Back pain

Back pain has many different causes and characteristics.

1 May 2021 | 5 Min. Reading Time

Overview

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.

Symptoms

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
- Inflammatory processes, osteoporosis
- Spinal tumours and metastases
- Tumours of the internal organs

Causes and treatment

Causes

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
- Psoriasis
- Ulcerative colitis, Crohn’s disease
- Bekhterev’s disease
Diseases of the internal organs
- Kidney and pancreatic tumours
- Biliary colic
- Gynaecological causes (e.g. endometriosis, menstrual pain)
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