Back pain is mainly caused by strained muscles and ligaments or wear and tear on the spine and intervertebral discs. Why is that so, diagnosis, therapies.
Almost everyone becomes acquainted with back pain, fortunately many sufferers only once. Most of the time the pain is in the area above the buttocks. Commonly this is the cross or the lower back. Doctors also speak of lumbar back pain here: lumbar refers to the lumbar spine.
The pain can be felt more in the middle, more on the side or in the whole of the lower back. Sometimes they also radiate into the environment, for example into the leg, or they are mainly felt there.
Back pain is not always back pain
There are two main groups: non-specific and specific back pain:
- Non-specific back pain : This is what the majority of back pain sufferers have to do with. There is no evidence of a specific cause that needs to be treated. This means that for the time being, your back will “only” suffer from tense, shortened and overstretched muscles. Functional disorders associated with this do not correspond to a specific disease to be treated – as long as the diagnosis “non-specific” applies, no specific damage to the spine is detectable or no other disease related to the back or radiating pain to the back can be identified.
- However, this is the case for specific back pain. Back problems themselves as well as other diseases that involve the back can be the cause.
The division into “non-specific” (or also unspecific) and “specific” does not always find all experts happy. However, it helps to sort out the multitude of back pains and is often used, as is the case in this article.
Other important differences result from the temporal course of the back pain:
– Acute back pain is a new occurrence (for the first time or again after at least six pain-free months) and lasts for a maximum of six weeks.
– Subacute is a state of pain between acute and chronic: back pain has plagued those affected for more than about six, but less than twelve weeks.
– If pain does not go away within twelve weeks, there is a risk of it becoming chronic. Back pain and lower back pain that has been present for more than three months (up to six months; there are different definitions) is referred to as chronic.
Frequency : From a single (acute) episode through recurring phases to persistent, chronic pain, there are many forms of back pain.
Expression : Back pain can be barely, moderately or alternately noticeable to almost unbearable. Doctors let patients evaluate this using a pain scale or a questionnaire, if necessary.
The localization of the pain is also important:
– Lower back (area of the lumbar spine (lumbar spine), pelvis): Back pain most often affects the lower part, which is also the most stressed. Here, for example, muscle tension, disorders of the gliding tissue and fasciae, but also herniated discs often occur. Special inflammatory changes sometimes take place in the pelvic area.
– Middle back : Back pain at the middle height of the spine can also be triggered by muscle irritation, changes in the rib-vertebral joints and skeletal deformations, especially of the thoracic spine.
– Upper back / neck: The area of the upper thoracic spine (thoracic spine) and the cervical spine (cervical spine) is affected here. Pain in the neck region is often relieved by poor posture when working. Muscle tension and hardening occur. Inflammatory loosening of the cervical spine with a herniated disc is possible, albeit less often.
Neck pain often radiates to the back of the head, shoulder, or arm. Parasitic sensations are also possible. You may also feel dizzy. A separate article on our health portal provides information about neck pain.
What to do with acute back pain
The good news is that if you have acute back pain without any further symptoms, health problems or alarm signs (see section “What to do in an emergency?” Below), you can usually help yourself to a certain extent: for example, with light exercise and stress relief, ideally also avoiding stress, for example “switching off”, countering the usual stress with something that gives pleasure, taking a short-term distance from well-established movements.
This also helps to relax and is good for the psyche. Bed rest is not the order of the day, at best a short rest.
However, with acute pain it is sometimes not possible without the short-term help of a simple pain reliever or, for example, a heat patch (see information on therapy in the chapter “Non-specific back pain: causes, diagnosis, therapy” in this article). Your doctor and / or pharmacy can give you more detailed advice.
Acute back pain for three days? To the doctor!
Most of the time, the patient’s symptoms, his “back history” and general medical history give the doctor information about the likely type of back pain.
A thorough physical examination supports the assessment. The doctor uses, among other things, certain movement tests, checks strength and muscle tendon reflexes. In short: He usually makes the diagnosis clinically.
Main problem: Chronic non-specific back pain
In the majority – in over 80 percent of cases – the muscles and ligaments on the back cause problems, both acute and chronic. Back problems often arise as a result of excessive strain during heavy physical work or as a result of one-sided movements. Like a lack of exercise, these can under-challenge certain muscle groups, leading to imbalances in the back. Being very overweight ( BMI <30) also has a negative effect, as are smoking and excessive alcohol consumption.
In addition, various risk factors play a role, which the doctor will focus on at an early stage:
- Ergonomic problems: Unfavorable setting of the devices at the workplace
- Psychosocial factors : Conflicts in the professional and private environment, lack of recognition, excessive demands, social dissatisfaction
If risk factors for a chronic course can actually be identified, they should be included in the therapy concept at an early stage:
- Strive for adjustments when the work is physically difficult or unsatisfactory; Improved working conditions and processes (work ergonomics), recognition and more can increase job satisfaction and help relieve and stabilize the back
- Look for solutions to stressful emotional conflicts at work and privately, if necessary with the support of a psychologist
What help is there in the further course?
The manual medicine may be a possible treatment path with techniques such as mobilization and manipulation in non-specific low back pain. This is best judged by the attending physician. Gentle exercise therapy ( physiotherapy, formerly: physiotherapy) with controlled exercises (under the expert guidance of a physiotherapist) is recommended for acute and chronic non-specific as well as specific back pain when mobility is limited due to pain. Physiotherapy can, above all, relax tense muscles and correct incorrect posture.
Massage can be used in conjunction with targeted exercises for subacute and chronic non-specific low back pain.
Specially designed programs such as back training should help prevent recurring low back pain. In addition to elements to strengthen the back and improve posture, such programs should also teach those affected strategies to learn to avoid fears and to build self-confidence. Your doctor or physiotherapist can inform you about suitable offers on site.
The prerequisite for the exercise treatment, especially in the case of accompanying or underlying illnesses, is that the doctor confirms the ability to exercise. Back school programs can also be useful for specific back pain.
You will also find exercises to imitate that strengthen your back in the chapter “Non-specific back pain: causes, diagnosis, therapy”.
Relief for the back, of course, brings weight loss in overweight, back-friendly footwear, possibly an optimized mattress.
In the case of specific back pain, the therapy is geared towards the diagnosis and the medical requirements.
Important: Avoid back pain from becoming chronic
If there is non-specific back pain and the resulting incapacity to work for longer than about two weeks despite therapy, the doctor will check whether more detailed examinations are recommended. Otherwise he will intensify the pain therapy.
If the symptoms persist, measures are recommended after a few weeks to check the diagnosis: for example, a comprehensive neuro-orthopedic examination and a one-off diagnostic imaging procedure, for example x-rays or magnetic resonance imaging (MRI). If back pain persists, a comprehensive specialist psychotherapeutic diagnosis should be carried out in order to identify relevant psychosocial disease factors.
These can be tackled as part of a so-called multimodal pain therapy with the aim of straightening your back and psyche again.
If the pain persists for more than twelve weeks or is only now presented to a doctor, as it is now significantly affecting everyday life, and if organ findings that require treatment are (still) not recognizable, multimodal therapy is generally indicated. Further information in the chapter “Non-specific back pain: causes, diagnosis, therapy” in this article.
Specific back pain: possible causes
According to studies, for example, less than ten percent of patients with back pain can be found to have a herniated disc with pressure on an adjacent nerve. However, wear and tear on the spine or on the intervertebral discs is one of the most common diagnoses: with and without back pain.
In the case of specific back pain, diseases of the musculoskeletal system come into question – osteoporosis, chronic inflammatory diseases such as so-called spondyloarthritis, which are classified as rheumatic diseases, and then inflammation of the spine due to pathogens such as bacteria. Malformations or shape disorders of the spine such as scolioses, injuries, bone and metabolic diseases also play a role, sometimes also neurological disorders and tumors. Occasionally, side effects of drugs such as cortisone can also come into consideration. Cortisone can accelerate or worsen osteoporosis.
The main causes of specific back pain include diseases of the musculoskeletal system such as:
- Inflammatory osteoarthritis of the vertebral joints
- Prolapse Disc
- Osteoporosis (bone loss)
- Osteomalacia (softening of the bones)
- Scheuermann disease
- Vertebral sliding (spondylolisthesis)
- Narrowing of the spinal canal ( spinal canal stenosis )
- Chronic inflammatory diseases of the spine and joints (spondyloarthritis), including
- Bechterew’s disease
- Inflammation of the vertebrae, intervertebral discs or nerve roots in the case of infections with bacteria or viruses
- Metabolic bone disease
- Paget’s disease of the bone
Diagnosis and therapy of specific back pain
In the case of suspected specific back pain, the doctor will arrange for suitable examinations in addition to a comprehensive physical examination at an early stage in order to narrow down the possible causes and make the diagnosis. This also applies if back pain initially classified as non-specific has not subsided after a few weeks under appropriate therapy (see above).
Therapy is based on the diagnosis and includes various conservative (non-surgical) measures including medication and physiotherapy, as well as targeted interventions and surgical procedures, if necessary. The chapters “Specific back pain: clarifying and treating the causes” and “Specific back pain: therapies” provide more detailed information on this.
What to do in an emergency
If acute back pain – often referred to in the lower back as lumbago (acute lumbar pain) – does not subside very quickly, increases, spreads or returns after a short improvement, those affected should consult a doctor as soon as possible. If there are other complaints, such as pain, abnormal sensations or muscle weakness in the leg (“sciatica”, more on this in the chapters “Non-specific back pain: causes, diagnosis, therapy” and “Specific back pain: clarify and treat causes”), must a doctor re-examine the patient. If sensory disturbances in the genital area, paralysis of the legs, acute disorders of the bladder, rectum and potency occur, call the emergency doctor immediately.
Do this even in the event of alarm symptoms such as severe pain in the back, chest area or stomach with significant discomfort and poor circulation.
Acute neck pain radiating into the arm and accompanying symptoms also belong in the hands of a doctor.
The same applies if back pain in connection with general symptoms such as fever, chills, fatigue, weight loss and / or in connection with another (pre-) disease such as osteoporosis, a tumor disease, a rheumatic disease and with cortisone treatment (such as prolonged tablet intake ) appear.
“Back pain”: Not only from, but also to the back
Pain that has arisen elsewhere in the body can sometimes radiate to the back: for example, in the kidneys (colic), in the abdomen (for example in the case of an inflammation of the fallopian tubes and ovaries), in the pancreas (especially in the case of acute inflammation) or the gallbladder ( Inflammation, colic), in the heart (narrowing of the coronary arteries, myocardial infarction ) and last but not least in the main artery ( aortic aneurysm, bulge in the vascular wall, possibly with a tear or perforation).
Pay attention to the psyche
Mental factors and anxious patterns of thought and behavior – both of which are often intertwined – can favor or intensify back pain. In depression, back pain is a very common physical symptom in addition to sleep disorders.
If you suspect that you may have this kind of situation and you would like to actively seek a solution, speak to your doctor about it. He can refer you to a specialist who can help your back.