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Back pain and its causes

Whether tall, short, fat, thin, young or old there is hardly anyone who has not experienced back pain. The stabbing pain in the small of your back for example, that suddenly runs through your body like an electric shock. This is commonly known as lumbago and fortunately is usually harmless, but figures show that back pain is a part of life. Three out of four Germans suffer from it at least once in their lives. The amazing thing about this is that younger people are affected more frequently than older people. As painful as this can be fortunately:

  • In over 90 percent of all cases back pain is uncomplicated.
  • Serious illnesses are rare.
  • And very importantly: Those affected can do a great deal themselves to ensure that the symptoms soon disappear and, above all, do not recur.

Overstrained muscles

Doctors and therapists have puzzled over the causes of back pain for many years. One thing is certain, it can have both physical and psychological causes with both factors often influencing one another.

The most common causes of pain along the spine are:

  • Muscle tension due to poor posture and one-sided strain (often work related)
  • lack of exercise (the average calorie consumption per day through exercise has fallen by 400 calories a day since the 1970s)

Alongside muscle-related back pain nerve dysfunction is the second most common cause of low back pain, accounting for around five percent. "A pinched nerve which is constriction of a nerve exit point in the spine or nerve inflammation can cause severe pain," explains Dr. Martin Buchholz (specialist in surgery and orthopaedics, former board member of the Federal Association of German Back Schools (BdR) e.v.). Other causes such as bone fractures or tumours are much rarer and are only responsible for around one percent of all back pain.

Conclusion: in the vast majority of cases, signs of wear and tear are to blame for the pain because we have increasingly forgotten how to utilise our bodies in a natural way. Therefore, what could be more obvious than learning how to use our backs properly again? Fortunately, this is very easy because what is good for our back is firmly anchored in our genes. It just takes a little practice and perhaps some effort, but when back pain is a thing of the past it is worth it. So, what can be done?

The basic measures include four things:

1. More exercise for the back
2. Activating self-healing powers - the psyche helps the body
3. Strengthen your back with nutrition
4. Make your environment back friendly and follow tips from the New Back School

Vicious circle of back pain - First aid for back pain

‘Just don’t move’ is a completely human reaction when one is affected by back pain because movement becomes synonymous with pain. The difficult thing about it is that a link is created in the brain that causes us to adopt a protective posture which in fact, also leads to pain relief. However, this is only temporary. Other muscle groups will inevitably be strained and overloaded by the relieving posture and these areas will also eventually become painful. This leads to the famous vicious circle:

1. Physical and emotional stress puts the nerves under high tension. The muscles cramp up and start to ache.
2. The pain puts a strain on the psyche. If it persists, the unpleasant sensations can take on a life of their own.
3. The body adopts a protective posture and this puts a strain on other areas.
4. The pain also causes stress. The body demands rest, but this passivity leads to further muscle loss.
5. The cycle starts all over again.

Once this vicious circle has started the reason for its development is no longer so important as the resulting treatment does not change. 

 "You can do a lot to break this cycle through your own commitment. Despite all adversity it is important to keep moving as much as possible! Simple painkillers, heat applications and massages help to relieve acute pain. If possible, you should walk for 5 to 15 minutes several times a day if you have acute but uncomplicated back pain. Light bicycle, ergometer training can also contribute to a rapid improvement. You should avoid prolonged lying down or sitting with the exception of a position that relieves symptoms (a stepped position). “Under no circumstances should you lie in bed"
sa
ys Dr. Marco Gassen (sports physician and back specialist from Wiesbaden - www.qimoto.de)

Exercise and sport in everday life

Humans are born for movement

This is far more than just a cliché, but a scientific fact. Not so long ago, people used to walk or even run 10, 20 or even 30 kilometres a day. Today, most people can barely manage 700 meters. This is fatal for our backs. A lack of exercise causes more than 600 muscles in the human body to atrophy. They are then no longer able to support us properly. All it takes is one small wrong move and the pain shoots you in the back. More movement has long been regarded as the best back protection and that is not a Herculean task. Just 20 to 30 minutes a day is enough. Of course, it is important that the exercise is fun.

More movement in everyday life again

Ulrich Kuhnt, sports educator, head of the Hannover Back School and member of the board of directors of the Federal Association of German Back Schools (BdR) e. V., also emphasizes this: "We have to manage to bring more movement into everyday life. Back pain is pre-programmed in the long term for those who are sedentary. Top sporting performance is not required. Even small tricks make it easy to incorporate more activities into everyday life.

  • Run errands on foot as often as possible.
  • Take the stairs instead of the elevator.
  • Get the bike out of the cellar.
  • Even couch potatoes can achieve half of their daily physical activity target with just a 15-minute walk twice a day at a moderate pace to the train or the shops.
  • Make good use of the queue at the ticket office or bus stop: 
    For example, elongate yourself as if you were being pulled upwards on an imaginary string like a marionette and stretch your spine.
    Stretch the muscles by leaning to one side or gently swaying your upper body to the left and right.

Exercise can do a lot to combat back pain in everyday working life. Also, in addition to an ergonomic workstation, physiotherapy exercises can prevent complaints. Seek advice from a therapist or take advantage of one of the many office gymnastics programs offered by health insurance companies. Small training sessions that one can incorporate throughout the day are usually easy to do at your desk or while standing without additional aids.

Changing position relieves the back

Varied movements can also prevent the most common cause of back pain which is muscle tension. Change your sitting position as often as possible. For example, sometimes sit leaning forward, sometimes more upright, then lean back again in a completely relaxed position. This is all the easier if the office chair or the sofa at home meet ergonomic requirements. However, variety of movement can be added to everyday life if sitting is interrupted more often by periods of standing:

  • Short meetings can be held at a standing desk, for example.
  • Instead of sending an email to the colleague down the hall, a short walk is a good alternative.
  • Place the waste bin or printer in the corridor instead of right next to the workstation.
  • If you must stand for longer periods of time, relieve the strain on your spine by occasionally shifting your weight from one leg to the other because variety is also required when standing. Workplace mats and aids for standing in motion can help with this.

Which sport is back friendly and suits me?

Muscles are the human motor. Every person has over 600 muscles. They work just like any other motor, transforming energy into movement. The human body cannot survive without muscles. We would not be able to breathe, see clearly, speak or move. Consequently, to ensure that your back can cope with the demands of everyday life your muscles should be strengthened regularly. "Strong muscles help the spine accomplish its support function and prevent back pain. Sport plays an important role in this. Many types of sport also promote mobility and coordination and thus the interaction of all components that keep the back healthy," advises Petra Regelin from the German Gymnastics Federation.

There are a wide range of sports that are considered back friendly: Aqua fitness, jogging, walking, inline skating, strength training, Pilates, cycling, TaiChi, QiGong, yoga, trampolining, gymnastics... However, there is no scientific evidence as to which sport is best for back pain. It's all about the ‘how’. With the right amount, targeted training and good technique, the positive effects outweigh the negative effects in almost all sports. In addition to building muscle, sport also helps with depression, sleep disorders and feelings of isolation which often go hand in hand with chronic back pain. However, successful outcomes are only achieved if you exercise regularly.

When choosing a suitable sport, it is less about whether it is generally, considered to be "back friendly" and much more important that the sport suits you. It must be fun and fit into your daily schedule. If you are unsure about the health requirements when you start exercising, you should seek advice from a doctor or therapist.

Back Pain and the psyche

Activating self-healing powers - the psyche helps the body

As already mentioned, back pain is not a purely orthopaedic problem. The psyche also plays a decisive role in problems relating to the spine. Any form of stress, whether at work, in the family or in relationships, makes the muscles tense and this causes pain. The latest research even shows that the back has its own stress memory. Admittedly, this sounds a little crazy but no matter where the stress comes from your back remembers everything. It is these bad memories that subsequently influence our perception of pain. This can be shown quite well with an example: If you have a problem with your boss, just thinking about the next meeting is enough to trigger back pain. Easy-to-learn, anti-stress techniques can be valuable help in these situations. Examples include meditation, muscle relaxation according to Jacobsen, breathing techniques, autogenic training and much more. For more serious problems no one should be afraid to seek professional psychological help. So, to summarize again:

  • Stress and mental overload often lead to muscle tension.
  • Due to the close relationship between back pain and mental stress, the symptoms can often be improved by treating the psyche.
  • Health psychology counselling and training help you to deal better with stress. The symptoms can be reduced and chronicity can be prevented.

Timely help prevents permanent pain

As with many other health problems, far too many patients with chronic back pain are still reluctant to start appropriate behavioural therapy. This is a shame because it can change existing habits and attitudes that have led to muscle tension. "If treatment with psychotherapeutic methods is started in good time, there is a good chance of preventing further chronicity" says qualified psychologist Fredi Lang (Federal Association of German Psychologists, Berlin). "It should also be borne in mind that, in principle, any pain can become chronic. For this reason alone, early measures are necessary," adds Lang. Psychological treatment methods are often an important step towards alleviating existing, permanent back pain.

Another behavioural therapy goal is to reduce the psychological and social consequences of chronic back pain. "Our aim is to make life more bearable for those affected and to give them back their often severely restricted ability to act," says Lang. Psychological care is therefore becoming more and more important in interdisciplinary pain therapy.

Successfully combating pain with psychotherapy

The process of pain processing during therapy takes place on different levels. In classical psychotherapy, these are primarily conversations but there are also supplementary strategies. Experts differentiate between the following psychotherapeutic approaches:

Behavioural therapy - oriented treatment

The aim here is to improve the way you deal with pain through self-control.

Depth psychology treatment


The aim here is to track down psychological conflicts that are (partly) responsible for the pain and that can go back to childhood.

Psychotherapeutic body-oriented methods

The aim here is to stimulate the body's self-healing powers through intensive awareness of physical functions.

With mindfulness
live consciously

Mindfulness can also be a building block that stabilizes and strengthens mental health. Mindfully through the day by Ulrich Kuhnt from "Die Säule" 3/2019

Cognitive behavioural therapy for back pain

One of the most important psychological methods for back pain today is cognitive behavioural therapy. It assumes that a person's opinions, attitudes, wishes, ideas and intentions have a significant influence on their behaviour. This makes one’s perception of their own back pain very individual and can both intensify and weaken the extent to which they are affected. "Anyone who sees back pain as a stroke of bad luck will experience the pain more strongly than someone who actively does something for their back health," explains the Hon. Prof. Dr. Anne Flothow (psychologist from Hamburg - board member of the Bundesverband deutscher Rückenschule (BdR) e.V.).

Learning to think positively

In behavioural therapy, patients with back pain should learn to look at the pain from a different perspective and re-evaluate it. In a conversation between therapist and patient, negative attitudes can be uncovered and changed in favour of a new, more positive perspective. "The aim is to convince people that they are not helplessly at the mercy of their back pain," says Dr. Flothow. She advises people to use coping strategies to overcome their fears, become active and increase their self-confidence. The prerequisite for successful psychotherapeutic treatment of pain is therefore the cooperation of the patient. Chronic back pain can only be alleviated in the long term if those affected are prepared to actively help shape the process.

Back pain and nutrition

Pay attention to your diet - for the sake of your back

Another important pillar for a pain free back is good nutrition. Half of all women and two out of three men are overweight. These extra kilos not only damage the cardiovascular system and increase the risk of developing diabetes, they also seriously disrupt the function of the spine. The intervertebral discs are particularly affected. For example, movement with leverage places a load of over 100 kg on the buffer elements of the lumbar spine when standing, up to 175 kg when sitting and over 223 kg when lifting a load from a stooped position! If you are overweight, the values are correspondingly higher. Such large loads squeeze the "juice" out of the disk, so to speak. Overweight people suffer from back pain more frequently than people of normal weight.

The reasons for the extra kilos are certainly known to most people, an oversupply of food is promoted every day. Ready meals and fast food may be convenient, but they are often high in calories. It's no wonder that around three quarters of all adults have already undergone at least one slimming diet and yet there are more and more overweight people. Why is that? Nutritionists agree that most diets are not effective. With radical or crash diets, you lose weight quickly, but usually only water. Instead of fat stores, carbohydrate and protein stores are tapped into. During longer diets, protein is also broken down in the form of muscle tissue. In some cases, this accounts for 40 percent of the weight loss. This can have adverse health consequences.

The good news: being overweight is not an insurmountable fate! Anyone can achieve their desired weight, even without torturing themselves.

The most important weight loss tips

  • Keeping a diary: What has worked well, what should we look out for in the future?
  • Write down your weight at the beginning of the week, do not weigh yourself every day, only once a week.
  • Have I eaten enough fruit and vegetables? Have I drunk enough water?
  • Drink a glass of water before every meal to boost your metabolism.
  • If the day has gone well, give yourself a star. After five stars, reward yourself with something that has nothing to do with food, for example buy a good book, go to the movies or sauna.
  • Lose weight in pairs so that you might motivate each other.
  • Eat enough vegetables (guideline 400 g) and fruit (guideline 200 g) every day. Fruit gets the metabolism in order and strengthens the immune system. Vegetables are high in fibre, vitamins and phytochemicals and low in calories.
  • Eat seasonally, for example cabbage in winter, winter salad ...
  • Instead of fast food prepare a lunch box or take a piece of fruit with you.
  • Use high-quality vegetable oils, for example rapeseed oil, olive oil and soybean oil (also good for stir-frying).
  • Use butter and margarine sparingly, better half-fat butter or half-fat margarine or sour cream, insider tip: Tomato paste.
  • Use cold cuts as sparingly as possible.
  • Low-fat cheese, ideally cottage cheese or quark and low-fat cold cuts such as turkey ham, smoked pork loin or salmon.
  • Only buy real wholemeal bread (some bakers mix in syrup for a darker colour). Health food stores and organic food stores offer the greatest variety. The whole grains do not have to be visible and the bread does not have to be completely dark. It is crucial that the complete whole grain has been ground and used. Only then does the bread contain eight times as much vitamin B1 and two and a half times as much fibre. Advantage: It makes you feel full for longer and keeps the blood sugar curve stable.
  • At lunchtime, often eat a large portion of raw vegetable salad with a little vinegar and oil dressing beforehand - chew well.
  • Main courses with a large portion of vegetables
  • Trim the fat from pieces of meat.

Tips for grocery shopping

  • Just ‘go shopping’. If you go to the supermarket hungry, you buy more!
  • Buy enough fruit and vegetables every day, preferably fresh or frozen.
  • Write a shopping list. This avoids unnecessary additional purchases and calories.
  • Avoid sweets and cookie shelves.
  • Only buy thin slices of cheese.
  • If possible, buy flour type 1050 and not 405, better still wholemeal flour.

Basic information about meal plans

  • Frozen products (except ready meals) are perfectly okay.
  • As little sugar and honey as possible.
  • Plenty of fresh herbs, salt sparingly, basil and savory are good for the stomach, thyme supports fat digestion, oregano promotes the flow of bile.
  • Only mix home-made dressings for leaf salads into the salad immediately before eating.
  • Keep meat portions small. The basic rule is: fish twice a week, meat once a week (if at all), vegetables and fruit every day and salad regularly.

Source: Das große Rückenbuch by Thorsten Dargatz

Conclusion: What does the body need? It’s very simple: A diet rich in protein, vitamins and minerals that supports muscle development, strengthens the bones and supplies the intervertebral discs with sufficient fluid.

Self-help starts in your own environment

Sufficient exercise and the correction of one’s own unfavourable behaviour are the decisive foundations for a pain-free back. However, commitment to keeping your back healthy is limited when your personal efforts come up against an environment that is hostile to your back. Examples are bad chairs, beds or car seats. An ergonomically adverse working and living environment can also lead to back pain. This important factor must not be forgotten in the search for the causes and prevention of back pain.

Back friendly environment

"The smallest detail relating to a back complaint can reveal the story of its origin. The causes of back pain are manifold and can rarely be reduced to X-ray-detectable spikes, misalignments, wear and tear or even herniated discs."
Dr. med. Bernd Reinhardt (orthopaedist, sports physician, chiropractor, spa physician, Federal Association of German Back Schools):

"Basic care in the surgical and medical fields is constantly being improved, and prevention and rehabilitation techniques are being refined. Unfortunately, normal everyday aids and objects used in daily living, working and leisure environments are rarely considered from a preventative perspective. However, prevention must be accounted for. Back-friendly equipment in the workplace, schools, sports facilities and leisure environments are the logical solution. Everyday products should meet the medical requirements for back-friendly behaviour."
Dr. med. Erich Schmitt (orthopaedist and long-standing chairman of the Forum Gesunder Rücken - besser leben e. V.)

This means focusing on changing and optimizing our personal environment. Optimised standing, sitting, lying, lifting, carrying, bending, the use of back friendly products as well as a back friendly environment and workplace design are prerequisites for a healthy back.

Back friendly standing

Do you work standing up a lot and often feel your back in the evening? Prolonged monotonous standing such as at a standing workstation, can have negative consequences for the body. The back becomes tense and the lumbar spine suffers. Circulatory disorders can occur in the leg muscles, and the pelvic and leg muscles tire more quickly than when you are in motion.

Dynamic standing

Try to avoid a monotonous and rigid standing posture. Here are a few suggestions:

  • Bring movement into your standing position by alternating between a parallel stance and stepping position.
  • Change the load on the legs (from more left to more right, etc.)
  • Keep stretching your body.
  • Take the strain off your body, for example by by supporting yourself with your arms.
  • Leaning, for example against a wall.
  • If possible, always try to take short breaks and walk around.
  • Keep moving your feet and do mini-exercises such as moving your toes, shifting your weight from toes to heels etc.
  • Keep doing mini-exercises with the pelvis, for example simply tilt the pelvis forwards and backwards.

Upright standing posture

We know that dynamic standing is not always easy to achieve. You should therefore also ensure that your posture is favourable:

  • That knees are slightly bent.
  • That the back is straight with the pelvis tilted slightly forward.
  • That the sternum is slightly raised.
  • Shoulders are pulled slightly backwards and downwards.
  • Keep your head relaxed and straight.
  • Stand with your feet about hip-width apart and the tips of your feet pointing slightly outwards.
  • It is better to avoid shoes with high heels. High heels shift the body's centre of gravity. This creates a hollow back and leads to strain on the lumbar spine.

Further support when standing 

Additional relief can be gained from back friendly products and appropriate equipment:

  • Pay attention to good cushioning when buying shoes.
  • A standing aid can provide relief.
  • If possible, place one foot alternately on a small footrest or box.
  • The working environment should be adaptable to body height so that it is possible to work with a relaxed, upright upper body (for example height- djustable work surfaces, use of attachments).
  • Impact-absorbing floor mats can noticeably reduce the strain on the spine and the surrounding muscles.

Back optimised sitting

Sitting for long periods of time is poison for our body. Sitting phases should be as back-friendly as possible.
Pay attention to:

  • If sitting, stay active. No rigid sitting. Keep changing position while sitting on the seat. The best sitting posture is the next sitting posture.
  • Change of posture: Frequent changes between sitting and standing, for example in the office with the help of a height-adjustable desk.
  • As a rule of thumb: 25% standing, 25% moving and 50% sitting.
  • Always take breaks and use every opportunity for exercise.
  • Tip for office workers: Office concepts that promote movement bring movement into the work day as a matter of course.

Back friendly lying

On average, we spend a third of our lives sleeping and our bed should be more important than any other object in our home. Often this is not the case, many people buy the next best or cheapest bed or simply a new mattress. It is easy to forget that the slatted frame underneath must also meet many requirements. The same goes for the pillow and duvet. Otherwise, the intervertebral discs which are naturally exposed to considerable strain day after day, can no longer regenerate sufficiently and the muscles cannot relax. Poor sleep is also noticeable in other ways, tiredness limits our ability to perform and concentrate and can also affect our mood.

  • The important foundation is a back friendly bed system consisting of an appropriate base and mattress.
  • The bed should support the spine according to its own shape in the supine and lateral position.
  • Movement while lying down or sleeping must be supported and facilitated. A sinking effect should be avoided. Detailed information on mattresses and co. here at www.agr-ev.de/bedsystems
  • There is no such thing as a one-fits-all bed. What is ideal for person A does not necessarily suit person B. We recommend going to a specialist bed shop so as to avoid detrimental and expensive purchases.
  • A good neck support pillow prevents tension in the shoulder and neck area.
  • Also make sure you choose a duvet that suits you for a good sleeping climate to avoid associated sleep disorders.
  • Lying on your back lengthens and stretches tense muscles.
  • Make sure the temperature in the room is around 16 to 18 degrees and the humidity should be between 40 and 60 percent

Back optimised bending, lifting and carrying

That damn gravity, many a person may have thought when it came to lifting a water tank into the trunk. If you do this with your legs stretched out and your back hunched over, as unfortunately far too many people still do, you squeeze your intervertebral discs into a wedge and they don't like that at all. The more often this happens, the faster wear occurs. Sooner or later, the intervertebral disc nucleus in the middle no longer has any support, shifts backwards and painfully presses on the nerve fibres of the spinal cord.

Particular attention must also be paid to back-friendly behaviour at the workplace. If things must be constantly lifted care should be taken to ensure that the design is as low load as possible. A hunched back or hollow back, but especially twisting of the spine should be avoided in the long term. The same applies to bending down. However, it should also be noted that occasional bending and lifting with a curved spine is by no means harmful for healthy people. Tips for back optimised bending, lifting and carrying are:

  • Stand as close as possible and front on to the object.
  • Place your feet at least hip-width apart.
  • Make complete foot-ground contact so that the heel also touches the ground.
  • Tighten your pelvic floor and abdominal muscles, but do not hold your breath.
  • Lift loads from the legs: Bend your legs. This is also much easier on the body because the strength then comes from the thigh, which is usually the strongest muscle in the body.
  • Keep your back straight during the work process.
  • Do not move the load unsteadily.
  • Avoid frequent one-sided twisting of the spine.
  • If possible, heavy loads should not be carried alone.
  • Also utilise aids at work.

Back friendly environment and workplace design

You have already read a lot about BEHAVIORAL PREVENTION in the previous articles. But what about RATIO PREVENTION? Relational prevention describes, among other things, the creation of a back friendly environment and workplace design. Put simply, the aim is to improve the relationship between people and objects. According to studies, almost one in two employees would like more preventative, ergonomic support from their employer in the workplace. As a side note, an average of one in four days of incapacity for work has long been due to back pain. Employers can support their employees with back friendly products and aids. Additionally, studies have shown that measures taken in order to make the working day more exercise intensive significantly increase employees' concentration and work performance.

Products bearing the AGR seal of approval are tested and recommended by doctors and therapists and are considered particularly back friendly. These cover many areas, promoting a back friendly life.

An overview of topics for which the Healthy Back Campaign provides explanations, checklists and lists of tested products can be found here. It highlights to what you must pay attention so that you can do something good for your back.

Car & truck seats

Even the backs of the many professional drivers and sales representatives can benefit from back-friendly truck and car seats. Of course, this also applies to private cars.

→ AGR-certified car and truck seats

Babies & Children

Whether at school or out and about, in a child seat, baby carriage or baby carrier, the spine should be supported in the best possible way from the outset with back-friendly products.

→ AGR-certified baby & children's products

Office & Homeoffice

Whether sitting in the office, at standing/sitting workstations or with the help of concepts for more movement in the office, excellent products help to make office work or the home office back-friendly.  

→ AGR-certified office & homeoffice products

Industry & trade

Here you will find tested products that have been proven to contribute to back health in the working day. From industrial vehicles, help lifting, carrying and packaging in industry to industrial workstations including practical tools.

→ AGR-certified products for industry & trade

Sleeping & lying

After work, back-friendly products for sleeping and lying down can provide real relaxation. Not only the mattress should be taken into account, but also the duvet and neck support pillow. The bed should be seen as a complete system.

→ AGR-certified products for sleeping and lying

Shoes

Choice of shoe is particularly important for adults and children. Shoes are often bought too small, too big or too tight. Among other things, this leads to shortened tendons as well as blisters and skin diseases. There are different requirements depending on the application of the shoe.

→ AGR-certified shoes

Sport & Leisure

Whether treating fasciae, using online training programs or cycling in the fresh air, back friendly products can also be used in sport and leisure activities to prevent back muscle pain.

→ AGR-certified products for sport & leisure

Therapy & Care

Back comfort can be positively influenced with special aids. Rollators, warming pads and back therapy devices help to relieve the burden on those in need as well as caregivers. 

→ AGR-certified products for therapy and care

Home & Garden

This also makes DIY, house cleaning or gardening easy with back friendly products. 

→ AGR-certified products for home & garden

In almost all areas of life - whether at work, on the move, during sport or at home – back friendly products can make your day more pleasant and enjoyable. The AGR seal of approval helps you to identify these products so that you can be sure that they have been tested and recommended by doctors and therapists.