating lacks adequate support. Whole-body vibration from prolonged riding or driving further aggravates spinal stress.
Older adults — as the population ages, spinal structures naturally degenerate. Conditions such as osteoarthritis, degenerative disc disease, and spinal stenosis become more prevalent, which makes lower back pain a frequent complaint among seniors.
Physically inactive individuals — a sedentary lifestyle weakens the core muscles that support the spine. Without adequate strength and flexibility, even routine movements can trigger back pain or worsen existing symptoms.
People who are overweight or obese — excess weight increases the load on the lumbar spine, contributing to faster disc degeneration and joint stress. Obesity is also linked to systemic inflammation, which may exacerbate musculoskeletal pain.
Those experiencing chronic stress — psychological stress can lead to increased muscle tension and heightened pain sensitivity. In Singapore’s high-pressure work and academic environments, stress-related back pain is not uncommon.
School children and adolescents with heavy backpacks — carrying heavy school bags, especially if worn improperly, can strain the developing spine and back muscles. This is a growing concern among school-aged children in Singapore.

How can I prevent lower back pain?

Taking proactive steps to protect your spine can reduce the risk of both acute and chronic back pain. Some simple and effective strategies include:

Maintain good posture — whether sitting at a desk, standing in a queue, or using your phone, keeping your spine aligned and avoiding slouching can reduce strain on your lower back.
Use ergonomic furniture — choose chairs that support the natural curve of your spine, and ensure your workstation is set up to reduce awkward movements and forward head posture.
Stay physically active — regular movement helps keep your back muscles strong and flexible. Walking, swimming, or low-impact exercises can support spinal health.
Strengthen your core — a strong core provides stability for your spine. Incorporate exercises that target your abdominal, pelvic, and back muscles into your routine.
Lift objects correctly — always bend at your knees, not your waist, and keep the object close to your body. Avoid twisting while lifting.
Take breaks from prolonged sitting or standing — if your job involves long hours at a desk or on your feet, take short, regular breaks to stretch and change position.
Maintain a healthy weight — excess body weight, especially around the abdomen, can increase pressure on the lower back and contribute to disc and joint wear.
Sleep with spine alignment in mind — use a firm mattress and avoid sleeping on your stomach. Sleeping on your back with a pillow under your knees, or on your side with a pillow between your legs, can help maintain spinal alignment.
Manage stress — chronic stress can cause muscle tension, especially in the back. Relaxation techniques such as deep breathing, mindfulness, or gentle stretching can help.

How is lower back pain diagnosed?

Diagnosing lower back pain involves more than locating where it hurts. To identify the root cause accurately, a structured approach is necessary, one that considers both physical and neurological factors.

At Apicare Pain Clinic, we start by listening to your history, assessing how the pain affects your movement, lifestyle, and sleep, and then perform targeted evaluations to guide the next steps.

Diagnostic methods may include:

Comprehensive medical history

Physical examination

Imaging studies (when indicated)

Diagnostic nerve or joint blocks

Functional assessments

How is lower back pain treated?

The right treatment for lower back pain depends on its underlying cause, how long it has lasted, and how severely it affects your daily life. Treatment options may include:

Medications — pain relief may involve anti-inflammatory drugs (NSAIDs), muscle relaxants, or medications that target nerve pain, depending on the nature of your symptoms.
Physiotherapy and rehabilitation — tailored exercises can strengthen the core, improve posture, and enhance flexibility. These are often key to long-term recovery and preventing future episodes.
Image-guided injections:
- Facet joint injections — Used to reduce inflammation and pain in the small joints at the back of the spine.
- Nerve root blocks — Targeted injections around irritated spinal nerves to reduce pain that radiates into the legs (e.g. sciatica).
- Epidural steroid injections — Used to manage pain related to disc bulges, spinal stenosis, or nerve irritation.
- Sacroiliac joint injections — For pain stemming from the joints connecting the spine and pelvis.

Radiofrequency ablation (RFA) — a minimally invasive procedure that uses heat to disrupt pain signals from specific spinal nerves, providing longer-lasting relief in selected cases.
Trigger point injections — for muscular knots or spasms contributing to localised back pain.
Lifestyle and ergonomic advice — simple changes in posture, movement patterns, or workstation setup can make a significant difference in managing recurrent or chronic pain.
Referral to spine specialists — when needed, we collaborate with orthopaedic surgeons, neurosurgeons, and rehabilitation specialists to ensure comprehensive care.

Why see a pain management specialist for lower back pain?

Not all lower back pain requires surgery. In many cases, a pain management specialist can provide effective, non-surgical treatments to help relieve your discomfort and restore function. These options include minimally invasive treatment modalities, such as image-guided injections, radiofrequency ablation, or nerve blocks. These therapies can even work hand-in-hand with physiotherapy, helping you move better and recover faster.

If surgery becomes necessary, your pain management specialist can also refer you to the right surgical doctor, ensuring continuity of care throughout your treatment journey.

Summary

Lower back pain is a widespread issue that can affect anyone, from young adults to older individuals. It may present as a dull ache or sharp, radiating discomfort that disrupts daily life, sleep, and work. Common causes include muscle strain, poor posture, or spinal changes with age, but the exact source isn’t always clear without proper evaluation.

If you are suffering from persistent or recurring lower back pain, schedule a consultation with us for a thorough assessment and personalised pain management plan.