The 10 biggest misconceptions about back pain: What is really true?

What is really true?

Hardly any other disease is surrounded by as many myths and errors as back pain. Recommendations and advice are often even contradictory and unsettle patients. The spinal surgeon Dr. Timmo Koy clears up the biggest misunderstandings.

 

 

Misconception1: If you have back pain, you should rest

In order not to provoke the pain any further, those affected usually try to put less strain on their back. What is meant well at first usually has the opposite effect. The best chances of quickly getting rid of back pain, however, are patients who continue to move moderately and take painkillers over a short period. Targeted gymnastics and relaxation techniques also help to release tension and strengthen the muscles.

Misconception 2: Usually a herniated disc is the cause of back pain

A herniated disc is much less often the cause of back pain than is commonly assumed. In more than 90 percent of cases, acute back pain is the result of joint blockages and muscular tension due to over- or incorrect exercise. However, if additional numbness or even paralysis symptoms occur in the legs or arms, a herniated disc is suspected. In such a case, further investigations should always be carried out by a specialist.

Misconception 3: Lumbago is the same as a herniated disc

Even if lumbago and herniated disc are often thrown into the same pot, they are two different diseases. Lumbago is an acute pain in the lumbar spine that can radiate into the buttocks and thighs. Lumbago is usually caused by blockages of the small vertebral joints of the lumbar spine or the sacro-iliac joint (ISG). This leads to very painful restrictions of movement, which usually force the affected person into a relieving posture. In contrast, the herniated disc can be largely symptom-free. However, if a part of the gelatinous nucleus of the disc presses from the already damaged fibrous ring onto a nerve root in the spinal canal, massive pain is often associated with sensory disorders or paralysis.  Lumbago is an acute pain in the lumbar spine that can radiate into the buttocks and thighs. Lumbago is usually caused by blockages of the small vertebral joints of the lumbar spine or the sacro-iliac joint (ISG). This leads to very painful restrictions of movement, which usually force the affected person into a relieving posture. In contrast, the herniated disc can be largely symptom-free. However, if a part of the gelatinous nucleus of the disc presses from the already damaged fibrous ring onto a nerve root in the spinal canal, massive pain is often associated with sensory disorders or paralysis.

Misconception 4: Osteoporosis is a pure disease of women

Not at all! Although the proportion of osteoporosis patients is still significantly higher among women, men are also becoming increasingly ill. Nearly one third of the six million osteoporosis patients in Germany are male. Hormonal changes - the breakdown of the male hormone testosterone - but also a lack of exercise and a diet containing little vitamins and minerals are considered to be the main cause of bone loss. However, the disease is often diagnosed very late in men - usually only after an overload or an accident has resulted in a broken bone. Therefore, men over 50 should also have their osteoporosis risk checked regularly in order to be able to take effective precautionary measures.

Misconception 5: I don't want to take painkillers because of my back pain, because they are addictive.

If prolonged complaints remain untreated, there is always a risk that acute, usually temporary back pain will develop into chronic complaints. This is what we talk about when pain lasts longer than three months. In order to counteract chronification, it is absolutely advisable to take pain- and anti-inflammatory medication at short notice. If the pain has already become chronic, only multimodal therapy involving psychological and social stress can usually help.

Misconception 6: Injections to the nerve roots lead only for a short time to pain relief.

Injecting painkillers and anti-inflammatories directly to the site of pain is proven to be very effective. Especially in the case of a herniated disc, the so-called periradicular injection therapy has proven itself. Under CT control, a very thin needle is placed in the immediate vicinity of the affected nerve root and a mixture of a local anaesthetic and a long-acting cortisone is then injected. This leads to the regression of the root swelling and thus to significant pain relief. In the spine center of the KLINIK am RING we usually carry out three to four treatments every week in order to achieve a reduction in pain or freedom from pain. The therapeutic effect persists in approx. 80% of cases.

Misconception 7: If I go to a spine specialist, my herniated disc is operated on immediately.

Unfortunately, this is a misconception that is persistent among many of those affected. Under the premise "As much as necessary, as little as possible" the treatment always starts - as long as it makes medical sense - conservatively, with the therapy with the fewest side effects and the gentlest. Because our experience shows: In more than 90 percent of cases, conservative therapy with medication and physical and physiotherapeutic treatment is sufficient for a slipped disc. Only if the symptoms persist for more than six weeks despite comprehensive conservative treatment or if the incident threatens to permanently damage nerves is surgical intervention necessary. However, surgery should always be performed immediately if the spinal cord is severely constricted and there is acute paralysis.

Misconception 8: When my spine is stabilized in surgery, it is completely stiff.

In a so-called fusion surgery, one or two segments in the region of a spinal segment are usually stabilized with the aid of a screw-rod system. By fixing the vertebral bodies in their original position, stability in the musculoskeletal system is restored. However, the remaining parts of the spine are still flexible, so that mobility is usually only slightly restricted. However, it is important that those affected regularly undergo targeted strength training to build up the trunk and back muscles, otherwise there is a risk that instability may also occur in neighbouring segments, which is referred to as connection instability.

Misconception 9: Cervical spine surgery is very dangerous.

The risk of damaging sensitive structures during cervical spine surgery is extremely low. Nowadays, the techniques are so sophisticated that the procedure can be performed without any problems. In addition, the operation is usually performed from the front, through a small transverse skin incision of approx. 3-4 centimetres in length. This approach enables the gentle removal of disc tissue or bony constrictions from the spinal canal without having to manipulate the spinal cord. Furthermore, the access is very gentle, since - with the exception of the skin - no tissue has to be cut through. The different layers of tissue can be forced apart very gently in order to reach the cervical spine from the front. But here too - as in all spinal surgery - the surgeon's expertise is of decisive importance. When choosing a spinal surgeon, pay attention to the number of cases and experience values.

Misconception 10: Surgery of the spine should always be performed by a neurosurgeon, not an orthopedist. It's safer.

Surgery of the spine should always be performed by an experienced spinal surgeon. The fields of orthopaedics and neurosurgery operate equally on the spine. While the neurosurgeon has always performed microsurgical operations on nerves and spinal cord, the correction of spinal deformities and the treatment of bony diseases of the spine (tumors, wear) was traditionally reserved for orthopaedists. In the meantime, both disciplines have complemented each other perfectly and are also organized in a joint umbrella organization, the German Spine Society (DWG). The latter pays attention to regular further education and training, quality assurance and organises the major joint annual congress. It also issues certificates to attest to the surgical quality of its members. Dr. Timmo Koy, for example, holds the master certificate of the DWG.

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