Back pain is one of the most common complaints in western industrialized countries. In over 80 percent of cases, it is caused by signs of wear and tear in the intervertebral discs and vertebral joints in the lumbar spine. Here you will find further information and selected back pain doctors and centers.
The diagnosis is made by
These procedures can be used to detect disc wear, for example. Further examinations are sometimes necessary to rule out other diseases with similar symptoms. Such other diseases are, for example
Many people experience accelerated wear of the intervertebral discs. The causes of this include
There is an intervertebral disc between each bony vertebral body in the spine. Intervertebral discs act as a buffer between the vertebral bodies. They consist of a fibrous ring and an elastic core.
Very early on in the course of wear and tear, small cracks appear in the fibrous ring. The core loses elasticity and volume and can eventually tear completely. Core material and parts of the fibrous ring penetrate outwards as a herniated disc. This puts pressure on the nerve roots in the spinal canal.
Healthy intervertebral disc (left) and various stages of a herniated disc © bilderzwerg | AdobeStock
In addition to pain, this can also cause sensory disturbances or muscle weakness. In the lumbar vertebrae, sciatica is caused by irritation of the roots of the sciatic nerve. This is associated with pain and discomfort in the foot, lower leg and thigh.
When the intervertebral discs become worn, they become flatter and lose their mobility and buffering effect. This indirectly leads to increased strain on the vertebral joints. Although the intervertebral disc is not primarily sensitive to pain, it becomes so in the course of the wear process.
The back extensor muscles try to compensate for the wear and tear and straighten the collapsed spine. This can cause the muscles to cramp and become painful. In addition, the vertebral joints can develop osteoarthritis and contribute to the development of pain.
The pain typically begins with static stress. Patients initially complain of deep-seated back pain (lumbalgia, acute lumbago). They occur
sitting. The pain is usually aggravated by
Lying down usually brings relief.
In the early stages, difficulties starting up in the morning with a feeling of stiffness in the lumbar spine are also frequently reported.
In the advanced stage, the pain is also present at night. It can then no longer be influenced by movement or relieving positions.
Back pain often occurs in the lumbar spine © BigBlueStudio | AdobeStock
Conservative treatment is the first course of treatment for proven disc wear. This includes both medication and physiotherapy. The medications used are
are used.
Conservative therapy aims to maintain or restore activity.
In cases of acute pain symptoms, treatment is supplemented by semi-invasive procedures (image converter-assisted injections, etc.). At this stage, procedures whose effectiveness has not been scientifically proven are also frequently used. These include, for example
Multimodal, outpatient rehabilitation concepts provide support for persistent complaints. These include medical treatment, but also training in dealing with the symptoms or workplace behavior.
In more than 80 percent of cases, the symptoms improve after a few days. They should disappear completely after a maximum of four to six weeks.
In around five percent of patients, the pain threatens to become chronic despite conservative treatment.
As the pain is caused by the worn disc and increases with movement and strain, segmental fusion surgery is often considered as a last resort. In this standard spinal surgery procedure, the pain trigger (intervertebral disc) is removed. The adjacent vertebral bodies are then "stiffened" by inserting rigid metal implants and bones ("cages").
The pain disappears as a result, but previously mobile sections of the spine then become immobile and functionally rigid. This was previously accepted as an unavoidable "side effect" of the treatment. Other risks and possible complications of this procedure include
Late consequences of segmental immobilization can include degeneration of adjacent segments or complaints in the sacroiliac joint.
In view of improved and more tolerable modern surgical techniques (e.g. minimally invasive approaches), the acceptance of these side effects has now declined.
With minimally invasive surgery, patients are allowed to stand up for the first time on the day of surgery and are quickly mobilized without a corset. Postoperative treatment is "functional", i.e. all pain-free movements are permitted.
The inpatient stay is usually less than a week. In the first seven to ten days, drug therapy with painkillers and anti-inflammatory drugs is routinely carried out. After that, painkillers are only necessary in exceptional cases.
An active rehabilitation program is recommended from the fourth postoperative week. The aim of this program is to reintegrate the patient professionally and socially.
The results of recent years show success rates of over 82 percent. More than 60 percent of patients were able to return to work after six months at the latest. The absolute majority of competitive athletes who underwent surgery were able to return to their sport.
Even sporting activities that put a strain on the spine (e.g. marathon running, dancing, parachuting) can be resumed.
The prospects of recovery are therefore very good compared to spinal fusion surgery. However, as this is an innovative procedure, no reliable long-term results are yet available.
During back rehabilitation, patients learn to avoid movements that strain the back and become active again © contrastwerkstatt | AdobeStock
It is important to keep moving despite pain and to strengthen the back muscles. Exercises that forcefully strain your mobility will disrupt any healing process.
Peak loads caused by jumping or jolting as well as sports that require sudden evasive movements (martial arts, handball, soccer) are unsuitable. Swimming, cycling or Nordic walking, on the other hand, make sense.
Back schools offer useful tips and information on how to deal with back pain. The functional training offered by the Rheumaliga provides motivation to exercise without overloading yourself.
The general rule is: stay relaxed! Pain and anxiety reinforce each other. Relaxation techniques such as autogenic training, progressive muscle relaxation according to Jacobsen or pain management training are often helpful. Individual psychotherapeutic treatment can also reduce stress.
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