Since chiropractors are not recognised in Singapore, which other health professionals provide effective back pain treatment in a healthy person?

The main aim of treating back pain is to identify and prevent further damage to the spine. This is best achieved by seeing your family physician or a specialist. They may order an MRI to exclude any major pathology and to recommend the best course of therapy. For back therapy, I would recommend seeing an accredited physiotherapist, exercise therapist or even an acupuncturist if you prefer the TCM approach. Generally, I would not recommend any form of back manipulation unless the MRI shows that the lumbar disc is healthy with no annular tear.

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Human

When is surgery necessary for a slipped disc?

Dr Fong has given an excellent answer to your question so I won’t repeat what he has already said. Certainly surgery is not often required for minor disc problems or nerve impingement - usually symptoms settle with physiotherapy and activity modification. In some situations, patients in clinic have undergone nerve root or facet joint injections for chronic pain symptoms. In situations where you have “red flags” or profound neurological symptoms together with singnficant changes on an MRI, it may then warrant surgical intervention.

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Dr Dinesh Sirisena

Sport Medicine

Can slipped discs heal by themselves?

Thanks for your question. Dr Fong has given you an excellent answer so I won’t repeat what he has said, but I would certainly advocate assessment and treatment for back pain symptoms. Having had personal experience of it, I know that it can be frustrating and limit your activity. While there might be a degenerative element to things, often symptoms settle with physiotherapy, activity and lifestyle modification and other treatments such as acupuncture or cupping.

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Dr Dinesh Sirisena

Sport Medicine

Will my back pain persist even after I have done an open back surgery?

This is certainly a concern for patients with a widely degenerative spine where multiple discs have herniated and there maybe other wear and tear changes. The simple answer is - we don’t know! Your surgeon will operate with the best intentions and provide you with the best service possible. But there are many other factors than the surgeon or surgery itself that can impact on your recovery.

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Dr Dinesh Sirisena

Sport Medicine

Can a herniated lumbar disc make you shorter?

Thanks for your question. It’s certainly an interesting one! Typically with normal healthy discs you tend to be “taller” in the morning once they have had a chance to recover from the rigours of the previous day. They tend to absorb fluid and hence are fuller - giving the impression of increased height. Often by the end of the day, with muscle fatigue and a degree of dehydration, intervertebral discs tend to shrink a little and hence you are a little “shorter”.

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Dr Dinesh Sirisena

Sport Medicine

Can a L4/5 herniated disc improve with only physiotherapy and exercise?

Depending on the severity/size (or Stage) of your disc herniation in both your clinical signs and in your MRI, Stage 3 (large, severe) slipped disc must undergo surgery to improve no other choice ! Early Stage 1 (small, mild) and Mid Stage 2 (moderate disc bulge) can be "managed" by physical therapy whenever it "acts up" but without surgery cannot be permanently "cured".

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Dr Shee Yan Fong

Orthopaedic Surgeon

When is laser treatment recommended for herniated discs?

According to Ministry of Health guidelines, laser treatment is currently NOT a recommended treatment for spinal disorders in Singapore (unlike in USA). In fact, laser spine surgery is NOT even included in the Ministry of Health list of Table for Surgical Procedures for purposes of fee benchmark/insurance/medisave claims ! Please be aware of this and double check with your specialist again if you are recommended to undergo laser spine treatment as you may be charged under another different spine procedure instead (e. g. radiofrequency discoplasty "injection" which is NOT laser treatment !)

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Answered By

Dr Shee Yan Fong

Orthopaedic Surgeon

What is a laminoplasty, and how will the surgery benefit me?

Laminoplasty is a surgical procedure for the spine where the surgeon removes the bone located at the back of the spinal canal. The surgeon then proceeds to free the nerves, remove tumours, etc but after the decompression is achieved, the surgeon will replace the bone and screw it back in place to create a larger opening in the spinal canal. This is a common procedure for those with multiple level cervical spine compression where anterior surgery (from the front of the neck) would be excessive. It allows for good decompression for a larger area of the spinal canal.

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Human

For a lower back injury causing pain that radiates down my buttocks and right leg, what treatment options can help to completely relief my symptoms?

Hi there, From what you describe, it sounds like you have sciatica - which is basically pain along the sciatic nerve at the back of your leg. This can be due to a problem in the back or from an injury or irritation of the nerve in the leg itself. The first thing to do is to get this assessed, particularly if you are experiencing "red flag" symptoms. A Sports/MSK physician or physiotherapist can assess your back and determine where the pain might be coming from.

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Answered By

Dr Dinesh Sirisena

Sport Medicine

What are recommended exercises for someone with a herniated disc?

In principle, low or non-impact "horizontal" exercises (swimming, yoga, etc) are safer for your lower back. You don't want high impact "vertical" exercises (running, racket games, etc) to stress your worn out L4-5 disc further ! Heavy weight lifting stresses your back too if done upright "vertically" better to do them lying down "horizontally" or without bending your back.

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Answered By

Dr Shee Yan Fong

Orthopaedic Surgeon

How can you tell the difference between a lower back muscle strain and a herniated disc?

Thanks for your question. This is very important as often people are diagnosed with muscular back pain and turn out to have a disc problem and vice versa. The reason is that is can be very difficult to differentiate the different causes of back pain as there can often be quite an overlap. In situations with a disc or nerve problem, the lower back muscles can become tight and go into spasm. Equally, with a muscle pull in the back, there can be pain shooting I tot he legs etc.

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Dr Dinesh Sirisena

Sport Medicine

When is neck pain a cause for concern?

Neck pain is a common occurrence especially with the use of our mobile devices like handphones and tablets. Most of the time, it is due to poor posture and prolonged looking down on the laptop computer. Neck pain when it is persistent, worst at night and affects your sleep, needs to be assessed by a doctor.

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Human

What can I do to reduce the pain of a herniated disc?

Thank you for your question and I’m sorry to hear about your symptoms. Three years is an awfully long time to be experiencing pain symptoms - I presume you have had and MRI scan to confirm the disc herniation? Options basically fall under two categories - non-surgical (conservative) and surgical. Depending on your symptoms, it might be worth seeking another assessment prior to deciding one way or the other.

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Answered By

Dr Dinesh Sirisena

Sport Medicine

How do doctors determine if a back injury due to heavy lifting is causing nerve problems?

Back injury resulting in nerve problems will present as pain or numbness spreading from back/buttock down along your leg, with or without "pins and needles" sensation or weakness in your leg/foot/buttock, ON TOP OF your main back pain. The presence of one or more of these signs usually necessitate a referral to a spine specialist by your GP so that an MRI scan can be done to evaluate both your spine as well as your nerves (remember X-rays CANNOT visualise nerves).

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Answered By

Dr Shee Yan Fong

Orthopaedic Surgeon

What are the implications of having a diffuse disc bulge at the lumbar spine (L4-L5)?

A diffuse disc bulge in your MRI, assuming your MRI radiologist meant a small disc protrusion in his report, represents an aging disc that has naturally lost his water content and its cushion and height with time, resulting in a bulge, like a bulging "worn out" car tyre. Because this is a natural aging process it cannot be reversed or “cured” and disc bulges can also be seen in MRI even if you have no back pain as you age.

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Answered By

Dr Shee Yan Fong

Orthopaedic Surgeon

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