Conditions Back pain and lower back pain

Lower back pain is extremely common, but the good news is that it is rarely dangerous. The pain usually starts suddenly and disappears after a few days or weeks. It is important to stay active when experiencing back pain. Those with back pain should continue to go about their daily activities and to exercise when possible. A protective posture, insufficient movement, and bed rest can prolong recovery.

There is almost never a single cause of back pain. “Nonspecific” pain is typically not dangerous. Lower back pain is not an indication of a back injury. That is also true for chronic or recurring back pain.

However, chronic pain can affect quality of life.

Because multiple causes often interact, even imaging tests such as magnetic resonance imaging (MRI) usually do not allow for a reliable diagnosis. Experts therefore advise against performing routine imaging of the back.

Pain in the region of the lumbar spine, i.e. in the lower region of the back between the hips and buttocks, is referred to as lower back pain or back pain. The pain is usually associated with muscle tension, often also with restriction of the range of motion.

Sudden severe pain in the lower back is referred to as lumbago.

The pain can also radiate to one or both legs. If the pain goes beyond the knee or into the foot, it is referred to as sciatica. The most common cause of this type of back pain is a slipped disc.

Although back pain and pain in the legs can occur at the same time, they do not necessarily have the same cause. If the leg pain is worse than the back pain, follows a certain nerve pathway, or occurs with other symptoms like tingling or numbness, sciatica is probably the cause.

In general, there are two types of back pain: nonspecific and specific.

In over 85 percent of those affected, there is no specific cause for their symptoms. Nonspecific lower back pain can be affected or triggered by the following factors:

• a lack of exercise and weak core muscles
• abnormal biomechanical stress or unilateral stress, e.g. due to sitting for long periods of time (at a desk), unilateral or unaccustomed strenuous manual labor
• muscle tension (also due to abnormal mechanical stress)
• psychological factors like stress, financial or family stress, anxiety, self-doubt, or diseases like depression
• changes in pain perception in the central nervous system
• hereditary predisposition

Specific causes of lower back pain can be clearly identified. Causes include narrowing of the vertebral canal, an acute slipped disc, a broken vertebral body (e.g. due to osteoporosis), or Bechterew’s disease. Therefore, different treatments are sometimes selected for specific back pain than for nonspecific back pain.

In most cases back pain usually resolves within several days or weeks even without treatment. However, many people repeatedly experience symptoms: In studies, up to half of those affected experienced a recurrence of back pain within a year.

For some people, the symptoms are more persistent and only improve slowly over many months. Or they become chronic and therefore persist for longer or keep returning.

Chronic lower back pain, i.e. pain that last for months, can have varying degrees of severity:

• sometimes severe, sometimes mild
• mild but constant
• severe and lasting

It is difficult to predict how acute or chronic lower back pain will develop.

The most effective way to prevent back pain is regular exercise.

Targeted training of the core muscles with strength and stabilization exercises is recommended. Regular exercise is also important. Studies have shown that exercises to strengthen the core muscles can reduce the frequency of back pain by 50%. 

Those who struggle with sports can reduce the frequency of back pain almost as effectively by taking regular walks. This was shown in a large study in which the participants were encouraged to go for a half-hour walk five times a week, if possible. 

For more information for example about why exercise is important when experiencing back pain, visit gesundheitsinformation.de.

A general practitioner or orthopedist will ask questions to determine the cause of back pain. Possible questions include: Is this the first occurrence of lower back pain or is the pain recurrent? What is the exact location of the pain? Does the pain occur during movement or at rest?

It is also important for the doctor to know if the patient had a recent accident, takes certain medications like cortisone products, has other diseases, has other symptoms like tingling and numbness, or has paralysis. Certain types of physical and mental strain can also play a role.

During the physical examination, the muscles are palpated to identify sites of pain and tension, reflexes are tested, and mobility is checked. Based on the patient history and the physical examination, serious health problems can usually be ruled out. It is therefore not necessary to perform additional examinations like X-ray, computed tomography, or MRI.

If there is no suspicion of a serious problem, medical societies recommend against imaging. Imaging may show a supposed cause of back pain that actually has nothing to do with the problem. A misdiagnosis can result in unnecessary or incorrect treatment and scare patients.

Examinations such as X-ray, MRI and computer tomography (CT) can also be useful if there is a concrete suspicion of a specific cause or disease. Further examinations are also sometimes recommended for symptoms that have not subsided or have worsened after several weeks.

Acute back pain almost always goes away on its own. People with severe acute back pain, e.g. in the event of lumbago, should temporarily avoid heavy lifting and be careful when bending. However, it is important to remain active as much as possible. This includes going about one’s daily life as normally as possible, for example not sitting without moving for long periods at work and avoiding lying down for extended periods. Even light physical activity, such as walking, swimming, or loosening-up exercises, is beneficial.

Some people find heat treatments, such as hot water bottles or heat pads, soothing. Anti-inflammatory painkillers like ibuprofen can also sometimes help. However, they are only recommended for a short time (a maximum of two weeks).

The best thing anyone suffering from persistent or recurrent nonspecific lower back pain can do for themselves is to stay physically active. They should not allow the pain to prevent them from doing the things that make them happy.

Many studies have shown that exercise is the most effective treatment for chronic lower back pain. Medications are only recommended as a supplementary measure and should preferably not be taken long-term because of their risks. Mindfulness training and relaxation exercises like Jacobson’s relaxation technique have been successful for some people.

Cognitive behavioral therapy can also be helpful for chronic back pain. These approaches use management strategies to help deal with pain, e.g. how to change thought patterns that can intensify pain.

Frequently recurring or persistent back pain can result in longer absences from work and affect daily life. In some cases, outpatient or inpatient rehabilitation may be an option. The goal is to reduce the pain so that patients can resume their normal daily routine to the greatest extent possible. Accordingly, this type of rehabilitation program is not only considered in cases of imminent reduced earning capacity. An application for rehabilitation is submitted through the general practitioner’s practice. 

Rehabilitation often involves multimodal pain therapy. It includes physio, movement and behavioral therapy, as well as training sessions and relaxation techniques. The therapy should be tailored to the individual situation. Rehabilitation usually lasts three weeks. 

Multimodal pain treatments are usually carried out on an outpatient basis, and sometimes also on a partial or full inpatient basis in specialized clinics. This requires referral to hospital.