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How to (efficiently) treat low back pain in Hong Kong

Lower-back pain is the worldwide leading cause of activity limitation and absence from work. Hong Kong is no exception. Medical and economic costs associated with the pathology are very high and tend to increase every year.

At Hong Kong Sports Clinic, we strive to incorporate the latest evidence available, in order to increase treatment efficiency, while lowering the overall cost to both our patients and society.

We hope that you enjoy reading the following essential, evidence-based facts about low back pain.

1.What is low back pain?


"Understanding the complexity of lower back pain is essential to treat it efficiently"


A general definition of low back pain

Let’s start with defining the lower back anatomical area. To keep it simple, it runs from the lowest set of ribs, down to the start of the gluteal fold.

Low back pain can be either acute or chronic.

  • An acute low back pain episode can last from just a couple of days, and stay up to 6 weeks. It usually resolves by itself within that timeframe.  In Hong Kong, like in most countries around the world, the most common first line of treatment would include rest and painkillers - which in most cases will not help a lot. While drugs like anti-inflammatory pills can give some sort of symptoms relief, bed rest is not advised for more than two days. Our Instagram feed has a selection of exercises you can safely perform even during a very acute episode.

  • Chronic low back pain is defined as lasting more than 3 months and is a real therapeutical challenge. The pain usually does not solely come from damage or irritation of our soft tissues anymore. We now need to have a more global bio-psycho-social approach to pain.

Different types of low back pain

We can classify the different types of low-back pain as follow.

  • Discogenic: the pain is most likely coming from the intervertebral disc. A lot of patients are afraid that something “doesn’t work properly” or that a vertebra is “out of place”. This often creates unnecessary fear-avoidance patterns. People become scared of moving or exercising. Let’s just remember that the spine is a very stable structure, that sometimes gets irritated. In the vast majority of cases, nothing is structurally wrong with our spine. This type of pain can be with or without radiating pain in the butt/groin/leg.

  • Joint-related: the pain comes from the part of the facets - where the joints touch each other -, or the surrounding capsule.

  • Musculoskeletal/myofascial: the pain comes from soft tissues, and is often related to repetitive strain or trauma. Some specific tender spots - trigger points - can be found.

  • Non-specific back pain: the most common type of low-back pain is a symptom of abnormalities or other conditions, which often remain unidentifiable.

2.What are the predictive factors of low back pain?

“Our sedentary lifestyle appears to be one of the leading contributing factors to low back pain”


The most common risk factors for low back pain

Some people are more at risk of developing back pain than others. The list includes, but is not limited to, the following:

  • Obesity: more weight equals more load on our joints.
  • Motorization: the vibrations coming from sitting in a car seat may lead to accelerated disc degeneration.
  • Sedentary lifestyle: lack of physical activity prevents the optimal functioning of our body.
  • Overuse: just like not enough sport is detrimental, too much sport can also have a negative impact on our body.
  • Gender: women are more affected than men.
  • Age: getting older implies normal and progressive wear and tear of our bones, ligaments, tendons, and muscles. Arthritis consists of normal, age-related degeneration of the cartilage, which can lead to some form of bone deformation. Sometimes it will pinch a nerve, or trigger inflammation, leading to a painful back episode.
  • Prolonged sitting: People who sit for more than 5 hours a day are at a higher risk of triggering back pain.
  • Smoking: heavy smokers are more at risk of developing low back pain.
  • Recent episodes of low back pain: multiple studies have shown the “vicious circle” aspect of low back pain.

3.Presentation and symptoms of a typical low back pain episode




"Most back pain episodes are benign, but some cases require your attention"


Physical and functional aspects of low back pain

Back pain episodes can have a mix of physical and psycho-emotional causes.

  • For a lot of people, a typical painful episode starts with a “false movement”. It may involve lifting, twisting, forward-bending, or any combination of the above. Pain can start immediately, or be delayed until the next morning.

  • The usual presentation can vary from one individual to the other, with some people getting movement-related pain, while others would mostly complain at night. Pain can be centered or one-sided, triggered by our spine’s flexion or extension. Referred pain in the leg may or may not be present.

Red flags and more serious causes of low back pain

In rare circumstances, some signs point to a more serious condition that requires immediate attention. While 99% of low back pain cases are benign,  there are some conditions that call for specific attention and advice from a qualified general practitioner. These "red-flags" can be ruled-out during the initial assessment.

Serious causes of low back pain include a history of:

    • Malignancy: when there is a previously treated cancer.
    • Fractures: when a physical trauma/fall/accident is described. Pain is almost constant, regardless of the movement or position of the body.
    • Infection: fever could be a sign of an infectious disease.
    • Chronic inflammatory disorder: associated with the HLA-B27 gene, often with a family history.
    • Acute nerve compression: associated with urinary retention, loss of bowel control, or a sudden loss of strength in a group of muscles.

4.Why are there so many different  treatments available for lower back pain in Hong Kong?


“What we see on X-rays and MRIs does not always match the intensity of pain”


The plurality of existing options indicates that to this day, there are no gold standards for the treatment of low-back pain. Ineffective treatments based on image findings or tunnel-vision focus on the low-back area are common reasons for treatments with a poor outcome.

  • Imagery and low back pain: X-ray or MRI findings may not necessarily match the symptoms. Therefore, their prescription should remain specific to certain conditions, involving severe referred pain in the lower limb. Recent worldwide guidelines do not recommend routine imaging anymore.

  • The hip-pelvis-back complex: the lower back does not function independently of other areas. The closest key anatomical structures include the hip and the pelvis. One of the reasons so many treatments are inefficient might be the sole focus of said approaches to the lower back area, focusing on symptoms instead of the root cause.


5.What treatments work and what are not working for lower back pain?


“There is a need to stop wasting resources on ineffective treatments”

In 2019, over 200 different treatment methods have been reported by US insurances. Lower back pain is very common, but still poorly understood and treated.

Common treatments that do not work

  • Here is a short-list of common approaches to low-back pain that have been described as ineffective, or not significantly better than a placebo. Following these treatments for your lower back pain may result in sub-optimal use of your time and resources.
    • Steroid injections
    • Surgery
    • Electrical nerve stimulation
    • Opioid drugs
    • Bed rest
    • Shock-wave therapy
    • Ultrasounds
    • Low-level laser therapy
    • Tractions
    • Corsets
    • And probably many more...

There is some evidence for efficient treatments

  • The following approaches have been studied and proven to provide at least short-term relief. Combining exercises with some type of manual therapy seems to provide the best long-term results.
    • Exercise: moving more is the best remedy for low-back pain, both for prevention and treatment. While a specific, better set of exercises has not been identified yet, many different approaches show a significant positive impact on patients suffering from low back pain.
    • Drugs: non-steroidal anti-inflammatory drugs can give some initial short-term relief. We advise you to try the lowest effective dose and shortest duration, first. Muscle relaxants can help, too. Beware of potential side-effects with both medications.
    • Manual therapy: physiotherapy, osteopathy, and chiropractic demonstrate both short and long-term benefits on acute low back pain.
    • Cognitive-behavioral therapy: some studies have described a positive short-term impact on pain, disability, and relaxation.
    • Multidisciplinary approach: combining different fields may give a greater overall outcome.
    • Heat and ice packs: both may help with symptoms control.
    • Dry needling: seems to reduce pain intensity and functional disability. It may work even better in association with other treatment modalities.
    • Massage: can give a short-term relief - from a few days up to a week - for both acute and chronic low back pain. Usually pretty harmless, but better avoid it during the onset - first few days - of an episode.
    • Surgery: the following advice from Wikipedia is correct: “surgery is useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. It may also be useful in those with spinal stenosis. In the absence of these issues, there is no clear evidence of a benefit from surgery”.


6.Tips and advice for the prevention of low-back pain



“A few changes to your lifestyle will contribute greatly to live a pain-free life”


Several of the predictors/risk factors for low back pain are in fact modifiable lifestyle components. Here is a list of simple - but not always easy to apply - advice to consider if you want to sustain less intense and frequent back pain episodes.


Lifestyle changes

  • Manage your stress: a high level of stress and/or anxiety has often been associated with both higher intensity and frequency of low back pain episodes. 
  • Increase your level of physical activity: sedentary and obesity often go hand in hand, especially in high-income countries like Hong Kong. We ideally want to sleep for at least 7 hours a day, so what we do for the remaining 17 hours matters the most. Try to find a sport that you enjoy and conveniently fits your hectic schedule. Make it easy to attend, and fun! 
  • Sit less: this advice seems logical in regards to the previous one, but we can’t emphasize enough how bad sitting is for our general health.
    Office workers sustain more musculoskeletal injuries than any other industry sector workers. Sitting for as little as 2 continuous hours increases the risk of heart disease, diabetes, metabolic syndrome, cancer, back and neck pain.
  • Sleep more: getting these 7 hours of sleep instead of 6 (or less) has a huge impact on several aspects of our lives, including lower back pain.

Attention to posture and ergonomics

  • At our clinic, we see many office workers from various Hong Kong-based companies. One question that we keep hearing is: “What is the best posture I should adopt when sitting at my desk?”. While there are better postures than others, the best posture maintained for 10 hours per day will still hurt you. 
  • The advice here is to add some variety to the sitting position. Try to use a standing desk or alternate between sitting and standing throughout the day. When you sit, change the position of your legs often. Extend them, bring one foot on the opposite knee, bring your ankles together while pushing the knees out, sit at the edge of your chair… Be creative with your legs!

7.Why do patients book Hong Kong Sports Clinic for their low-back problems?


“Learn the right movements first, then repeat them a lot. This will promote your physical health”


We are back experts

Every practitioner at our clinic is capable of helping you with your low back pain. We will always do our best to give you some substantial and fast short-term relief through hands-on therapy while guiding you towards the best long-term changes.


We have an active approach to pain

We believe that a purely manual approach to low back pain has its limits. For that reason, exercises are almost always on the menu. We want you to feel in control, and understand that what you do outside of the clinic is just as important, if not more, than the time you spend with us. Of course, we will do our best to ease up your pain, but there is a limit to the “magic” our hands can provide.


We keep an honest and open-minded vision of your pain

Lower back pain is complex. There is a lot we still don’t know about it. While we understand how pain works, we do see that sometimes patients get better and that sometimes they do not. We keep educating ourselves to deliver the most adequate and up-to-date advice. And as a team, we trust each-others. So if needed, we will not hesitate to refer you to one of our colleagues, for a second opinion, or a different approach to your pain.



8.How to experiment with Hong Kong Sports Clinic approach to low back pain


“Contact us to guide you through your journey towards a pain-free back”


Contact us


Simply call our reception - 37092846 - for more information, or to book an appointment. You can also use the Whatsapp button on the bottom right corner of the page.





Da Silva, T., Mills, K., Brown, B., Pocovi, N., de Campos, T., Maher, C. and Hancock, M., 2019. Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy, 65(3), pp.159-165.

Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21.

Liu, L., Huang, Q., Liu, Q., Thitham, N., Li, L., Ma, Y. and Zhao, J., 2018. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 99(1), pp.144-152.e2.

Nascimento, P., Costa, L., Araujo, A., Poitras, S. and Bilodeau, M., 2019. Effectiveness of interventions for non-specific low back pain in older adults. A systematic review and meta-analysis. Physiotherapy, 105(2), pp.147-162.

Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. and Santilli, V., 2018. Chronic low back pain and postural rehabilitation exercise: a literature review. Journal of Pain Research, Volume 12, pp.95-107.

Shaw, B., Kinsella, R., Henschke, N., Walby, A. and Cowan, S., 2020. Back pain “red flags”: which are most predictive of serious pathology in the Emergency Department?. European Spine Journal, 29(8), pp.1870-1878.

Wu, A., March, L., Zheng, X., Huang, J., Wang, X., Zhao, J., Blyth, F., Smith, E., Buchbinder, R. and Hoy, D., 2020. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine, 8(6), pp.299-299.






Dereck Fu



Dereck completed his physiotherapy training at the Hong Kong Polytechnic University. After graduation, he started practicing in a public hospital where he had extensive experience in treating different musculoskeletal, orthopedics, and sports conditions. He recognizes the complex contribution to pain and musculoskeletal injuries and is keen on using a wide range of skill sets such as exercise therapy, manual therapy, and acupuncture tailored to individual conditions.

Before joining HKSC, Dereck completed his Master of Clinical Physiotherapy (Musculoskeletal Physiotherapy) and accreditation in Level 1 strength and conditioning coach under the Australian Strength and Conditioning Association (ASCA). These exposures enriched his practice, considering the psychosocial, biomechanical, and training load aspect of the clients’ story.

He has a particular interest in treating sports-related injuries and desk job conditions, assisting clients on their way back to function, and prevent recurring injuries.

Dereck has been a sports enthusiast since his teenage years. He is a keen football (soccer) and badminton player who treasures the enjoyment and satisfaction brought by both team and individual sports.

Icy Bo Lin

Head of Mobility

Icy has spent thousands of hours studying yoga, stretching and mobility through a broad range of in-depth courses. She has more than 7 years of experience teaching group and 1-on-1 classes to people ranging from athletes, pregnant ladies and new mums, children and especially the average Joe’s.

Icy is passionate about helping people move better, recover well and get pain free.

She believes it takes a combination of tools to help build a healthy body and has therefore spent substantial time practising strengthening and conditioning as well

Her passion for her craft is demonstrated through a focus and attention to detail with her clients.

Icy is a mother, experienced former banker and we are proud to have such an accomplished person on our team.

Below is a list of her completed training:

Leslie T. Evangelista

Head of Strength and Conditioning

Leslie’s athletic achievements speak for themselves. She is a true world class power lifter and continues to compete at the highest level. She has reached the pinnacle of her sport, medalling in a number of international powerlifting federation events. She has been Asia’s best lifter and holds a number of national records.

As impressive as it is, Leslie’s athletic resume pales in comparison to her passion, knowledge and dedication to the science of physical human performance. She is a student and expert of strength and conditioning, working in the industry as a coach and consultant for 10 years. We are very glad to have her on our team as her technical knowledge of compound movements and training methodology helps us bridge the gap between injury and a better you.

Leslie takes most pleasure in teaching the average person. Leslie’s deep knowledge and experience means she can build you from the bottom up or take you to a level beyond your expectations. Whether you are a mother or a mother to be, an office worker wanting to learn how to keep strong, or a youth wanting to learn the essentials of training, she is the expert for you.

Leslie is available as a consultant for long or short-term basis if you are serious about improving your health. She is an invaluable asset to have on anyone’s team.

Hideo “Harry” Loasby

Head Running Coach, Founder of BuffCo

Harry discovered running at 16, and quickly rose through the ranks in Hong Kong and became a national champion over 1500m when he was 17. He represented Hong Kong at the Asian Schools Championships and won several gold medals in cross country and track. Harry’s performances earned him a place on the Loyola Marymount University cross country and track team.

Towards the end of his university career, Harry became increasingly interested in studying various training methods and running philosophies. After moving back home, and knowing first hand the gap in grass roots development in Hong Kong, he set up Buffalo Running Company (BuffCo) in the hopes of changing that for the better. While coaching full time, Harry has remained competitive in the local scene, winning the 2020 China Coast Marathon by over 8 minutes. During the absence of races, he coached himself to personal bests in solo road time trials in the 10k and half marathon, running 31:38 and 70:30 respectively.

After running and now coaching in Hong Kong for the majority of his running career, Harry builds his coaching and training philosophy around the context of the city and what it means to be a runner here. He enjoys hunting for excellence in every level of runner, because he knows what Hong Kong’s running scene has to offer despite the tough conditions. From complete beginner to aspiring college athlete, on any surface over any distance, Harry is keen to help you with your running journey.

Harry is available as a consultant for any race you have on the calendar, but he is particularly passionate in developing runners over several years and building a sustainable relationship with all aspects of the sport, so that you can enjoy a lifetime of healthy, happy running.

May Lee
Sports Massage Therapist and Sports Scientist

May is an Internationally experienced Sports Massage Therapist, she focuses on deep tissue massaging to aid recovery, optimise performance but also general health and well-being. Throughout her years of training and watching others train, May has found that many people neglect the recovery process. The recovery process is fundamental for muscles to grow and develop and more importantly to reduce injury in the long term. Deep tissue massage helps to smooth out those little aches and pains you experience in normal day to day activities.

May has studied Sports Science at degree level and has completed her Level 4 Diploma in Sports Massage Therapy in the UK as well as being qualified in Dry Needling, Myofascial Release, Trigger point therapy and Pre-Hospital immediate care in sport.

She has previously worked a ski season in Niseko followed by working in clinical practice in Tokyo before deciding to move to Hong Kong to pursue her career further.

May has always had a keen interest in sports, training and exercise which has allowed her to pursue a successful career within sports and exercise rehabilitation.

Lizemari Marais
Physiotherapist and Pilates Instructor

Liz is a Physiotherapist and Pilates Instructor from South Africa. Her greatest passion is health education and empowerment, which is why she flourishes in the corporate wellness setting. She’s good at analysing corporate settings to determine risk factors to individual health as well as employee productivity. She will not just remind your employees to sit up straight – she will walk a path with your company to encourage healthy lifestyles and happy employees.

Liz’s approach to rehabilitation is grounded in the balance between mobility and foundation strength. She explores this in her calisthenics, yoga and pilates. She believes that with the right foundation and training, the human body can do anything.

Liz values independence and wishes to equip her patients with everything they would need to maximise their body’s potential, allowing them to pursue independent lives.

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