Back pain is considered a classic widespread condition, as almost everyone suffers from it at some point in their lives. The proverbial backache often subsides after a while. In some cases, however, back pain can become chronic, leading to severe physical limitations and even inability to work.
Statistically speaking, women are affected more often than men. However, the individual causes of back problems are closely related to a person's lifestyle, physical strain, and general state of health.
Some types of back pain commonly occur with age, for example as a result of age-related conditions or weakening muscles. However, young people - sometimes even schoolchildren - also suffer from back problems.
The causes can be just as varied as the type and location of the pain. Identifying the trigger of the problems plays an important role in every back therapy. Fortunately, there are also many ways to treat and prevent back pain.
In this article, we look at the different types of back pain and their causes, and present various therapy and treatment options. Simply click on the relevant line to jump to the section you want.
Where does back pain radiate?
Back pain can radiate to many different areas of the body. As a result, it is often not easy to identify the exact cause or source of the pain. However, the type and location of the pain usually make it possible to quickly narrow down which area of the back it originates in.
- Lower back pain: Back pain most commonly occurs in the lumbar region. The lumbar vertebrae are exposed to the greatest strain, so herniated discs are most common here. Pain in the lumbar vertebrae is often abbreviated as lower back pain and is what is actually meant when people refer to “backache.” However, this term is now commonly used for all kinds of back problems. Lower back pain can radiate into the middle back or legs. Sometimes it is even accompanied by numbness. Sciatica is one type of pain that can originate in the lower back. The sciatic nerve runs from the lumbar spine down into the legs. That is why the pain literally shoots into the legs when the sciatic nerve is pinched.
- Mid-back pain: In the middle back, pain is often caused by muscle tension or deformities of the spine. The rib joints are located here, among other structures. Overall, back problems occur more frequently in the neck or pelvic area, but the mid-back is also susceptible to pain from incorrect strain or poor posture.
- Pain in the upper back and neck area: The upper thoracic spine and, above all, the cervical spine support the considerable weight of the head and are closely connected to strong muscles in the shoulders, chest, and neck. Many typical office-related complaints caused by an unbalanced and unnatural head posture manifest as pain in the upper back and neck. It often does not stop at neck pain. Pain originating in the neck area can sometimes radiate to the head, shoulders, and arms. A distinction is made between pain in the thoracic spine (thoracic spine pain) and pain in the cervical spine (cervical spine pain).
Pain in the upper back is usually attributable to the cervical spine
In general, the spine plays a major role in determining the cause of back pain. It supports our body and, with its two dozen vertebral bodies, allows us to flexibly turn and move our upper body and neck.
Nerves emerge between the vertebrae, maintaining the connection from the brain to the most remote parts of the body. The vertebral bodies are separated by intervertebral discs, which act like natural gel cushions to absorb weight and force exerted on the vertebrae. Both the points where nerves emerge and the intervertebral discs are among the areas that frequently cause back pain.
The spine itself is supported by a complex network of muscles. The back muscles are not the only important ones for correct posture and a healthy back; the abdominal and leg muscles, for example, also play an important role.
Because a painful back can have many different causes and manifestations, doctors will first try to categorize the pain.
A doctor attempts to categorize back pain based on the patient's statements
When categorizing back pain, doctors rely heavily on the patient's cooperation. Only you can describe exactly where the pain is located and what it feels like. The first question is: What type of back pain is it? A distinction is made between specific and non-specific back pain.
Specific back pain: When back pain is caused by illnesses or congenital conditions, it is considered specific. It has a clear cause. Unfortunately, this does not mean that the cause is always easy to find. Doctors often have to carry out extensive examinations and question patients in order to make a clear diagnosis.
Possible triggers of specific back pain include pathological deformities of the spine, wear and tear of the vertebral bodies, or inflammation in the back. Osteoporosis and certain metabolic diseases are also possible causes. Once the cause has been identified, it can be treated specifically. However, specific pain is often also caused by diseases or injuries that are difficult to treat.
Nonspecific back pain: If there is no single, clear trigger, it is considered nonspecific back pain. In many cases, nonspecific back pain is caused by tense or overstretched muscles and disappears on its own.
They are often caused by overuse - muscle soreness, strains, or muscle fiber tears during sports are good examples. Nonspecific back pain can also result from muscle tension or shortening, which is encouraged by a lack of movement and poor posture. If the nonspecific pain does not go away on its own, identifying the causes can require a great deal of patience. Relaxing and/or mobilizing therapies are often used.
Neurological or psychological triggers are sometimes also investigated. If the triggers cannot be narrowed down or eliminated, nonspecific back pain can become chronic.
How long does the pain last? This is the next important question.
Acute back pain: If the pain has only just appeared, it is acute. The prerequisite is that no back pain occurred for at least six months beforehand. Acute pain should be gone after a maximum of six weeks.
Subacute back pain: If back pain lasts longer than six weeks and up to twelve weeks, it is considered subacute. Medical advice should be sought by this point at the latest, if this has not already happened. Strains, sprains, and similar complaints should have healed by now.
Chronic back pain: If it lasts longer than twelve weeks, back pain can become chronic. This does not necessarily mean that the pain will never go away. In many cases, however, those affected have to come to terms with the situation.
Depending on the cause and whether it is known, surgery could help. A doctor must assess on a case-by-case basis whether back surgery is likely to be successful.
Lifting heavy loads can damage the back
What can cause back pain?
The causes of back pain can be just as varied as its manifestations. An accurate diagnosis therefore always depends on various individual factors that differ from case to case.
Because the back keeps us upright, it has to withstand a great deal. Heavy physical exertion is therefore one of the most common triggers of back pain. Regularly lifting and moving heavy loads in particular puts strain on the back muscles.
Back problems caused by incorrect or excessive strain therefore occur more frequently in some occupational groups. In elderly and nursing care, for example, washing and repositioning patients puts considerable strain on the back. Incorrectly performed exercises or overexertion during strength training can also damage the back.
In general, however, exercise and training are recommended, because people who generally get little exercise risk losing back muscle. If these muscles become too weak, even minor strains or awkward movements can cause back pain.
This is often already expressed through a sunken or slightly crooked posture - often a kind of protective posture. Over time, posture problems are frequently unconsciously "trained" like bad habits. They can be corrected through targeted training.
Body weight is another factor in maintaining a healthy back. Being overweight is harmful not only to the heart and other organs - every excess kilo puts strain on the spine and intervertebral discs. This is one reason why back pain can worsen during pregnancy.
However, in addition to weight, the size and position of the unborn child in the womb also play a role. Pregnant women often report lower back pain. Pain in the middle back at the level of the ribs is also common.
These pains are usually harmless, but medical advice should be sought in cases of persistent and very severe back pain. In early pregnancy, severe lower back pain could be caused by an ectopic pregnancy.
The factors described above mainly cause non-specific back pain. It is often temporary (pregnancy, strains, etc.) or can be influenced through therapy and training. People between 30 and 50 are most frequently affected. Specific back pain is different, as it occurs more often from the age of 50 onward.
Non-specific back pain mainly affects people aged 30 - 50
An overview of possible triggers for specific back pain
- Hollow back and rounded back: Many people deal with spinal deformities. Very few people are endowed with a perfectly shaped spine. As soon as the shape of the spine deviates too far from the typical double S-curve, back problems are virtually inevitable. Hollow back (lordosis) and rounded back (kyphosis) are among the most common deformities. With lordosis, the cervical and lumbar spine curve forward, causing a curvature of the lower back. With kyphosis, a rounding develops in the middle of the spine, caused by a backward curvature of the thoracic spine.
- Scoliosis: With scoliosis, the spine becomes severely curved and twisted. It occurs particularly frequently in adolescent girls and usually causes noticeable back pain only in later stages. If detected early, scoliosis can often still be corrected while the person is growing. Once it has advanced significantly or growth has ended, scoliosis is much more difficult to treat. Surgery may be considered in severe cases.
- Herniated disc: It is one of the best-known and most feared back injuries. The intervertebral discs wear down over the course of a person's life and become brittle and cracked - under heavy strain, this can happen relatively quickly. Severe jolts to the spine also wear down the discs or can injure them, causing the gelatinous core to protrude and press on the surrounding nerve tissue. Depending on its severity, the resulting bulge can cause severe back pain, numbness and paralysis. Symptoms and effects also depend on which area of the spine is affected. Herniated discs in the lumbar region, for example, are often accompanied by abdominal and back pain because the pain spreads from the lower back to the abdomen. In fact, in most cases, a herniated disc can be treated without surgery. Physiotherapy is used to strengthen the surrounding muscles so that they can better support the spine. A special mattress and modifications to the workplace may also be necessary to eliminate the causes of the disc problems.
- Osteoporosis: As people age, their bone mass gradually decreases. Some people are affected more severely or prematurely. With osteoporosis, the bones become increasingly brittle and susceptible to injury. The bones of the spine are usually particularly severely affected. Women are far more frequently affected than men.
- Inflammatory osteoarthritis: With osteoarthritis, the cartilage in the joints wears down excessively quickly. In advanced stages, this degenerative disease is often accompanied by inflammation (osteoarthritis) and is very painful. Severely arthritic joints are sometimes surgically replaced with artificial joints. In the case of spinal osteoarthritis, the facet joints along the spine are affected. This often leads to spondylosis - the formation of bone spurs on the affected vertebral joints.
- Spondylolisthesis: The so-called spondylolysis refers to an excessively large gap between two vertebral bodies - a deformity that is presumably aggravated by excessive or incorrect strain in children and adolescents. Sports in which the back is strongly bent, such as ballet or artistic gymnastics, are considered conducive to the development of this cleft. If the gap between two vertebrae becomes too large, the vertebral bodies can shift, a condition known as “slipped vertebra” (spondylolisthesis). It usually occurs in the lumbar region and accordingly manifests itself through lower back pain. The condition is difficult to detect and, if left untreated, can lead to problems such as osteoarthritis. Severe symptoms often do not appear until adulthood.
- Scheuermann’s disease: Scheuermann’s disease primarily affects adolescents and initially manifests itself through back pain and tension. However, the symptoms sometimes do not appear until adulthood. Over time, deformities such as a rounded back or swayback develop. This is caused by uneven growth of the individual vertebral bodies, which are consequently subjected to excessive stress in some areas and deformed into a wedge shape. This can result in disc tissue protruding into the vertebral body. Scheuermann’s disease is by no means always severe - however, surgery may be necessary in cases of severe spinal deformities. Otherwise, the disease is treated, for example, with physiotherapy or by wearing a supportive brace
- Ankylosing spondylitis: This disease causes lower back pain resulting from inflammation of the joints between the pelvis and the intestines and/or sacrum. The pain is accompanied by increasing stiffening of the affected region of the body. Ankylosing spondylitis affects men more frequently than women. It cannot be cured but can be treated. It is suspected that a genetically predisposed immune deficiency promotes the development of ankylosing spondylitis.
- Paget’s disease: The exact cause of this common bone disease is still unclear. It is known that men over the age of 40 are affected more frequently. Paget’s disease causes deformities, thickening, or inflammation of the affected bones. In the spine, the lumbar region is usually affected. As a result, the disease manifests itself through lower back pain - deformities of the lumbar vertebrae can also irritate and pinch the sciatic nerve. In rare cases, Paget’s disease can develop into bone cancer. Treatment approaches include taking calcium and vitamin D, as well as supportive measures such as wearing a brace.
- Infections caused by bacteria or viruses: Infections of the vertebral bodies or intervertebral discs are rare. Bacteria or viruses either need an entry point (open wounds, injections, operations) or attack bone tissue due to an immune deficiency. The resulting inflammation in the back leads to problems that are difficult to detect and treat. In addition to severe back pain - including at rest - acute bacterial infections are also accompanied by flu-like symptoms such as fever or chills.
- Osteomalacia: It is a metabolic disease similar to the childhood disease rickets, but occurs only in adults. It is generally caused by a vitamin D deficiency. This may be due to metabolic problems or poor nutrition. As a result, calcium deficiency and softening of the bones occur. Since the spine supports the body's weight, the resulting deformities have the greatest effect there. Intensive administration of additional vitamin D (and, if necessary, calcium) can counteract nutrition-related osteomalacia.
- Tumors: Cancer can affect virtually any part of the body - including the spine. Malignant bone cancer occurs mainly in childhood or adolescence. However, it is rather rare in the spine. Benign tumors can also cause severe back pain if their growth puts pressure on nerves or intervertebral discs.
Science has not yet reached a consensus on how alcohol consumption or smoking affect back disorders. However, it seems likely that these vices contribute to abdominal and back pain when consumed heavily. It is known that they can promote conditions such as heart disease and cancer.
The environment at home or at work, as well as living conditions and working conditions, can also constitute risk factors for back disorders and back pain.
This graphic shows how the extruded nucleus pulposus of the intervertebral disc presses on the nerves
The influence of the mind on back problems
This therefore raises the question - especially in the case of nonspecific back pain - to what extent the mind promotes back problems. Many people under severe psychological stress complain of abdominal and back pain. Expressions such as "it upset my stomach," "to have a bad day" or "to feel as if you've been run over" convey this.
People under emotional stress often unconsciously adopt a kind of protective posture. This may manifest as a hunched, crooked posture with a lowered head and slumped shoulders, for example. People who feel threatened instinctively make themselves small. Since lower self-esteem is often accompanied by less awareness of one's own body, people with depression also frequently suffer from lower back pain and other back problems.
Gym ball exercises for the back
Even people who exercise regularly often neglect back training. Since balanced training can prevent numerous back problems, we recommend back exercises with a gym ball. This can gently train the deep back muscles in particular - the small muscles along the spine
An unnatural posture causes the back muscles, including the smaller, deeper muscles that support the back, to weaken and shorten. This leads to tension and pain. It also increases the likelihood of sudden painful episodes such as lumbago.
A doctor explains X-rays of the spine to her patient
When should you see a doctor about back pain?
Whether and when you should see a doctor depends largely on your individual case and pain tolerance. A general guideline is to see a doctor after experiencing persistent back pain for four to six weeks at the latest.
Tension or minor injuries such as strains should actually have healed by this point. However, if you have severe acute back pain, you should act immediately and see a doctor right away or within three days at the latest.
As mentioned, only you can judge how severe the back pain is and how serious the associated limitations are. But even pain that we can “just about tolerate” harms us and may indicate more serious problems. Too many people now regard back pain as “normal” to some extent.
However, doctors and therapists can show you many ways to achieve a healthy back or maintain your back health. It does not always have to involve the dreaded injection in the back. If you have persistent, “bearable” back problems, seek help before they develop into chronic, severe back pain.
For example, lumbago can hurt so severely that you will undoubtedly want medical attention. Signs of paralysis and numbness in the legs and lower abdomen are another warning signal that you must not ignore.
Back pain can originate in a wide variety of parts of the body that seemingly have nothing to do with the back. While you can only speculate yourself, doctors have the knowledge and technology to use numerous diagnostic methods.
Inflammation in the back is painful but not always easy to recognize
How can you recognize inflammation in the back?
Medical expertise is essential to identify inflammation in the back. Symptoms that may indicate it include very severe back pain that worsens with movement and persists even at rest. The spine is often distinctly sensitive to pressure.
In some cases, inflammation is even externally noticeable through swelling or redness. Flu-like symptoms such as fever, chills, and a feeling of weakness may also occur. Inflammation in the back or other parts of the body can usually be confirmed through laboratory findings.
Standing workstations can help relieve strain on the back at work
What helps most with back pain?
The range of treatment options for back pain is almost as broad as the variety of possible causes. First of all, numerous preventive measures can be taken to prevent serious or chronic back problems from developing in the first place.
Too much inactivity is harmful to the body. Most people in Western industrialized countries get too little rather than too much exercise. Sitting for long periods is particularly harmful to the back. When there is insufficient strain, the small muscles in particular atrophy; these muscles support the larger ones. Lack of exercise also promotes excess weight, which places additional strain on the back.
In many cases, therefore, it is the wrong approach to take it too easy on your back. What matters instead is applying the right kind of strain. Plenty of exercise helps prevent back problems. Walking a good distance every day is one of the best activities you can do for your body. If in doubt, start small - you could simply walk through the park and take short breaks along the way.
Exercise also helps you maintain a healthy back despite working in an office. Make sure you sit with good posture, keeping your back straight, and do not let your shoulders slump forward. Change your sitting position from time to time and do stretching exercises while seated.
It is also advisable to stand up frequently, even if you only walk around your office chair for a few minutes. For example, you could make phone calls using a cordless headset so that you can walk back and forth while talking. Many offices now also enable people to work standing up. Workstations can be equipped so that you can work at your computer while standing.
In cases of severe or persistent back pain, movement therapy could provide relief. In such cases, you will probably need to build up more muscle to support your spine. Appropriate physiotherapy training can also help correct poor posture and train you to adopt better posture.
Movement therapy can also teach you how to lift loads correctly and perform common movements such as standing up and sitting down in a way that protects your back. Various training approaches can be used to build up and relieve specific muscle groups in a targeted and gentle manner.
Exercise aids such as gym balls, weights, or bands are also frequently used. For all exercises performed on the floor - even with a healthy back - a cushioned exercise mat is recommended as protective padding.
A back massage can help relieve deep-seated tension. Especially in cases of acute non-specific back pain, a massage can release blockages in the muscles. If the causes of back pain are not muscular, a back massage can often at least alleviate the symptoms and promote relaxation.
Heat also helps relieve muscle tension. Non-specific back pain caused by tense muscles can often be alleviated with a warm bath or by applying heat cushions. Anyone wanting to wear sustained heat directly on the body could try an electric heating pad. Modern rechargeable heat belts can even be fastened comfortably around the body.
For back tension or sore muscles, some people swear by warming balms or tinctures for rubbing in. An example of a heat gel that generates extra-strong heat is Kräuterhof® Horse Balm. Ingredients such as horse chestnut, hops, yarrow, valerian, and red vine leaf extract generate very intense heat on the skin, which also affects deeper muscle tissue.
Horse balm may therefore only be used externally and must never get into the face or eyes. If you rub warming ointments into your skin, you must wash your hands thoroughly afterward.
However, heat should never be applied when back pain has inflammatory causes.
Chronic back pain may be treated with multimodal pain therapy. This combines various medical specialties. For example, psychological and occupational therapy approaches could be pursued simultaneously to help patients on all levels of their back problems. At present, multimodal pain therapy is still used relatively rarely in Germany.
Please bear in mind that all the information we can provide is no substitute for medical expertise. If you suffer from back pain, only your doctor can make the correct diagnosis and determine the appropriate further treatment.
