Muscle tension, postural deformities and wear and tear diseases. Over 20 million people in Germany complain of back pain, some of which is chronic.
Causes of back pain
Congenital malformations of the spine, a pelvic oblique
stand, an unnoticed shortening of the legs, hollow back, flat feet or developmental disorders in childhood and adolescence can be causes of back pain. The result is:
- Muscle tension,
- Postural deformities and
- Signs of wear and tear on the vertebral bones and intervertebral discs.
In a herniated disc, the fibrous ring of the disc becomes brittle and parts of the gelatinous core come out. A herniated disc can occur at any point of the spine, but most often in the heavily loaded lumbar-
area. There is an increased risk in cases of congenital weakness of the intervertebral disc apparatus and connective tissue, as well as in cases of curvature of the spine. A too narrow spinal canal, a so-called spinal canal stenosis, can also lead to chronic pain. The same applies to scoliosis, a permanent (congenital or acquired) curvature of the spine. The latter, like spondylarthritis (ankylosing spondylitis), for example, is often treated by spondylodesis (surgical spinal fusion).
Back pain caused by osteoarthritis
Osteoarthritis is the most common joint disease. They are based on disorders of the hyaline articular cartilage matrix. After initial increased cartilage metabolism, the cell content and thickness of articular cartilage decrease. Eventually, sclerosis (bone thickening), cyst formation and marginal ridges at the joint edge occur. Although the articular cartilage itself is not innervated, possible sources of pain include the underlying (subchondral) bone, the bone marrow (increased pressure), and capsular stretching during joint instability. As in other joint diseases, inflammatory reactions lead to activation of pain receptors (nociceptors), resulting in central neuronal hyperexcitability and expansion of painful areas. The hip (coxarthrosis), knee (gonarthrosis), and spine are commonly affected, involving vertebral bodies, intervertebral discs (spondylosis), and small vertebral joints (spondyloarthritis).
Signs of wear and tear and their consequences
According to estimates, about 12 million people in Germany suffer from rheumatic complaints. In most cases, these are signs of wear and tear on the spine and joints, which lead to pain and restrictions in mobility and can ultimately result in pronounced joint arthrosis. Changes in muscles, tendons and tendon sheaths, as well as in connective tissue and bursae, can also cause severe discomfort. Both children and adults are affected by inflammatory joint rheumatism, chronic polyarthritis or rheumatoid arthritis. The onset of this disease, which occurs in episodes, is insidious. After initial pain and swelling of the joints, the skin lining the joint (synovium) thickens and releases messenger substances that promote inflammation. The joint continues to swell, and chronic inflammation destroys first the articular cartilage and later the bone. The result is pain, restricted mobility and joint deformities. Rheumatoid nodules often form on the extensor sides of the joints. The disease belongs to the autoimmune diseases, i.e. the body produces defensive substances against the body’s own substances. This leads to joint inflammation, but also explains the partial involvement of the skin and internal organs.
Osteoporosis – loss of bone mass.
Osteoporosis, also known as bone loss, is the most common bone disease in Germany, affecting approximately 6 million people. About 18 percent of all women and 8 percent of men over the age of 40 suffer from osteoporosis. One in three women over the age of 60 is affected. Osteoporosis is a continuous loss of bone mass because the normal balance of bone formation and breakdown no longer exists and breakdown predominates. Signs of osteoporosis are severe back pain on exertion and, in the advanced stages, also at rest. If there is a pronounced reduction in bone substance, fractures may occur.The most common (80-90 percent) are the so-called “primary” forms of osteoporosis (without any other underlying disease), while the “secondary” forms occur in the context of or as a consequence of another disease (e.g. diabetes mellitus, hormonal disorders) or even after taking cortisone.Sources:
Gesundheit in Wort und Bild: Rückenschmerzen, Wort und Bild Verlag, Munich, 1995.
F. Becher, E. Keck, RHEUMA: Recognize. Treat, Herder-Verlag, Freiburg, 1993
H.W. Minne, Th. von Holst (eds. ), Deutsches Grünes Kreuz and Bundesselbsthilfeverband für Osteoporose e.V. (BfO), Osteoporosis – questions and answers, Verlag im Kilian, 2000.
