What to do for back pain? - Tips for back health

Where does back pain radiate?

Back pain can radiate to many different areas of the body. As a result, it is often not easy to pinpoint the exact cause or source of the pain. However, the type and location of the pain usually make it possible to quickly narrow down which area of the back it originates in.

• Lower back pain: Back pain most commonly occurs in the lumbar region. The lumbar vertebrae are exposed to the greatest strain, so herniated discs are most common here. Pain in the lumbar spine is often abbreviated as lower back pain and is what is actually meant when people speak of “back pain.” However, this term is now used colloquially for all kinds of back problems. Lower back pain can radiate to the mid-back or legs. Sometimes it is even accompanied by numbness. Sciatica is one of the types of pain that can be caused in the lower back. The sciatic nerve runs from the lumbar spine down into the legs. That is why the pain literally shoots into the legs when the sciatic nerve is pinched.

• Middle back pain: In the middle back, pain is often caused by muscle tension or deformities of the spine. The rib joints are located here, among other structures. Overall, back problems occur more frequently in the neck or pelvic area, but the middle back is also susceptible to pain from incorrect strain or poor posture.

• Upper back and neck pain: The upper thoracic spine and, above all, the cervical spine support the considerable weight of the head and are closely connected to strong muscles in the shoulders, chest, and neck. Many typical office-related complaints caused by an unbalanced and unnatural head posture manifest as pain in the upper back and neck. It often does not stop at neck pain. Pain originating in the neck sometimes radiates to the head, shoulders, and arms. A distinction is made between pain in the thoracic spine (thoracic spine pain) and pain in the cervical spine (cervical spine pain).

Pain in the upper back usually originates in the cervical spine

In general, the spine plays a major role in determining back pain. It supports our body and, with its two dozen vertebral bodies, allows us to flexibly turn and move our upper body and neck.

Nerves emerge between the vertebrae, maintaining the connection from the brain to the body's most remote areas. The vertebral bodies are separated by intervertebral discs, which act as natural gel cushions to absorb weight and forces exerted on the vertebrae. Both the nerve exit points and the intervertebral discs are among the areas that frequently cause back pain.

The spine itself is supported by a complex network of muscles. The back muscles are not the only ones important for correct posture and a healthy back; the abdominal and leg muscles, for example, also play an important role.

Because a painful back can have many different causes and manifestations, doctors will first try to categorize the pain.

A doctor tries to categorize back pain based on the patient's statements

When categorizing back pain, doctors rely heavily on the patient's cooperation. Only you can describe exactly where the pain is located and what it feels like. The first question is: what type of back pain is it? A distinction is made between specific and non-specific back pain.

Specific back pain: When back pain is caused by illnesses or congenital conditions, it is considered specific. It has a clear cause. Unfortunately, this does not mean that this cause is always easy to find. Doctors often have to carry out extensive examinations and question patients in order to make a clear diagnosis.

Possible triggers of specific back pain include pathological deformities of the spine, wear and tear of the vertebrae, or inflammation in the back. Osteoporosis and some metabolic diseases are also possible causes. Once the cause has been identified, it can be treated specifically. However, specific pain is often also caused by diseases or injuries that are difficult to treat.

Nonspecific back pain: If there is no single, clear trigger, it is considered nonspecific back pain. In many cases, nonspecific back pain is caused by tense or overstretched muscles and disappears on its own.

They are often caused by overexertion - muscle soreness, strains, or muscle fiber tears during sports are good examples. Nonspecific back pain can also result from muscle tension or shortening, which are encouraged by a lack of movement and poor posture. If nonspecific pain does not go away on its own, finding the causes can require a great deal of patience. Relaxing and/or mobilizing therapies are often used.

Neurological or psychological triggers are sometimes also examined. If the triggers cannot be narrowed down or eliminated, nonspecific back pain can become chronic.

How long does the pain last? This is the next important question.

Acute back pain: If the pain has only just appeared, it is acute. The prerequisite is that there was no back pain for at least six months beforehand. Acute pain should be gone after no more than six weeks.

Subacute back pain: If back pain lasts longer than six weeks and up to twelve weeks, it is considered subacute. At the latest now, medical advice should be sought if this has not already happened. Strains, sprains, and similar complaints should have healed by this point.

Chronic back pain: If it lasts longer than twelve weeks, back pain can become chronic. This does not necessarily mean that the pain will never go away. In many cases, however, those affected have to come to terms with the situation.

Depending on the cause and whether it is known, surgical procedures could help. A doctor must assess on a case-by-case basis whether back surgery is likely to be successful.

Lifting heavy loads can damage the back

What can cause back pain?

The causes of back pain can be just as varied as its manifestations. An accurate diagnosis therefore always depends on various individual factors that differ from case to case.

Because the back keeps us upright, it has to withstand a great deal. Heavy physical strain is therefore one of the most common triggers of back pain. Regularly lifting and moving heavy loads in particular puts strain on the back muscles.

Back problems caused by incorrect or excessive strain are therefore more common in certain occupational groups. In elderly and nursing care, for example, washing and repositioning patients places considerable strain on the back. Exercises performed incorrectly or overexertion during strength training can also damage the back.

In general, however, movement and exercise are recommended, because people who generally move very little risk losing back muscle mass. If these muscles become too weak, even minor strains or awkward movements can cause back pain.

This often already manifests itself in a sunken or slightly crooked posture - often a kind of protective posture. Over time, posture problems are frequently unconsciously "trained" like bad habits. They can be corrected through targeted training.

Body weight is another factor in maintaining a healthy back. Being overweight is harmful not only to the heart and other organs - every excess kilo puts strain on the spine and intervertebral discs. This is one reason why back pain can increase during pregnancy.

However, in addition to weight, the size and position of the unborn child in the womb also play a role. Pregnant women often report lower back pain. Middle back pain at rib level is also common.

These pains are usually harmless, but medical advice should be sought in cases of long-lasting and very severe back pain. During early pregnancy, severe lower back pain could be caused by an ectopic pregnancy.

The factors described above primarily cause non-specific back pain. They are often temporary (pregnancy, strains, etc.) or can be influenced through therapy and training. People between 30 and 50 are most commonly affected. Specific back pain is different, occurring more frequently from the age of 50 onward.

Non-specific back pain mainly affects people aged 30 - 50

An overview of possible triggers for specific back pain

• Hollow back and rounded back: Many people deal with spinal deformities. Very few people have a perfectly shaped spine. As soon as the shape of the spine deviates too far from the typical double-S shape, back problems are practically inevitable. Hollow back (lordosis) and rounded back (kyphosis) are among the most common deformities. With lordosis, the cervical and lumbar spine curve forward, causing a curvature of the lower back. With kyphosis, a rounding develops in the middle of the spine, caused by a backward curvature of the thoracic spine.

• Scoliosis: With scoliosis, the spine becomes severely curved and twisted. It occurs particularly often in adolescent girls and usually causes noticeable back pain only at later stages. If detected in time, scoliosis can often still be corrected during growth. Once it is advanced or growth has ended, scoliosis is much more difficult to treat. Surgery may be considered in severe cases.

• Herniated disc: It is one of the best-known and most feared back injuries. The intervertebral discs wear down over the course of a person's life and become brittle and cracked - even relatively quickly under heavy strain. Severe jolts to the spine can also wear down or injure the discs, causing the gelatinous nucleus to protrude and press on the surrounding nerve tissue. Depending on its severity, the resulting bulge can cause severe back pain, numbness and paralysis. Symptoms and effects also depend on which area of the spine is affected. For example, herniated discs in the lumbar region are often accompanied by abdominal and back pain because the pain spreads from the lower back to the abdomen. In fact, most herniated discs can be treated without surgery. Physical therapy strengthens the surrounding muscles to better support the spine. A special mattress and adjustments to the workplace may also be necessary to eliminate the causes of the disc problems.

• Osteoporosis: As people age, their bone mass gradually decreases. Some people are affected more severely or prematurely. With osteoporosis, the bones become increasingly brittle and susceptible to injury. The bones of the spine are usually particularly affected. Women are affected much more frequently than men.

• Inflammatory osteoarthritis: With osteoarthritis, the cartilage in the joints wears down excessively quickly. In advanced stages, the degenerative disease is often accompanied by inflammation (osteoarthritis) and is very painful. Severely arthritic joints are sometimes surgically replaced with artificial joints. In the case of spinal osteoarthritis, the facet joints along the spine are affected. This often leads to spondylosis - the formation of bone spurs on the affected spinal joints.

• Spondylolisthesis: The so-called spondylolysis refers to an excessively large gap between two vertebral bodies - a malformation that is presumably aggravated by excessive or improper strain in children and adolescents. Sports in which the back is strongly bent, such as ballet or gymnastics, are considered conducive to the formation of this gap. If the gap between two vertebrae becomes too large, the vertebral bodies may shift, a condition known as "slipped vertebra" (spondylolisthesis). It usually occurs in the lumbar region and consequently manifests itself through lower back pain. The condition is difficult to detect and, if left untreated, can lead to complaints such as osteoarthritis. Severe symptoms often do not appear until adulthood.

• Scheuermann's disease: Scheuermann's disease primarily affects adolescents and initially manifests itself through back pain and tension. Sometimes, however, the symptoms do not appear until adulthood. Over time, deformities such as a rounded back or swayback develop. This is caused by uneven growth of the individual vertebral bodies, which are consequently subjected to excessive stress in some areas and become wedge-shaped. This can result in disc tissue protruding into the vertebral body. Scheuermann's disease is by no means always severe - however, surgery may be necessary in cases of severe spinal deformity. Otherwise, the condition is treated, for example, with physiotherapy or by wearing a supportive brace

• Ankylosing spondylitis: This disease causes lower back pain resulting from inflammation of the sacroiliac joints. The pain is accompanied by increasing stiffness in the affected region of the body. Ankylosing spondylitis affects men more often than women. It cannot be cured, but it can be treated. It is suspected that a genetically predisposed immune deficiency promotes the development of ankylosing spondylitis.

• Paget's disease: The exact cause of this common bone disease is still unclear. It is known that men over the age of 40 are affected more often. Paget's disease causes deformities, thickening, or inflammation of the affected bones. In the spine, the lumbar region is usually affected. As a result, the disease manifests itself through lower back pain - deformities of the lumbar vertebrae can also irritate and compress the sciatic nerve. In rare cases, Paget's disease can develop into bone cancer. Treatment approaches include taking calcium and vitamin D, as well as supportive measures such as wearing a brace.

• Infections caused by bacteria or viruses: Infections of the vertebral bodies or intervertebral discs are rare. Bacteria or viruses either need an entry point (open wounds, injections, operations) or attack bone tissue because of an immune deficiency. The resulting inflammation in the back causes problems that are difficult to identify and treat. In addition to severe back pain - even at rest - acute bacterial infections are also accompanied by flu-like symptoms such as fever or chills.

• Osteomalacia: It is a metabolic disease similar to the childhood disease rickets, but occurs only in adults. It is usually caused by a vitamin D deficiency. This may result from metabolic problems or poor nutrition. This subsequently leads to calcium deficiency and softening of the bones. Since the spine bears the body's weight, the resulting deformities have the greatest impact there. Intensive administration of additional vitamin D (and, if necessary, calcium) can counteract diet-related osteomalacia.

• Tumors: Cancer can affect virtually any part of the body - including the spine. Malignant bone cancer occurs mainly during childhood or adolescence. However, it is relatively rare in the spine. Benign tumors can also cause severe back pain if their growth puts pressure on nerves or intervertebral discs.

Science has not yet reached a consensus on how alcohol consumption or smoking affect back disorders. However, it seems likely that these vices contribute to abdominal and back pain when consumed or practiced heavily. It is well known, for example, that they promote heart disease and cancer.

The environment at home or at work, as well as living circumstances and working conditions, can also represent risk factors for back disorders and back pain.

This graphic shows how the herniated nucleus pulposus of the intervertebral disc presses on the nerves

The influence of the psyche on back problems

This raises the question, particularly in cases of nonspecific back pain, of the extent to which the psyche contributes to back problems. Many people under severe psychological stress complain of abdominal and back pain. Expressions such as “it upset my stomach,” “having a chip on one’s shoulder,” or “feeling completely worn out” reflect this.

People under emotional pressure often unconsciously adopt a kind of protective posture. This may manifest, for example, as a hunched, contorted posture with the head lowered and the shoulders slumped. When people feel threatened, they instinctively make themselves small. Since lower self-esteem is often accompanied by less awareness of one’s own body, people with depression also often suffer from lower back pain and other back problems.

Gym ball exercises for the back

Even people who exercise regularly often neglect back training. Since balanced training can prevent numerous back problems, we recommend back exercises with a gym ball. This method can gently train the deep back muscles in particular - the small muscles along the spine

An unnatural posture causes the back muscles, including the smaller, deeper muscles that support the back, to weaken and shorten. This results in tension and pain. It also increases the likelihood of sudden painful episodes such as lumbago.

A female doctor explains spinal X-rays to her patient

When should you see a doctor about back pain?

Whether and when you should see a doctor depends greatly on your individual case and pain tolerance. As a general guideline, see a doctor if your back pain persists for four to six weeks at the latest.

By this point, tension or minor injuries such as strains should actually have healed. However, if you experience severe acute back pain, you should act immediately and see a doctor right away or within three days at the latest.

As mentioned, only you can assess how severe your lower back pain is and how serious the associated limitations are. However, even pain that we can “just about tolerate” harms us and may indicate more serious problems. Too many people now regard back pain as “normal” to a certain extent.

However, doctors and therapists can show you many ways to achieve a healthy back or maintain your back health. It does not always have to involve the dreaded injection in the back. If your back pain persists but is still “bearable,” seek help before it develops into chronic, severe back pain.

For example, lumbago can hurt so severely that you will undoubtedly want medical help. Signs of paralysis and numbness in the legs and lower abdomen are another warning signal that you must not ignore.

Back pain can originate in a wide variety of parts of the body that may seem unrelated to the back. While you can only speculate yourself, doctors have the knowledge and technology to use a wide range of diagnostic methods.

Inflammation in the back is painful but not always easy to recognize

How can you recognize inflammation in the back?

Medical expertise is essential to identify inflammation in the back. Symptoms that may indicate it include very severe back pain that worsens with movement and persists even at rest. The spine is often distinctly sensitive to pressure.

In some cases, inflammation is even externally noticeable through swelling or redness. Flu-like symptoms such as fever, chills, and a feeling of weakness may also occur. Inflammation in the back or other parts of the body can usually be confirmed by laboratory findings.

Standing workstations can help relieve strain on the back at work

What helps most with back pain?

The range of treatment options for back pain is almost as broad as the variety of possible causes. First of all, numerous preventive measures can be taken to prevent serious or chronic back problems from developing in the first place.

Too much inactivity is harmful to the body. Most people in Western industrialized countries get too little rather than too much exercise. Sitting for long periods is particularly harmful to the back. Without sufficient strain, the small muscles in particular atrophy; these muscles support the larger ones. Lack of exercise also promotes excess weight, which places additional strain on the back.

In many cases, therefore, taking it too easy on your back is the wrong approach. What matters instead is applying the right amount of strain. Plenty of exercise helps prevent back problems. Walking a good distance every day is one of the best activities you can do for your body. If in doubt, start small - you could simply take a walk through the park and take short breaks along the way.

Exercise also helps you maintain a healthy back despite working in an office. Make sure you sit with good posture, keeping your back straight and not allowing your shoulders to slump forward. Change your sitting position from time to time and do stretching exercises while seated.

It is also advisable to get up frequently, even if you only walk around your office chair for a few minutes. For example, you could make phone calls using a wireless headset so that you can walk back and forth while talking. Many offices now also allow people to work standing up. Workstations can be equipped so that you can work at your computer while standing.

In cases of severe or long-lasting back pain, movement therapy could provide relief. In such cases, you may need to build up more muscle to support your spine. Appropriate physiotherapy training also helps correct poor posture and train you to adopt better body alignment.

Movement therapy can also teach you how to lift loads correctly and perform frequent movements such as standing up and sitting down in a way that protects your back. Various training approaches can be used to specifically and gently build up and relieve certain muscle groups.

Aids such as exercise balls, weights, or resistance bands are also often used. For all exercises performed on the floor - even with a healthy back - a padded exercise mat is recommended as a protective surface.

A back massage can help relieve deep-seated tension. Especially in cases of acute non-specific back pain, a massage can release blockages in the muscles. If the causes of back pain are not muscular, a back massage can often at least alleviate the symptoms and promote relaxation.

Heat also helps relieve muscle tension. Non-specific back pain caused by tense muscles can often be alleviated with a warm bath or by applying heat pads. Anyone who wants to wear sustained warmth directly on the body could try an electric heating pad. Modern, rechargeable warming belts can even be conveniently strapped around the body.

For back tension or sore muscles, some people swear by warming balms or tinctures for rubbing in. An example of a heat gel that produces especially intense warmth is Kräuterhof® Horse Balm. Ingredients such as horse chestnut, hops, yarrow, valerian, and red vine leaf extract generate very intense heat on the skin, which also penetrates into the deeper muscle tissue.

Horse balm may therefore only be used externally and must never get into the face or eyes. If you rub in warming ointments, you must wash your hands thoroughly afterwards.

However, heat should never be applied when back pain is caused by inflammation.

Chronic back pain may be treated with multimodal pain therapy. This combines different medical disciplines. For example, psychological and occupational therapy approaches could be pursued at the same time to help patients with their back condition on all levels. Multimodal pain therapy is still relatively rarely used in Germany.

Bear in mind that all the information we can provide is not a substitute for medical expertise. If you suffer from back pain, only your doctor can make the correct diagnosis and determine the appropriate further treatment.