Back Pain: Cause, Diagnosis & Therapy

A sting in the back, a pulling pain in the neck or unbearable tensions in the entire back - according to estimates, 85 percent of Germans have back pain at least once in their lives. But what lies exactly behind the agonizing complaints sometimes resembles the famous search for a needle in a haystack. Back pain can have many causes. A detailed examination by a specialist is therefore important.

Non-specific back pain

Today we know that muscular causes account for the predominant share of back pain. The majority of complaints are caused by malfunctions, muscle tension and adhesions of the connective tissue (fascia). This leads to uneven strain on the muscles, with one muscle often shortened and the opponent overloaded. The result is hyperacidity and inflammation of muscles and tendons caused by a lack of energy.

Above all, people who move little, do a sedentary job or work in "forced postures" such as assembly line workers, surgeons or musicians often suffer from tense muscles. But professions that involve heavy physical strain also take their toll in the long run. If overweight, stress and postural errors are added, the pain is pre-programmed.

Painful blockages

Often blockages of the small vertebral joints are the cause of the sometimes very tormenting pain. Sometimes even a wrong movement, improper lifting of the water box or a night on a "bad" mattress is enough to disturb the functional interplay between joints, muscles and ligaments.

Each vertebra has two articular processes at the top and bottom, via which it is connected to the other vertebrae. These vertebral joints are called facet joints. Overloading can cause the muscles to become tense and reduce the mobility of the joint. Like a drawer that can no longer be opened and closed, a vertebral blockage restricts the movement of one or more vertebrae and is no longer able to perform its function perfectly.

This can affect all areas of the spine - the cervical spine, thoracic spine and lumbar spine. Such functional limitations most frequently occur after an abrupt movement in the lower part of the spine and are referred to as lumbago or, in technical terminology, acute lumbago. The so-called sacroiliac joints, which connect both iliac bones of the pelvis with the sacrum, can also block and painfully restrict mobility.

Diagnosis of non-specific back pain

A detailed questioning of the patient about the type and location of his complaints as well as a thorough physical examination usually provide the first indications of the presence of non-specific back complaints. The attending physician checks the mobility of the hip, shoulder and the individual vertebral segments, among other things, and carries out various test procedures to exclude structural damage.

But also the examination of the working and living conditions and the current psychological condition of the patient are part of a complete "inventory". Because it is not always easy to find the factors responsible for prolonged complaints. Here the tact and experience of the attending physician are of decisive importance.

Specific back pain

In contrast to non-specific complaints, specific back pain is due to certain damage to the spine. These include herniated discs, narrowing of the spinal canal (spinal canal stenosis), curvatures of the spinal column (scoliosis), porous and brittle vertebral bodies in osteoporosis, infections, inflammatory processes and, in rare cases, tumour diseases or diseases of the internal organs. Fortunately, structural changes in the spine are much less likely to cause back pain. However, recognizing it is of essential therapeutic and prognostic importance and should be reserved for a specialist.

Diagnosis of specific back pain
If after anamnesis and physical examination of the patient there is suspicion of a structural change of the spine, either an X-ray image, a computer tomography (CT) or a magnetic resonance tomography of the corresponding spinal segment is taken, depending on the suspected diagnosis. If pain conditions remain unclear, a blood test is also carried out to diagnose inflammatory diseases.

Therapy of specific back pain
Back pain underlying a structural change is also always treated conservatively, i.e. without surgery, if there is no emergency. In the acute phase, this includes the administration of pain and anti-inflammatory drugs and the use of physical therapies to relieve the pain. Manual or chirotherapeutic treatments and targeted back training can also help to eliminate functional limitations such as muscle imbalances, shortening and weakening and restore your mobility.

Injection therapy
If a herniated disc, spinal stenosis or degenerative wear of the vertebral joints is present, accompanying anti-inflammatory drugs can be injected directly into the nerve root or the spinal canal in order to alleviate the discomfort or even relieve pain. The so-called injection therapy is a conservative, minimally invasive procedure and is not performed "blind" but with high precision under sonographic or computed tomographic control. The advantage: The high concentration of the active ingredient at the site of damage effectively relieves pain. At the same time, the precise placement of the needle to the millimetre provides a high level of safety to prevent nerve and vascular injuries. Depending on the location of the pain and the disease, different techniques are distinguished.

Operative procedures
Only when all conservative methods fail should surgical intervention be considered. Spinal canal stenoses or herniated discs with the involvement of the nerve roots can often only be effectively treated with surgery. Surgery should always be performed immediately if, for example, the spinal cord is severely constricted by a herniated disc and there is acute paralysis or if there is a risk of advanced deformity of the spinal column due to wear and tear. The use of microsurgical procedures allows the patient a quick recovery and little physical impairment.

In general, this also applies to specific back complaints both before and after an operation: Regular exercise and targeted muscle building training are essential to prevent renewed structural damage to the spine and to alleviate possible pain.

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