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Low back pain is a very common health problem affecting people of all ages, from children to the elderly, and is a very frequent reason for medical consultations and a major cause of disability worldwide. Low back pain can be acute, sub-acute, or chronic. Though several risk factors have been identified (including occupational posture, depressive moods, obesity, body height and age), the causes of the onset of low back pain remain obscure and diagnosis difficult to make.

It is difficult to estimate the incidence of low back pain as the incidence of first-ever episodes of low back pain is already high by early adulthood and symptoms tend to recur over time. The lifetime prevalence of non-specific (common) low back pain is estimated at 60% to 70% in industrialized countries. The prevalence rate for children and adolescents is lower than that seen in adults but is rising.

At present low back pain is treated mainly with analgesics. The causes of lower back pain are rarely addressed. Alternative treatments include physical therapy, rehabilitation and spinal manipulation. Disc surgery remains the last option when all other strategies have failed, but the outcomes are disappointing (Phillips et al).

Over these years of practice, I saw countless low back pain patients with different symptoms and various degree of pain. I find out:

1. There is only one type of low back pain – degenerative disc syndrome. There is no other type!!. 

Lot of patients or healthcare professional will disagree with me. Yes, I, at the beginning years of my own practice, would disagree my current view too. I naively accepted there are a lot of types of low back pain from the textbook back in the medical university. I have to say, the textbook is entirely wrong on this issue, that is why the management of low back pain has no real progress over hundreds years.

2. The degenerative disc syndrome begins very early in some people, that is why the average age when a patent is diagnosed suffering bulging disc is 28 years of age!!!. I saw children as young as 11 year old have sciatic nerve irritation symptoms and had disc surgery at early twenties.

3. Don’t be fooled by the ever changing symptoms of low back pain due to the different degrees of disc degeneration. I categorizes into three stages according to the development of the symptoms.

Stage I. Low back pain only. This is beginning of the problem. A lot people start feel their low back stiff in their teenage. Most people would not pay any attention to these symptoms. If this problem does not solved, it will develop to second stage in a few years to decades.

Stage II. Gluteus & hip & thigh pain.  This is the time all patient start to worry and in most times find no real help.  The patients go to see different healthcare professions and come back disappointedly because no one really understand them. In most cases, the patients are told they have “hip bursitis”, “hip arthritis”, or “hip cartilage tear”. A lot patients went through cortisone injection, hip arthroscope, hip replacement but nothing seems help much. Yes, you have degenerative disc syndrome and in the stage II. If not solved, your pain will develop into the third stage very soon.

Stage III. Sciatica. If you don’t know what it is, google it. It is a terrible pain along the sciatic nerve. The first sign of sciatica is tight calf muscle or hamstring.  A lot patients came to me complaining stiff calf for years and lot treatments on it but not getting anywhere. Yes, treatment for bulging disc will solve it. Acute sciatica is a terrible pain developed on these early signs.

4. The cause of low back is bad posture. If you don’t change your posture, no treatment will help you in the long term. The bad posture starts early in life, likely from 5 years of age. If you see your children have s-shaped low back, please don’t be proud, get it corrected. If you have a s-shaped low back, you know you have a problem (photos in the lady magazines are very misleading).

5. In most cases, surgery will not help you in the long term if you don’t have bowel movement or urination difficulties. The patients may feel fantastic for days, weeks, months or rarely years, but eventually they are regretful (Phillps et al).


Phillips FM, Slosar PJ, Youssef JA, Andersson G. Lumbar Spine Fusion for Chronic Low Back Pain due to Degenerative Disc Disease: A Systematic Review. Spine, 2013, (Phila Pa 1976).