Back pain

Back pain has many different causes and characteristics.


Back pain has many different causes and characteristics. Mostly it is caused by wear and tear, improper load distribution and overuse. Various diseases can also cause back symptoms. A doctor should be consulted if there are any signs of paralysis or sensory disturbances. Preventive measures include regular physical activity and exercises to strengthen the core muscles.


Pain characteristics and possible conditions:

  • Movement-dependent
    • Muscle tenseness
    • Inflammatory or degenerative (due to wear and tear) processes in the vertebral joints or vertebrae
  • Mobility-compromising pain, inability to move (lower back pain, lumbago)
    • Sudden shooting pain in the lumbar area of the spine
    • Patients are immediately unable to move and forced to adopt a pain-relieving posture
  • Radiation of pain (to the buttocks, leg, foot)
    • Compression (bruising) of a nerve (sciatica, lumbago with sciatica)
    • The nerve roots are irritated or compressed by a slipped disc
    • Sciatic nerve: pain radiates from the back to the leg and the foot; sometimes the muscles are partially paralysed (drop foot)
    • Pain often worsens when coughing, sneezing or pressing
  • Recurring and period-dependent: Gynaecological disease
  • Constant, pain at night

Causes and treatment


  • Degenerative changes (caused by wear and tear)
    • Affect many areas of the back as we age
    • Vertebrae, vertebral joints, sacrum joints or intervertebral discs
    • Slipped disc (herniated disc)
    • Spondyloarthrosis, spondylosis
      • Age-related shrinking and loss of elasticity of the intervertebral discs
      • Worn vertebral joints
      • Mobility is often painfully reduced
      • Spine becomes shorter, person becomes smaller
      • Bone spurs grow on the sides of the vertebrae
    • Spinal stenosis, spinal canal stenosis (less often)
      • Narrowing of spinal column in lumbar area of the spine
      • Entire spinal cord is compressed (narrowed)
  • Muscular and paralysis-related impairment of posture
  • Osteoporosis
  • Loosening of the spine: a (higher) vertebra can “slip down” over the one below
  • Improper spinal load distribution, even in younger people
    • Anatomical
      • Difference in leg length, foot anomalies, congenital vertebral abnormalities
      • Deformation due to fractures, scoliosis, flat back, round back
    • Functional
      • Improperly equipped working places
      • Poor posture and improper load distribution
      • Tense shoulder, neck and back muscles
  • Inflammatory processes affecting the vertebral joints and intervertebral discs
  • Diseases of the internal organs
  • Tumours of the vertebrae (also bone metastases) or spinal cord
  • Infections of the vertebrae (spondylitis)
    • Bacterial infections (very rare nowadays)

Further treatment by your doctor / in hospital

Possible tests
  • Physical examination
  • Blood test
  • X-ray
  • MRI (magnetic resonance imaging)
Possible therapies
  • Conservative management
    • Local application of heat (usually better) or cold
    • Medication (e.g. painkillers and anti-inflammatories)
    • Physiotherapy, chiropractic treatment
    • Electrotherapy, acupuncture and other physical processes (try out different methods)
    • Bed rest (not recommended, movement is usually better)
  • Operation (when other measures are pointless)

What can I do myself?

  • Try out and combine different methods
  • To ease muscle tension
    • Exercise, maybe temporary immobilisation
    • Sauna, swimming, massage
    • Brisk walking (at least 30 minutes per day)
  • Learn techniques for gentle lifting and carrying of loads
    • Balanced load distribution
    • Straighten back when lifting things
    • Move whole body and legs
    • Don’t bend or twist the spine
  • Strengthen core muscles: back, chest and stomach muscles
  • Relieve pressure on spine
    • Lie down flat (on the back)
    • Rest legs on a box or chair (hips and knees at an angle of 90°)
  • Avoid being overweight
  • Workplace ergonomics
    • Sitting position (elbows and knees at an angle of 90°)
    • Standing desk
    • Positioning of screen
    • Regular breaks - stand up and move around
  • Soothe painful areas with St. John’s wort oil

When to see a doctor?

  • First appearance of severe back pain
  • Back pain together with a fever
  • Symptoms change character
  • Emergency: signs of nerve damage
    • Sensory disturbances in legs
    • Muscle weakness (e.g. pulling leg up)
    • Problems with urination or defecation
    • Pelvic floor paralysis together with back pain

Further information

In conjunction with TopPharm pharmacies, CSS offers a pain assessment and advice programme. This should help to improve your quality of life.


back pain, lower back pain and lumbago, lumbago

Exclusion of liability

CSS offers no guarantee for the accuracy and completeness of the information. The information published is no substitute for professional advice from a doctor or pharmacist.