These patient guidelines are aimed at patients with new or recurring lower back pain. The intention is to help you to better understand the causes, symptoms, studies and finally provide you efficient options of lower back pain treatments. In addition, the goal is to promote your own commitment to helping yourself because you can do a lot in this area
- to get better more quickly
- to prevent further symptoms!
Strong pain is not only unpleasant but is also worrying. You want to know what’s “behind it” and may think you have a serious illness. However, this is rarely the case with back pain and problems are usually caused by imbalances in the interacting muscles and tendons. They usually disappear by themselves. In most cases, it helps to move around as long as this isn’t too painful.
Having back pain doesn’t mean you have a back injury. You need to have the confidence that your back can get better again. The most important rule is to be as active as possible! Movement strengthens your back, reduces the duration of pain attacks and the risk that your symptoms will come back.
Many patients believe that the spine is very sensitive and that doing exercises will lead to trapped nerves. That’s why they rest their back when it hurts. This is understandable but usually unjustified because the clever relationship between your bones, ligaments and muscles means your spine is both mobile and extremely resilient!
How does back pain develop?
We can’t be sure exactly how back pain develops. You can feel pain in all areas of the body through pain receptors. These react to different stimuli, such as pressure, heat, cold or chemicals the body produces. They’re known as pain mediators. When you have tissue damage or inflammation, these pain mediators or pain receptors are activated. At the same time, substances in the body that magnify pain start to form and increase the sensitivity of pain receptors.
Pain stimuli first enter the spinal cord through nerve pathways and then reach the brain, where they’re processed or stored in different areas (e.g. memory).
For most people, it’s likely that their back pain is caused by muscle tension. The progress of pain from its origin is as follows: Tense, taught muscles can “irritate” the nearby nerves and we perceive this as pain. When the nerves responsible for remote areas become irritated, this can lead to pain, which can even reach into the legs. Occasionally, a slipped disc can ‘press’ on a nerve. Discs can change in nature through ageing or sustaining an increased load. These changes can lead to deformities and ‘trapped’ nerves.
However, there’s often no connection between wear and tear or the damage to a disc and the pain a patient will feel. In other words, there are people who have no pain despite massive signs of wear to their spine and discs. Others, on the other hand, will feel significant pain with just slight or even no changes. This means that back pain is very different between individuals and difficult to measure across the board. A painful back often leads to a viscious circle: to reduce pain, you tense your muscles and your spine becomes “lopsided”. This means the other side of your back is under stress, you tense your muscles and you now feel back pain on the side that was previously unaffected. Even your hips can hurt because your pelvis is twisted.
Once this viscious circle takes hold, the cause of your back pain doesn’t matter quite as much because it doesn’t change the treatment. Your own will power can significantly contribute to breaking this cycle:
Don’t let your pain control you, take control of your pain in your own hands!
It’s more likely that your lower back pain is caused by bad posture or lack of movement and often both these factors play a part. The fact that many people sit for very long periods of time in the same position means their lower back muscles are significantly stressed in an irregular manner. This leads to tension, spasms and poor posture which, in turn, triggers back pain.
What causes muscle tension?
Muscle tension can be caused by, for example, habitual poor posture or an unbalanced load on the affected area. Other factors are: lack of exercise, being overweight, and being sedentary. Also bad lifting techniques – e.g. lifting and carrying things with your back bent and heavy physical work – can all put a strain on your back. Stress, domestic or work problems and mental pressure can lead to permanent inner tension, which can also lead to muscle tension.
A long period of bed rest will only increase the imbalanced tensions in your muscles. That’s why it’s better to strengthen and develop your back muscles through movement and possibly playing sport.
What role does movement play?
You can follow the best lower back pain treatment on your own: that is – keep moving!
- Don’t have more than two days’ bed rest when you have back pain.
- Try to get back to your daily activities and be active as soon as possible. If you don’t play sport as yet, use those everyday opportunities to get fit (see 5.).
- Walking, swimming or biking according to your physical fitness trains your muscles and strengthens your back. If in doubt, discuss what type of sport or level of activity is right for you with your doctor.
- To get back into action, you can take pain-killers (see below).
Lower back pain treatments?
Standard training programs (back school)
- In general, exercise is good for you and for your back! In addition to certain muscle-strengthening exercises, a training program usually consists of information on the structure and function of the back and the strain that different postures can put on your back. The best results come through an intensive 3-5 week program.
What effects can heat have?
- Many patients find that heat helps. In many cases, heat loosens the muscles, promotes blood circulation and relieves pain. The muscle-relaxing effect heat has on back pain is scientifically proven. Make sure that your back is warm when moving about on a daily basis.
Acupuncture is an ancient Chinese treatment based on the philosophical concept that every illness is a sign of imbalance in the body between the two forces of yin and yang. Conventional medicine is unable to explain exactly how this works.
- Up to now, results of studies into acupuncture for back pain are inconclusive. Some studies show that acupuncture is as effective as conventional treatment (medication, exercise) in treating chronic back pain.
- Transcutaneous electrical nerve stimulation (TENS)
Transcutaneous electrical nerve stimulation (TENS) is also referred to as stimulation current therapy. Using this procedure, small electrical currents relax muscle tension and improve mobility.
- Stimulation current therapy can be used in conjunction with other methods as a treatment option for chronic back pain (ie. pain lasting in excess of six weeks). Although this therapy can be effective, its effect on acute back pain has not yet been proven.
Since stress and mental exertion can lead to muscle tension, which can manifest as back pain, there’s a close relationship between back pain and emotional stress. This means back pain can often be improved through psycotherapy. Behavioral therapy is a psychotherapeutic method and can help to change existing habits and attitudes as these can lead to tension. Often, physical stress and emotional stress go together. This method is designed for patients who’ve been suffering from back pain over a long period of time.
Operations are only necessary and helpful in exceptional circumstances and surgery is only carried out when discs are damaged.
What can I do to help myself?
Successfully treating your bad back depends on your own commitment! Strengthen your back through movement. When doing this, pay attention to balancing tension with relaxation.
Try to resume your daily activities as quickly as possible. You should get back to being as physically active as before as soon as you can. If you only exercised a little previously then start doing this now as a minimum! Use everyday opportunities to strengthen your back.
Of course, you must protect your back from stressful activities (heavy lifting and carrying, long periods of sitting and bearing unbalanced loads).
- Don’t lift or carry with a bent back. Keep your back straight.
- When going downwards and kneeling, try to kneel without bending your back.
- Avoid unbalanced loads in general, try to distribute the weight evenly.
- Don’t stay in the same position for more than 30 minutes. Exercise helps to relax the muscles.
- If you sit a lot, you should relax your back by leaning back regularly.
- Use a chair with a flat seat or one slightly inclined forwards. The backrest should be slightly tilted backwards.
- You don’t need to buy a special mattress; a good “normal” mattress is sufficient.
- Try to lose any excess weight as this increases the load on your back.
- Make sure you take relaxation breaks. Learn relaxation techniques.
- Take part in sport as this helps you to strengthen your back while losing weight.
- Cover shorter distances on foot or by bike rather than by car.
- Use the stairs instead of the elevator.
Tips and first aid for back pain
It only takes one small, awkward movement to throw things out of kilter. Severe lower back pain makes lying down, standing and sitting difficult. Even when the pain is bad, it doesn’t necessarily mean there’s a serious reason behind it. Try to keep moving despite the pain and, above all, relax. Here are a few tips on how to help yourself with acute back pain first before you go to the doctor:
Don’t stand up abruptly
Use something to support yourself when you try to get up again. Standing up sideways is easier than from a rear position (as shown).
First aid for acute back pain: the therapeutic position
If acute back pain occurs, especially in the lumbar spine, the therapeutic position allows you to take the strain off your spine and make the pain more tolerable. To do this, lay flat with your back on the floor. Rest your lower legs on a chair, stool, stack of pillows or foam cubes (available from a medical center) and at right angles to your thighs. You can support your head with a small pillow or a neck roller. The muscles relax in the therapeutic position. It reduces pressure on the discs and relieves pain in the nerve endings. Don’t stay immobile for too long. Try to get up and get around a little.
Relaxation through breathing and positive thinking
You can also use the therapeutic position to relax. Lay down calmly and breathe consciously in and out. With one hand on your belly, you can feel your abdominal wall rising and lowering. Breathe slowly and regularly. Go on a journey in your mind and think of something beautiful, for example, a positive experience that you can see very clearly. If you listen to your favorite music at the same time, it’s better still.