Back pain is the most common form of acute and chronic musculoskeletal pain. Almost everyone lives with back pain at least some of the time. As a rule, this pain subsides within a few weeks due to adaptation processes in the body. However, it is not uncommon for attacks of pain to recur.
Here you will find further information as well as highly qualified back pain specialists and centers.
In evolutionary terms, the spine is designed by nature to walk on four legs. The back is not yet optimally adapted to the upright gait of humans. When walking upright, the spine is loaded longitudinally from top to bottom by the weight of the body.
When carrying and lifting loads, additional leverage forces act on the spine and the intervertebral discs. The intervertebral discs are particularly stressed where a mobile section of the spine merges into a less mobile section: cervical vertebrae - thoracic vertebrae and lumbar vertebrae - sacrum.
An intervertebral disc consists of a fibrous ring and the elastic core. Very early on, small tears appear in the fibrous ring and the core loses elasticity and volume. Eventually, the fibrous ring can tear completely. The core material and parts of the fibrous ring penetrate outwards as a herniated disc.
This wear and tear or degeneration of the intervertebral discs often begins around the age of 20. The most heavily loaded intervertebral discs in the lower lumbar spine are particularly affected, as are the middle and lower cervical spine. By the age of 40, these processes are often already very advanced.
If the shape of the spine deviates significantly from the implied double S-shape when viewed from the side or if there are pronounced bends to the side, additional local stress peaks occur. Other risk factors for premature wear and tear are
As wear progresses, the intervertebral disc loses its buffering function and collapses. The back extensor muscles attached to the spinous processes and the posterior arches then try to straighten the spine. The muscles tense up and so-called blockages develop, which cause back pain. These blockages are difficult to release.
Back pain often occurs in the lower back © BigBlueStudio | AdobeStock
The looser the disc tissue is, the more unstable the section of the spine becomes. The back pain only occurs occasionally, sometimes intense and highly acute(lumbago). They subside again, then recur more frequently and finally the pain can become permanent.
The burden of straightening the spine rests on the vertebral joints, which become increasingly strained and overloaded as the intervertebral discs wear down. A joint that is overloaded in the long term also wears out and arthrosis develops. This can eventually cause pain after exertion and also at rest.
The increasing loosening of the intervertebral discs is compensated for by a natural repair mechanism. Around the torn intervertebral discs, calcium deposits form in the connecting ligament structures, which form braces and bridge the loosened intervertebral disc space.
The instability gives way to increased stability. Although the spine loses some of its mobility, it gains significantly in resilience. The fatigable and often painful postural muscles are relieved and back pain is reduced.
Illustration of joint wear and tear on the spine © bilderzwerg | AdobeStock
Back pain is particularly intense when a herniated disc puts pressure on a nerve root.
The spinal column surrounds the spinal canal with the spinal cord and nerve roots. At the level of each intervertebral disc, a nerve root leaves the spinal canal on both sides. It passes through the nerve canal, which runs through the
and articular processes.
The nerve roots supply the arms, trunk and legs. Information about the sensory qualities as well as impulses for controlling the muscles run through these nerve tracts. If there is a bulging or herniated disc in this area, the pressure on the nerve root in the narrow canal can cause
can be triggered.
Different degrees of severity of a herniated disc © bilderzwerg | AdobeStock
Sciatica develops in the lower lumbar region due to irritation of the roots of the sciatic nerve. Stretching the nerve, for example by lifting the outstretched leg from a supine position, triggers or intensifies pain in the course of the sciatic nerve.
Increased pressure in the nerve canal causes discomfort in the foot, lower leg and thigh. Parts of the body become numb or hypersensitive and eventually the muscles lose their strength.
In the lower cervical spine, pain and sensory disturbances radiate into the arm and even the hand. Circumscribed muscle weakness can also occur.
Acute back pain initially requires relief and pain relief. The following are useful
Medication is also required to relieve pain and swelling.
If the acute back pain does not subside, sensory disturbances or muscle paralysis may occur. It is then advisable to consult a doctor.
If bladder or bowel control is impaired, rapid action is required. Inpatient admission to a hospital department for neurosurgery or spinal orthopaedics may be necessary.
Surgery is only immediately necessary if a severe prolapse has led to a disruption of bladder and bowel control.
If disorders or loss of control occur here, action must be taken at short notice. Surgery may be advisable if
During disc surgery, the prolapsed disc material is removed from a small incision in the back and the nerve root is relieved. Loose material is also removed from the intervertebral disc space.
After a few weeks, scar tissue forms in the intervertebral disc space. The load-bearing capacity of the spine increases again.
Rheumatic pain medication such as ibuprofen, diclofenac or Coxibe are particularly effective. They relieve the pain and reduce swelling in the area of the nerve roots. These medications are often injected into the muscle in combination with cortisone.
When injecting into the gluteal muscle in this way, there is always a risk of long-term damage to the sciatic nerve due to accidental injection of the medication into the nerve itself.
Location of the sciatic nerve (red) © Nathan Devery com | AdobeStock
In the case of highly acute back pain that does not respond to painkillers, local anaesthesia of the nerve at the herniated disc itself is necessary. This is done by injecting a local anesthetic.
Make your back strong! Maintain or improve the muscular strength of the spine to enable dynamic control and stabilization. To do this, it is important to keep moving despite back pain.
However, the following are unsuitable
Swimming, cycling and Nordic walking are also useful. Important tips and information on how to deal with back pain problems can be obtained from a back school. The functional training offered by the Rheuma League provides motivation to exercise without overexerting yourself.
Stay relaxed! Pain and anxiety are mutually reinforcing. Relaxation techniques such as autogenic training or progressive muscle relaxation according to Jacobsen or pain management training are often helpful.
Individual psychotherapeutic treatment can also reduce stress.
When it comes to back pain or complaints, an orthopaedic specialist is usually the first point of contact. If there are indications that the nerves of the spinal cord are affected, it may also make sense to consult a neurologist.
Back specialists are usually members of specialist associations, such as the German Spinal Society. In many cities, there are also special spine or back centers where orthopedists, neurologists and neurosurgeons work hand in hand with physiotherapists to offer their patients diagnosis, therapy and rehabilitation in one place.
The use of alternative healing methods is possible, especially for non-specific back pain for which doctors cannot find a cause. Osteopaths, chiropractors or healing techniques from traditional Chinese medicine may be able to alleviate the symptoms.
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