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Most back pain settles within weeks and never needs a scan. A small proportion does not, and a smaller number is a sign of something else — so the useful question is which of those you are dealing with.
Back pain is rarely an emergency. These are the exceptions, and they are worth knowing because they are easy to dismiss as part of a bad back.
Call us on +65 8849 0677 and describe the symptom. We will see you the same day and arrange imaging if it is needed.
If we are closed, go to an emergency department. We are shut on Sundays and after 1pm on Saturdays. For the first symptom on that list in particular, do not wait for us to open.
Call +65 8849 0677The region narrows the likely cause considerably, because the parts of the spine do different jobs and fail in different ways.
Cervical, seven bones. The most mobile segment, and the one carrying the head. Wear, disc problems and nerve compression into the arm. See neck pain.
Thoracic, twelve bones. Anchored by the ribs, so it moves least — and is the least common source of back pain. Pain here is more often muscular or postural, and occasionally referred from an organ.
Lumbar, five bones. Carries the weight of everything above it while still needing to bend. That combination is why most back pain happens here. See lower back pain.
Sacrum and coccyx, nine fused bones. No discs and almost no movement — so problems here are usually at the joint where the sacrum meets the pelvis, the sacroiliac joint.
More useful than the location is the behaviour. Four patterns account for almost all of it, and they point in different directions.
"It hurts when I move a certain way"
Pain from the joints, discs, muscles and ligaments of the spine. Worse with activity and certain positions, better with rest. Often starts after a specific movement. This is the large majority.
"It travels down my leg"
Pain, numbness, tingling or weakness following a nerve's path rather than staying in the back — sciatica being the familiar example. Often from a disc or narrowing pressing on a nerve root.
"It's worse when I wake up"
The opposite pattern — worse after rest, better with movement, with morning stiffness lasting over half an hour. Typically starts under 45. See ankylosing spondylitis.
"Nothing I do to my back changes it"
Pain felt in the back but originating in an organ — kidney, gut, or major blood vessel. Characteristically unaffected by posture or movement, which is the clue.
Scans find things that are not causing your pain. Disc bulges, degeneration and annular tears appear routinely on the scans of people with no back pain at all, and become more common with age. That is why imaging early in ordinary back pain tends to confuse rather than clarify — and why a finding on a report only matters if it matches your symptoms and examination.
Beyond the urgent signs above, it is worth being assessed when:
The examination comes before the scan, not after it. What matters is which movements provoke the pain, whether nerve function is affected, and whether the pattern fits a mechanical, nerve-related or inflammatory cause.
Treatment moves in steps, and the great majority of people never reach the last one.
Bed rest makes ordinary back pain last longer. What helps is staying active within limits, changing the positions and loads that provoke it, and returning to normal activity sooner than feels comfortable. Dull advice, and the best-supported there is.
Targeted strengthening, movement retraining and posture work. More effective when it addresses the specific pattern rather than generic core exercises — which is why the assessment matters first.
Anti-inflammatories and, briefly, muscle relaxants where spasm is limiting. Where pain is nerve-related, ordinary painkillers help little and different medication is used.
Image-guided injections to the facet joints, the epidural space or a nerve root. Both diagnostic and therapeutic: the response tells you whether the level treated is the level responsible, which matters before any surgical decision.
Surgery treats a structural problem causing identifiable symptoms — a nerve under pressure, an unstable segment, a deformity. It does not treat pain with no structural explanation, and offering it in that situation is how people end up worse.
Decompression, foraminotomy, discectomy, disc replacement and fusion are among the procedures performed here — see spine surgery.
Back pain is the commonest reason people come to this clinic, and most of them do not need surgery. What an assessment provides is an explanation and a plan — which is what people are usually missing after months of being told to rest.
Spine surgery is done by two different specialities, and back pain rarely announces which one it belongs to. Both train specifically in the spine and the overlap between them is substantial — discectomy, decompression and fusion are performed by both. Where they differ is emphasis.
Trained on the nervous system first. Leans towards problems where a nerve or the spinal cord is under pressure — sciatica, myelopathy, stenosis, disc herniation with limb symptoms. Dr Mathew Tung.
Trained on the musculoskeletal system first. Leans towards problems of alignment and load — instability, a vertebra slipping, deformity, fracture, reconstruction. Dr Lim Heng Hing.
The difficulty is that you cannot usually tell in advance which kind of problem you have. Leg pain might be a compressed nerve or a slipping vertebra. Neck pain might be wear, or the cord running out of room. Establishing which is the whole point of the assessment — and it comes before the choice of surgeon, not after it.
Having both in the same clinic means that assessment is not shaped by whoever you happened to book, and that if the answer turns out to be the other speciality, it is a conversation down the corridor rather than a fresh referral and another wait.
More detail on the two: neuro spine and orthopaedic spine surgery.
Usually not, at least at first. Scans find changes in people with no pain at all, so an early scan in ordinary back pain often adds confusion rather than clarity. Imaging becomes useful where nerves are involved, where the pattern is unusual, or where treatment decisions depend on it.
Briefly at most. Prolonged rest makes ordinary back pain last longer and weakens the muscles that support the spine. Staying active within your limits is better supported by evidence than anything else on this page.
Not necessarily. Degenerative change is close to universal with age and appears in people with no symptoms. What matters is whether the finding matches your pain and examination — a judgement made with you in the room, not from the report alone.
Most people with back pain do not. Surgery is for a structural problem producing identifiable symptoms — nerve compression, instability, deformity. Where there is no structural explanation, surgery is unlikely to help and can make things worse.
If there are none of the urgent signs above, four to six weeks of sensible self-management is reasonable. Sooner if pain travels into a limb, or if there is numbness or weakness.
For most back problems either is appropriate, and the overlap is large. Nerve problems lean neurosurgical; instability, deformity and fractures lean orthopaedic. Since you usually cannot tell which you have until you have been assessed, the practical answer is to see whoever can establish that — and both work from this clinic.
No. Bring any imaging you have had, a note of what makes the pain better and worse, and what you have already tried.
Lower back pain · Neck pain · Slipped disc · Sciatica · Spinal stenosis · Annular tear · Ankylosing spondylitis · Spine surgery
Most back pain does not need surgery. It does need an explanation, which is what an assessment is for.
