Back pain ( low back pain) has a wide variety of causes - so it knows almost everyone.
Now, however, it is important to find the appropriate cause of the pain in order to be able to initiate a targeted therapy. The cause does not necessarily have to be in the area of the back. Often they are based on other causes (urological, gynecological, ...) which need to be clarified during the investigation.
In the following, the back pain is sorted by location and quality.
Low back pain
Back pain in the lumbar spine (Lumbar spine) is common, as this area of the back is exposed to high levels of stress. They affect all age groups. Colloquially, pain in this area is referred to as lumbago or low back pain, in technical language they are called lumbalgia . They are also referred to as lumbar spine syndrome and include blockage of the vertebral joints, irritation in the joint capsule, general overloading and tension of the muscles and ligaments of the spine.
In most cases, pain medications are necessary as a therapy, which in combination with physiotherapy should lead to the tense situation dissolving and the muscles to be properly trained.
Possible causes can be:
Back pain that occurs in the middle of the back can have various causes. Firstly, a disc herniation of the thoracic spine often leads to this symptom. Depending on the location of the affected disc, the pain may be in the upper, middle or lower back and radiate into the arms or legs.
Another possible cause is inflammation of the vertebral bodies, the pain of which is increased by prolonged sitting. The forward bending usually reduces the pain.
Osteoarthritis of the vertebral joints can also cause central back pain. This pain is then usually felt as dull and are worse at long standing, sitting or lying down. In addition, the irritation of a nerve root can cause pain in the middle of the back, which then radiates into the buttocks or legs. Even with a strong muscle tension, this pain can be triggered.
In addition, gynecological problems can also lead to central back pain. These are usually noticeable in the area of the sacrum and the buttocks. These usually appear in combination with other symptoms, such as abdominal pain or urinary problems.
If the back pain is focused on one side, this can be caused by a misuse or overload. A muscle strain caused by a fast movement while exercising, heavy lifting over the side or other things can lead to this. This results in a temporary imbalance of the back muscles, which should not be compensated by a rest posture. If this is attempted, the malposition can become a permanent condition and cause long-term discomfort with the spine.
A herniated disc can also cause unilateral back pain, depending on the direction in which the disc protrudes. If a herniated disc, so often come to the one-sided pain and unilateral numbness or paralysis in the arms or legs.
In the presence of inflammatory kidney disease, such as kidney pancreatitis, which affects only the left kidney, the back hurts in the left flank. Here the cause must be clarified and if necessary an antibiotic therapy be initiated.
Also kidney diseases can lead to back pain. In most cases, this is pain that occurs in the area of the flanks, ie in the area of the lower back and they can radiate into the groin area. Kidney-related back pain occurs either on one or both sides, depending on which kidney is affected.
To distinguish between back and kidney pain, the freedom of movement can be checked. This is usually less limited in kidney pain and the pain is dull and not movement dependent. Typical of kidney pain is that they do not consistently have the same intensity, but are sometimes worse and sometimes less severe. A pain that worsens with light tapping on the back about two fingers over the iliac crest, indicates problems with the kidneys.
To determine whether the kidney is the cause of the back pain, a blood test should be performed to detect any inflammation in the body and a urine test to see if blood is eliminated. Various causes can cause kidney pain. The most common is inflammation of the kidney or renal pelvis, which is triggered by an infection. When inflammation occurs, the patient usually also complains of a poor general condition, fever and tiredness. Also pain during urination occur frequently. Inflammation due to an infection is treated with an antibiotic.
A disabled urine drainage can also lead to kidney pain. This can be caused by urinary stones, which settle in the kidney or in the ureter.
Kidney stones can lead to renal colic, which is accompanied by very strong spasmodic pain. The pain is often so severe that nausea and vomiting occur as concomitant symptoms. Here anticonvulsant drugs in conjunction with painkillers help. The pain usually arises from the fact that the kidney stone has dissolved and the ureter clogged. To remove kidney stones, there are different methods. They can be destroyed by shock waves, removed through the ureter, or, if too large, surgically removed.
In addition, it can lead to kidney pain during pregnancy, when the unfavorable position of the child causes the urine to stagnate back into the kidney.
Renal pain in the back may also be caused by kidney cancer. The pain usually occurs here only in an advanced stage.
More than half of the back pain affects the lower back, but basically back pain can occur in all areas or radiate there. In addition to the pain in the affected area, other symptoms may be present or already present as harbingers, such as muscle tension or morning stiffness. Back pain can either occur suddenly or develop slowly over several days.
If the back pain is caused by a muscle tension, the symptoms should go back by itself after a few days. If this is not the case, then a doctor should be consulted. Sudden back pain usually manifests itself in stabbing pain, which may radiate into the leg. Depending on the location of the back pain radiating into the neck is possible. Often these acute back pain is triggered by too heavy lifting or by a wrong movement. Due to the pain, the mobility is limited and the patient can not straighten up.
In addition to back pain, when numbness or tingling in the arms or legs, paralysis, or incontinence is added, these are warning signs that suggest a lumbar disc herniation. In this case, a doctor should be consulted quickly. A herniated disc can occur at different heights and cause different symptoms and pain, depending on the location. Depending on whether he pinched a nerve or not, it comes accordingly only to pain or in addition to accompanying symptoms.
If you suffer from a feeling of numbness and suspect a lumbar disc herniation as the cause, we recommend our topic: Is a herniated disc cause my numbness?
Back pain can also be chronic. Then they are characterized by a constant increase and decrease in the intensity of pain, which always alternates phases. This can be caused by wear-related protrusions of the intervertebral disc, when nerves are permanently irritated, or by wear of the vertebral joints, which rub against each other when moving.
Back pain is considered a widespread disease in Germany, which, statistically speaking, is the second leading cause of a doctor's visit. As already mentioned, back pain is often chronic and thus returns again and again. In most cases, the area of the lumbar spine is affected by back pain.
In many cases, finding the root cause of " chronic" back pain is extremely difficult.
It has already been pointed out above that many causes can be organic and / or psychological. The causal components can always interact and, under certain circumstances, reinforce one another.
The task of the physician is to find out the cause of the back pain and to clarify syndromes by differential diagnosis. This is not always easy.
Differential diagnostic measures are available in our practice in Frankfurt am Main. To homepage.
Cause of back pain
Based on the various clinical pictures described above, it can be seen that the underlying causes of back pain are also complex.
Common causes of back pain are degenerative, wear-related changes in the spine and intervertebral disc. It is always necessary to take account of individual changes in the causes. For example, patients with a hollow back ( hyperlordosis ) or cavities ( hyperkyphosis ), as well as patients with weak back muscles, etc., may be more likely to suffer from back pain.
Regardless of the individual factors, there are potential causes for the development of back pain. Below are the most important to be mentioned and described.
Possible causes for the development of back pain are:
Since the causes of back pain can be so diverse, we have outsourced all possible causes in a separate topic.
For more information, see our topic: Causes of Back Pain
More than half of pregnant women suffer from back pain during pregnancy. These are usually harmless and due to the increased burden of the back due to the increasing weight. This can cause muscle tension that is painful.
The back pain during pregnancy can be divided into two groups: the real back pain and the pelvic pain. The true back pain is the same that non-pregnant women and men suffer from. They are caused by an overload of ligaments, muscles and joints and are often triggered by lifting to heavy loads or by wrong movements. If pain occurs that radiates into the back leg, irritation of the sciatic nerve may be responsible. Although this is rare in pregnancy, it can be caused by the back pressing on the nerve.
The majority of back pain during pregnancy is the so-called pelvic pain.
To avoid or prevent back pain during pregnancy, it is important to have a well-trained back and abdominal muscles. Back exercises at home or a visit to the gym can help here.
During pregnancy, pregnancy gymnastics or aqua classes can be visited to strengthen the muscles and to relieve or prevent the pain.
In case of existing back pain heat in combination with massages can prove to be effective. Here, the gynecologist should be asked for advice. A support belt that takes on part of the baby weight can also be helpful.
For lower back pain, which occurs in the first trimester of pregnancy, a doctor should be consulted as a possible cause of a cervix kinking. But also complications of early pregnancy, in the worst case a miscarriage, can cause them.
As the pregnancy progresses, contracting the uterus or pushing the infant's head on pelvic nerves can cause back pain. In addition, kidney disease may be one reason for this. By changing the posture of the pregnant woman, it often comes to a hollow back, which leads to a Fehlbelastung the back and pain.
Another reason for back pain during pregnancy is the onset of labor. These cause a violent pulling in the area of the lower back.
At this point, back pain is considered, the cause of which is to be found in the area of the spine and the neck. By way of example, some diseases have been selected for this, of which patients are affected more often than average.
These back pain include:
Other illnesses and injuries leading to back pain:
A - neck pain
B - upper back pain
C - pain in the area of the lumbar spine
D - lumboglutalgia
(Radiating into the buttocks)
E - lumboischialgie
(Radiating into the leg)
Illustration of belt disc
Figure spinal cord
Figure herniated disc
Figure lumbar spine syndrome
Figure vertebral fracture
As already described above, the causes that can be made responsible for back pain are very diverse.
Very often, however, they are triggered by muscle tension. Through these tensions, the muscles appear hardened and disturb the surrounding nerves in some sensitive way. Since some nerve tracts also radiate into more distant areas of the body (eg leg), pain in other areas can very often be attributed to back pain. A targeted diagnosis of the back and abdominal muscles helps to uncover deficits and dysbalances of the trunk musculature and to initiate targeted therapy options. To the backend diagnostics
However, pain is not always caused solely by the muscle tension mentioned above. It is also possible that a patient, for example, suffering from a so-called root syndrome. This syndrome is due to tendency, age, wear and / or stress. A displaced disc pushes on the surrounding nerves and causes back pain.
Which cause can be held responsible for the development of the back pain, is always the diagnosis of the doctor.
Again and again, the subjective perception of pain / back pain has to be pointed out. This shows again and again that the pain tolerance limit of people are sometimes very far apart.
Thus, there are people who suffer from the most severe signs of wear and tear but subjectively feel no pain. The reverse case is just as possible. Thus, it can be noted that there is often no relationship between the severity of pain and the diagnosis of back pain.
As already mentioned above, it is possible for patients to get their aching backs under control by so-called restraint. This restraint usually causes tensions on its part, because other muscle parts are overstressed than is the case normally.
To prevent back pain in the long term one should decide for oneself to move more. This is easily possible in everyday life (stairs instead of lifts) and can also be supplemented by other sports activities. See also back training.
Since there are different causes for the development of back pain, and it has been proven that there is a close relationship between pain and psyche, a careful history (= collection of medical history ) seems inevitable.
In the diagnosis of back pain, the focus is often quite first on the profession of the patient. Knowledge of the profession already allows to identify possible risk factors ( occupations that are "almost" exclusively exercised when standing or sitting, those that stand out by lifting heavy loads, ...) or, if not applicable, exclude.
To record the severity level, so-called "pain diaries" can be added to the diagnosis. As part of a pain diary, the patient documents daily his ( subjective ) perceived pain using an analog scale. The evaluation is usually done by the doctor.
In principle, the X-ray image of the spine can be described as a basic diagnosis of back pain. About the X-ray images of the attending physician receives an insight into the spinal column. In addition, bony changes can be detected.
The cross-sectional diagnosis (CT and MRI, either with or without contrast agent) also allows the assignment of the pain to a specific nerve or a herniated disc. Due to the different diagnostic methods one wants and can draw extensive information with regard to therapeutic measures to be taken. It should also be noted at this point that an additional administration of a contrast agent is usually only carried out if there is a suspicion of inflammation or tumor.
To exclude nerve damage or to determine the degree of possible nerve damage, far more extensive investigations must be carried out. This can be done by neurological examinations
Myelography describes a study in which the patient injects contrast agents into the dural sac. The dural sac is the area that surrounds the beginning of a nerve before it leaves the spinal canal. By mixing nerve water and contrast agents, it is thus possible to better clarify specific questions with regard to the spinal cord.
Breathing is a vital process for humans, which can not be waived. Therefore, in spite of back pain during breathing, care should be taken not to keep the breathing flat, so that the body is supplied with sufficient oxygen.
The respiratory pain can have different causes. In case of a severe cold or bronchitis inhaling and exhaling may temporarily cause back pain. If these get worse or do not get better, a doctor should be consulted to clarify possible causes. But also injuries of the ribs or the spine, which are caused by violence, can lead to respiratory back pain.
Since both the back muscles, as well as the abdominal and the respiratory muscles have their approaches to the spine, there is a close connection here. If the back muscles are damaged, they are passively moved by breathing, which can lead to pain. Also, an inflammation of the muscles ( myositis ) can be felt by breathing pain. This can be caused by a lack of oxygen supply to the muscles and should be treated as quickly as possible in order to maintain the muscles.
The pleura, which surrounds both lungs, may become inflamed in the course of pneumonia or other influences. This inflammation (pleurisy) can cause severe pain, which is usually greater with inhalation than with exhalation.
Respiratory back pain is treated in pain condition with analgesics and then, depending on the cause, a corresponding therapy is performed.
Since back pain can have many different causes, it is first necessary to isolate the cause as accurately as possible in order to be able to treat them accordingly. When choosing the appropriate therapy, the extent of the pain and the possible impairment or paralysis symptoms should be taken into account.
To alleviate the acute back pain, analgesics (eg ibuprofen) are usually used. Although these are available at the pharmacy, they should not be taken without medical advice, especially if you have a persistent backache. Also anti-inflammatory drugs (eg acetaminophen) can help against the acute pain. In addition, anti-inflammatory drugs, such as cortisone, can be injected directly into the painful area with the help of a cortisone syringe to achieve a rapid improvement in pain. For very severe pain, opioids may need to be used for a few weeks. These have an anesthetic effect and can be combined with anti-inflammatory drugs.
Back pain often leads to relieve tension, which can cause additional pain. In contrast, muscle-relaxing drugs, so-called muscle relaxants, help. However, these are rarely prescribed by the doctor, as they have strong side effects and among other things can lead to temporary inability to drive.
Although back pain brings some relief and limitation in many activities, enough exercise is still important to the healing process. Too long sitting or standing and heavy lifting should be avoided, but light activities should still be carried out as much as possible.
Back pain is often caused by instability of the spine or a permanent strain. That is why physiotherapy is often the standard therapy for back pain. Since the spine is held not only by the back muscles but also by the abdominals, shoulders and neck muscles and hip muscles, the goal of the physiotherapy is to stabilize this entire holding apparatus in order to achieve optimum support of the back.
But massages can also be part of physiotherapy. This will relieve tension and promote blood circulation to relieve the pain. In addition, thermal patches, such as ThermaCare®, can help relax the muscles. In inflammatory processes, however, we usually feel cold as a pleasant, so a cryotherapy (cryotherapy) is recommended. In addition, an electrotherapy can be carried out, in which electric currents are supplied from outside, which are to promote the blood circulation and to initiate the healing process.
In addition, the so-called Blackroll, a self-massage roller, can provide relief for back pain. Another option for mild back pain is to apply some horse ointment to the affected area to treat the symptoms.
For chronic low back pain that has no apparent cause and persists for more than 12 weeks, multimodal therapy should be initiated. This means that doctors, pain therapists, physiotherapists, occupational therapists, psychotherapists and psychiatrists work together to identify and treat a possible psycho-social cause.
In the long term care should be taken with back pain that, above all, the workplace is back ergonomically designed. Desks that are adjustable in height are often helpful in order to be able to do parts of the work while standing.
If back pain is due to herniated discs and conservative methods do not alleviate pain, surgery should be considered. Here are different methods possible.
Since this topic is so extensive, we have also written a separate page on back pain of the lumbar spine.
The so-called lower back includes the lumbar spine, which consists of 5 vertebrae and closes the spine downwards. Back pain in this area are common, the treatment tedious. The causes are chronic and acute complaints of the lower spine and discomfort from the upper spine and originating in the lower spine.
Acute lower spinal complaints are less common and most of them are linked to accidents and dislocations. If spinal vertebrae are damaged by falls or accidents, the lower vertebrae may experience very severe pain.
In addition, rapid lifting of heavy loads and spinning around in the spine can cause dislocations that can severely affect spinal pain. It is often said that a nerve has become jammed, but in fact it is rather irritation of nerves that are muscle-tight and irritated by the muscles that are cramped by the dislocation.
The chronic causes of back pain in the lower back are primarily related to postural deformity that can grow over time and cause severe discomfort. Patients who exercise for a long time or who have had unbalanced posture since childhood are particularly at risk of getting back pain in the lower part of the back.
Today, it is assumed that a not inconsiderable proportion of back pain in the lower back actually originate in the upper part of the back and then radiate downwards into the lumbar spine. Causes can also be chronic damage here but also acute.
Again, malpositions are the most common cause of chronic discomfort, while injuries and dislocations are more likely to be acute. Also often it comes to back pain from herniated discs. They come in almost all cases of chronic postural damage. In a herniated disc, it slips out of the core of the disc.
Die Bandscheibe rutscht zwischen beide entsprechenden Wirbelkörper hervor und verursacht Schmerzen. Bandscheibenvorfälle entstehen meistens durch Haltungsschäden vornehmlich im Bereich der mittleren Wirbelsäule (Brustwirbelsäule) und können nach unten in die untere Wirbelsäule ausstrahlen und dort Beschwerden auslösen. In einigen Fällen entstehen Bandscheibenvorfälle aber auch in der unteren Wirbelsäule (Lendenwirbelsäule) und verursachen Schmerzen.
Folgende Erkrankungen betreffen unter anderem ursächlich den Wirbelsäulenbereich (besonders Ursachen chronischer Nackenschmerzen):
Rückenschmerzen der Lendenwirbelsäule sind besonders häufig.
Diese auch als Kreuzschmerzen bezeichneten Rückenschmerzen können unter Umständen auch in andere Gebiete des Körpers ausstrahlen. Dies ist beispielsweise beim Krankheitsbild der Lumboglutäalgie ( Ausstrahlen in das Gesäß ) oder der Lumboischialgie ( Ausstrahlen in das Bein ) der Fall.
Da für diese Arten von Schmerzen wiederholtes Auftreten typisch ist, spricht man hierbei häufig auch von einer chronischen Schmerzkrankheit. In der Regel besteht hierbei keine neurologische Symptomatik.
Schmerzen des unteren Rückens können durch eine Vielzahl von Ursachen ausgelöst werden. Bei der Diagnostik ist entscheidend, die erheblichen Ursachen von den leichteren Ursachen zu unterscheiden.
Zu Beginn der Diagnostik steht die Krankenbefragung, bei der der Patient über die Art und die Dauer des Schmerzes befragt wird, sowie Bewegungen, die die Schmerzen mindern oder verstärken herausgefunden werden sollen. Schildert der Betroffene Sensibilitätsstörungen an den Beinen in Form einer Taubheit oder Kribbeln, ist schnelles Handeln geboten, da die Ursachen der geschilderten Rückenschmerzen am ehesten in einer Problematik der Nerven der Wirbelsäule liegen. Schildert der Patient gar eine neu aufgetretene Inkontinenz handelt es sich um einen neurologischen Notfall.
Bei der Diagnostik von nicht behandelbaren Rückenschmerzen kommt der Bildgebung eine entscheidende Bedeutung zu. Eine Röntgenaufnahme der Wirbelsäule kann Frakturen an den Wirbelkörpern darstellen. Weiterführend ist die Durchführung einer Magnetresonanztomografie, die auch Weichteile darstellen und ua Bandscheibenvorfälle sichtbar machen kann. Neben den bildgebenden Verfahren kann auch eine umfangreiche Blutuntersuchung Aufschluss darüber geben, was zu den Rückenschmerzen führt. So können Entzündungen der Wirbelkörper oder der Bandscheiben durch Erhöhung der Entzündungswerte dargestellt werden.
Die Therapie richtet sich nach der die Beschwerden auslösenden Ursache. Unkomplizierte Rückenschmerzen, die in den meisten Fällen aus Haltungsschäden herrühren, können in den meisten Fällen konservativ behandelt werden.
Zu den konservativen Therapieoptionen zählen zum einen eine adäquate Schmerztherapie, die meistens aus Medikamenten besteht, zum anderen auch aus einer entsprechenden Physiotherapie, die aus Wärme- oder Kälteanwendungen bestehen oder das Erlernen bestimmter Rückenübungen kann. Ist der Rückenschmerz durch die konservativen Behandlungsoptionen nicht beherrschbar, und ist die Ursache prinzipiell operabel, muss über einen invasiven Eingriff nachgedacht werden.
Bandscheibenvorfälle können in vielen Fällen konservativ behandelt werden, es sei denn, die Schmerzen sind so stark und nicht medikamentös beherrschbar, oder es treten bereits neurologische Störungen, wie Taubheit oder Lähmungen sowie Inkontinenzen auf. In diesem Fall muss sofort einen operative Therapie geplant und durchgeführt werden, da aus dieser Situation schnell ein neurologischer Notfall entstehen kann. Sind neurologische Symptome vorhanden handelt es sich bereits um eine Nervenkompression, die durch eine Operation an der Wirbelsäule entlasten werden muss. Bandscheibenvorfälle werden abgetragen und die beiden aufeinanderfolgenden Wirbelkörper oftmals versteift.
Handelt es sich um Frakturen der Wirbelkörper ist entscheidend, ob es sich um eine stabile Fraktur oder eine instabile Fraktur handelt. Stabile Frakturen werden in den meisten Fällen konservativ durch eine Behandlung mit Schmerzmittel behandelt oder auch durch Ruhigstellung in Form eines Korsetts. Instabile Frakturen müssen operiert und mittels Verschraubungen stabilisiert werden. Die geschilderten operativen Eingriffe werden in Abteilungen der Neurochirurgie durchgeführt. Oftmals reichen minimal invasive Operationsverfahren mittels der sogenannten Schlüssellochtechnik.
Rückenschmerzen des unteren Rückens sind häufig und haben unterschiedliche Ursachen. Man unterscheidet chronische von akuten Beschwerden sowie im unteren Rücken entstehend und vom oberen Rücken ausstrahlend.
Akute Ursachen sind meistens Frakturen, Bandscheibenvorfälle oder Verrenkungen sowie Verletzungen der Wirbelsäule nach Unfällen. Chronische Ursachen basieren in den meisten Fällen auf Haltungsschäden, die über lange Zeit ausgeübt worden sind.
Manchmal entstehen die Ursachen von Rückenschmerzen im Bereich der Brustwirbelsäule und ziehen nach unten in die Lendenwirbelsäule, wo sie dann als schmerzhaft empfunden werden, manchmal sitzt der Kern direkt in der LWS.
Diagnostisch muss neben der Krankenbefragung bei starken Rückenschmerzen immer eine Bildgebung durchgeführt werden. Diese kann aus einer Röntgenaufnahme der Wirbelsäule bestehen, durch die Frakturen der Wirbelkörper gesehen werden können oder durch eine MRT-Untersuchung, durch die man Bandscheibenvorfälle etc. sehen kann. Schildert der Patient eine neurologische Symptomatik ist Eile geboten, da die Nerven der Wirbelsäule offenbar in irgendeiner Weise beeinträchtigt sind. Therapiert wird der unkomplizierte Rückenschmerz in den meisten Fällen konservativ. Darunter versteht man ein Behandlungskonzept bestehend aus einer adäquaten medikamentösen Schmerztherapie und einer ergänzenden Physiotherapie.
Physiotherapeutisch kann auch ein Behandlungsversuch mit Wärme, Kälte oder Reizstrom erfolgen. Komplizierter Rückenschmerz kann, je nach Ursache, operativ behandelt werden. Sind neurologische Ursachen vorhanden, muss operativ versucht werden die Kompression der Nerven zu reduzieren.
Dies geschieht in Abteilungen der Neurochirurgie in vielen Fällen in minimal invasiven Eingriffen durch die sogenannte Schlüssellochtechnik, bei der nur wenige Schnitte notwendig sind und die eigentliche Operation durch ein Mikroskop durchgeführt wird. Rückenschmerzen können viele Ursachen haben, die alle ein spezifisches Behandlungsvorgehen notwendig machen.