Back pain

Mild to moderate complaints that occur over a short period of time are often the result of poor posture, overload or psychological and emotional challenges. You can often achieve rapid relief or even freedom from symptoms by increasing your physical activity and reducing stress or strain. In the case of chronic and acute, severe pain, however, a visit to the doctor is necessary in order to identify and treat a possible underlying disease as the cause.

Overview: What is back pain?

Experts differentiate between back pain according to various criteria:

• Duration: acute (a few days to six weeks), subacute (longer than six weeks), chronic or chronically recurrent (longer than twelve weeks)
• Frequency: single acute, recurrent or persistent
• Severity: hardly, moderately, alternately severe or unbearable (assessment using pain scale or questionnaire)
• Affected area: upper back and neck (cervical spine to upper thoracic spine), middle back (middle to lower thoracic spine) and lower back (lumbar spine, pelvis, “low back”)
• Type of back pain: non-specific, i.e. without indication of a cause or specific, i.e. the cause can be determined)
• Origin of back pain: The cause may be irritation of the nerve root, for example due to inflammation or a herniated disc (radicular), or the pain may not be caused by the nerve, but rather by the surrounding structures (intervertebral joints, muscles, fascia) (spondylogenic).

As back pain is not clearly measurable – neither by a laboratory test nor by other techniques – it is ultimately difficult to determine as a personal experience of those affected. Successful treatment is therefore measured above all by the perception and communication skills of those affected.

Back pain first emerged as a widespread complaint in the middle of the 20th century. Within this short period of time, however, back pain has developed into a widespread social phenomenon with extensive medical and health economic consequences.

Back pain: causes and risk factors

In the case of acute onset of back pain without accompanying symptoms or health problems, those affected often do not know which event triggered the pain. If symptoms occur frequently or persist for a long time, a medical diagnosis is advisable to determine the cause of the pain and to rule out any serious underlying illnesses. However, it is not always possible to determine the cause beyond doubt.

Muscles and ligaments in the back are responsible for acute and chronic complaints in over 80 percent of cases. Heavy physical work or one-sided movements over a long period of time can lead to overloading. However, a lack of exercise also tends to unbalance the back muscles.

Possible causes of so-called non-specific back pain are

• Muscle tension
• Poor posture or sitting position due to unergonomic furniture at the workplace
• unfavorable workflows
• Lack of exercise
• Draught
• Obesity
• Loss of mobility (for example as a result of an accident)
• Functional impairment (with voluntary or enforced rest)
• Reduction in physical fitness and holding muscles (age, change in life circumstances)
• Sensitivity in painful parts of the body with resulting relieving posture
• Overactivity for self-therapy for pre-existing complaints
• Psychological factors: private or professional conflict, excessive demands, dissatisfaction, overload, stress

Back experts know that our mental state plays a major role in back pain. Even in our language there are references to the connection between life circumstances and back pain:

• Personal and professional circumstances “weigh on the shoulders”,
• Some of life’s challenges are not “in the back of your mind” and you still try to “overcome” them.

The interaction of body and mind can have an unfavorable effect on mild and short-term complaints. If you suffer from frequent or severe back pain, it can therefore be helpful to seek psychotherapeutic support.

Possible causes of specific back pain are

• Herniated disc with pinched nerve
• Narrowing of the spinal canal (spinal canal stenosis)
• Osteoporosis (bone loss)
• Osteoarthritis (joint wear and tear)
• (Inflammatory) osteoarthritis of the vertebral joints
• Nerve inflammation as a result of diabetes mellitus
• advanced Lyme disease
• Syphilis (sexually transmitted disease)
• Circulatory disorders
• Alcohol, drug or medication withdrawal
• Osteomalacia (bone softening)
• Scoliosis (curvature of the spine)
• Tumor
• Inflammation of vertebrae, nerve roots or intervertebral discs following infection with a virus or bacteria (discitis / spondylodiscitis)
• Scheuermann’s disease
• Spondylolisthesis (spondylolisthesis)
• Ankylosing spondylitis / axial spondylarthritis
• Paget’s disease of the bone
• metabolic bone diseases
• Disease of internal organs (e.g. kidneys, gallbladder, pancreas, heart, abdomen, aorta)
• Period pains
• Endometriosis
• Accident / Trauma

You can influence some of the causes listed yourself. Others, however, are not easy to fix and may not be fixed at all. Back pain is always a major psychological burden. Those affected should assess their pain level with a sense of proportion. You do not need to seek medical advice immediately for every acute back pain, but in exceptional cases an emergency call may be necessary.

Symptoms: Back pain

Due to the subjective experience of pain, an assessment of the severity and extent of the symptoms can only be determined to a limited extent from an external perspective. However, there are accompanying symptoms of back pain for which you should definitely visit us. These include:

• Numbness in the leg or arm
• Tingling
• Feeling of weakness or signs of paralysis
• Pain in the legs or genital area
• Increased pain when moving, coughing or sneezing
• Restrictions on holding urine or stool
• Unusual weight loss
• Loss of appetite
• Nausea
• Dizziness
• Tendency to faint

Back pain: diagnosis at the USZ

During a medical examination, it is important that you describe your condition as realistically and comprehensibly as possible. With your help, we will localize the pain in the upper, middle or lower back and ask you about the following symptoms:

• Movement restrictions
• so-called “red flags” (indications of an underlying disease which must be clarified quickly)
• Shooting or stabbing pain
• Radiation in the leg or arm with loss of strength or sensation

Back pain: prevention, early detection, prognosis

Before back pain manifests itself, there are various signs that you can take as a warning. These include: Muscle tension, fatigue and morning stiffness of joints and back. These symptoms may be signs of permanent stress or even occasional overload. You can prevent back problems by taking the following measures:

• Load distribution: When carrying your shopping, make sure it is distributed evenly on both sides. Use two bags instead of one.
• Active bending: The legs should do the main work when bending down. This means that the body is brought into a squat position by bending the knees and the back remains straight.
• Correct lifting: When lifting heavy objects, place your legs about hip-width apart and lift the load with your back straight and as close to your body as possible. A crate of drinks should be lifted close to the torso using mainly the arms. Breathing out at the same time can help you to do this.
• Sitting correctly: Place your feet flat on the floor, thighs slightly sloping downwards, back upright. When working at a desk, your upper and lower arms should be at right angles and your head upright. The chin and neck also form a right angle. Adjust the optimum seat and table height by trial and error. In addition, you should keep changing your position and be at least minimally in constant motion.
• Stand loosely: Evenly distributing your body weight on both feet with your knees not stretched out relieves the strain on your joints and back.
• Regular exercise: Targeted back training strengthens muscles, tendons and ligaments, supports the metabolism of the intervertebral discs, trains the back and abdominal muscles and thus gives the spine the stability it needs.
• Sport: Swimming, and backstroke in particular, is the classic preventive sport. Long walks, walking or light jogging as well as cycling strengthen back health and train your fitness. Yoga and Pilates, along with Tai Chi, Qi Gong and various other gentle strength sports, can also offer a sustainable preventative option.
• Avoiding excess weight: Excess weight puts a strain on the whole body in various ways. Back problems are often a consequence of this. A balanced diet, regular exercise and abstaining from alcohol can help you lose weight.
• Mental health: Whether as a triggering consequence or interaction – the psyche plays a causal role in back pain. Regularly check your personal, professional and private situation for stress. You may be able to bring about changes in these areas that will enable you to have a more relaxed, stress-reduced everyday life. If necessary, seek support from psychotherapy.
• Relaxation: We all move between phases of tension and relaxation. To achieve a healthy balance, there are various relaxation methods, some of which you can learn and carry out yourself, such as autogenic training, meditation or progressive muscle relaxation. Enjoying art and culture also has a positive effect that should not be underestimated.

Progression and prognosis of back pain

As back pain can have various individual causes, its course can only be predicted to a limited extent. In the case of chronic, non-specific back pain, a complete cure is not always possible. The focus is then on dealing positively with the complaints. Although your health is limited, you can still consider yourself to be partially healthy. Everyday life, leisure and work can usually be continued. A positive perception of your quality of life also depends on you.

In the case of specific back pain, a cure depends on treating the cause. In addition, shifting the inner focus away from the pain can promote recovery.

Back pain: effective treatment

The complexity of the causes of back pain and the considerable interaction between body and psyche play a major role in treatment. Drug or surgical treatment may be able to eliminate the cause of the pain, but those affected continue to suffer as if from an old pain habit. It is therefore important that you play an active role in eliminating back pain yourself.