Back pain is common, but the cause often remains unclear for a long time. Exercise and physical therapy can help manage the pain.

A single point of pain or small misalignment can set off a chain reaction in the body and lead to pain in the lower or upper back. During treatment, doctors are faced with the difficult task of avoiding harmful or useless examinations on the one hand but not overlooking threatening diseases such as a tumour on the other. Doctors and physiotherapists should work closely together when treating back pain.

Back pain often has muscular causes.

Good orthopaedists usually only have eyes, ears and hands to come to the right diagnosis and therapy in most cases. All they have to do is have the complaints described in detail, observe the patient’s movements and examine the body closely, test joints and feel for tension. In four out of five cases, excessive or incorrect straining of the muscles due to poor posture is to blame for the pain.

When we move, many different parts of our body have to work closely together: the brain, nerves, muscles, bones and various joints. If even one part is impaired in its function, this can affect other parts of the body and disrupt the entire musculoskeletal system. The result can be back pain, for example, which does not originate directly in the back.

Incorrect loading after arthrosis in the knee

In the case of problems and pain in the knee joint, for example, due to arthrosis, the back is often also affected, although it is not in the immediate vicinity of the knees. This happens when constant severe knee problems lead to permanent improper strain. Those affected automatically adopt a protective posture in order to avoid complaints. As a result, the entire body axis shifts over time. The result: tense muscles that press on nerves. And the pain can continue through nerve tracts to the back.

Pelvic torsion can cause back problems.

Pelvis and hips can also cause back pain. The pelvis plays a central role in the body. It connects the upper body to the legs. The hip joint provides stability but also flexibility. When standing, the pelvis assumes an almost horizontal position. A permanent one-sided load, for example, through constant carrying on one shoulder, tilts the pelvis to the side – a pelvic obliquity develops. The result is tension in the lumbar iliac muscle (iliopsoas muscle). As a result, one leg is muscularly pulled higher – a so-called functional leg length difference occurs. This in turn, is the starting point for further bad posture, tension and multiple pains – a vicious circle. The back hurts, although actually, the hip is to blame.

Herniated disc, stenosis or vertebral fracture possible causes

However, a severely herniated disc, a narrowing of the spinal canal ( spinal canal stenosis ) or a vertebral fracture as a result of osteoporosis can also be the reason for back pain. Sliding vertebrae, excess mobility due to weak connective tissue ( hypermobility ), joint wear and tear ( arthrosis ), Bechterew’s disease, a tumour, an infection in the spine, a dangerous widening of the main artery (aortic aneurysm) or diseases of internal organs can also trigger back problems. Some of these diseases urgently require special therapies.

Identify neurological symptoms

During the diagnosis, the doctor pays attention to certain warning signs that indicate serious causes of back pain and justify further examinations. These include neurological signs such as pain radiating into the legs with numbness, tingling, muscle weakness, bladder and rectum weakness, sensory disturbances in the anus and a reduction in pain with increasing paralysis. Such signs indicate a spinal disease affecting the spinal cord or individual nerve roots. Imaging procedures such as X-rays or MRIs can then provide information about the cause of the symptoms.

Other warning signs for triggering diseases

Other warning signs that justify imaging procedures are, for example, weight loss, loss of appetite, rapid fatigue, fever, chills, severe nocturnal pain or increasing pain when lying on your back.

Further clarification is generally recommended after accidents or injuries, as well as for former cancer patients or patients who are taking medication to suppress the immune system.

Physiotherapy: treatment in five pillars

A comprehensive physiotherapeutic therapy concept can help to get rid of long-term back pain. It rests on five pillars:

Pillar 1: Thorough anamnesis

In order to understand the current pain and to be able to treat it optimally, it is important to look back at its origin and possible causes. Looking back is important to understand the current illness:

  • when does the pain come
  • When will he get better?
  • What does the body have to do in everyday life?
  • Have there been operations, accidents, and falls in the past?
  • What mental grief, what worries are there?

Pillar 2: Tests and investigations

With mobility tests, manual therapy and osteopathic examinations, trained physiotherapists can search for causes of pain, such as blockages or adhesions.

Pillar 3: Education and coaching

An important prerequisite for successful physiotherapy is that those affected understand the connections that lead to, worsen or improve their pain symptoms. Through education and coaching, patients regain confidence in their bodies. Those who understand their pain can change their own behaviour and are motivated to become active themselves. Otherwise, the risk is too great that they will fall into a relieving posture and hardly move at all. That would ultimately make the pain worse and only lead deeper into a spiral of pain. In order to maintain mobility and prevent an unfavourable relieving posture from becoming entrenched, the use of pain medication can also be useful in the acute phase of severe pain.

Pillar 4: Passive therapy

If necessary, blockages can be released with special hand movements from manual therapy, vertebral joints can be mobilized again, and functional disorders between bones, muscles and nerves can be corrected. Osteopathy procedures can be helpful for scars and adhesions. Heat applications or massages have a relaxing effect and are well-suited as a relaxing preparation for muscle-strengthening training.

Pillar 5: Active therapy

The fifth pillar is about becoming active yourself and carrying out the exercises learned in physiotherapy consistently and regularly. It is important to integrate the exercises and, if possible, other sporting activities into everyday life because three exercises for ten minutes a day are not enough.

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