Back pain
Back pain is the most common cause of sick leave in Germany. In 2020, an average of 77.48 sick days per 100 insured years were attributed to back pain. More than enough reason for us to delve deeper into this topic. Before we get to the causes and possible treatments, we first need to look at the anatomy of the back.
The spine
The spine consists of the cervical spine, the thoracic spine, the lumbar spine, the sacrum, and the coccyx. The first three sections comprise a total of 24 free bony vertebrae, of which seven belong to the cervical spine, twelve to the thoracic spine, and five to the lumbar spine. The sacrum also has five vertebrae, and the coccyx has three to five vertebrae, which are fused together. A distinctive feature of the spine is its double-S shape, which serves to maintain balance and to cushion the forces acting on the spine during upright walking.
The eddies
A vertebra consists of a vertebral body and a vertebral arch, with a hollow space between them. This hollow space serves a specific purpose, as it houses the spinal cord. Nerve roots branch off from the spinal cord, and these roots are composed of nerve fibers that transmit information between the central nervous system (brain and spinal cord) and the peripheral nervous system (outside the brain and spinal cord). Each vertebra consists of a spinous process, to which ligaments, tendons, and muscles attach, two transverse processes, and four articular processes. Between the articular processes and behind the intervertebral discs are the facet joints, which allow flexion, lateral flexion, and rotation of the spine. The first two cervical vertebrae (atlas and axis) are unique in their shape, differing from all other vertebrae.
The intervertebral discs
The intervertebral discs, located between the vertebral bodies, are firmly attached to the periosteum of the vertebrae above and below, preventing them from slipping out of place. They consist of a fibrous ring and a gel-like nucleus pulposus and act as a cushion for the spine, absorbing shocks. To receive nutrients, the discs need movement. They must be regularly compressed and relieved of pressure. If this does not happen, or if it happens unevenly, the disc can become deformed, and in the worst case, a herniated disc can occur.
The back muscles
A large number of muscles can be classified as the back muscles, including the latissimus dorsi, the largest muscle in the human body by surface area. In their complex interplay, they all enable us to walk upright, lift objects, pull things towards us, and twist. The back muscles can be further divided into the deep back muscles, the superficial back muscles, and the erector spinae. The deep back muscles lie beneath the superficial back muscles and act exclusively on the joints of the spine. They provide the necessary stability and enable rotation and flexion. The erector spinae muscles also belong to the group of deep back muscles, fulfilling their namesake function. The superficial back muscles consist of the trapezius, latissimus dorsi, levator scapulae, rhomboid, and serratus posterior muscles. They connect the spine to other parts of the skeleton, thus enabling the movement of arms and legs.
Types of back pain – Common diagnoses
Specific vs. Non-specific back pain
First, a distinction can be made between specific and non-specific back pain. Specific back pain has a clear cause, such as falls, accidents, organic or structural changes, or even bacteria. Non-specific back pain, which affects the majority of sufferers, has no structural cause. Most often, it is muscular-fascial tension that triggers the pain, causing stiffness or blockages.
Tension and blockages
This is because our predominantly sedentary lifestyle causes certain muscles, such as the hip flexors, hamstrings, and abdominal muscles, to shorten, and their fasciae become under-supplied with nutrients. The back extensor muscles try to compensate for this, as they are responsible for maintaining an upright posture. The greater the pulling force from the front, the more these muscles have to counteract it. Thus, significant forces pull in opposite directions from the front and back, exerting immense pressure on the spine and intervertebral discs. This results in pain. However, this pain serves an important function: it protects the body from ever-increasing strain and, consequently, damage to the spine and intervertebral discs. If the tension and the associated pain are so severe that your movement is restricted or even impossible, it is often referred to as a blockage. Pinched nerves also typically originate from muscular-fascial tension. Sciatic pain is often caused by a frequently shortened hip flexor, which forces the gluteal muscles to work hard to counteract it. This impairs the blood flow in the vessels located within the nerve.
Herniated disc
For the same reasons, herniated discs can also develop. One-sided strain is detrimental to the intervertebral discs. For example, prolonged sitting compresses the disc at the front, while the back receives insufficient relief. As a result, the disc deforms and bulges. Furthermore, it essentially starves because it no longer receives enough nutrients. In the worst-case scenario, if the pressure and lack of supply become too great, a herniated disc occurs.
Scoliosis
Scoliosis (spinal curvature) is a chronic lateral curvature of the spine. The vertebrae are also twisted or even deformed. Scoliosis can occur in the thoracic spine, the lumbar spine, and the transitional regions between the two. The cause of the scoliosis is often unknown, but the cause of the pain is not. Muscular and fascial tension is frequently a contributing factor. If this tension is released, the scoliosis often becomes largely pain-free. However, this naturally depends on the degree of curvature.
Treatment depends primarily on the severity of the symptoms, the woman's age, and her desire to have children. Conventional medicine offers the option of medication or surgery. Osteopathy provides a complementary or alternative approach to the treatment of endometriosis. Visceral osteopathy, in particular, focuses on the treatment of endometriosis. At TRIUNE, we employ osteopaths specializing in visceral osteopathy. Furthermore, we are currently the only practice using the Endo Stretcher – a device that allows patients to actively participate in their treatment at home.
