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Back pain: causes, treatment, exercises

by Josephine Andrews
Published: Last Updated on 362 views

Back pain is a common ailment in modern civilization: almost everyone suffers from back pain etc. at least once in their life. Fortunately, in around 90 percent of cases the causes are not threatening. That’s why sufferers can do a lot themselves against back pain – from heat packs to exercises against back pain. Read more about the causes and treatment of back pain here.

quick overview

  • Back pain : is one of the most common types of pain and affects women in particular. Most often, the pain is located in the lower back and is non-specific (no cause can be identified).
  • Classification: by duration (acute, subacute and chronic back pain), by location (upper, middle or lower back) and by cause (specific and non-specific back pain).
  • Causes: In the case of non-specific back pain, no cause can be identified. On the other hand, specific back pain has a verifiable trigger (muscle tension, vertebral blockage , ISG syndrome, herniated disc, osteoporosis , kidney infection, heart attack, prostate inflammation, lung tumor, etc.).
  • Examinations: Depending on the patient, physical examination, blood and urine tests, neurological examination, gynecological examination, electroneurography, electromyography, X- ray , gastroscopy , computed tomography, magnetic resonance imaging (MRI), scintigraphy, cardiac catheterization , etc.
  • Treatment: In the case of specific back pain, treatment of the cause. For non-specific back pain, including heat treatment, medicinal plants, correct bending and lifting, exercise and back-friendly sport, back school, back-friendly workplace, relaxation techniques, acupuncture, possibly medication

Back pain: description & classification

Lower back pain, lumbago , stiff back or simply “having it in your back”: back pain is a diverse affliction. Sometimes it presses in the lower back, sometimes it pulls in the neck. Sometimes the back pain spreads to the flanks, arms or legs. The symptoms can be persistent or only appear intermittently. Sometimes they are so severe that those affected can hardly move.

Those affected are as varied as the type and extent of the symptoms: Back pain can plague people of almost any age. They are among the most common pain problems of all. Women in all age groups report back pain more frequently than men – a phenomenon that is also evident in other types of pain.

Doctors classify back pain according to various criteria:

Back pain: Classification according to localization

  • Back Pain – Upper Back: Pain that occurs at the top of the spine (neck region) can range from acute to chronic. They often radiate to the shoulders, arms, and/or back of the head. Triggers for neck pain are, for example, incorrect posture at work, herniated discs or psychological influences.
  • Back pain – middle back: Back pain in the area of ​​the thoracic spine is rarely caused by injuries. More often they are triggered by irritation (irritation) of large muscle groups in this area or by dysfunction of the rib-vertebral joints.
  • Back Pain – Lower Back: Back pain is most commonly located in the lower back. Because the lumbar spine (LWS) is more susceptible to injuries and damage than the cervical and especially the thoracic spine. Back pain in the lower back is called “lower-back pain”. Possible causes include herniated discs or overexertion of the muscles.

Back pain: classification according to duration

Depending on the duration of the symptoms, doctors distinguish between acute, subacute and chronic back pain:

  • Acute back pain: Acute back pain is back pain that occurs for the first time or after at least six pain-free months and lasts for a maximum of six weeks. The prognosis is generally good: Acute back pain improves within a few weeks in the majority of those affected.
  • Subacute back pain: If the back pain lasts longer than six weeks to a maximum of three months, it is considered subacute.
  • Chronic back pain: Chronic back pain or chronically recurring (recurring) back pain lasts longer than three months. The intensity of the pain can vary during this time – sometimes the back pain is weaker, sometimes stronger. Chronic back pain becomes more common with age.

Chronic back pain is usually more than just back pain. Additional diseases (comorbidities) often occur . These include, for example, wear-related (degenerative) and inflammatory joint diseases, osteoporosis, stroke, cardiac insufficiency, depression, abuse of painkillers, severe overweight (obesity) and chronic bronchitis. When a patient comes to the doctor with back pain, the doctor will take such comorbidities into account when diagnosing and treating the symptoms.

Back pain: Classification according to the cause

Depending on whether a clear cause for the symptoms can be proven or not, doctors distinguish between specific and non-specific back pain. You can read more about this in the next section.

Back pain: causes

Back pain can be roughly divided into two groups according to the cause: non-specific and specific back pain.

Non-specific back pain

In the case of non-specific back pain, the doctor cannot find a clear cause of the symptoms. The vast majority of all cases of back pain fall into this category.

Specific back pain

Specific back pain has a clearly identifiable cause. However, this does not necessarily have to be in the area of ​​the spine (such as in the case of a herniated disc). Instead, a wide variety of diseases in other organs are often the reason for the pain in the back: the spectrum ranges from shingles and pneumonia to kidney stones and heart attacks. Below you will find an overview of important causes of specific back pain:

  • Muscle tension: Very often, muscle tension is the cause of back pain. In the case of incorrect posture, one-sided strain and a lack of movement, the muscles are stressed unevenly – some muscles are overstrained, others understrained. As a result, muscles shorten or harden, which can lead to tension and pain. A pinched nerve can also result from muscle tension and cause back pain.
  • Blockage (vertebral blockage, vertebral misalignment): Over time, a tense muscle can pull a vertebra out of its normal position. Such a vertebral misalignment or blockage can also occur if you suddenly do something that your body is not used to (e.g. a jerky movement when exercising). Vertebral blockages can cause pain in the muscles, in the vertebral joints or in the exit channels of the nerves from the spinal cord. Sometimes the pain radiates to the arms or legs.
  • Sacroiliac Joint Syndrome (SIJ Syndrome): The SIJ syndrome is an example of the vertebral blockage described above and is quite common. The blockage here affects the joint between the sacrum and the pelvic bones, the so-called sacroiliac joint (ISG) or sacrum-iliac joint. In contrast to other joints in the body, it has only limited mobility because it is held together tightly by strong ligaments. In an ISG syndrome, the joint surfaces of the sacroiliac joint shift against each other and block due to increased muscle tension. This can cause back pain.
  • Herniated disc: The discs are cushion-like shock absorbers between the individual vertebral bodies. They consist of a soft gelatinous core surrounded by a ring of fibrocartilage. If the gelatinous core slips and the fibrous covering breaks through, there is a herniated disc. It causes severe back pain when the gelatinous mass escaping from the slipped intervertebral disc presses on the neighboring nerves.
    The sciatic nerve is most commonly pinched, more precisely: one of the nerve roots that emerge from the spinal cord in the lumbar vertebrae and sacrum area and unite below the pelvis to form the sciatic nerve. This thickest and longest nerve in the body runs down the back of the thigh after multiple branches down to the foot. A pinched sciatic nerve can therefore cause pain that radiates from the buttocks down the back of the leg to the foot. Such sciatica can also have other causes in addition to a herniated disc.
  • Wear and tear of the spine (arthrosis of the spinal joints, facet syndrome ): With increasing age, the spinal joints in the body wear out. If this age-related joint wear and tear goes beyond the normal level, doctors speak of arthrosis. Such arthrosis of the spinal joints can cause back pain. The symptoms occur particularly at the beginning of a movement (e.g. when getting up in the morning). During the movement, they slowly subside.
  • Spinal canal narrowing ( spinal canal stenosis ): The spinal canal with the spinal cord lying in it runs in the spinal column. This conducts nerve signals from the brain to the body and back. In the case of spinal stenosis, the spinal canal is narrowed in places and presses on the spinal cord or the exiting nerve roots. The result is back pain, for example in the area of ​​the sacrum (back pain).
  • Spinal curvature : In what is known as scoliosis , the spine is curved to the side. This leads to premature wear and tear, which can cause muscle tension and back pain, among other things. The spine also curves in a characteristic way in what is known as Scheuermann’s disease. The consequences are a hunchback (hunched back), back pain and restricted mobility.
  • Inflammation of the spine (Bechterew’s disease): This is a chronic rheumatic inflammation of the spine and the joint that connects the spine to the ilium (sacroiliac joint). As the disease progresses, it triggers deep-seated back pain and can make the joints stiffer and stiffer over time. Bechterew’s disease is therefore also called ankylosing spondylitis, which translates to “stiffening vertebral inflammation”.
  • Slipped vertebrae (spondylisthesis): In this condition, the vertebrae are unstable, so they can easily shift. This happens mainly in the lumbar region. Many of those affected have little or no symptoms. However, back pain can also occur, for example with stress and certain movements. If a displaced vertebra presses on a nerve root, neurological deficits such as sensory disturbances or paralysis are also possible.
  • Osteoporosis (bone loss): In osteoporosis, the bones become increasingly brittle. They can then break even under the slightest stress (such as falling down, bumping into something). This often leads to vertebral body collapses, which are accompanied by back pain. The preliminary stage of osteoporosis – osteopenia – can already be accompanied by back pain.
  • Pregnancy: Many pregnant women experience back pain . There are mutliple reasons for this. For example, the hormonal changes in pregnant women cause tendons and ligaments in the pelvic floor area to loosen. This causes you to lose stability, which can cause pelvic and lower back pain. In addition, the center of gravity of the woman’s body shifts as a result of the growing unborn child. To compensate, many pregnant women fall into a hollow back. This can also cause back pain. In addition, pre-term labor and early labor can also be associated with back pain.
  • Shingles: This painful skin rash is caused by the same virus that causes chickenpox (variella zoster virus). It usually forms on one side of the torso, along spinal nerves (e.g. where the belt of your pants is). Herpes zoster can cause severe back pain.
  • Acute inflammation of the prostate (prostatitis): Acute inflammation of the prostate gland ( prostate ) can cause men pain and burning when urinating, among other things, back pain.
  • Inflammation of the renal pelvis: Inflammation of the renal pelvis is usually caused by bacteria and occurs mainly in women. Especially if it is chronic, it can cause long-term back pain.
  • Kidney stones: In contrast to inflammation of the renal pelvis, kidney stones tend to occur in men. Sometimes they are so small (kidney debris) that they are simply excreted with the urine through the ureter. Larger kidney stones, on the other hand, can get stuck in the ureter. The result is renal colic, which, depending on the location of the kidney stone, can cause stabbing, cramping and wavy back pain.
  • Chest tightness (angina pectoris): When the heart muscle is temporarily starved of oxygen, it triggers an angina pectoris attack. Common signs are pain and tightness in the chest , feelings of anxiety, sudden shortness of breath, nausea, vomiting – and back pain.
  • Heart attack (myocardial infarction): The pain in the heart area that occurs during a heart attack often radiates to other parts of the body, for example between the shoulder blades in the back.
  • Inflammation of the heart muscle (myocarditis): Sometimes back pain hides an inflammation of the heart muscle . Such myocarditis is usually caused by viruses or bacteria.
  • Inflammation of the sac around the heart (pericarditis): Acute pericarditis can be triggered by pathogens (such as viruses or bacteria), other diseases or heart surgery. It causes sharp pains behind the breastbone or in the left chest. Sometimes the pain radiates to the shoulder blade region – the patient complains of back pain.
  • Enlargement of the main artery (aortic aneurysm): The saccular or spindle-shaped enlargement of the aorta occurs most frequently in the abdominal area. Such an abdominal aortic aneurysm can lead to back pain, among other things.
  • Inflammation of the lungs (pneumonia): In addition to cough and fever , back pain can sometimes be attributed to pneumonia. Inflammation is usually caused by bacteria.
  • Collapsed lung (pneumothorax): In a pneumothorax, air collects in the narrow space between the lungs and the chest wall (pleural space or pleural space). This can happen spontaneously with no apparent cause, or it can be the result of a disease or injury to the lungs. The affected lung collapses. This can be recognized, among other things, by the sudden onset of pain in the chest area, which can radiate to the back.
  • Pulmonary infarction ( pulmonary embolism ): A pulmonary embolism occurs when an attached blood clot blocks blood flow in an artery in the lungs. The result is pain in the chest, which, like in a pneumothorax, continues backwards and can trigger back pain in the chest area (thorax).
  • Inflammation of the pleura (pleurisy): Pleurisy often occurs as a result of a lung disease such as pneumonia. The dry form of the disease (little fluid in the pleural space = space between the lung and pleura) is noticeable through severe, stabbing chest pain or back pain.
  • Inflammation of the esophagus (oesophagitis, reflux disease): Inflammation of the esophagus mucosa mainly causes burning pain behind the breastbone (heartburn). These can radiate to the back.
  • Esophageal spasm (esophageal spasm): This leads to spasmodic contractions of the esophageal muscles – spontaneously or triggered by swallowing. The food pulp can then no longer be transported in the direction of the stomach. It builds up, which causes severe pain behind the breastbone. Even pain in neighboring areas of the body – such as back pain – can be due to esophageal spasms.
  • Esophageal Injuries: In rare cases, swallowing a foreign object can tear the wall of the esophagus. Even rarer are large tears, such as those caused by violent vomiting such as in bulimia. They may present with a sudden, severe pain (annihilating pain) behind the breastbone that may radiate to the back.
  • Inflammation of the pancreas (pancreatitis): Both acute and chronic inflammation of the pancreas causes pain in the upper abdomen. These often radiate backwards in the form of a belt and are then perceived as back pain.
  • Pancoast tumor: Pancoast tumor is a rare malignant growth at the apex of the lungs. Among other things, it can cause back pain, more precisely: complaints in the area of ​​the cervical spine .
  • Spinal tumor and rib tumor: Back pain can also be caused by a spinal tumor or rib tumor. Sometimes such tumors are benign, sometimes malignant. In the second case, it is almost always secondary tumors of cancerous tumors in other parts of the body, such as breast or lung cancer.

Risk factors for back pain

There are several factors that increase the risk of back pain. These include above all:

  • Work -related factors: Carrying and lifting heavy loads, vibrations (like working with a jackhammer) and working in awkward postures strain the spine, joints and muscles. This can lead to back pain over time. Therefore, some back diseases are recognized as occupational diseases.
  • Work -related psychosocial conditions: Those who are dissatisfied with their job or who have to do monotonous work from morning to night (e.g. on the assembly line) are more susceptible to back pain. Social conflicts at work and high workloads without appropriate rewards (in the form of money, recognition, opportunities for advancement, etc.) can also promote back pain.
  • Social status: Back pain occurs more frequently in people with low social status in terms of school education, occupation and income than in people with high social status.

The course of existing back pain can also be influenced by unfavorable conditions, such as psychological factors. This includes, for example, unrealistic fears about back pain, depression and passive or overactive behavior – i.e. a pronounced protective posture or too much activity.

Back pain: therapy

In the case of specific back pain , the doctor will treat the cause of the symptoms if possible. For example, in the case of a herniated disc, conservative (non-surgical) therapy is usually sufficient, such as heat applications, physiotherapy , relaxation techniques and pain-relieving or muscle-relaxing medication. Surgery is rarely necessary. If the back pain is caused by an inflammation of the renal pelvis, the doctor usually prescribes antibiotics. Bacteria are usually the cause of the inflammation.

In the case of the much more common non-specific back pain , the main aim is to alleviate the symptoms (treating the symptoms). It is primarily up to you as the patient: there is a lot you can do to relieve your back pain (back-friendly behavior, proper exercise, warmth, etc.). You may also be able to try alternative healing methods. But be careful with the many guides that are circulating mainly on the Internet. It is always best to consult a doctor before attempting any method.

  • Attitude: Your mental attitude has a major impact on your health. Your attitude towards back pain greatly influences its progression and treatment. If you are convinced that you have to put up with the pain, or if you think of a tumor whenever you feel pain, it will be difficult to get rid of the back pain. So avoid both hopelessness and catastrophic thinking about your back pain.
  • Correct bending, lifting and carrying: How do you lift a water box? By bending down with straight knees and jerking the box up? Not a good idea, because the intervertebral discs are squeezed together in a wedge shape. This one-sided load causes the intervertebral discs to age faster and become porous over time. As a result, the gelatinous core of the intervertebral discs can shift and press painfully on nerve fibers. You can avoid this by always bending your knees when lifting and setting down loads and keeping your back straight. When carrying around, you should always keep loads close to your body.
  • Back-friendly workplace: If you sit at your desk and computer a lot, you should make sure that your workplace is ergonomically designed – i.e. so that the work does not cause you health problems over time, such as painful tension in the neck and shoulder area, pain in the lumbar spine, arms and joints or tendonitis.
  • No excessive rest and bed rest! In the case of acute, non-specific back pain, many patients try to move as little as possible. Some even go to bed. Experts advise against both! Anyone who avoids movement or stays in bed for fear of the pain encourages the symptoms to become chronic (chronification). Instead, you should continue with your normal everyday activities even if you have acute non-specific back pain. A walk can also do you good. The back muscles are relaxed and the vertebral joints are gently moved.
  • Exercise and sport: Exercise therapy and back-friendly sport are recommended for subacute and chronic non-specific back pain, but not for acute back pain. The term “back-friendly sport” means less specific sports. Rather, it depends on the right training dose, a targeted training structure and good technique – then positive effects can be achieved with a wide variety of sports for back pain. Targeted strength training is particularly effectiveto strengthen the deep muscles in the torso area: the stronger the back and abdominal muscles, the more they help the spine with its supporting function. Such a strong muscular corset can even prevent back pain. It is best to seek advice from a sports doctor or a sports trainer who has experience with back pain patients!
  • Special exercises against back pain/back school:Different variations of squats, arm lifts, mini crunches and more – such exercises train flexibility, balance, strength and performance of the back. Under the guidance of an experienced trainer (e.g. in a back school), you should do the exercises regularly at home. This not only helps against existing back pain. Exercises like the ones mentioned above are generally suitable for strengthening the back and can therefore also prevent back problems. In the case of non-specific back pain, experts consider back school to be useful if the symptoms last longer than six weeks or keep recurring. A back school with a biopsychosocial approach should be chosen: Here the body is not viewed as a purely mechanical construct. Instead, one considers
  • Relaxation techniques: Experts recommend progressive muscle relaxation (PMR) for acute and subacute non-specific back pain when there is a high risk of the symptoms becoming chronic. The targeted relaxation helps against stress and tension (both play an important role in back pain). If the pain is already chronic, a PMR can also be useful. Incidentally, there are other relaxation methods such as autogenic training and meditation . Many back patients have also had positive experiences with it.
  • Holistic exercise methods: Yoga, Qi Gong and Tai Ji Quan also have a relaxing effect. These holistic exercise methods are also suitable for preventing lumbago and herniated discs. In the case of painful muscle tension due to incorrect movement patterns, you can try the Alexander Technique or the Feldenkrais Method: Both methods help you to break the habit of unhealthy movement patterns.
  • Heat treatment: Heat applications (e.g. in the form of hot-water bottles, heat packs, mud baths, fango packs) relax the muscles and can provide relief for non-specific back pain. This also applies to acute complaints. Experts recommend combining heat treatment with activation (that is, movement). This can significantly improve the pain.
  • Medicinal plants: Combination preparations of ash and aspen can relieve back pain. A cream or plaster with capsaicin helps with painful muscle tension: the pungent substance from various types of paprika stimulates blood circulation locally (and thus warms you up). In combination with activating measures (exercise), this can relieve non-specific back pain. If stress-related, nervous tension is (partly) responsible for the back pain, you should drink valerian tea. It relaxes both the mind and the muscles.
  • Aromatherapy: For lumbago (low back pain), you can rub the affected area with pine, sandalwood or ginger oil. This can help alleviate the symptoms.
  • Homeopathy: For acute back pain, homeopaths recommend, for example, Aconitum C30 (acute lumbago after exposure to cold), Arnica D12 (back pain after overexertion or lifting) or Nux vomica C30 (nervous tension and tension). The homeopath will advise you on the selection and dosage of the preparations.
  • Schuessler salts: Ferrum phosphoricum D6 is said to relieve acute back pain. To do this, the tablets are dissolved in hot water, which is then drunk in sips. Anyone who suffers from lumbago more often can try Calcium floratum D6 (taken over several weeks). It is best to consult a naturopath or doctor with experience in the field of Schuessler salts for the selection and dosage of the remedy.
  • Bach flower therapy: If there is psychological tension behind the back pain, taking Bach flowers can help: For example, Rock Water is recommended for those who lack flexibility and rigid adherence to principles. Oak , on the other hand, is used when someone demands a lot from themselves and is never satisfied with themselves. The advice of a Bach flower expert will help you to choose the right remedy.
  • Traditional Chinese medicine: TCM experts see lumbago and herniated disc as a weakness of kidney qi or kidney yang. Acupuncture and herbal treatments are used to strengthen the patient’s kidneys. Acupuncture and moxibustion of the bladder meridian can also be helpful. According to conventional medicine, acupuncture can be tried for chronic non-specific back pain and in certain cases of acute non-specific complaints (e.g. when conventional medical treatments do not help).
  • Ayurveda: From the point of view of an Ayurveda expert, low back pain (lumbago, lumbago) is to be regarded as an excess of Vata. Vata-reducing oil massages and herbal oil enemas should quickly remedy this.
  • Back-friendly nutrition: Bones, joints, muscles and intervertebral discs need a lot of nutrients in order to be able to fulfill their tasks. Therefore, make sure you have an adequate supply of essential fatty acids, calcium, fluoride, vitamins C, D and E as well as B vitamins, magnesium, boron, selenium and zinc . This is not only good for the back, but also promotes general health.
  • Drink a lot: The nutrient supply of the intervertebral discs only works with a lot of liquid. This is the only way for the small shock absorbers between the vertebral bodies to remain healthy and elastic. Studies also show how important adequate fluid intake is for back pain: Anyone who drinks around two liters of water a day can often relieve their pain with it.

Experts advise against this

There are also methods that experts consider unsuitable for treating certain types of back pain. For example, cold treatment, magnetic field therapy and kinesio taping are not recommended for non-specific back problems. Patients with acute, non-specific back pain should avoid both massage and occupational therapy .

Medicines for back pain

With non-specific back pain, any physical activity can be painful. In the case of acute symptoms, many patients therefore want to move as little as possible. In the case of subacute and chronic, non-specific back pain, some sufferers refuse the exercise and sports therapy recommended by their doctor because of the pain.

In such cases, medication can be useful: They relieve the back pain to such an extent that physical activity is possible again. Over time, the dose of medication should and can be reduced: As the level of fitness increases, patients usually need less medication to move (almost) pain-free. The doctor will give each patient precise instructions on when a drug can be used, in what dosage and for how long. Patients should follow these instructions to avoid side effects or habituation effects.

Pain therapy can also be useful and necessary for specific back pain. It is usually only carried out for a short time.

In principle, different groups of active ingredients are available for the treatment of back pain. It depends on the type and severity of the symptoms which preparation is best suited in each individual case:

  • conventional painkillers (analgesics) such as ibuprofen or diclofenac
  • very strong painkillers from the group of opiates, also called opioids (opioid analgesics). In the case of severe back pain, for example after a herniated disc, they are often the first aid to enable the patient to move again. 
  • Muscle relaxants (muscle relaxants): not recommended for non-specific back pain
  • certain antidepressants, eg in the case of chronic non-specific back pain if the patient also suffers from depression or a sleep disorder

Some of these medications require a prescription, i.e. they have to be prescribed by a doctor. Among the painkillers, however, there are also preparations that are available without a prescription (e.g. with analgesic active ingredients such as ibuprofen or acetylsalicylic acid ). Nevertheless, you should discuss their use and possible side effects with your doctor in advance.

Herbal supplements are also available to relieve back pain . For example, taking willow bark extracts (capsules, tablets, etc.) can help with chronic non-specific back pain – in combination with activating measures (such as exercise therapy).

Back pain: when do you need to see a doctor?

Back pain is not always the sign of a more or less serious illness that requires a doctor’s visit. There are often relatively harmless causes behind it, for example muscle tension due to a lack of exercise or incorrect posture. However, to be on the safe side, you should see a doctor in the following cases:

  • unusual back pain
  • persistent back pain
  • increasing back pain

Back pain: investigations

To clarify back pain, the doctor will first talk to you in detail to collect your medical history (anamnesis). Possible questions are:

  • Where does the back pain occur?
  • Does the back pain radiate to other parts of the body (e.g. to the flanks or into a leg)?
  • How long has the current episode of pain been going on?
  • Have you had previous episodes of back pain? How was the pain progressing?
  • Are there factors that trigger, aggravate or alleviate the back pain (such as heat, cold, movement, etc.)?
  • How has the back pain been treated so far (medication, massages, etc.)? Were the measures successful? Did side effects occur?
  • What does the (daily) temporal course of the back pain look like?
  • How bad is your back pain? Do they interfere with everyday activities?
  • Do you have accompanying complaints or accompanying illnesses of a mental or physical nature?

The doctor will also ask what attitude you have towards your pain (for example, a pessimistic attitude). Your pain behavior is also important, for example whether you move as little as possible out of fear of the symptoms. The doctor also asks about any psychosocial risk factors such as stress, conflicts at work or a tendency to depression. All this information can be used, among other things, to assess the risk of your back pain becoming chronic.

Examinations at the doctor

After the anamnesis interview, the doctor can carry out various examinations to get to the bottom of the causes of the back pain.

  • Physical examination: The doctor pays attention to incorrect or relieving posture, for example. These often provide an important indication of the cause of the symptoms. If shingles (herpes zoster) is the trigger for the back pain, the doctor will recognize this from the typical skin rash.
  • Orthopedic examination: This is primarily indicated for the detailed clarification of low back pain (lumbago, lumbago).
  • Blood test: The measurement of various blood values ​​can, for example, provide indications of spinal wear, inflammation (such as pleurisy, prostate inflammation, kidney inflammation) or heart attack as a trigger for back pain.
  • Urinalysis: The analysis of a urine sample can eliminate or confirm the suspicion of kidney disease or acute prostate inflammation.
  • Gynecological exam: This is for pregnant women who may have back pain as a sign of labour.
  • Neurological examination: The functional and conduction status of nerve tracts is examined if the cause of the back pain could be a narrowing of the spinal cord or nerve roots (e.g. in the case of a herniated disc).
  • Electroneurography (ENG): Examination of nerve conduction in the arms and/or legs can provide indications of a herniated disc.
  • Electromyography (EMG): The measurement of the electrical activity of a muscle is also used to clarify a herniated disc as a possible cause of back pain.
  • Ultrasound examination: If the back pain is caused by an inflammation of the renal pelvis or kidney stones, an ultrasound (sonography) can bring certainty.
  • Elimination urography: With an X-ray examination of the urinary tract using a contrast medium, kidney stones can be detected as the cause of back pain.
  • Gastroscopy : A gastroscopy is performed when the cause of back pain may be in the esophagus (esophagitis, esophageal spasm, esophageal tear).
  • X- ray: A simple X-ray examination can provide information about various possible causes of back pain such as pneumonia, pneumothorax , spinal wear, spinal inflammation (Bechterew’s disease) or osteoporosis.
  • Computed tomography (CT): This is done when back pain is suspected to be caused by a herniated disc, spinal degeneration, an aortic aneurysm, pancreatitis, or a lung tumor.
  • Magnetic resonance imaging (MRI): This examination, also known as magnetic resonance imaging, can be used to investigate suspected slipped discs or inflammation of the spine (Bechterew’s disease).
  • Scintigraphy: In this nuclear medical examination, the activity status of various tissues is determined, such as bone tissue (bone scintigraphy: if Bechterew’s disease is suspected ) or lung tissue (lung scintigraphy: if pulmonary embolism is suspected).
  • Electrocardiography ( ECG ): The electrical activity of the heart muscle is examined if the cause of back pain is suspected to be heart disease (angina pectoris, heart attack , myocarditis, pericarditis).
  • Cardiac ultrasound: An echocardiogram is indicated when inflammation of the heart muscle or pericardium could be responsible for the back pain.
  • Cardiac catheterization: A cardiac catheter is placed if angina pectoris is suspected .

When which examinations are necessary

The physical examination and laboratory tests (blood, urine) are part of the routine program when diagnosing back pain. On the other hand, radiological examinations – i.e. X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) – are only recommended if specific back pain is suspected. This is deliberately avoided during the initial diagnosis of acute and uniformly chronic back pain: Too many examinations can fuel the patient’s fear that there may be a serious cause behind the back pain that has not yet been found. This can contribute to acute back pain becoming chronic (chronification).

The other very special examinations such as cardiac catheterization or scintigraphy are only carried out on patients with back pain in certain suspected cases.

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