Back discomfort - common symptoms
The term back pain is usually understood to mean pain in the lumbar spine. Of course, cervical spine pain or pain in the thoracic spine is back pain, but is almost always referred to as neck pain or thoracic spine pain. The lumbar spine, i.e. the lower back, is most affected by pain (lumbar pain). The symptoms can be acute or chronic. Back pain is generally confined to the lower back. Sometimes there is pain radiation to the leg region (lumboischialgia). Likewise, neck pain can be limited to the neck and head movements are accompanied with pain. It can also radiate into the arms and hands.
Causes of back pain
There are many causes of back pain. This includes:
- Muscle tension
- Disc problems
- Narrowing of the spinal canal
- Vertebral fractures
Muscle tension occurs very often and is often the result of incorrect or disproportionate strain. This often happens at home or at work (lopsided sitting position, computer work, etc.) The resulting uninterrupted muscle tone ultimately leads to an oxygen and blood deficiency of the muscles and metabolic waste products can no longer be properly removed. Muscle tension can be very painful, but it can be treated well with physiotherapy and changes of the daily physical strain.
The wear on the intervertebral discs in both the lumbar and the cervical spine is constantly increasing. The intervertebral discs serve as a buffer between the vertebral bodies. In the aging process, or for other reasons, the intervertebral disc tissue changes and become narrower and narrower. Lack of movement or disproportionate strain have fatal consequences for the quality of the intervertebral discs. Since the intervertebral disc tissue is not supplied with blood, the disc must be „massaged" as much as possible for an adequate metabolism. This hardly happens when sitting lopsided. The intervertebral disc then changes in shape and ability to optimally support the vertebral bodies, causing the vertebral bodies to become less stable. Eventually, the intervertebral disc can ossify (this is called osteochondrosis). As a result of the degenerative change, damage to neighboring nerves or narrowing of the spinal canal can occur.
An intervertebral disc consists of a fiber ring (anulus fibrosus) and a gelatinous inner mass (nucleus pulposus). The gelatinous nucleus carries the vertebral body like a water cushion. If the disc is deformed, the disc will bulge/protrude. The fiber ring is still intact and there is no leakage of gelatinous mass. If the fibrous ring breaks, the inside of the intervertebral disc is pushed out, which is then called a herniated disc. In addition to the mechanical pressure exerted on the intervertebral disc tissue, it can also lead to the accumulation of inflammatory proteins, which then contribute to pain.
By young people and especially athletes, vertebral sliding can occur due to a stress fracture of the vertebral body. Vertebral sliding (spondylolisthesis) is far more common due to degenerative changes in the vertebral joints or degenerative changes in the intervertebral disc. Vertebral sliding can lead to narrowing of the spinal canal and damage to the nerves. Mostly, vertebral sliding can be treated conservatively. However, if the nerves are compressed too much, surgical measures must be discussed.
All of the degenerative processes described above can ultimately lead to a narrowing of the spinal canal, the so-called spinal canal stenosis. Since these are degenerative changes, older patients are mostly affected. Most often, arthrosis of the vertebral joints leads to the formation of a spinal canal stenosis, and the spinal cord and nerve roots are increasingly affected. In the advanced stage, there may be a considerable pain-related restriction of the walking distance. Whether and when a spinal stenosis is to be operated can be decided very individually. This requires precise diagnostics and a consideration of the benefits / risks of the operation.
The vertebral bodies are stably linked to each other. The so-called facet joints serve this purpose. The facet joints, like all joints, are covered with cartilage. If the facet joints wear out, this affects the mobility of the spine; restricted movement and pain can occur. Often the pain is not only felt in the back, but can also radiate into the legs in the case of lumbar facet arthrosis. In the worst case, facet joint arthrosis can lead to vertebral sliding or spinal canal stenosis.
Vertebral fractures are very serious injuries, because unstable fractures can lead to paralysis or even death. Fractures occur in the context of accidents, but can also occur through pronounced osteoporosis without having strong impacts on the spine.
Spondylitis is an infection of the spine. It can be acute or chronic, but is in both cases very rare. The cause of spondylitis is often unknown. Occasionally, urinary tract infections, dental operations or even injection treatments can lead to the accumulation of bacteria in the spine. If spondylitis is suspected, blood tests and other diagnostics should be carried out quickly to prevent consequential damage.
Diagnostics of back pain
Since, as described, the causes of back pain can be very different, a precise medical history, a very good physical examination with assessment of the statics, assessment of reflexes, muscle strength etc. must be carried out. Laboratory diagnostics to clarify inflammatory, rheumatic or malignant diseases should be part of the diagnosis. X-ray examinations, MRI or CT examinations will complete the diagnosis if necessary.
Therapy for back pain
the diagnosis, the therapy consists of physical therapy, injection treatments, acupuncture and / or drug treatment. In addition to these conservative forms of therapy, there are various other measures that will not be discussed further below. In our practice we will propose a conservative treatment concept. Should surgical interventions become necessary, we can quickly call in operational colleagues (e.g. neurosurgeons) to design an optimal treatment concept. As a special feature of our practice, we offer orthomolecular therapy, in which we try to influence pathological changes in the spinal area via anti-inflammatory effects. These are, for example, injections with the body's own proteins.
You are welcome to make an appointment with us to plan an effective therapy in your personal case.