Low Back Pain

Low back pain is a common ailment in Hong Kong. Medical studies show that around 80% of adults experience low back pain at least once in their lifetime. There are many causes of low back pain, but most of them are due to back strain, poor posture and degenerative problems. The keys to recovery from low back pain are learning the proper ways and postures to carry out different tasks correctly, establishing habits in regular and appropriate exercise, and enhancing consciousness in self-management and health. The following information provides an overview of low back pain and the ways to manage it.

(Special thanks to Dr. Y. K. CHAN, Consultant of Department of Orthopaedics & Traumatology, Pamela Youde Nethersole Eastern Hospital / Hong Kong East Cluster and Ms. Susane KWONG, Consultant Physiotherapist (Musculoskeletal Specialty), Hong Kong East Cluster for reviewing the information of this page.)


The human spinal column (spine) runs from the neck to the pelvis. It consists of 5 segments made up from vertebrae: cervical vertebrae in the neck; thoracic vertebrae in the upper back; lumbar, sacral and coccygeal vertebrae in the lower back. The vertebrae are connected by ligaments and muscle, facet joints, and intervertebral discs. The intervertebral disc serves as cushion to damp down force transmitted over the spinal column. The spinal column encloses and protects the spinal cord and spinal nerves roots. It supports the head and connects the limbs. There are many muscles and tendons attached to the spine. Deep muscles maintained the spine in good position and support the body, whereas superficial muscles provide power for movement.

Low back pain usually refers to pain in the tissue of the lumbosacral region, such as muscles, tendons, intervertebral discs and facet joints. The pain may radiate to the buttocks and the backs of the thighs.

Low back pain differs from sciatica. It does not extend down to the foot as sciatic pain does.


Low back pain in the middle-aged and young people is usually due to muscle strain and poor posture, whereas backache in the elderly people is mainly caused by degeneration of intervertebral discs and aging facet joints.

The following factors can also increase the risk of developing low back pain:

  • Smoking
  • Obesity
  • Lack of exercise
  • Prolonged sitting or bed rest
  • Subject to long term vibration movement over the trunk
  • Improper working posture
  • Working in the same posture or bending at work for long periods of time

Maintaining proper posture at work and during daily activities, regular exercise and a balanced diet can help prevent low back pain.

Pay attention to postures

Avoid working in extreme positions or in the same posture for long periods of time.

Maintain good sitting posture

Sit up with your back straight. Do not lean backward over the back of the seat. From the side view, the ear, shoulder and hips should be in line from top to bottom. Gently pull in your abdomen muscle to assist back support. Adjust the chair height. Keep your feet flat on the floor with knees and hips bent to 90 degrees. You should look straight ahead. Avoid forward or side-bending of your neck. Retain the three natural curves of the spine, that is, the concave curve of the cervical and lumbar regions and the convex curve of the thoracic region. You can place a small cushion over your low back hollow. Change posture and move your neck and back at interval.

Maintain correct standing posture

Lift up your head and look forward. Keep your shoulders in a horizontal line. Lift your chest up and out. Gently tighten your abdominal muscles. The three natural spinal curves (cervical, thoracic and lumbar) should be present, which form the normal S-shaped curve of the spine. From the side view, a vertical line should pass through the ear, the shoulder, the back of the knee and the front of the ankle. Beware not to arch your low back too much backwards.

If you have to remain standing for long periods, gently tighten the abdominal muscles to adjust spine loading. Rest one of your feet on a low stool or step, and keep the hip, knee and low back muscle over the same side slightly relaxed. Changes side at interval allowing the other side of the body to rest. While washing your face or brushing your teeth in the bathroom, keep your back straight, lower yourself a bit with the knee & hip of one leg slightly bent in front of the other. Put one hand on the sink to help supporting your weight.

Note proper posture of lifting and moving heavy objects

Before you lift a heavy object, please plan before you act. Check the weight of the object and formulate the path and methods you should employ to accomplish the task. To pick up an object that is lower than the waist level, stand with a wide stance close to the object and keep your feet firm on the ground. Kneel down with one knee and keep your back straight. Grasp the object and tighten your abdominal muscles. Use your leg muscles to lift the object. Straighten your knees and keep the back straight. Don't twist the waist. Keep the object close to the body and at waist level. When you have to reach the object overhead, use a foot stool to bring yourself up to the level. Avoid too much stretching of the back. When pushing a heavy object, lean forward with knees slightly bent, use your weight to push. Avoid pulling of heavy objects. You should find others to help you if you need to carry extremely heavy object.   
Exercise regularly

* Information in this section is for reference only, you should consult your doctor or health professional for any medical condition that you may have, rather than relying on the information provided in the article

Regular exercises can enhance strength, flexibility and toughness of muscles, tendons and ligaments, and help support the spine. Do exercises on a regular basis to achieve the goals gradually. Don't overdo it at a time. Follow exercise methods. Don't change them or create your own ways.


There are many causes of low back pain. In most cases, it is not due to a serious disease. Rather, it is mainly caused by muscle strain and poor posture. Low back pain in older people is largely due to spinal degeneration.

If you do not have problems with the tendons, joints or nerves in your low back and the pain persists, the following are some possible causes:

  • When you feel painful over your back, you naturally tighten your muscle and tendons, restrict your movement. Your muscle over-contract and become too tight. Your back becomes stiff. Any movement against the tight muscle will paradoxically cause pain over the muscle. The contracted muscle also increases the pressure over the joints and disc which might also increase the pain in your back. 
  • If you do not move your back, your back muscles become weak and easily get fatigued and spasms
  • Since your sensory nerves repeatedly sent pain signals to the brain, you can feel pain even with minor outside stimulation.
  • Psychological factors: Depression, negative feelings (e.g. you feel useless), bad interpersonal relationships (at work, in family or social life), can increase your pain.

Some people with low back pain may become anxious as they cannot find out the exact cause of the ailment. In fact, having non-specific back pain doesn't necessarily mean that you have serious health problem. Just like having headache doesn't necessarily mean that your head is injured. We should focus on how to manage the pain properly, rather than just worrying that the pain is a symptom of a serious illness. Over-anxiety will only increase the pain.


Patients with low back pain may have the following symptoms:

  • Low back muscle tension and soreness on movement
  • Low back muscle sores and aches after standing or sitting for long periods
  • Numbness ,weakness or pain in the legs or around the buttocks

Doctors usually can diagnose the causes of low back pain based on patients' medical history and clinical physical test results. Sometimes, doctors may use X-rays, MRI (Magnetic Resonance Imaging) and CT scans to evaluate disc and joint degeneration, spinal canal width and the status of the spinal cord and spinal nerve roots.


Most back pain results from excessive, strenuous or improper movement. The condition can be alleviated by a few days' rest, reduction of drastic physical activities, and appropriate exercises to mobilize the back and strengthen back muscles. 80% of people who suffer from it can recover within one month.

Intervertebral disc displacement can cause low back pain. 80% of the people with this condition are between the ages of 20 and 40. Proper and regular exercise can alleviate the pain.
Treatments for low back pain include taking medicines, physical therapy, occupational therapy and surgery.

Physical therapy includes electrical stimulation, heat application, lumbar spine traction, manual & manipulative therapy, acupuncture, posture correction and exercise therapy. These therapies can help muscles to relax, alleviate local pain so as to allow for later phase of active therapy.  Active physical therapies include postural & stabilization training, back and leg mobilization exercise, relaxation exercise, back muscle, abdominal muscle and leg muscle strengthening exercise. They help to recover the normal biomechanical properties of the low back and avoid abnormal stimulation to the nerves.

Surgery is recommended when symptoms persist or when there is severe nerve compression, spinal instability or deformity. Severe nerve compression can lead to muscle weakness, persistent numbness, loss of bowel or urinary bladder control. Surgery makes room for spinal cord and nerve roots to recover, fix and fuse unstable spinal segments to improve support, and correct deformed spines.


Low back pain usually does not have complications. However, people with low back pain should be alert to the following:

  1. Sciatica due to spinal nerve compression caused by intervertebral disc displacement. When there are symptoms like muscle weakness, loss of bowel control, urinary retention, persistent pain and numbness despite adequate physical therapy, surgery is needed to relax the nerve roots.
  2. Spinal stenosis due to old age. Degeneration of intervertebral discs and vertebral joints related to aging process can lead to a narrowing of the spinal canal, which can put pressure on the spinal nerves at the level of compression. Symptoms often occur when the patient walks or stands for a period of time. Symptoms include lumbar pain, weakness or numbness of lower limbs, legs get fatigued easily. The patient has to sit down for some time to ease the discomforts. However, symptoms will occur again when the patient resumes walking or standing for another period of time, especially when walking downhill. In the early stages of the condition, the patient simply cannot walk or stand for long periods of time. In the later stages, when the nerves are damaged due to persistent compression, the patient will suffer from weakness and numbness of muscles, or even loss of bowel control, retention of urine, etc. By then, the patient has to take surgery to relax the nerve roots and create additional space for the spinal canal
  3. Fever of unknown origin, drastic weight loss, loss of appetite, or organ problems. When any of these occurs, seek medical advice as soon as possible to detect the causes, and make sure that the problem is not due to tumor disease, infection or diseases of internal organs.

You may think that taking rest and inactivity can relieve low back pain. This is wrong. It will only worsen the condition. Lack of movement can lead to loss of flexibility and strength of the tendons and joints, and thus cause pain when you move. This is a vicious circle. Therefore, you should resume activity as soon as possible.

Apart from physical and occupational therapies, you can also participate in daily activities. Just pay attention to correct postures and do it within your abilities. You can participate in daily housework, social activities, physical activities and work normally. All kinds of movement can enhance the flexibility and strength of tendons, joints and muscles, and help support the spine. Through participating in various kinds of activities, you can alleviate your stress and over-concentrated thoughts, and build up self-confidence.

Some patients fear that activity will increase pain. So they hope to ease their pain just through medicines or massage. In fact, when the patient first resume activity, the muscles have to adapt to wide range of motion of tendons and joints, this may increase the pain temporarily. However, when the body strength is enhanced, the problem of vicious circle will be solved and the pain will gradually diminish. If you depend only on passive therapies (such as medications, electrotherapy, lumbar spine traction, massage) and ignore the importance of strengthening your body, you will become over-dependant on the passive therapies. It cannot help to solve your problem.

Low back pain is actually a signal to remind you that it is time for you to know more about your body, habits and low back condition. You should cope with the problem positively in order to recover from the ailment.

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