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Backache has many causes

Dr. Martin Buchholz
Dr. Martin Buchholz

Who has never known backache? Three in four Germans suffer from backache at least once in their lives. Younger people suffer more frequently than the elderly. The good news is that more than 90% of all cases of backache are uncomplicated. Serious diseases are only rarely the cause. There is a lot that backache sufferers can do for themselves to ensure that the pain disappears again soon.

Backache can have both physical and psychic causes – often these factors have a mutual effect. The most frequent cause is muscle tension resulting from incorrect posture, one-sided strain and a lack of exercise. This puts uneven strain on the muscles. "Some muscle groups are under too much strain, others under too little. As a result, muscles shorten or harden. Muscular imbalance of this kind causes tension and pain. The back becomes instable", is the explanation given by Dr. Martin Buchholz (orthopaedic specialist from Hamburg - www.orthopaediecentrum.de).

Together with muscle-related backache, disorders of nervous functions are the second most frequent cause of backache, accounting for about five percent. "A trapped nerve, constriction of the point where a nerve joints the spinal column or neuritis can cause severe pain", Dr. Buchholz says in describing the effects. Other causes such as broken bones or tumours are much rarer and only responsible for about one percent of all backache.

Backache – the vicious circle

Backache often leads to a vicious circle: many people with acute pain are afraid to move at all and take up a protective posture that reduces the pain at first. But avoiding painful movements with a protective posture in turn puts too much strain on muscle groups that had not been hurting up to then. In this way, the initially localised tension gradually affects the whole back.

Once this vicious circle has started, the original cause is no longer so important because it does not change the treatment. "By making an effort, you can make a great contribution to interrupting this mechanism:

Go for a walk and exercise on your ergometer, instead of taking to your bed and resting
Keep moving as much as you can!", advises Dr. Marco Gassen (sports doctor and back specialist from Wiesbaden - www.qimoto.de). Simple pain relief, heat treatment and massage can help to alleviate acute pain. "In cases of acute but uncomplicated backache, try to go for a walk for 5 to 15 minutes several times a day; gentle exercising on a bicycle ergometer can help bring swift relief. Avoid lying or sitting for longer periods, unless in a relief position ("psoas" position). You should certainly not take to your bed!" says Dr. Gassen.


Causes of backache

Self-help begins in your own immediate surroundings

Without doubt, taking adequate exercise and correcting inappropriate behaviour patterns form the basis for a pain-free back. But your own efforts to keep your back upright will meet their limits when you come up against a back-hostile environment: poor chairs, beds or car seats. An ergonomically inappropriate working and living environment can also cause backache, so that this important factor should be taken into account when looking at corresponding causes and prevention.

As a result, the treatment and prevention of backache needs a holistic approach. Together with medical care and paying attention to your own back-friendly behaviour, you also need a back-friendly environment in your everyday life and job. Take a good look at your workplace. Often all it takes is a few simple adjustments to the office furniture to reduce the strain on your back. Make sure your private surroundings also offer back-friendly conditions. Your bed, couch, shoes or car seat for example should fulfil the requirements made of back-friendly products. More information can be found on this website.


Activating your self-healing powers: the mind helps the body

Marco Gassen
Dr. Marco Gassen

Backache has a considerable influence on your psychic well-being. Together with the physical causes, the origins and above all the persistence of backache come from inappropriate behavioural and emotional mechanisms. Stress and emotional conflict situations frequently cause muscle tension which can be expressed in backache. Treating the mind can often help to alleviate backache on account of this close relationship between backache and emotional stress. Psychological counselling and training sessions to cope better with stress and strains can be most effective at the onset of backache and prevent or delay any chronic development. There again, psychological measures are also very helpful for chronic pain.

Timely help prevents constant pain

Unfortunately, many patients with chronic backache hesitate before starting suitable behavioural therapy. But such therapy can change existing habits and attitudes that have caused muscle tension. "Early psychotherapy offers good chances for preventing any further chronic development process", says psychologist Fredi Lang (Bundesverband Deutscher Psychologinnen und Psychologen - German Association of Psychologists - Berlin). "It is also worth remembering that in principle, any pain can become chronic. Just one reason why early measures are necessary", Lang adds. Taking the psychological approach is often an important step towards alleviating existing permanent backache.

Another aim consists in reducing the psychic and social consequences of chronic backache. "Our endeavour is to make life more bearable for those affected, restoring their frequently drastically reduced sphere of activity", says Lang. Interdisciplinary pain therapy therefore also increasingly focuses on psychological support.

Psychotherapy supports pain treatment

Fredi Lang
Fredi Lang

Psychotherapy intervenes in the process of coping with pain, which takes place on different levels. Classic psychotherapy consists above all in talking the patient through the various issues, while today it is common practice to include appropriate supplementary strategies. Psychotherapy can take the following approaches, among others:

  • Behavioural therapy, using self-control to improve how the patient copes with the pain, also learning pain management techniques.
  • Psychoanalysis with an attempt to track down the emotional contacts with (shared) responsibility for the pain, which can go right back to childhood. The aim is for the patient to say farewell to old behaviour and experience patterns and follow new paths.
  • Body-oriented psychotherapy, aiming to stimulate the body's self-healing forces by become intensively aware of the body functions. This is frequently successful in combination with certain relaxation techniques.

It's the attitude that counts

Anne Flothow
Hon.-Prof. Dr.
Anne Flothow

Cognitive behaviour therapy is today one of the most important psychological approaches to dealing with backache. It presumes that a person's opinions, attitudes, wishes, ideas or intentions have a major influence on that person's behaviour. This leads to a personal perception of one's own backache. As a result, the pain can be either augmented or also weakened in the person's perception. "Someone who sees backache as a real calamity will feel the pain more intensively than those who take an active approach to dealing with their backache", explains Honorary Professor Dr. Anne Flothow (psychologist in Hamburg – Board Member at the Bundesverband deutscher Rückenschule (BdR) e.V. – Federal Association of German Back Schools).

Be active, take a positive approach

Behaviour therapy therefore aims to teach backache patients how to view and reassess the pain from another angle. In sessions with the therapist, patients discover negative attitudes and can change them in favour of a new, more positive approach. "The aim is to come to the conclusion that backache does not render you helpless", explains Dr. Flothow. She advises patients to use management strategies to overcome fears, become active and boost their self-confidence.

Successful psychotherapy treatment of pain therefore depends on active involvement on the part of the patient. Only patients who are willing to play an active role in the treatment process will see long-term alleviation of chronic backache.

More exercise alleviates and helps to prevent backache

Ulrich Kuhnt

Exercise is good for you and helps to prevent backache. But most people in Germany have not yet come round to this way of thinking. Two in three Germans prefer to spend their leisure time at home on the couch, according to the results of a survey by F.A.Z. Institute and Forsa which asked 1,000 people aged over 14 years about their exercise habits. In spite of having a guilty conscience, the Germans simple can't be bothered to make the effort.

"Somehow we've just got to introduce more exercise into everyday lives. Otherwise backache will be a foregone conclusion in the long term for these couch potatoes", says Ulrich Kuhnt, sports instructor and head of Hannover Back School. We're not talking about peak sporting achievements here. Even little tricks can bring more activity into everyday routines. Do more errands on foot, take the stairs instead of the lift or get that bike out of the cellar. Walking briskly twice a day for fifteen minutes to the station or to the shop is already sufficient for inveterate lazy bones to achieve half their daily physical exercise target. A little bit more won't hurt either.

Exercise, always and everywhere

You can even exercise when standing in the queue at the supermarket checkout or at the bus stop. For example, stand really tall as if you're a puppet being pulled up on a string: this stretches your spinal column. Or stretch your muscles by bending over to the side or let the upper part of your body sway gentle from left to right.

Exercise can be integrated in everyday office routines to help counteract backache. In addition to an ergonomic workplace, physiotherapy exercises can help to prevent ailments from developing. Consult a therapist, e.g. a back school instructor or attend one of the office exercise programmes offered by the health insurance funds. In most cases you can do the little training exercises in between times while sitting or standing at your desk – without needing additional apparatus.

Changing your posture relieves your spine

Alternating movements also help to prevent one of the most frequent causes of backache, which is muscle tension. Change your sitting position as often as possible. Possibilities including bending forwards slightly, holding an upright posture or then again leaning back in a relaxed position. This is much easier if your office chair or couch at home fulfils the ergonomic requirements.

You can also introduce more exercise and variety into everyday routines by standing for a while to interrupt your sedentary activities. Brief meetings for example can also be held at a high desk. And instead of sending an e-mail to your colleague at the other end of the corridor, surely talking a short walk is a viable alternative. If you have to stand for a longer period of time, relieve your spinal column by shifting your weight from one leg to the other: changing your posture is also important when standing.

Back-friendly sport

The muscles need to be strengthened regularly to ensure that your back can cope with its daily challenges. "Strong muscles help the spinal column to fulfil its supportive functions and prevent backache. Sport plays an important role here. Many sports also foster mobility and coordination, thus enhancing the interaction of all the components that keep a back fit and healthy", is the advice given by Petra Regelin from Deutschen Turner Bund (German Gymnastics Association).

Regina Regelin

But there are no scientific findings to indicate which sport is the best for backache. While back problems frequently occur in some disciplines at competition level, it is not true to say that on an amateur level these particular kinds of sport would not be suitable for people with backache. It all depends on how it's done. In the right quantity, with an appropriate warm-up and good technique, almost all sports will have a positive effect. As well as building up the muscles, sport also helps to deal with depression, sleeping disorders and the feeling of isolation that frequently accompany chronic backache. But the sport has to be pursued regularly to have any real success.

"When choosing a suitable sport, it is less about whether it is generally considered "back-friendly". It is much more important that the chosen sport suits you. It must be fun and fit into your own daily routine," recommends Regelin. If you are unsure about the health requirements at the beginning of your sporting activity, you should seek advice from a doctor or physiotherapist.

Specific pain therapy helps alleviate backache

Everyone knows what pain is, but even experts struggle to put it into exact words. According to a definition given by the International Association for the Study of Pain in 1979, "pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage". In contrast to previous interpretations that saw pain as a purely physical process, this also includes the personal way in which the pain is experienced. And so someone can be ill with pain even when the physical cause has long since healed or cannot even be found.

Pain is the guardian of our health

Nobody likes pain. Even so, pain shouldn't be evaluated in negative terms without any further ado. "As a symptom, for example, acute pain fulfils an important warning and protection function, showing that something is wrong. The body reacts accordingly and tries to alleviate further damage by taking countermeasures", explains Dr. Jan-Peter Jansen MD, Medical Director of Schmerzzentrum Berlin (Berlin Pain Centre). This is why the old Greeks referred to pain as the "barking watchdog of health". Pain occurs for example for a limited period of time in the case of inflammation or injuries and can usually be treated successfully by dealing with the cause.


Dr. med. Jan-Peter Jansen
Dr. med. Jan-Peter Jansen

But pain loses this positive alarm function when it becomes chronic. On the contrary, chronic pain wears the patient down physically and can eventually dominate all the patient's thoughts and feelings. Pain becomes an even worse burden to bear than the actual original illness. Persistent pain keeps going on and on and in time becomes a clinical symptom in its own right that has to be treated individually. It is also known that chronic pain causes changes in behaviour, depression and social isolation

Early therapy prevents pain memory

When pain signals recur constantly, the nerve fibres can change permanently and form a pain memory. As a result, even slight stimuli such as touch, warmth or stretching can suddenly be felt as pain. Many people who had to have a limb amputated also report this effect. The injury to the nerves caused by the amputation or loss of a limb develops a life of its own. The damage caused in this way leaves a memory trace in the central nervous system without there being a corresponding physical reason. This is also possible in the case of backache. "To prevent pain memory, the pain pulses have to be suppressed by suitable treatment early on", advises Jansen. Otherwise, pain loses its function as the body's warning signal, with the risk of becoming chronic, says the pain expert.

Pain is not always pain

The way pain is felt can vary greatly from one person to the next and is influenced by the mind. People who are anxious or feel greatly stressed are less able to relax. This in turn increases pain sensitivity. All in all, this leads to a vicious circle where pain and stress have a mutually reinforcing effect. On the other hand, a positive mood or distraction can help to reduce the pain. Some people have a higher pain threshold, others a lower pain threshold. Pain is felt, assessed and described on highly individual different levels.

Pain therapy permits exercise

Many patients with backache live according to the motto "An Indian Brave Knows No Pain" and grit their teeth unnecessarily. But this false bravery means that they fail to exercise enough if at all. Once again, this leads to a vicious circle which reinforces the pain until it becomes almost unbearable or chronic.

Instead, regular exercise is necessary to strengthen the muscles and sustain mobility so that patients can continue with their daily activities. But the severe pain experienced in many cases usually means that the physiotherapy necessary to achieve this effect has to be accompanied by adequate pain therapy.

The aim of pain therapy is therefore to choose suitable pain relief in an appropriate dose so that the patient has no or scarcely any pain all the time. "It transpires that a patient with less pain is more relaxed, less anxious and has more joy in life. One other very important point is that the patient can then also make an earlier start with active therapy such as physiotherapy", says the Berlin pain therapist Jan-Peter Jansen.

In the case of acute backache where the nerve roots are not affected, to start with the doctor will prescribe simple pain relief. Here paracetamol is the first choice active substance because of its minimum side effects. However, it only brings a low level of pain relief. And so paracetamol may possibly not be sufficient. In this case, non-steroid anti-inflammatory drugs (NAIDs) should be used. This group includes active substances such as acetylsalicylic acid, diclofenac and ibuprofen. They should not be taken for longer than six weeks. The side effects that NAIDs have on the digestive system and kidneys makes them unsuitable for constant use. People aged more than 65 are particularly at risk. However, the side effects rate is not the same for every substance. An augmented risk of gastric complications can be counteracted by preventive administration of omeprazole. Ask your doctor about the best solution for your specific case.


Which backache type are you? Do the test!

Dr. Dietmar Krause
Dr. Dietmar Krause

An acute pain shoots through your back. As an automatic reflex, you freeze and don't move an inch. Every move is paralysed by the fear that something bad has happened. But medical experience shows that this is rarely the case. Even so, fear prevents many people from continuing to move normally. "If you keep still and lie in bed, you're at risk of the pain really settling in", says Dr. Dietmar Krause, Chairman of the Aktion Rückenwirbel e. V. (Campaign for the Dorsal Vertebrae) in Marburg. "It is important to remain as active as possible", advises Krause. But patients manage their ailments differently, depending on the type of person they are. "In practice we see how differently people cope with pain. Some avoid any kind of exercise and are afraid. Others in turn take an active approach to the problem and learn to deal with the pain", is how Dr. Wolfgang Sohn, psychotherapist and pain expert from Kempen, describes what he has observed.

Source: Dr. Dietmar Krause, Aktion Rückenwirbel e.V.