Baastrup syndrome is a chronic back condition of the lower lumbar spine, which is often associated with heavy work as well as can occur in older age. It causes symptoms such as severe lower back pain, restricted mobility and poor posture, which can severely limit the quality of life of those affected. Baastrup’s syndrome is initially treated conservatively with medication, exercise and heat therapy. Only after all conservative methods have been exhausted, can surgical intervention be considered.
What is Baastrup syndrome?
Baastrup syndrome is one of the chronic pain syndromes of the lumbar spine (LS), the cause of which is usually contacting spinous processes (processi spinosi). Due to the non-physiological contact of the bony processes, moderate to severe pain occurs, which can be motion-dependent and is only slightly improved by rest. An association with degenerative diseases of the spine, such as a reduction in the height of the vertebrae with age, can often be observed. In addition, people whose occupations require heavy lifting are more frequently affected, as this also places greater stress on the spine.
Causes
There are several causes that can lead to the development of Baastrup’s syndrome. The most common cause is spinous processes that are too large. These are unpaired bony prominences that originate from the vertebral arch of a vertebra and point toward the back. Each vertebral arch therefore has only one spinous process. In their entirety, all processi spinosi are an important holding element of the deep back muscles as well as fasciae, ligaments and tendons. They contribute to the stability of the entire spine and to the upright gait. Hyperlordosis of the lumbar spine can also promote the development of Baastrup syndrome. Hyperlordosis is an excessive convex curvature of the spine forward, which leads to a convergence of the adjacent processi spinosi and can result in poor posture of the entire body in the long term. In old age, degenerative changes in the intervertebral discs are responsible for a reduction in the height of the vertebrae in relation to each other. This is also related to the development of Baastrup’s syndrome. In most cases, heavy workers and old people are affected by the disease.
Symptoms, complaints and signs
The symptoms of Baastrup’s syndrome are relatively nonspecific, especially at the beginning, and difficult to distinguish from other lumbar spine problems. Affected individuals frequently complain of increasingly severe pain in the lower lumbar spine, which improves only slightly with rest. Pain worsens especially when a hollow back is formed and when stretching. This can lead to everyday movements being severely restricted. For this reason, sufferers often adopt a protective posture, which can tend to worsen the symptoms in the long term. Physical examination reveals pressure and tapping pain in the lower lumbar spine. In addition, the pain may be aggravated by shaking the hip.
Diagnosis and course
Initial indications of the existence of Baastrup’s syndrome may be present after a consultation with a physician and a detailed physical examination. Many patients express pain in certain situations, such as cycling (jolting pain) or stretching in the morning. Imaging usually confirms the diagnosis. This involves either an X-ray or a CT scan, as these imaging techniques provide the best representation of the bony structures of the spine. The mutual contact of the spinous processes located one above the other (“kissing spines”) can be made directly visible, especially in the CT. Bony attachments (osteophytes) are often found on the adjacent bone of the vertebral arches. The deep back muscles may show calcifications in the affected regions. From time to time, local anesthesia is also performed for diagnostic purposes. This involves injecting an anesthetic into the affected region using a syringe. In this case, an improvement in pain strongly suggests the presence of Baastrup’s syndrome.
Complications
Baastrup syndrome can result in many serious complications. In most cases, patients complain of severe pain in the back. This limits the patient’s ability to move.Often, the affected persons are dependent on walking aids in order not to lose their mobility completely. The quality of life is severely restricted by Baastrup’s syndrome. In many cases, patients adopt a protective posture when the pain occurs. Although this relieves the symptoms and pain for a short time, it is very unhealthy in the long term and usually leads to a worsening of Baastrup’s syndrome. However, the pain from Baastrup’s syndrome does not have to be permanent. For some sufferers, they only occur in certain situations or when performing heavy physical labor. The hip is also affected by this pain. In severe cases, surgical intervention is possible. However, operations on the spine are very risky and not infrequently lead to complications and consequential damage. Furthermore, therapeutic treatments are possible, but they cannot completely combat the cause of the pain. They can, however, limit the pain so that ordinary everyday life is possible. Further complications and worsening can occur if the patient performs heavy physical work despite having Baastrup syndrome.
When should you see a doctor?
Since Baastrup syndrome is associated with relatively severe restrictions in the daily life and in the life of the affected person, a doctor should definitely be consulted if there is pain in the back and restricted movement in the patient. Particularly in the case of poor posture or relieving posture, a doctor should be consulted in any case to correct this posture in order to avoid further damage to the body. Especially in the area of the spine permanent discomfort occurs, which can also lead to a hollow back. As a rule, severe pain during light exertion or when pressure is applied to the back is also a sign of Baastrup’s syndrome and must be examined in any case. Also, in case of discomfort or pain on the hip, treatment by a doctor is necessary. In most cases, a family doctor can be consulted for this. Baastrup’s syndrome can be diagnosed relatively easily. The actual treatment is then carried out by massages or by physiotherapies, which can significantly alleviate and reduce the discomfort.
Treatment and therapy
Treatment of Baastrup’s syndrome is mainly conservative. Strengthening of the deep back muscles in the lumbar region through physiotherapy is important. The aim is to achieve a widening of the distance between the individual processi spinosi, which leads to pain relief. The same goal is pursued by means of trunk orthoses, which also help to improve posture. Heat and pain therapy are used in a supportive manner to avoid relieving postures and to be able to successfully implement physiotherapies. Medicinal pain therapy also contributes to an improved quality of life and can maintain the ability to work, which is a prognostically favorable factor. Only in rare cases is conservative therapy insufficient for treatment. Then surgical treatment procedures can be considered. In this case, a spinous process is removed under general anesthesia to eliminate the contact with each other and thus the cause of the pain. It should be noted that surgery in the spine is always associated with a particular risk.
Outlook and prognosis
Baastrup’s syndrome has a good prognosis and prospect of cure, provided that the patient cooperates actively. In some cases, the affected person can achieve relief and cure of the disease without seeking medical treatment and medical care. Necessary for the healing process is the building up of the musculature of the back. This can be done independently with very good prospects of success. People who feel insecure about a good and healthy muscle build-up can get the necessary help and support from a doctor. In a specific treatment plan he refers the patient to a physiotherapist and in parallel controls the achieved results. The cooperation of all parties usually leads after a few months to the alleviation of discomfort and subsequently to freedom from pain for the patient. The learned exercises should also be performed outside the therapy. This supports the healing process to a considerable extent. In addition, the patient can engage in various sports activities that optimally promote the development of his musculature.Movement sequences should also be controlled and optimized. Particularly in the case of everyday occupational stresses on the body, it is also necessary to achieve restructuring. The prospects of recovery diminish as soon as the patient suffers from further diseases of the skeletal system. If movement restrictions are already present, this makes it more difficult to build up muscles.
Prevention
A number of things can be done to prevent the development of Baastrup’s syndrome. Probably most important is consistent strengthening of the back muscles through endurance sports such as running or swimming. Strength training can be used to specifically train the deep back muscles, which serve as spacers between the individual vertebrae. Furthermore, it is important to design the workplace in a back-friendly way. It makes sense to alternate between sitting, standing and walking activities. Activities in the office should be performed alternately at the desk and at the standing desk. Lifting heavy loads should be avoided. When lifting moderately heavy, it is important to stand up from the knees rather than bending at the hips and to keep the back straight at all times. For people with an existing back condition, targeted physical therapy as well as back school may be useful.
Aftercare
After healing, the typical complaints may always recur. The patient is obliged to take preventive measures. These are aimed at strengthening the back muscles. Regular attendance at a gym is advised. For sufficient reason, a doctor may order physiotherapy. There, the patient learns exercises that he can use in his free time. There is also room for improvement in the workplace. Lifting heavy loads should always be done in the correct posture. Anyone who sits at a desk for long periods should make a point of using an ergonomic office chair. The most important indication of Baastrup’s syndrome is back pain and restricted movement. Imaging procedures such as an X-ray and a computer tomography provide information about the back structure. A physician orders these examinations in the case of acute complaints or thereby documents the progress of the disease. Baastrup’s syndrome can be present over a long period of time. This is the case when conservative treatment methods are initially given preference, even in the case of a severe condition. Given the abundance of options, it is important to find the right mix of therapies. Pain cannot always be ruled out. Patients may be given medications at their request to experience a tolerable daily life.
Here’s what you can do yourself
The most important self-help contribution that affected individuals can make is to strengthen the lower back muscles in the lumbar region. In this way, a widening of the distance between the spinous processes (bony processes on the vertebra) can be achieved, leading to a reduction in pain. At a very early stage and as a preventive measure, it is usually sufficient for those affected to engage in regular endurance sports. Sports such as running, walking or swimming are particularly suitable. In addition, the muscles can be strengthened through targeted strength training. Any good gym will have special equipment and professionally trained staff who will put together a suitable training plan for those affected. In more severe cases, especially if movement is already restricted, physiotherapeutic therapy should definitely be started. This is aimed not only at strengthening the relevant muscle groups, but also at correcting malpositions, thus counteracting further degeneration. For heavy workers, it is important to ensure correct posture when performing their work. For example, lifting should never be done bent over from the hips, but from the knees. If the employer does not offer appropriate training, those affected can seek training from a physiotherapist or request information from their health insurance provider. Anyone who works in a seated position and is affected by Baastrup’s syndrome should ensure that their workplace is ergonomically designed and, if possible, alternate between sitting and standing.
