Back pain is the most common type of musculoskeletal complaint—whether acute or chronic. In most cases, back pain subsides within a few weeks as the body adapts. For other people with back pain, the episodes recur or develop into chronic back pain (if they last for twelve weeks). The most common type is lower back pain (low back pain) in the area of the spine—specifically, the lumbar spine (“lower back pain”).
Here you will find further information as well as highly qualified back pain specialists and treatment centers.
From an evolutionary perspective, nature’s design intends the spine to support walking on four legs. The back has not yet adapted optimally to human upright walking.
When walking upright, we place a longitudinal load on the spine from top to bottom due to our body weight.
When carrying and lifting loads, additional lever forces act on the spine and the intervertebral discs.
The intervertebral discs are under particular strain where a mobile section of the spine transitions into a less mobile section: the cervical vertebrae to the thoracic vertebrae and the lumbar vertebrae to the sacrum.
Acute back pain lasts up to 6 weeks; back pain is considered chronic if symptoms persist for twelve weeks. Nonspecific back pain (the most common form) occurs without a clear underlying medical condition—such as muscle tension, lack of exercise, poor posture, or physical strain. Specific back pain (e.g., herniated disc, inflammation, fracture, or, more rarely, a tumor) can be traced to a specific cause of the pain. Most back pain is nonspecific; however, if warning signs are present, it is important to seek medical evaluation.
Back Pain: What Are the Causes?
The most common cause of back pain is nonspecific: muscle tension, poor posture, lack of exercise, and overexertion; specific causes such as a herniated disc, inflammation, or a fracture are less common. Back pain ranges from short-term stiffness to chronic pain—depending on the cause of the back pain and the level of strain.
An intervertebral disc consists of a fibrous ring and an elastic nucleus. Minor tears in the fibrous ring develop very early on, and the nucleus loses elasticity and volume.
Eventually, the annulus fibrosus can tear completely. The nucleus pulposus and parts of the annulus fibrosus protrude outward, resulting in a herniated disc.
This wear and tear, or degeneration, of the intervertebral discs often begins as early as age 20.
The intervertebral discs in the lower lumbar spine, which bear the heaviest load, 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 double-S curve or if there are severe lateral curvatures, localized stress peaks occur.
Other risk factors for premature degeneration include:
- a pronounced swayback
- excessive curvature of the thoracic spine (kyphosis) or
- severe lateral deviation (scoliosis)
As wear and tear progresses, the intervertebral disc loses its cushioning function and collapses.
The back extensor muscles, which attach to the spinous processes and the posterior arches, then attempt to straighten the spine.
The muscles tense up, creating blockages that cause back pain. These blockages are difficult to resolve.
Back pain often occurs in the lower back © BigBlueStudio | AdobeStock
In the lumbar spine, lower back pain is often caused by strain and tension in the muscles and ligaments; in the cervical spine, poor posture (e.g., working at a computer) causes muscles to tense up and reduces mobility. Degenerative disc disease, herniated discs, and an irritated nerve root can cause pain of varying intensity to radiate—even into the buttocks and legs. The pain can radiate into the legs when pressure is placed on the nerves.
The more degenerated the intervertebral disc tissue is, the more unstable that section of the spine becomes.
Acute back pain (e.g., lumbago) can recur and develop into chronic back pain.
Back pain caused by facet joint osteoarthritis
The weight of the spine’s upright posture rests on the facet joints. As the intervertebral discs wear down, these joints become increasingly strained and overloaded.
A joint that is overloaded over the long term also wears down. Osteoarthritis develops. It can eventually cause pain both during activity and at rest.
The increasing loosening of the intervertebral discs can be compensated for by a natural repair mechanism.
Calcium deposits form in the connecting ligament structures around the worn-out intervertebral discs. They form bridges to span the loosened intervertebral disc space.
The instability gives way to renewed stability. Although the spine loses some of its mobility, it gains significantly in resilience.
The postural muscles, which are prone to fatigue and often painful, are relieved, and back pain subsides.
Illustration of joint wear in the spine © bilderzwerg | AdobeStock
Back Pain Caused by a Herniated Disc
Particularly severe back pain occurs when a herniated disc puts pressure on a nerve root.
The spine encloses the spinal canal, which contains the spinal cord and the nerve roots. At the level of each intervertebral disc, one nerve root exits the spinal canal on each side.
It passes through the neural foramen, which consists of the following structures:
- Vertebral arch root
- Posterior edge of the vertebral body
- Intervertebral disc, and
- articular processes
The nerve roots supply the arms, trunk, and legs. Both sensory information and motor impulses for muscle control travel through these nerve pathways.
If a disc bulge or herniation occurs in this area, the following symptoms may arise:
- Pain
- Sensory disturbances and
- Muscle weakness
Various degrees of severity of a herniated disc © bilderzwerg | AdobeStock
Development of Radicular Syndrome
In the lower lumbar region, sciatic pain (ischialgia) results from irritation of the sciatic nerve roots. Stretching the nerve (by lifting a straightened leg while lying on your back) causes pain along the course of the sciatic nerve.
When there is increased pressure in the neural canal, sensory disturbances occur in the foot, lower leg, and thigh. Certain areas may then become numb or hypersensitive. Eventually, the muscles lose their strength.
In the lower cervical spine, pain and sensory disturbances radiate down the arm into the hand. Localized muscle weakness may also occur.
Diagnosis begins with a physical examination (posture, range of motion, nerve tests)—often the back pain is nonspecific. Imaging is only necessary in cases of severe back pain, neurological deficits, or persistent symptoms. Further tests (e.g., MRI/CT) help diagnose specific causes of back pain, such as a herniated disc or inflammation. The doctor will determine whether the back pain is due to spinal degeneration or pressure on the nerves and will decide on a treatment plan. If back pain recurs during physical activity or occurs alongside neurological deficits, you should see a doctor promptly.
Treatment of Back Pain: Targeted, Medication-Based, and Surgical
In cases of acute back pain, the first step is to relieve pressure on the affected area and manage the pain.
The goal is to relieve pain, improve mobility, and specifically reduce the risk of recurrence—through medication, physical activity, and, if necessary, surgery.
The following are recommended:
- lying on your back or side with your legs bent to relieve pressure on the irritated sciatic nerve,
- heat for the cramped back muscles (hot water bottle, heating pad, warmed grain sack)
- In addition, medication for pain relief and to reduce swelling is necessary.
If the acute back pain does not subside, or if sensory disturbances or muscle paralysis occur, it is advisable to see a doctor.
If you experience bladder or bowel incontinence, prompt action is required. Admission to a surgical ward specializing in neurosurgery or spinal orthopedics may be necessary.
Back pain is rarely dangerous—the key is to identify the cause of the symptoms and treat it specifically.
Surgery for Back Pain
Surgery is only necessary if a severe herniation leads to bladder or bowel incontinence.
If such problems or loss of control occur, immediate action is necessary.
Surgery is advisable if:
- the pain radiating down the leg (sciatica) does not subside and
- the loss of sensation and, in particular, muscle weakness persist for days or weeks.
During disc surgery, doctors remove the herniated disc material through a small incision in the back. This relieves pressure on the nerve root.
In addition, they remove loose material from the affected intervertebral disc space. After a few weeks, scar tissue forms in the intervertebral disc space.
The spine’s load-bearing capacity gradually increases again.
Medications for Back Pain
Medications for rheumatic pain are particularly effective, such as:
- Ibuprofen
- Diclofenac or
- Coxibs
They relieve pain and reduce swelling around the nerve roots. Doctors often inject these medications into the muscle in combination with cortisone.
With such an injection into the gluteal muscle, there is always a risk of long-term damage to the sciatic nerve itself. This can occur if the doctor accidentally injects the medication directly into the nerve.
Location of the sciatic nerve (red) © Nathan Devery com | AdobeStock
In cases of acute back pain that does not respond to painkillers, local anesthesia of the nerves affected by a herniated disc is necessary. This is achieved by injecting a local anesthetic around the affected area.
Preventing Back Pain: Simple Exercises & Everyday Tips
Strengthen your back! Maintain or improve the muscle strength of your spine to enable dynamic control and stabilization. To do this, it’s important to stay active despite back pain.
However, the following are not recommended:
- Exercises that force mobility with excessive force
- Peak loads caused by jumping or pushing, as well as
- Sports that require sudden evasive movements (martial arts, handball, soccer)
Swimming, cycling, and Nordic walking are recommended. You can get important tips and information on managing back pain in back training classes.
Simple exercises and specialized exercises from the back school can help prevent back pain—they alleviate back discomfort and increase the back’s overall tolerance for physical stress.
The Rheuma-Liga’s functional training program helps motivate you to stay active without overexerting yourself.
Stay relaxed! Pain and anxiety reinforce each other. Relaxation techniques, such as autogenic training, progressive muscle relaxation according to Jacobson, or pain management training, are often helpful.
Individual psychotherapy can also help reduce stress.
Back Pain: When to See a Doctor?
Seek medical help / see a doctor if
: - you experience severe back pain or the symptoms persist for twelve weeks,
- you experience numbness, pain radiating into the legs, muscle weakness, or paralysis,
- you have problems with your bladder or bowel, you have a fever or back pain associated with an accident or cancer (tumor),
- you are repeatedly unable to work or carry out daily activities due to back pain, or the episodes become frequent.
In most cases, acute back pain improves—but persistent symptoms should be evaluated by a doctor so that the cause can be identified and treated appropriately.
Back Pain: Which Specialists Should You See?
When it comes to back pain or discomfort, an orthopedic specialist is usually the first point of contact. If there are signs that the nerves of the spinal cord are affected, it may also be advisable to consult a neurologist.
Back specialists are usually members of professional associations, such as the German Spine Society.
Many cities also have specialized spine or back centers.
The following professionals work there:
- Orthopedic surgeons
- Neurologists
- Neurosurgeons
- Physical therapists
They work hand in hand to provide patients with diagnosis, treatment, and rehabilitation all in one place.
Alternative healing methods may be used, especially in cases of nonspecific back pain for which doctors cannot identify a cause.
Osteopaths, chiropractors, or therapeutic techniques from traditional Chinese medicine may help alleviate the symptoms.
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