Back pain
In 2024, roughly one quarter of insured individuals in Germany (24.8 percent) suffer from back pain. (Source: KKH Kaufmännische Krankenkasse)
Are you one of them and want to know how to get rid of these symptoms and prevent pain? Then Juzo has the right information for you. Back pain is the most widespread condition. In most cases, it is only a “temporary health problem”, but very frequently associated with severe pain nonetheless.
There are various reasons for back pain but they can be difficult to determine. In industrialized nations, the lack of movement caused by a lifestyle characterized by office work is frequently the trigger. Back pain is often “home-made” and can be ascribed to wrong or sudden movements, one-sided strain or a lack of exercise. In some cases, however, it may be caused by serious illnesses. Other factors such as stress or excess weight must not be ignored in this context either. Therefore get active today and support your back as much as you can – a strong back is less prone to problems.
The back and spine – Function and structure
A supportive column with complex tasks
The spine is the central axis of the human body, and it connects all parts of the skeleton. It supports the body and is responsible for its movement at the same time, allowing a straight posture and upright gait. Despite its structure including very small parts, the spine is strong enough to bear the load of the head, torso and arms at the same time.
Even the smallest changes in the spine, in the form of misalignments, wear or injuries, can cause severe pain which must be taken seriously. Clarification from a specialist is necessary in order to counteract a worsening or chronification of the condition.
Structure of the spine
The spine consists of 24 moveable vertebrae, 8 to 10 fused vertebrae (the sacral bone and tailbone (coccyx)) as well as the intervertebral discs. It is stabilised by various ligaments, ligamentous systems and muscles that surround the bony spinal structure.
The intervertebral discs consist of elastic fibres and a soft, gelatinous nucleus pulposus. They are located between each moveable vertebrae and act as elastic links between the vertebral bodies, allowing the mobility of the spine.
The characteristic shape of the spine, the double S shape, helps to absorb impact and to evenly distribute applied forces across the entire body.
- Thoracic spine
Together with the ribs, twelve robust vertebrae form the rib cage that protects the heart and the lungs. The thoracic vertebrae and ribs are equipped with joints that ensure the mobility of the rib cage, meaning it can expand and contract during breathing.
- Lumbar spine
The lumbar spine bears a large proportion of the body weight. The five lumbar vertebrae are very strong and resilient, yet highly flexible. They allow for bending movements in different directions.
- Cervical spine
The seven cervical vertebrae carry the entire weight of the head, they keep it upright and enable movement.
- Sacral bone and tailbone
The spine ends in the sacral bone and tailbone. The sacrum develops during the human growth stage as five vertebrae fuse together. The tailbone is located right under the sacral bone and is the insertion point of some of the pelvic muscles and ligaments.
Typical symptoms of back pain
Patients perceive acute back pain in very different ways. Some people experience a stabbing pain like a knife, others feel a pulling sensation on their pelvis or pressure on the spine. The intensity varies particularly with chronic pain. Acute pain is generally pronounced.
Lumbago is an acute form of back pain with very pronounced symptoms that frequently leads to a restriction in mobility. Patients are unable to straighten their upper body, or can only do so with severe pain.
Acute back pain can also radiate to the arms or legs. If this is accompanied by feelings of numbness or paralysis in the extremities, a doctor should be consulted immediately because there may be a more serious underlying cause. A doctor should also be consulted if the patient experiences additional problems with the bowels or bladder, fever or chills.
General causes and risk factors for back pain
Back pain can be attributed to various causes. The Western lifestyle plays a large role here. Long periods of sitting during work can cause excess strain on the muscles of the cervical spine and trunk. Insufficient movement in daily routines, one-sided strains and excess weight cause overloaded and painfully tight muscles. Increased life expectancy also leads to more frequent wear conditions which can cause pain in turn.
In fact, some cases of back pain cannot be attributed to a clear cause and are therefore referred to as “unspecific” or “non-specific”. Imaging methods for diagnosis are unable to detect structural damages or injuries to the spine or organs. With this type of back pain, the pain comes from the back muscles in most cases. This is because the muscles are weakened, insufficiently trained or cramped. Non-specific back pain becomes rarer with age, but the symptoms are often more severe.
“Specific” back pain has a physical trigger. A clear cause can be identified. However, this occurs in only a very small percentage of cases—approximately four to seven percent. Causes may include spinal conditions (e.g., herniated discs, spinal deformities) or inflammatory processes in the spinal region. Hormonal causes and autoimmune diseases are also possible. In cases of specific back pain, the underlying cause is treated. As a result, the pain subsides in most cases. With increasing age, specific back pain increases due to factors such as wear and tear on the spine.
Frequent causes and risk factors for specific back pain:
- Muscle loss due to insufficient movement
- Excessive strain due to too much movement
- Undue strain due to incorrect movement
- Incorrect posture
- Illnesses
- Wear
- Injuries
- Emotional distress
- Congenital predisposition
Pain areas and pain situation in the back
Pain in the middle back
Pain in the middle back
Back pain in the area of the thoracic spine is rarely caused by injuries. Functional disruptions in the costal vertebral joints or irritations, diseases or inflammation of large muscle groups in the area of the thoracic spine are generally the cause for mid-back pain.
Pain in the upper back
Pain in the upper back
Pain in the upper spine can be acute (up to six weeks), subacute (up to three months) or chronic. Sometimes pain can radiate into the back of the head, the shoulders and the arms. In particular, neck pain is often triggered by bad posture – for example, sitting at a desk.
Pain in the lower back
Pain in the lower back
Back pain can often be pinpointed to the lower back, since the lumbar spine is much more susceptible to damage and injuries than the thoracic or cervical spine. Reasons can include excessive strain or tension in the muscles, joint blockages or an organic cause such as a herniated disc.
The most common disorders and injuries of the back
Specific back pain is caused by a disease or injury. You can find the most common causes here:
Low back pain (LBP)
The lumbar spine is affected very frequently by pain because the force applied to the spine and the load to be supported are largest here. This pain in the lumbar spine, known as low back pain, can range from mild to severe. This back pain can occur for a few days or even permanently (chronic).
Low back pain can have various causes. The trigger is often a sudden movement, a twist or lifting and carrying heavy objects. Back pain can also be caused by excessive stress, incorrect posture, congenital misalignments of the spine, herniated discs or shifting of the vertebral bodies.
A severe kind of low back pain is known as lumbago, where sudden severe and cramp-like pain occurs in the lumbar spine and the back muscles that may even trigger temporary immobility.
If the pain in the lumbar spine persists for several days, it can become chronic and cause permanent problems. In this case, it’s called chronic low back pain.
Osteoarthritis
Osteoarthritis of the spine is a chronic, degenerative disease of the intervertebral joints. A reduction in the joint cartilage due to wear and tear often leads to nerve irritation, which in turn often gives rise to pain.
Herniated disc
With a herniated disc, the disc’s nucleus pulposus (the soft centre of the disc breaches the annulus fibrosus (the tough exterior) and slips out of place. The gelatinous substance can press against the surrounding nerves and cause pain. If nerve structures are constricted more severely, this can cause disruptions in sensitivity and reduced strength or even paralysis.
Osteoporosis
Osteoporosis is a disorder of the bone metabolism. Bone mass declines significantly and this results in changes to the bone structure. This is commonly referred to as “bone loss.” Bones become porous, lose their stability and can break more easily, resulting in pain.
Osteoarthritis
Osteoarthritis of the spine is a chronic, degenerative disease of the intervertebral joints. A reduction in the joint cartilage due to wear and tear often leads to nerve irritation, which in turn often gives rise to pain.
Herniated disc
With a herniated disc, the disc’s nucleus pulposus (the soft centre of the disc breaches the annulus fibrosus (the tough exterior) and slips out of place. The gelatinous substance can press against the surrounding nerves and cause pain. If nerve structures are constricted more severely, this can cause disruptions in sensitivity and reduced strength or even paralysis.
Osteoporosis
Osteoporosis is a disorder of the bone metabolism. Bone mass declines significantly and this results in changes to the bone structure. This is commonly referred to as “bone loss.” Bones become porous, lose their stability and can break more easily, resulting in pain.
Rheumatoid arthritis
In rheumatoid arthritis, an autoimmune disease, the body’s immune system attacks the lining of the joints. This leads to painful inflammation of the small and large joints in the arms and legs. Those affected find it particularly difficult to move in the morning.
Ankylosing spondylitis
This chronic inflammatory rheumatic disease primarily affects the spine and the sacroiliac joints, but can also affect other parts of the body. The disease begins with persistent back pain and often occurs in flare-ups. Typical symptoms include morning stiffness, nighttime pain, and pain in the lower lumbar region as well as the sacroiliac joints. In advanced stages of the disease, pain also occurs in higher segments of the spine. Later, the spine stiffens, which usually causes the pain to subside.
Fibromyalgia syndrome (FMS)
Fibromyalgia syndrome is a functional somatic syndrome characterized by chronic pain in multiple areas of the body, almost always including the spine. The condition usually begins gradually. In addition, sleep disturbances often occur, accompanied by fatigue and physical or mental exhaustion.
Rheumatoid arthritis
In rheumatoid arthritis, an autoimmune disease, the body’s immune system attacks the lining of the joints. This leads to painful inflammation of the small and large joints in the arms and legs. Those affected find it particularly difficult to move in the morning.
Ankylosing spondylitis
This chronic inflammatory rheumatic disease primarily affects the spine and the sacroiliac joints, but can also affect other parts of the body. The disease begins with persistent back pain and often occurs in flare-ups. Typical symptoms include morning stiffness, nighttime pain, and pain in the lower lumbar region as well as the sacroiliac joints. In advanced stages of the disease, pain also occurs in higher segments of the spine. Later, the spine stiffens, which usually causes the pain to subside.
Fibromyalgia syndrome (FMS)
Fibromyalgia syndrome is a functional somatic syndrome characterized by chronic pain in multiple areas of the body, almost always including the spine. The condition usually begins gradually. In addition, sleep disturbances often occur, accompanied by fatigue and physical or mental exhaustion.
Spondylolisthesis
Spinal spondylolisthesis occurs when one or more vertebrae in the spine slip out of alignment. This is usually caused by a loss of volume in the intervertebral disc, which reduces the support between the vertebral bodies. Spinal spondylolisthesis leads to increased stress and wear on the small facet joints. The increased mobility and the resulting potential compression of nerves can cause localized and radiating pain.
Spinal canal stenosis
Spinal stenosis is a narrowing of the spinal canal, through which the spinal cord and, in the lower section, the lumbar and sacral nerves pass. Pressure on the nerves often causes sharp pain in the back. The narrowing is caused by bony growths that develop over a long period of time as a compensatory response.
Psychological stress
Psychological stress often plays a key role in the development of back pain. Stress and anxiety can trigger muscle tension, which over time can lead to muscle spasms as well as poor posture and forced postures.
Spondylolisthesis
Spinal spondylolisthesis occurs when one or more vertebrae in the spine slip out of alignment. This is usually caused by a loss of volume in the intervertebral disc, which reduces the support between the vertebral bodies. Spinal spondylolisthesis leads to increased stress and wear on the small facet joints. The increased mobility and the resulting potential compression of nerves can cause localized and radiating pain.
Spinal canal stenosis
Spinal stenosis is a narrowing of the spinal canal, through which the spinal cord and, in the lower section, the lumbar and sacral nerves pass. Pressure on the nerves often causes sharp pain in the back. The narrowing is caused by bony growths that develop over a long period of time as a compensatory response.
Psychological stress
Psychological stress often plays a key role in the development of back pain. Stress and anxiety can trigger muscle tension, which over time can lead to muscle spasms as well as poor posture and forced postures.
Pain memory
If back pain remains untreated for a long period of time, a “pain memory” can form. Recurring pain experiences result in biochemical, functional and morphological changes in the central nervous system. Then a minimal irritation like contact, slight stretching or heat is enough to trigger a pain sensation. It is a long and laborious process to change this again.
Injuries
Caution is necessary when dealing with back injuries. As soon as the spinal cord is affected, serious neurological consequences can result. If back pain occurs after an accident, the body should be moved as little as possible.
Due to the large diameter of the spinal cord near the cervical spine, injuries there are often associated with neurological consequences such as paralysis or impaired sensation. The thoracic spine is actually protected very well by the ribcage. However, if injuries do occur, caution is necessary because the diameter of the spinal cord is still relatively large. Bone injuries of the spine generally occur in the lumbar spine, because it is subjected to the greatest mechanical stress. The spinal cord has a smaller diameter in this area of the spine. For this reason, neurological disruptions are more rare.
Diagnosing back pain
Back pain can have a wide variety of causes. That’s why an individual diagnosis is essential for finding out the true reason for your symptoms. The basis is a thorough medical history. This is followed by a careful medical examination with functional tests. As part of the muscle strength and function diagnosis, your posture and the alignment of your spine are checked and existing pressure points or movement pain points are identified. The subsequent tests indicate your spinal mobility. Neurological examinations allow for conclusions regarding the sensitivity, reflexes, strength of your muscles and thus regarding potentially pinched nerves. If there is suspicion of functional restrictions, targeted testing will be conducted during training and physical therapy.
If there is suspicion of specific pain causes, imaging technology such as X-ray images, core spin or computer tomography are used. If symptoms persist despite initial non-surgical treatment, an X-ray image should be prepared – or core spin tomography, also known as magnetic resonance tomography (MRT), if there is suspicion of pain causes or the involvement of nerve structures. In case of prior accidents with a suspicion of spinal injury, a comprehensive neurological examination is generally essential.
Further examinations such as specific lab tests or bone density measurement are possible.
A holistic examination and precise diagnosis involves many disciplines such as orthopaedics, neurology, pain therapy, psychology and physical therapy. For this reason, interdisciplinary cooperation is generally beneficial.
Therapy and treatment of back pain
Back pain often occurs very suddenly. Depending on the cause and symptoms, various therapy methods can be used. Non-specific back pain generally subsides after a few days or weeks with non-surgical treatment such as active kinesiotherapy or short-term administration of painkillers. For specific back pain, therapy is oriented on the underlying condition. Mild injuries of the spine can be treated with non-surgical methods, while serious injuries generally require surgery. In many cases, different therapies are combined.
1. Treatment of back pain without medication
Non-surgical treatments for back pain can be as individual as the pain itself. There are many options that can bring relief.
Physical therapy
Physical therapy
For many back pain patients, physical therapy is the right approach, particularly if they are experiencing severe tension and weakened back muscles. During physical therapy, patients are mainly mobilised through active exercises, enhancing mobility and strengthening the muscles. The overarching goal is a strong, flexible muscle corset that supports the spine.
Use of orthoses
Use of orthoses
Depending on the symptoms and cause of pain, different models are used with a varying range of stabilisation. For weak muscles, an orthosis can help to maintain upright posture, prevent tightening and provide support along with pain relief. Orthoses with compression stimulate the circulation and metabolism. Pads with friction nubs massage the muscles. An orthosis can correct bad posture. Stabilisation rods can be removed after successful therapy.
Manual therapy
Manual therapy
In this method, functional disruptions in the musculoskeletal system are examined and treated. The patient takes on a more passive role here. The therapist aims to feel out disruptions in the musculoskeletal system, muscles and joints, and then to loosen them with special hand movements and mobilisation techniques.
Osteopathy
Osteopathy
This alternative form of treatment assumes a balance of body, soul and spirit which the osteopath restores. For this purpose, painful blockages are broken down and the balance between all body systems is built up again. A variety of massage, stretching and hand techniques are used. Whether the health insurance provider will pay for the costs must be resolved individually here.
Acupuncture
Acupuncture
This treatment method from traditional Chinese medicine aims to achieve a therapeutic effect by placing needles at specific spots on the body. Treatment by an experienced acupuncturist is generally well tolerated. In many cases, health insurance providers will reimburse part of the costs.
Thermal applications
Thermal applications
Heat relaxes the muscles, promotes the circulation and metabolism. However, heat can make pain worse for example in case of sciatica irritation. Cooling is required here to slow down the transmission of pain signals. Thanks to pain reduction using heat or cooling, certain types of functional motor physiotherapy can be facilitated, improved or made possible.
Massage
Massage
To treat acute low back pain, a massage is not helpful. For chronic symptoms, they are sometimes applied in combination with kinesiotherapy.
Multi-modal pain therapy
Multi-modal pain therapy
Interdisciplinary cooperation is the foundation of multi-modal pain therapy. Here, doctors work hand in hand with specialists from the fields of physical therapy and psychology. Stress and anxiety can cause tension. Relaxation exercises such as progressive muscle relaxation or autogenic training can be helpful. A combination of physical therapies and psychosocial care achieves the best results.
Rehabilitation
Rehabilitation
Whether inpatient or outpatient therapy is required can be decided by the attending physician. A multi-disciplinary treatment concept for successful therapy generally extends for multiple weeks with intensive daily sessions.
Please note: The most promising therapy for you must be chosen individually may involve a mix of various approaches. The best course of action is to consult your physician.
2. Treatment of back pain with medication
A physical imbalance often can lead to back pain. For instance, this pain may give rise to a relief posture that can trigger further pain. This vicious cycle of pain, restriction of movement and tension can be interrupted by treating pain with medication.
Inflammatory rheumatic diseases such as rheumatoid arthritis trigger specific back pain that can be treated with special medication. Muscle-relaxing medications can also break this vicious cycle, particularly if the tension is the primary cause of pain. You should absolutely consult your doctor before taking medications, since there may be contraindications that argue against the ingestion of such medications depending on the circumstances.
Anyone who takes medication without consulting a physician for longer periods of time or exceeds the recommended dosage is at risk of serious consequences.
In all cases you should consult your physician to find out which medication is most effective and low-risk for your back pain. If you experience side effects, consult a medical professional immediately. The right medication for pain therapy is highly individual and is determined by the attending physician.
3. Surgery for back pain
Surgery is only necessary immediately in exceptional cases such as serious spinal injuries with a risk of spinal cord damage, otherwise plans can be made for the medium term after weighing the necessity and risks.
The most common back surgeries are interventions on the intervertebral disc and for narrowing of the spinal channels (spinal canal stenosis). In the last two decades, minimally invasive microsurgical intervention has become an established practice.
However, surgery alone is not enough. After surgery, physical therapy is important for building muscles and recovering physical sensations. Balance, bending, turning and lifting all need to be trained along with walking exercises. Especially in the first weeks, spine orthoses can help to maintain the results of surgery. Whether outpatient treatment or inpatient rehabilitation is more beneficial must be decided on an individual basis.
Prevention of back pain: Tips for living without back pain
- Get active: Walk or use a bicycle on short journeys. Take the stairs instead of the lift. Have a good stretch, e.g. before getting out of bed or after long periods of sitting down. Here you can find tips for greater movement in everyday life.
- Use the correct lifting technique: Position your legs hip-width apart and squat. Use the strength of your legs to straighten up. Keep the weight close to your body and avoid one-sided strain.
- Use the correct carrying technique: Avoid one-sided carrying. If possible, use a backpack or shopping trolley with wheels. When carrying bags, balance the weight between two bags, carrying one with each hand.
- Sit correctly: The upper body should be erect and straight, and the pelvis tilted slightly forwards. Change your sitting position from time to time – lean slightly forwards or back, then make a conscious effort to sit straight again.
- Maintain a healthy diet: Every additional pound also puts extra strain on your back. Include a lot of calcium in your diet, for example from milk, cheese, broccoli or kale.
Exercises for a healthy and strong back
Often, the reason for pain is that the back muscles are insufficiently developed. This problem is aggravated when the muscles are rested for too long. In order to counteract back pain, you should start with gentle physical activity as soon as the pain permits it.
It is recommended to strengthen the trunk muscles specifically with targeted exercises. A mobile back and well-trained abdominal muscles with strong, stretched muscles, ligaments and fasciae are much less prone to back pain.
In case of acute complaints, consult your doctor to find out if and what exercises are right for you.
JuzoPro back orthoses, your strong companion for everyday life
Lumbar orthoses support the back in the event of acute as well as chronic pain. With additional stabilisation and support in the lumbar region, pain reduction can be achieved.
In order to counteract recurring pain, they can also be worn when there is strain on the back.
Gentle to very strong support
The individual indication forms the basis for selecting the corresponding orthosis. Depending on the product, it can provide relief or correction of relief postures or incorrect postures. JuzoPro Lumbal orthoses combine extraordinary wearing comfort and ease of use with optimum medical effectiveness. Thanks to four different versions from Light to Strong, the required support can be adapted depending on individual needs
and on the diagnosis.
JuzoPro Lumbal Xtec Light
The JuzoPro Lumbal Xtec Light provides patients with light yet durable support. Wearing this stabilizing orthosis promotes an upright posture and can help prevent muscle tension. It is particularly suitable for individuals with weak or unevenly developed back muscles in the lumbar region and can be worn during all daily activities that place strain on the back.
JuzoPro Lumbal Xtec
Thanks to the firm Xtra fabric of the JuzoPro Lumbal Xtec, the lumbar orthosis exerts gentle to moderate compression on the patient’s lumbar region. A removable sacral pad with firm friction nubs additionally massages the muscles and tissues and loosens hardened fasciae. The orthosis can be used for most lumbar problems and offers relieving and pain-alleviating effect.
JuzoPro Lumbal Xtec Plus
The JuzoPro Lumbal Xtec Plus lumbar orthosis is the preferred choice for severe, chronic pain. Especially at the start of treatment, this orthosis provides strong stabilization. The additional support straps and sacral pad can then be removed as treatment progresses. This increases freedom of movement in the lumbar region and supports mobilization.
JuzoPro Lumbal Xtec Strong
The JuzoPro Lumbal Xtec Strong lumbar orthosis is ideal for severe pain caused by poor posture, joint wear, or chronic irritation. The high waist height and double cross-strap design ensure even pressure is applied across the entire lumbar region. The very firm stabilizing rods can be removed and reshaped to provide either relief or correction, depending on the specific need.
FAQs – The most important questions and answers about back pain
What can help with back pain?
What can help with back pain?
For back pain, depending on the cause and severity of pain, there are different measures that can provide relief. After consulting with a doctor, possible options to consider are:
Physical therapy, moderate exercise, use of orthoses, warmth, cold, pain relievers, improved ergonomics, relaxation techniques, osteopathy, acupuncture, manual therapy, surgery.
What should you avoid doing if you have back pain?
What should you avoid doing if you have back pain?
Neither bed rest nor sudden movements when you're in pain are helpful. If you're able to move, start with light exercises. If the pain severely limits your mobility, please seek medical advice!
How long does back pain last?
How long does back pain last?
The duration varies depending on the cause of the pain. A distinction is made between acute pain, which subsides after a few days to a maximum of six weeks. Subacute back pain lasts approximately six weeks to three months. Beyond that—that is, longer than 12 weeks—it is referred to as chronic back pain. Back pain that occurs repeatedly is called recurrent or relapsing.
What can cause back pain?
What can cause back pain?
Back pain is usually not caused solely by wear and tear on the spine and intervertebral discs. However, the exact causes can rarely be clearly identified. Often, several unfavorable factors come together when back pain develops. Possible causes include obesity, lack of exercise, weak core muscles, excessive or uneven strain, muscle tension, and psychological stress.
What types of back pain are there?
What types of back pain are there?
There are various types of back pain, including nonspecific lower back pain with no specific cause and specific back pain with a specific cause, such as a herniated disc or sciatica.
When should I consult a doctor?
When should I consult a doctor?
If your back pain is unusually severe, does not subside, or even worsens, you should consult a doctor. If you experience numbness or paralysis, please seek help immediately. You should also be taken to a hospital or doctor’s office immediately if you experience sudden, severe pain, have a back injury, or suspect a herniated disc.
How can I prevent back pain?
How can I prevent back pain?
There are several steps you can take to help prevent back pain:
- Exercise: Regular exercise strengthens the back muscles and improves blood flow to the intervertebral discs. Please don’t overdo it. Excessive strain can damage your back.
- Ergonomics: Maintain good posture when sitting, standing, and lifting.
- Weight management: Being overweight puts additional strain on your back.
- Stress management: Mental stress can lead to muscle tension.
- Back exercises: Learn about back-friendly habits and effective exercises.
- Comfortable footwear: High heels can cause back pain.
- Healthy sleep: Your back can relax at night. Support this with an ergonomic slatted frame, a mattress that suits you, and a neck support pillow.
Which sleeping position is back-friendly?
Which sleeping position is back-friendly?
Lying on your stomach causes your lower back to arch, which can lead to tension and pain in the cervical and thoracic spine, so it’s best to avoid this position.
Tip 1: When lying on your side, place a pillow between your knees to keep your pelvis straighter.
Tip 2: When lying on your back, place a pillow under your knees to relieve pressure on your lower back.
How many people suffer from back pain?
How many people suffer from back pain?
Back pain is considered the number one widespread ailment. Over the course of their lives, nine out of ten people will experience lower back pain at least once. At the same time, the pain is rarely caused by a serious underlying condition.