What do you do about back pain?
Back pain is among the most common physical complaints of our time, from sitting too long to poor posture.
Due to our lifestyle (e.g. sitting in front of the computer, in the car, in front of the TV, heavy work and due to stress) we spend many hours in a bad posture.
We hold our backs incorrectly, and this always causes increased tension in the back muscles, which aims to correct the poor posture. This increased muscle tension makes the back stiff and leads to 85% of back problems and pain.
Where do back problems come from?
Back pain is caused by over-tension of the muscles around the back. These muscles pull on the back, causing lower back pain. A vicious cycle develops, preventing the back and body from relaxing. This is the beginning of the vicious cycle – the back and body can no longer relax
Help yourself with back pain
Where do back problems come from?
Back pain is caused by over-tension of the muscles around the back. These muscles pull on the back, causing lower back pain. A vicious cycle develops, preventing the back and body from relaxing. This is the beginning of the vicious cycle – the back and body can no longer relax.
Back pain usually arises from tension in the muscles surrounding the back. These tense muscles constantly pull on the spine, which can cause lower back pain. This persistent tension makes the body increasingly less able to relax. This creates a vicious cycle: the back and body remain tense, which perpetuates or even worsens the pain.
This cycle can be caused by several factors. Poor posture puts constant strain on certain muscles. Furthermore, a lack of movement in the thoracic (chest) region of the spine place additional strain on the lower back. Overuse of the lower back, for example, due to heavy lifting or one-sided movements, also plays a significant role. Finally, difficulty relaxing to the retention of muscle tension, which hinders recovery and perpetuates the symptoms.
Incorrect sitting can lead to stiffness in the thoracic spine (the thoracic spine). Normally, this part of the spine should be able to extend about 5 degrees, which is necessary for sitting and standing upright. When this flexibility is lost, the thoracic spine often stiffens in a flexed position.
To remain upright, the cervical (neck) and lumbar (lower back) spines compensate by creating an excessive curve (hyperlordosis). This causes the joints in these parts of the spine to constantly remain in their final position, increasing the risk of wear and tear .
In addition, the muscles of the neck and lower back remain constantly tense to maintain this posture. This constant muscle tension can lead to muscle crampsand, in the long term, to muscle degeneration. Ultimately, poor posture can therefore cause a variety of complaints, such as shoulder and neck complaints (for example, thoracic outlet syndrome), tension headaches , and difficult-to-explain, “vague” back pain.
What are low back pain
Lower back pain is pain in the lower back, often caused by overuse and increased muscle tension. It's often perpetuated by poor posture, limited mobility, and difficulty relaxing.
Lower back pain is the most common musculoskeletal complaint after shoulder and neck pain. It is estimated that at any given time, at least 10% of the population in industrialized countries suffers from back pain. Annually, 35 out of every 1,000 patients consult their general practitioner because of back pain. In a small percentage of these people (less than 10%), the complaints can be explained by a specific condition. However, in more than 90% of patients, no cause can be found. This is called non-specific back pain. In principle, anyone can develop non-specific back pain. It appears that most people experience some form of back pain before the age of 30. Very often, it remains a one-time episode. However, some develop recurring complaints within a short period of time. Often, one or more of the following factors appear to be present, causing the complaints to recur.
In the majority of people with lower back pain, no clear medical cause can be identified. These so-called non-specific back complaints can affect anyone and often occur at a young age. Although for many people it remains a single episode, others experience regularly recurring symptoms. This occurs especially when the underlying contributing factors are not addressed.
Symptoms often recur due to poor posture and/or incorrect movement patterns, which repeatedly overload the back. Muscle weakness, spinal stiffness , and shortened muscles a significant role, as they reduce stability and mobility. Factors such as excess weight, limited hip function, leg length discrepancy , or pelvic instability can also cause uneven loading of the back. When several of these factors occur simultaneously, the likelihood of recurring back pain increases.
There are several factors that increase the risk of developing or recurring symptoms. For example, frequent lifting and twisting movements, especially with straight knees, can place a heavy strain on the back. Muscle weakness and poor general physical condition reduce the body's stability and load-bearing capacity.
In addition , physically demanding work , working in a single position for extended periods , and repetitive tasks increase the risk of overload. Lifting and sudden, strenuous exertion can make the back particularly vulnerable, especially when performed without proper technique. Furthermore, exposure to vibrations , for example when working with machines or vehicles, constitutes an additional risk factor. Finally, psychological factors such as depression and lifestyle choices like smoking also play a role, as they can negatively influence recovery and perpetuate symptoms.
What is the treatment for back pain?
Primary therapeutic phase.
Back pain lasting less than 4 weeks; we see a favorable course during this period, and fortunately, 74% of these people are able to return to work. Scientifically, there is no single treatment that can shorten this duration. However, this does not mean that no treatment is necessary. Physiotherapy can be very beneficial during this period in the form of good information regarding postures and movements that relieve back pressure. Additionally, pain can be addressed through massage and, for example, electrotherapy or heat packs. However, these interventions are supplementary to the advice on postures and movements.
Secondary therapeutic phase.
Back pain lasts between 4 and 7 weeks; this is the critical phase in the treatment of lower back pain. The graph shows that after 4 weeks, the natural progression becomes less favorable. If no intervention is performed, we see impending dysfunction, and it is clearly necessary to work on activity management. Research has shown that treatment during this phase is fundamentally different from the first phase. The focus should be on functional training, such as building strength, coordination, and stabilization, as well as improving fitness. Research has shown a positive relationship between fitness and lower back pain.
Back pain lasts between 7 and 12 weeks; we see increasing dysfunction and only a small increase in the percentage of people who recover during this period. During this period, too, the focus of treatment is on guiding activities and maintaining functional training.
Between 12 and 26 weeks; We clearly see that the recovery rate hardly increases. It becomes more difficult to increase muscle strength, etc., through exercise therapy. However, during this period, improving functional skills is the only solution.
Back pain for more than 26 weeks. We're not seeing any changes anymore; treatment through specialized back schools is still an option to help you learn some additional skills.
Which elements influence lower back pain?
Some knowledge of the anatomy of the back and the forces acting on it will give you insight into the load and load capacity of the back.
The Backstretcherand Rolastretcher offer an alternative treatment method that has proven highly successful. The Backstretcher and Rolastretcher offer a high chance of recovery for the following complaints: repetitive stress injury (RSI), lower back pain, stiff neck, tension headaches, radiating pain to the shoulders, stiff thoracic spine, and increased lordosis. Rehabilitation always begins with improved posture. The Backstretcher and Rolastretcher offer you the opportunity to correct your back posture daily. The operating principle is based on Shiatsu massage. Shiatsu Nederland supports the use of the Backstretcher.
When we look at the spine from the side, we see that it naturally has curvatures. The forward curvature is called lordosis, and the backward curvature is called kyphosis.
From top to bottom, we see cervical lordosis, thoracic kyphosis, and lumbar lordosis.
When these curvatures become too great, we speak of postural deviations. For example, an increased lumbar lordosis (a pronounced hollow back) is often seen in people with weak abdominal muscles.
Between the vertebrae are the intervertebral discs, which often play a significant role in the development of back pain. The lower two intervertebral discs, in particular, are often subject to heavy strain.
To better understand how the back functions, we'll use a motion segment as an example. A motion segment refers to two vertebrae connected by intervertebral joints, or facet joints. Between the vertebrae is the intervertebral disc, and on the side is the nerve pathway that runs from the spinal cord. The facet joints connect the vertebrae and allow them to move relative to each other. Like other joints in the body, these joints are susceptible to arthritis and osteoarthritis. The nerve pathways between the vertebrae transmit information from the legs to the brain in the lower back. Leg pain can be caused by irritation of the nerve pathway.
It's not entirely clear what causes the pain in the lower back. It's not just the intervertebral disc that plays a role, but also the facet joints, or intervertebral joints, along with nerve irritation. The image on the left shows a movement segment where the intervertebral disc is narrowed and there is irritation of the intervertebral joint. The nerve is compressed, and the extent to which you experience discomfort depends on the pressure on the nerve and the movements in this movement segment. Furthermore, changes in this movement segment can cause one vertebra to shift easily relative to another. This creates instability that can irritate the nerve. Depending on the intensity of this irritation, we feel the pain either solely in the back or radiating to both legs. The radiation rarely extends beyond the knee.
This instability can cause the muscles in the back to tense up, locking the spine in place to protect it. However, prolonged back muscle spasms also cause pain. The back feels hard and stiff, and sometimes even leads to a forced posture to avoid the pain.
When the nerve is stimulated on one side, we see that the radiation to the left or right leg becomes more prominent. This radiation often extends beyond the knee, and during examination, we see that the pain increases with tests that stretch the nerve. This stimulation of the nerve is often called sciatica, after the name of the posterior leg nerve, the sciatic nerve.
In summary, we see the following structures playing a role in stimulation within a movement unit:
- The intervertebral disc
- The intervertebral joints
- The nerve that is stimulated in the intervertebral space
We often see that intervertebral disc pain increases with prolonged sitting and hunched postures because the pressure in the disc is then directed more to the back where the nerves run. Prolonged standing and arching of the back increase the irritation of the intervertebral joints. Especially with arthritis (= inflammation of the joint) or osteoarthritis (aging of the articular cartilage), we see that prolonged standing and walking increases the pain.
Many back problems are a consequence of intervertebral disc degeneration. Different postures and movements of the back cause pressure changes in the intervertebral disc. In particular, movements of the back that result in a rounded posture cause the intervertebral disc to bulge backward. The image above shows that the pressure in the intervertebral disc can increase from 25 kg to 275 kg in different postures. It is therefore logical to explain that for back problems caused by the intervertebral disc, lying down provides pain relief, while sitting for extended periods in a low, soft chair (think of a car seat) causes the most discomfort. Forward-leaning postures also cause high pressure in the intervertebral disc, which is directed backward.
In the picture: Intradiscal pressure in the third lumbar intervertebral disc in the following body positions (from left to right): supine position, side position, standing, standing 20 degrees forward flexion, the same with a weight of 20 kg, sitting without support, sitting 20 degrees forward flexion, and the same with a weight of 20 kg. (after Nachemson)
The nightmare, the much-discussed Hernia
The following description illustrates how changes in the intervertebral disc can lead to a herniated disc. It's important to note that this is the final stage of the condition, and the symptoms are considered specific back pain. Your physiotherapist can accurately determine whether or not a herniated disc is suspected through a simple movement examination and will, in that case, discuss further testing with your referrer. (Incidentally, more than 80% of herniated discs heal spontaneously.)
The first changes in the intervertebral disc caused by overload are tears in the ligaments surrounding the nucleus. These tears heal in the same way as other ligaments, forming scar tissue. However, scar tissue is not as strong as the original tissue. Repeated overloading eventually causes the intervertebral disc to degenerate. Its shock-absorbing capacity diminishes, and the disc thins due to the loss of fluid from the nucleus. The tears in the ligaments can become so extensive that the contents of the nucleus press against the nerve roots. This pressure on the roots causes radiating pain along the nerve path, along with numbness and muscle weakness.
We speak of a Hernia Nucleus Pulposus, which is nothing other than the Latin name for a bulging intervertebral disc.
The images on the left and right show clear examples of hernias. Fortunately, in practice, we do not see these clear examples very often. Nevertheless, even slight pressure on the intervertebral disc can lead to severe pain. The moment neurological deficits occur, it is important to contact a doctor as soon as possible. Paralysis of the leg muscles (the inability to walk on the heels or toes), loss of bladder function, and loss of the sphincter, making it impossible to control your bowel movements, are the most common symptoms. In such cases, the bulging of the hernia is so large that the nerve pathway is completely compressed.
More news about hernias can be found on the neurochirurgie-zwolle.nl website.
Work attitude
From the above story, we can deduce that sitting is too much of a burden for many people with back pain. Properly setting up the workstation is therefore essential for treating lower back pain. More information about this can be found on the Screen Work page, which discusses in detail what to consider when setting up the workstation.
General points of attention when bending and lifting:
- Lift gently
- Lift the load as close to the body as possible
- Do not lift above shoulder height
- Avoid a maximally bent forward position of the torso
- Avoid twisting and sideways bending of the torso
- Lift with both hands
Picking up objects:
Only pick up something with the support of a well-secured object. Do this from your legs with your back straight. Be careful not to reach forward, sideways, or backward. Keep your shoulders above your hips to keep your back straight, and keep your arm beside your body. Picking up a load too far from your body is bad for your back.
Overweight, a weighty matter.
However difficult losing weight may be for many people, the fact remains that every 10 kg of excess weight places an increase of 40 kg of pressure on the intervertebral discs. At the physiotherapy department, weight is measured using a scale that indicates both weight and body fat percentage. Another way to assess weight is by calculating the Body Mass Index, which examines the ratio between height and weight. When determining the “ideal” weight, insofar as such a thing exists, measuring body fat percentage is more important than determining the body mass index in the treatment of lower back pain.
Physiotherapy and lower back pain (KNGF guideline on lower back pain).
The physiotherapist distinguishes between specific lower back pain and non-specific lower back pain. In non-specific lower back pain, no identifiable physical cause can be found for the pain, such as nerve compression or inflammation.
In 90% of cases, however, no specific cause can be found. In 60% of cases, a sudden shooting pain in the back occurs during bending or lifting. In 40% of cases, the pain gradually increases without a clear cause. Pain is the main complaint, along with back stiffness, with morning stiffness being particularly common. The natural course of the symptoms is favorable; in 80%-90% of cases, the symptoms disappear within 4-6 weeks. Physiotherapy for this group is limited to providing information and advice on how to maintain as much activity as possible in a modified manner.
An abnormal course is defined as symptoms not decreasing or even increasing after three weeks. We see that people need more rest during the day, use more medication, and are already doing less. If the course is abnormal, the physiotherapist will ask when the symptoms started and what you can and cannot do. Sometimes questionnaires such as the Quebec Back Pain Disability Scale are used for this. The Patient-Specific Complaints List (Beurskens) is also used as a measurement tool to determine the severity of your symptoms.
When physiotherapists classify lower back pain, the duration of a period of lower back pain is based on acute (0-6 weeks), subacute (7-12 weeks), and chronic (more than 12 weeks). Compared to the phase classification, we see that phase 1 corresponds to the acute period and phases 2 and 3 to the subacute period. The chronic period encompasses the other phases as described at the beginning of this brochure.
Therapies
Regarding acute back pain, scientific literature clearly indicates that bed rest is not beneficial. If bed rest is necessary, it is advised to keep it short (maximum 2 days). Staying active is the most sensible advice for acute and subacute low back pain. Therefore, in these first two phases, physiotherapy will primarily be limited to education and advice. For chronic back pain, it has become apparent that exercise therapy is beneficial in this phase. This applies particularly to a varied exercise program aimed at increasing the activity level through active participation and time-bound activities. Goals are set in consultation between the physiotherapist and the patient, and the timeframe for achieving these goals is determined. The physiotherapist determines the baseline level based on tests and builds up the therapy according to a step-by-step plan in which activities are expanded. Furthermore, there is no known literature reporting positive effects of massage, electrotherapy, ultrasound, or traction. However, exercising in water appears to be beneficial for patients with chronic back pain.