Definition
Back pain (low back pain) has a wide variety of causes – that’s why almost everyone knows it. However, it is important to find out the corresponding cause of the pain in order to be able to initiate a specific therapy. The cause does not necessarily have to be in the area of the back. They are often based on other (urological, gynecological) causes, which must be clarified during the examination. In the following, back pain is classified according to location and quality.
Where is your back pain located?
Back pain in the area of the lumbar spine (lumbar spine) occurs frequently, since this area of the back is exposed to high loads. They affect all age groups. Colloquially, pain in this area is known as lumbago or back pain, in technical terms it is called lumbalgia.
It is also known as lumbar spine syndrome and includes a blockage of the vertebral joints, irritation of the joint capsule, fundamental overloading and tension of the muscles and ligaments of the spine. In most cases, pain medication is required as a therapy here, which, in combination with physiotherapy, should lead to the tense situation being released and the muscles being trained properly. Possible causes can be the following:
- In most cases, the pain is due to changes in the intervertebral discs.
This pain usually radiates into the buttocks or even into the leg. A herniated disc is the sudden or slowly increasing displacement of tissue from the soft core of a disc into the spinal canal (spinal canal) or backwards and sideways (nerve root). As a result, nerve root compression can occur with pain, paralysis and/or sensory disturbances.
- Lumbago is characterized by sudden, severe pain, which often occurs after a jerky movement, e.g. lifting a heavy weight.
Muscles may be strained or a herniated disc may be present.
- But also irritated and tense muscles caused by a permanent incorrect load can lead to severe pain.
- Another cause is fast, violent movements that lead to sudden pain.
- Vertebral fractures due to osteoporosis
- Tumors in the lumbar spine
- Often kidney pain is also misinterpreted and perceived as back pain. In most cases, the pain is one-sided and not motion-dependent, as is usually the case for back pain. The pain periodically increases and decreases.
You will find detailed information in the further course of this page.
- Patients with degenerative, wear-related changes in the back area suffer more frequently from back pain. These include the hollow back (hyperlordosis) or the hollow round back (hyperkyphosis), as well as weak back muscles
- Pregnancy causes the curvature of the spine and a higher weight to be carried. The pain usually disappears after the birth.
Back pain that occurs in the middle of the back can have various causes.
On the one hand, a herniated disc of the thoracic spine often leads to this symptom. Depending on the location of the affected disc, the pain can be located in the upper, middle or lower back and radiate into the arms or legs. Another possible cause is an inflammation of the vertebral bodies, whose pain is intensified by prolonged sitting.
Bending forward usually reduces the pain. Arthrosis of the vertebral joints can also cause central back pain. These pains are then usually felt as dull and are worse when standing, sitting or lying down for a long time.
In addition, the irritation of a nerve root can cause pain in the middle of the back, which then radiates into the buttocks or legs. These pains can also be triggered by severe muscle tension. In addition, gynecological problems can also lead to central back pain.
These are usually felt in the area of the sacrum and buttocks. They usually occur in combination with other complaints, such as abdominal pain or problems urinating. If the back pain is focused on one side, this may be caused by incorrect or excessive strain.A pulled muscle due to a fast movement during sports, heavy lifting over the side or other things can cause this.
This results in a temporary imbalance of the back muscles, which should not be compensated by a relieving posture. If this is attempted, the incorrect posture can become a permanent condition and cause long-term complaints with the spine. A slipped disc can also cause unilateral back pain, depending on the direction in which the disc protrudes.
If a herniated disc is present, the unilateral pain is often accompanied by unilateral numbness or paralysis in arms or legs. In the presence of an inflammatory kidney disease, such as an inflammation of the renal pelvis, which only affects the left kidney, the back hurts in the left flank. Here the cause must be clarified and if necessary an antibiotic therapy must be initiated.
Diseases of the kidney can also lead to back pain. Mostly it is then pain that occurs in the area of the flanks, i.e. in the lower back, and it can radiate into the groin area. Back pain caused by the kidneys occurs either on one or both sides, depending on which kidney is affected.
To distinguish between back pain and kidney pain, the freedom of movement can be checked. This is usually less restricted in the case of kidney pain and the pain is dull and not dependent on movement. Typical for kidney pain is that it does not have the same intensity throughout, but is sometimes worse and sometimes less severe.
A pain that worsens with a light tap on the back about two fingers wide above the iliac crest indicates problems with the kidneys. To determine whether the kidney is the cause of the back pain, a blood test should be performed to detect any inflammation in the body and a urine test to check whether blood is being excreted. Various causes can trigger kidney pain.
The most common is an inflammation of the kidney or renal pelvis caused by an infection. If an inflammation exists, the patient usually also complains of a poor general condition, fever and tiredness. Pain during urination is also common.
Inflammation caused by an infection is treated with an antibiotic. Impaired urine flow can also lead to kidney pain. This can be caused by urinary stones that settle in the kidney or ureter.
Kidney stones can lead to renal colics, which are accompanied by very severe cramp-like pain. The pain is often so severe that nausea and vomiting occur as accompanying symptoms. Here, antispasmodic drugs in combination with painkillers can help.
The pain is usually caused by the kidney stone coming loose and clogging the ureter. There are various methods for removing kidney stones. They can be destroyed by shock waves, removed through the ureter or, if they are too large, removed surgically.
In addition, kidney pain can occur during pregnancy if the unfavorable position of the child causes urine to back up into the kidney. If kidney pain radiates into the back, kidney cancer can also be the cause. The pain usually occurs at an advanced stage.
More than half of all back pain affects the lower back, but in principle back pain can occur in all areas or radiate there. In addition to the pain in the affected area, other symptoms may also occur or already be noticeable as harbingers, such as muscle tension or morning stiffness. Back pain can either occur suddenly or develop slowly over several days.
If the back pain is caused by muscle tension, the symptoms should disappear of their own accord after a few days. However, if this is not the case, a doctor should be consulted. Sudden back pain usually manifests itself as stabbing pain that may radiate into the leg.
Depending on the location of the back pain, it may also radiate into the neck. These acute back pains are often triggered by lifting too hard or by a wrong movement. Due to the pain, mobility is restricted and the patient cannot straighten up.If, in addition to back pain, numbness or tingling in the arms or legs, paralysis or incontinence are added to the back pain, these are warning signals that indicate a slipped disc in the lumbar spine.
In this case a doctor should be consulted quickly. A herniated disc can occur at different heights and cause different symptoms and pain depending on the location. Depending on whether it pinches a nerve or not, it may only cause pain or additional accompanying symptoms.
If you suffer from feelings of numbness and suspect a herniated disc of the lumbar spine as the cause, we recommend our topic: Is a herniated disc the cause of my numbness? Back pain can also be chronic. Then they are characterized by a constant increase and decrease in pain intensity, which alternates in phases.
This can be caused by wear-related protrusions of the intervertebral disc, when nerves are permanently irritated, or by wear and tear of the vertebral joints, which rub against each other during movement. Back pain is considered a widespread disease in Germany, which is statistically the second most common reason for consulting a doctor. As already mentioned, back pain is often chronic and therefore recurs time and again.
Mostly the area of the lumbar spine is affected by back pain. In many cases it is extremely difficult to find the actual cause of “chronic” back pain. It has already been pointed out above that many causes can be of an organic and/or psychological nature.
In all cases, the components of the cause can influence each other and, under certain circumstances, even reinforce each other. The task of the doctor is to find the cause of the back pain and to clarify syndromes by differential diagnosis. This is not always easy.
The various clinical pictures described above show that the underlying causes of back pain are also complex. A frequent cause of back pain is degenerative, wear-related changes in the spinal column and intervertebral disc. Individual changes must always be taken into account in the causes.
For example, patients with a hollow back (hyperlordosis) or hollow round back (hyperkyphosis), as well as patients with weak back muscles etc., may be more frequently affected by back pain. Regardless of the individual factors, there are potential causes for the development of back pain. In the following, the most important ones will be mentioned and described.
Possible causes for the development of back pain are:
- Wear and tear, arthrosis, wear and degeneration
- Mechanical causes
- Injuries in the area of the spinal column
- Neoplasia, neoplasia and tumor
- Congenital causes
- Nerve Irritation
- Compression of the nerve root
- Ignition
Over half of all pregnant women suffer from back pain during their pregnancy. These are usually harmless and are caused by the increased strain on the back due to the increasing weight. This can lead to tension in the muscles, which is painful.
Back pain during pregnancy can be divided into two groups: real back pain and pelvic pain. The real back pain is the same as that suffered by non-pregnant women and men. They are caused by overloading ligaments, muscles and joints and are often triggered by lifting too heavy loads or by incorrect movements.
If pain radiates into the back of the leg, irritation of the sciatic nerve may be responsible. Although this rarely occurs during pregnancy, it can be caused by the back pressing on the nerve. The majority of back pain during pregnancy is the so-called pelvic pain.
To avoid or prevent back pain during pregnancy, it is important to have trained back and abdominal muscles. Back exercises at home or a visit to the gym can help here. During pregnancy, pregnancy gymnastics or aqua courses can be attended in order to strengthen the muscles and alleviate or prevent pain.
In the case of already existing back pain, heat in combination with massages can prove effective. Here the gynecologist should be asked for advice.A support belt, which takes over part of the baby’s weight, can also be helpful. If back pain occurs in the first third of the pregnancy, a doctor should be consulted, as a kinking of the cervix is a possible cause.
However, complications of early pregnancy, in the worst case a miscarriage, can also cause them. As the pregnancy progresses, the contraction of the uterus or the pressure of the baby’s head on nerves of the pelvis can lead to back pain. Kidney diseases can also be a reason for this.
Due to the change in the pregnant woman’s posture, a hollow back often occurs, which leads to an incorrect load on the back and pain. Another reason for back pain during pregnancy is the onset of labor. These cause violent traction in the area of the lower back.
At this point we will discuss back pain, the cause of which is to be found in the area of the spine and neck. As an example, a few diseases have been selected which affect patients more often than average. Among these back pains are:
- The lumbago (Lumbago)A lumbago is generally understood to be sudden, severe pain in the area of the lumbar spine to the coccyx.
These back pains can radiate among other things also into adjacent areas. Sometimes considerable restrictions of movement, combined with stabbing pain in the back are the result. Lumbago is caused, for example, by damage in the area of the intervertebral disc, by pressure pain in the area of the spinous processes and much more.
The exact causes of lumbago must be determined and examined individually.
Other diseases and injuries that lead to back pain:
- Disc protrusion
- Cervicobrachialgia
- Degenerative changes of the spine
- Inflammation of the intervertebral disc
- Facet syndrome
- Cervical spine syndrome
- Lumbar spine syndrome
- ISG – Blockade
- KiSS – Syndrome
- Lumboischialgia
- Baastrup’s disease
- Forestier’s disease
- Scheuermann’s disease
- Sacroiliitis
- Whiplash
- Spinal canal stenosis
- Spondylodesis
- Spondylodiscitis
- Vertebral fracture
- Spondylolisthesis
As already described above, the causes that can be made responsible for back pain are very diverse. Very often, however, they are triggered by muscle tension. Due to these tensions, the muscle areas appear hardened and disturb the nerves surrounding them in a sometimes sensitive way.
Since some nerve tracts radiate into more distant areas of the body (e.g. the leg), pain in other areas can very often be attributed to back pain. A targeted diagnosis of the back and abdominal muscles helps to uncover deficits and imbalances in the trunk muscles and to initiate targeted therapy options. For back diagnostics However, pain is not always caused exclusively by the above-mentioned muscle tensions.
It is also possible that a patient suffers from a so-called root syndrome, for example. This syndrome is caused by disposition, age, wear and/or stress. A displaced intervertebral disc presses on the surrounding nerves and causes back pain.
Which cause can be made responsible for the development of the back pain is always up to the doctor’s diagnosis. Again and again, the subjective perception of pain/back pain must be pointed out. It is always apparent that the pain tolerance limits of people are sometimes very far apart.
Thus, there are people who diagnostically suffer from the most severe signs of wear and tear but subjectively feel no pain. However, the opposite is also possible. It can therefore be stated that there is often no correlation between the intensity of pain and the diagnosis of back pain.
As already mentioned above, it is possible that patients can get a grip on their aching back by adopting a so-called relieving posture. This relieving posture usually causes tension again, as other muscle areas are overstrained than is normally the case.Since there are different causes for the development of back pain, and since there is also a proven close relationship between pain and psyche, a careful anamnesis (= taking a medical history) appears to be essential. When diagnosing back pain, the focus of attention is often initially on the patient’s profession.
By knowing the profession, possible risk factors can already be identified (professions that are “almost” exclusively practiced in standing or sitting positions, that stand out by lifting heavy loads) or, in the case that this is not the case, excluded. So-called “pain diaries” can be used to record the degree of severity in order to find a diagnosis. In a pain diary, the patient documents his (subjectively) felt pain on a daily basis using an analogue scale.
The evaluation is usually done by the physician. In principle, the X-ray image of the spine can be described as the basic diagnosis for back pain. The x-rays provide the treating physician with an insight into the spinal column posture.
In addition, bony changes can be detected. Furthermore, sectional image diagnostics (CT and MRI, either with or without contrast medium) allows the pain to be assigned to a specific nerve or a herniated disc. Through the different diagnostic procedures, one wants to and can draw extensive information with regard to therapeutic measures to be taken.
At this point it should be noted that an additional administration of a contrast medium is usually only carried out if there is a suspicion of inflammation or tumor. In order to exclude nerve damage or to determine the degree of possible nerve damage, more extensive examinations must be performed. This can be done by means of neurological examinations.
Myelography describes an examination in which the patient is injected with contrast medium into the dural sac. The dural sac is the area surrounding the beginning of a nerve before it leaves the spinal canal. By mixing the nerve fluid and contrast medium, specific questions relating to the spinal cord can thus be better clarified.
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