back pain


  • Keeping active can lead to faster recovery.
  • Staying in bed all day can stiffens the joints and weaken muscles. This can cause back pain to take longer to recover and increase the chance of long-term back problem.
  • Try walking, swimming or have an exercise routine. Start slowly and build up gradually if you haven’t done any regular physical activity for some time.
  • Contact a physiotherapist about types of exercises best for your condition.

back pain, treating chronic back pain without surgery


Below are 7 ways to treat chronic back pain without surgery:

(1) Diet
Some diet can trigger inflammation, especially those high in fats, refined sugars and processed foods. Consult your doctor or a dietician about the type of foods that will not trigger inflammation.

(2) Meditation
Chronic back pain is straining emotionally and physically. To manage the frustration, irritability and other psychological aspects of dealing with chronic pain you should consider rehabilitation psychologist who may recommend meditation, yoga and other cognitive and relaxation strategies to keep your mind away from focusing on the pain.

(3) Alternative Treatments
Acupuncture, massage and other nonsurgical spine treatments can make a difference for chronic back pain. Talk to your doctor about alternative treatments that could benefit you.

(4) Lifestyle Modifications
When you have chronic back pain, it is important to accept your limitations and adapt. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, but it could also prevent the underlying condition from advancing.

(5) Injection- based treatments
Epidural steroid injections, nerve blocks and other types of injection-based procedures are available for chronic back pain. They are used when the source of the pain is known and can sometimes help rule out certain causes if the treatment doesn’t work.

(6) Pharmacological treatments
Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to help chronic back pain. However, some come with side effects and are not intended for prolonged use.

Opioids should be prescribed only after a thorough examination by a specialist and if other drugs failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.

(7) Physical Therapy
Exercise may help chronic back pain treatment. The exercises have to be tailored to your specific symptoms and condition. Maintaining a home exercise routine is also part of success. Physical therapy may include:

back pain, Back pain at night


People with nighttime back pain (also called nocturnal back pain), describes the pain not stopping when they lie down. Some people with nocturnal back pain even describe the pain as getting worse when they lie down. For others, the pain doesn’t even start until they lie down.


Among other things, the following can be one or more of the cause of nocturnal back pain:

  • Disc degeneration. Discs are tissue between the vertebrae that function as a type of shock absorber, the discs can degenerate with age
  • Injuries such as sprains or fractures
  • Kidney stones
  • Arthritis
  • Diseases and conditions such as scoliosis, curvature of the spine, spinal stenosis


Nocturnal back pain can be a sign of spinal tumor (one that originates in the spine) or it could be a metastatic tumor (one that results from cancer that started elsewhere in the body and then spread to the spine).

Nocturnal back pain can also be a sign of spinal infection (osteomyelitis and ankylosing spondylitis), a condition that can cause the spine to fuse in a fixed position.

back pain


It is not easy to prevent back pain, but the following 6 tips may help reduce the risk of developing back pain:

  • check your posture when sitting, using computers or tablets and watching television,
  • do regular exercises and back stretches – your doctor or physiotherapist may be able to advise you about exercises suitable for your needs,
  • stay active – doing regular back exercises can help keep your back strong,
  • avoid sitting for long periods,
  • take care when lifting and
  • ensure the mattress on your bed supports you properly.
back pain, Lower back pain and spinal arthritis


Non-invasive treatments for low back pain and sciatica

The non-invasive treatments have two types, (a) non-pharmacological intervention and (b) pharmacological intervention.

(a) Non-pharmacological intervention includes:

(1) Self-management – self-management is advice and information tailored to individual needs and capabilities to help themselves self-manage their low back pain.

(2) Exercises – group exercise programme (aerobic, mind-body or a combination of approaches) for people with specific needs or flare-up of low back pain with or without sciatica.

(3) Manual therapies – manual therapy include spinal manipulation, mobilisation or soft tissue techniques such as massage for managing low back pain with or without sciatica, but only as part of a treatment package including exercise.

(b) Pharmacological intervention
Pharmacological intervention includes oral non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person’s risk factors, including age.

If NSAID is contraindicated or not tolerated or has been ineffective, weak opioids (with or without paracetamol) is usually considered for managing acute low back pain.

Invasive treatments for low back pain and sciatica

Invasive treatments have two types, (a) non-surgical interventions and (b) surgical interventions.

(a) Non-surgical interventions includes:

(1) Radiofrequency denervation

Referral for assessment for radiofrequency denervation for people with chronic low back pain has to be considered when non-surgical treatment has not worked for them and the main source of pain is thought to come from structures supplied by the medial branch nerve and they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral.

(2) Epidurals

Epidural injections of local anaesthetic and steroid are usually used in people with acute and severe sciatica and tend not to be used in people who have central spinal canal stenosis.

(b) Surgical Interventions

Most performed surgical interventions are spinal decompression, spinal fusion and disc replacement.

Spinal decompression is usually considered for people with sciatica when non-surgical treatment has not improved pain or function and their radiological findings are consistent with sciatic symptoms.

Spinal fusion is not usually offered to people with low back pain unless as part of a randomised controlled trial.

back pain


(1) Avoid bed rest for a long period.
In the few days of a new episode of back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible is important in aiding recovery.

(2) Exercise and activity to prevent back pain.
Exercise helps tackle back pain and is also the most effective strategy to prevent future episodes of back pain. No one type of exercise is proven to be more effective than others, so just pick an exercise you enjoy and that you can afford to maintain in the long-term and that fits in with your daily schedule.

(3) Painkillers.
They should only be used in conjunction with other measures such as exercises. Painkillers should be a short-term option as they can bring side effects after long term use.

(4) Surgery is rarely needed.
Most back pains do not require surgery however, in some uncommon back conditions where there is pressure on the nerves that supply the legs and there is incontinence, surgery may be recommended.

(5) You can have back pain without injury.
Many psychological factors, general health lifestyle factors and social factors may cause back pain. At times a combination of these factors may also cause back pain.

  • Psychological factors including fear of not getting better, feeling down and being stressed.
  • General health lifestyle factors like being tired, not getting enough good sleep, not getting enough physical activity.
  • Social factors such as difficult relationships at work or home, low job satisfaction or stressful life events.

(6) If your back pain does not clear up after 6 – 8 weeks make an appointment to see your doctor or a physiotherapist.

back pain, Pain between shoulder blades


Possible causes of back pain between shoulder blades

(1) Shingles
Depending upon which nerve roots the virus affects, shingles can cause pain nearly anywhere in the body and may occur well before a rash is noticed. The pain may be most pronounced in the region between your shoulder blades but tends to concentrate on one side of your body.

(2) Epidural anaesthesia
People who have an epidural for labour or a C-Section sometimes experience intense interscapular pain. This pain resolves when the drip is slowed down and this pain goes away after labour.

(3) A vertical compression fracture in the thoracic region.
Compression fractures, often due to osteoporosis, may cause interscapular pain.

(4) Scoliosis
Scoliosis of the thoracic spine may cause pain between shoulder blades.

(5) Pulmonary Embolism
Pulmonary emboli occur when clots in the leg (deep vein thrombosis) break off in the leg and travels to the lungs. The pain is often sudden in onset, sharp and may be associated with severe shortness of breath, although sometimes people notice only mild discomfort.

(6) Acid Reflux
Gastroesophageal reflux (acid reflux) may cause referred pain to the back in the region between the shoulder blades. Other symptoms include chest pain, hoarseness and difficulty swallowing.

(7) Nerve entrapment
Nerve entrapment on rhomboid muscles can cause pain between the shoulder blades.

(8) Gallbladder disease
Referred pain from gallbladder disease often occurs as a stabbing pain between the shoulder blades and may be associated with pain on the right upper quadrant of the abdomen and nausea.

(9) Muscle strain
The most common cause of pain between the shoulder blades is a muscle strain. This can result from poor posture (especially leaning forward with prolonged sitting or standing), excess lifting and activities that involve twisting.

(10) Trauma
Example of this is trauma on the shoulder.

(11) Arthritis
Arthritis in the neck or even the ribs may cause interscapular pain.

(12) Herniated or Bulging Discs

(13) Heart Attack

(14) Cancer
Lung cancer can cause referred pain between the shoulder.

back pain


  1. Muscle spasm and strained muscles or ligament. Activities that can lead to muscle strains or spasms include; lifting something improperly, lifting something too heavy, making an abrupt and awkward movement.

2. Injuries on the back, fractures and falls can cause back pain.

3. Ruptured disks. Each vertebra in the spine is cushioned by disks, if the disk ruptures, there will be more pressure on a nerve resulting in back pain.

4. Bulging disks. In much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.

5. Sciatica. A sharp and shooting pain that travels through the buttock and down the back of the leg caused by a bulging or herniated disk that is pressing on a nerve. Sciatica can also cause numbness, tingling and weakness in the lower back, buttocks, legs and feet.

6. Arthritis. Osteoarthritis can cause problems with the joints in the hips and lower back.

7. Spinal stenosis. A narrowing of space around the spinal cord.

8. Abnormal curvature of the spine. If the spine curves in an unusual way, back pain can result. An example is a scoliosis in which the spine curves to the side.

9. Osteoporosis. A condition where the bones, including the vertebra of the spine, become brittle and porous making compression fracture more likely.

10. Kidney problem. Kidney stones or kidney infection can cause back pain.

back pain

What are the warning signs of a serious problem when you have back pain?

Pain that travels down the leg is a sign of a serious problem.

Also, if you have any of the following symptoms, you should seek urgent medical attention:

  • difficulty controlling or passing urine,
  • loss of control of your bowels,
  • numbness around your back passage or your genitals,
  • a serious weakness in your legs so you find standing difficult, and
  • severe and ongoing back pain that gets worse over several weeks.

The above symptoms could potentially be linked to a rare but serious condition that needs urgent medical attention.

back pain


Back pain is a common problem and will affect many of us at some point during our lives.


Often back pain doesn’t have one simple cause but may be due to one or more of the following:

  • muscle strains or sprains
  • poor posture
  • lack of exercise resulting in stiffening of the spine and weak muscles
  • sciatica – this is caused by a nerve in the spine being pressed or squeezed. In most cases, sciatica is caused by a bulging disc pressing on the nerve causing pain that travels all the way down the leg and foot
  • spinal stenosis – this is a condition where the space around the spinal cord narrows and compresses a section of nerve tissue. This can happen from birth or can develop as we get older. Like sciatica, the main problem with spinal stenosis tends to be leg pain more than the back pain
  • bone problems such as a fracture on the back bone – often caused by trauma or thinning of the bones called osteoporosis
  • infection in the bones
  • a tumour
  • inflammation, for example ankylosing spondylitis


Although it’s common, most cases of back pain tend to clear up without the need to see a doctor. However, you should see your doctor if your pain:

  • stops you from working or doing the things you enjoy
  • affects your everyday activities
  • gets worse
  • is really bad