The clinical population of back pain

Studies have shown that approximately 60-80% of all people worldwide suffer from low back pain in their life, and Singapore is no exception. While most people do recover from low back pain, the risk of a second episode of back pain within the next 12 months is high (up to 80%). This is why seeking treatment at an early stage to prevent a recurrent episode is important.

There are many different professions and clinics in Singapore that treat individuals who are suffering from low back pain. Physiotherapy has always been a popular choice of non-invasive treatment for lower back pain. This is backed by many scientific journals over the effectiveness of using manual therapy and exercise to promote good outcomes of recovery for people with lower back pain.

unhappy man suffering from back pain

What are the causes of back pain?

The causes of back pain can be classified into two main categories. Studies regarding the clinical population of back pain in scientific journals have recorded that 15% of low back pain can be attributed to a specific pathology (specific lower back pain), but 85% of back pain is classified as non-specific lower back pain.

Some of the pathologies of specific lower back pain include:

  • Unstable spondylolisthesis
    • The backbone is made up of different bones on top of each other. Each of these bones is called a vertebra. This is a condition where there is a slippage of a vertebra on another vertebra.
  • Spinal stenosis
    • The spinal cord is located in the spinal canal of our vertebrae (backbone). This is a condition where there is evidence of narrowing in the spinal canal, causing compression on the spinal cord.
  • Foraminal stenosis
    • From the vertebrae column, the spinal cord exits from the side of the vertebrae column to form nerve roots. These nerve roots then connect to the different nerves in our body. Foraminal stenosis is a condition where the space allowing the nerve roots exit from the spinal cord is narrowed, hence causing compression of the nerve roots.
  • Intervertebral disc herniation
    • Also known as ‘slipped disc’, where the connecting parts (disc) between each vertebra slip out of position, causing pain and dysfunction.
  • Degenerative disc disease
    • Usually, an age-related condition that happens over time, causing wearing off the disc layers.

Non-specific lower back pain:

This is classified as such because musculoskeletal back pain is often complex and is causation of multiple factors, rather than just a specific cause in lower back pain. Some of the source contributing to non-specific lower back pain might be:

  • Poor postural control
    • Postural muscles fatigue and are unable to provide adequate support to the spine leading to pain.
    • Overworked muscles due to poor posture causing repetitive strain of the postural muscles leading to pain.
  • Reduced joint mobility
    • Stiff joints in the spinal column that might cause altered movement patterns leading to pain.
  • Prolonged static posture
    • Lead to muscle tightness and the formation of myofascial trigger points that cause pain.
  • Acute muscle strains
    • If left untreated, may lead to altered movement patterns or muscle tightness, which leads to pain.

Many of these pain sources are interchangeable and will form multiple layers of pain, making it difficult to pin the blame on one particular source. Because of this complexity, it is important to conduct a comprehensive assessment to identify the problems and choose the appropriate management to treat each layer of pain.

physiotherapist conducting a back assessment

Is Back Pain Therapy safe?

One of your concerns when deciding on a treatment for your lower back pain might be how safe it is. Research has shown that conservative treatment such as physiotherapy is generally safe for back pain treatment. As such, we will explain in detail why back pain therapy is safe, so you can be assured that you are in good hands when receiving physiotherapy treatment at Heartland Rehab.


One of the important steps before we commence physiotherapy is triaging. This will be done during our interview with you and in our physical assessment. Triaging is important for your safety. It helps us to identify if there are any red flags, which are disorders that might lead to serious pathology. With the suspicion of any red flags symptoms, we will refer you to the appropriate medical professional for an appropriate treatment instead.

Rehabilitation Exercises

With the clearance of red flags, you are generally safe to commence physiotherapy and start doing therapeutic exercises. The mainstay of any rehabilitation programme is exercise. Many recent studies have supported the claim that exercise and movement is an effective way to manage low back pain.

Bed rest, immobility, and pain avoidance, however, have been presented by scientific studies to be detrimental to your back pain, leading to poor outcomes in your recovery. With the appropriate prescription of exercises, proper guidance on your movement pattern, and reassurance from our physiotherapists at Heartland Rehab, it is definitely safe for you to begin your rehabilitation journey towards resolving your back pain.

patient stretching his back

Mobilization and Manipulation

Mobilization is a manual technique performed by a physiotherapist to apply targeted pressure of forces on your spine. This technique serves to move the level of vertebrae where it is stiff, to promote movement at the level, improve the mobility of your lower back, and reduce pain. Manipulation is a technique where your physiotherapist provides a thrust on the level of the vertebrae, often accompanied by a ‘crack’ sound. This technique serves to take the pressure off any sensitive nerve or tissue, reduce muscle tension, and improve mobility and blood flow to the area to reduce pain.

For mobilization and manipulation of the lower back to be safe, an in-depth understanding of your condition is required. These techniques are not to be performed on people with spinal cord compression or worsening nerve root compression. This is why a proper assessment, with an in-depth understanding of your condition is important before we commence any treatment. With an accurate diagnosis that clears you any cord or worsening nerve root compression, these are safe to be performed for lower back treatment. Unlike manipulation of the neck area, no major adverse effects have been documented for manipulation of the lower back area making this technique to be generally safe.

Massage Therapy

This is another manual technique physiotherapist do to free up any tissue restrictions and adhesions along your paraspinal muscles. The contraindications to massage therapy for lower back pain are contusions, open wounds, and inflammation. This is easy to pick up through general observation of your skin, making it a relatively safe technique to be used to reduce pain, stiffness, and tightness of the lower back.

Dry Needling

This is used to treat pain associated with myofascial trigger points. It is a minimally invasive treatment, inserting a thin filament needle into the muscle to stimulate the trigger point. This disentangles the taut bands in a trigger point to reduce muscle tightness and pain. To minimize the risk of infection, this technique will be done in a sterile manner. Also, because the lumbar vertebrae are large and wide anatomically, it is a relatively safe area to perform dry needling without the risk of puncturing any internal organs.

Electro Physical Agents (EPA)

At Heartland Rehab, we have machines such as ultrasound and electrical stimulation that can help to reduce your back pain. Usage of these machines for the treatment of lower back pain is generally safe, as long as we take into account any contraindications that prevent you from using these machines (e.g. metal implants or pacemakers).

Physiotherapy for treatment of back pain

Because of the complexity of lower back pain, our physiotherapists at Heartland Rehab believe that there is no “one size fits all” type of treatment. Hence, it is important that a comprehensive assessment is done to identify and prioritize the layers of pain. In doing so, you can be assured that you will receive a structured and proper treatment plan to guide you towards a safe and successful rehabilitation.

Should you have more enquiries, please feel free to contact us immediately.