Back pain


Back pain is a phenomenon that occurs to everyone in the course of life. The pain can also be expressed by pulling or burning in the back. Sometimes we know the cause relatively well, for example when we are embarrassed or injured while doing sports. However, sometimes the pain is chronic and it is difficult to find the cause or treat it. In such cases, patients often have a year-long odyssey across many different surgeons, orthopedists, and physical therapists and are still in pain.

The problem with back pain is that there is one great variety of causes there, learned from early wrong movement patterns, over Bone malpositions, up to Nerve compression with consecutive muscle loss. The large number of articles on the subject of back pain also shows how many people are affected and what volume this disease occupies in the healthcare market. This article aims at the exact causes of the most common back pain, As well as their Localization on the back illuminate.


The symptoms of back pain are widely known to all of us: If suddenly every movement causes pain in the back, the head can no longer be turned, or bending and lifting movements cause great pain, then we speak of back pain. The pain can come slowly - for weeks - or quickly, in the form of "lumbago". Often you wake up in the morning and feel pain all over your neck. This is usually the case when we have misplaced.

Depending on the origin of the back pain, one can draw conclusions about different causes. A detailed discussion of the symptoms is therefore particularly important. Whether the pain radiates to other parts of the body also plays a diagnostic role. In combination with newly occurring symptoms of paralysis, this complex of symptoms forms a so-called “red flag”, i.e. an alarm signal that requires clarification. Then no time should be lost and a doctor should be clarified quickly.

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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert


In addition to pulled muscles and pinched nerves, pain from the neck and rib area can also radiate into the back.

Since the causes can be very diverse, it is difficult to give a clearly structured classification. Since patients can usually only specify the location of the pain in everyday life and, if necessary, the development process, the causes are explained below using the anatomical conditions: If the back pain occurs more limited on the right side of the back, in the simplest case there is one Muscle strain. This can occur after heavy lifting, after excessive exercise, or after trauma such as an accident.

The pulls over the entire length of the back Erector spinae muscle, in German roughly "vertebral erector". It actually consists of many other small muscle cords and tracts, which are not anatomically defined in a completely uniform way, which is probably due to the complexity of the back muscles. The erector spinae muscle is located on both sides on and next to the spine and has the task of straightening the trunk, for example if we want to straighten or stretch ourselves after bending. It is a very strong and long muscle that can cause pain when performing the above movements. Classically, he is affected when lifting heavy loads, if they are lifted "out of the back" and not as recommended "out of the legs". Of course, almost every other muscle of the back muscles can be affected at any time, and when lifting loads, the well-known "lumbago" can typically also occur. However, the erector spinae muscle is of particular importance in the case of isolated left-sided pain, as it - symmetrically applied - represents a large muscle volume to the right and left of the spine. Muscle strains can therefore occur on the left or right side after overloading the "spinal straightener", however, as already mentioned, there are many other large muscles on the back that are affected by a strain. It should be mentioned that the muscles on the back are naturally symmetrical, and all the causes listed apply simultaneously to the right and left side.

Another large muscle in the back that can cause pain when pulled is the Latissimus dorsi muscle. It is particularly well-known among bodybuilders and strength athletes because - with sufficient training - it makes the back appear wider: it pulls at about the height of the hip up to the shoulder, and is responsible for the internal rotation and bringing the arm closer to the body. In terms of area, it forms the largest skeletal muscle in the entire body! Viewed from the front, in a trained state, it lifts itself off the side of the ribs and pulls over the armpit to the shoulder. Both excessive strain and improper strain can lead to strains of this muscle and, as a result, to left (or right-sided) back pain. In both cases, several days of rest and abstinence from training are usually sufficient to make the pain go away. This gives the body enough time to regenerate the broken muscle fibers and restore the anatomical structures. If the pain has not disappeared after several days, further imaging should be done.

A third region that should be mentioned at this point is the so-called "regio nuchae“, In German also very simple, the neck. Anatomically speaking, the neck is a very complex structure made up of many different, relatively small muscles. This is because the neck muscles have a number of tasks to do, mostly related to moving our head. These include, for example, extension, flexion, rotation, and tilt of the head. From an anatomical point of view, the neck muscles do not form part of the back muscles, but functionally they represent the continuation of the back muscles towards the head, and should therefore not go unmentioned at this point. In principle, neck pain occurs with any excessive strain on the six muscles of the neck muscles. This can be the case with all of the above-mentioned movement patterns: Typically after long flights or bus rides, our necks hurt, so we may have nodded off briefly in between, but in a position that is not good for the neck. Special neck supports may prevent this problem a little, but cannot completely prevent it. Since the head, including the brain and skull, weighs 5-10 kilograms, a constant weight pulls the neck muscles - so it's no wonder that many don't really feel recovered after a short nap in the bus, as their necks now hurt. The pain can occur in the middle, left or right of the neck, but it can also radiate to the head and lower back. Fortunately, it usually goes by within hours.

Find out more about the topic: Psychosomatic back pain

Figure back pain: causes and areas of pain points

A - neck pain
B - upper back pain
C - lumbar spine pain
Lumbago (lumbago)
D - lumboglutealgia
(Radiating into the buttocks)
E - Lumboischialgia
(Radiating into the leg)

  1. First cervical vertebra (carrier) -
  2. Seventh cervical vertebra -
    Vertebra prominent
  3. Trapezius -
    Trapezius muscle
  4. Broad back muscle -
    Muscle latissimus dorsi
  5. First lumbar vertebra -
    Vertebra lumbalis I
  6. Fifth lumbar vertebra -
    Vertebra lumbalis V
  7. Sacrum - Sacrum
  8. Tailbone - Os soccygis
  9. Iliac crest -
    Iliac crest
  10. Gluteus Middle -
    Muscle gluteus medius
  11. Gluteus Muscle -
    Muscle gluteus maximus
  12. Big Dresser -
    Adductor magnus muscle
  13. Two-headed hamstrings -
    Biceps femoris muscle

    a - Disc prolapse -
    Nucleus pulposus prolapse (from above)
    b - vertebral fracture
    (Vertebral fracture)
    c - spinal osteoarthritis -
    (Joint wear)

You can find an overview of all Dr-Gumpert images at: medical illustrations

Muscular strain or excessive strain can therefore be a cause of back pain. Form another group deeper injuries, how Herniated discs, or Bruised nerves. The latter are particularly dangerous as one nerve only has a certain tolerance limit and it for permanent damage can come. This then means one permanent failure of the muscles it supplies. In this respect, we almost have to be grateful that squeezed nerves loudly report themselves in the form of pain when it becomes "too tight" for them.

Of the Lumbago is such a case: After jerky or awkward movements, a strong pain suddenly shoots into the back. The cause is always one Bruising of the great sciatic nerve, either through a vertebral body, or through reflexively tense muscles. The body acknowledges the sudden constriction of the nerve with an uncomfortable shooting pain, usually in the lower back. As uncomfortable as the pain is, on the other hand it is also relatively harmless as long as there are no other symptoms Paralysis, or Complaints when using the toilet to be added. Lumbago is usually self-limiting and disappears after a few days. To a lumbago to prevent, by the way, it is recommended that the Strengthen back muscles through exercisesto pay attention to "healthy" movement sequences (best example: do not lift from the back, but from the legs) and close your back stretch. In lumbago, the back pain is usually in the hip area, as well as on the left and right of the spine. To speed up the healing process are recommended Heat application (extensive warm to hot showers, a hot water bottle) and possibly also Painkillerwhen the pain becomes too severe.

Furthermore, the Ribs Be affected by back pain: In everyday life we ​​only know the ribs as what forms the frontal chest. However, the ribs go almost completely around the body and meet at the back at the spine, where they are attached by small joints. Between the ribs are the so-called Intercostal muscles, also Intercostal muscles. Your job is to help inhalation to contract to increase the volume of the chest. So we need them to be able to breathe properly. In the so-called Intercostal neuralgia however, there is persistent pulling pain in the chest and back area, which is aggravated by taking a deep breath or coughing. The cause can be a number of diseases, which in the end mostly all have an irritation of the responsible nerve tracts as the cause. The pain occurs mainly in the chest area, but the back is also often affected. The Therapy is causal, that is, the cause, such as a nerve root lesion, is treated so that the subsequent pain disappears. If this is not possible, an symptomatic therapy with pain relieverswhich combats the symptoms but not the cause. The pain relievers vary depending on the strength of freely available NSAIDs like ibuprofen about Opioids like Tilidin, up to Anesthetics how Fentanylthat are also used in the OR.


If non-opioids (e.g. paracetamol, ibuprofen) do not help, your doctor may prescribe stronger pain relievers (opioids).

The therapy of back pain, like the causes, is diverse and must always target the cause. This is often not that easy to find, due to the complexity of the back and the many anatomical structures that influence it.

Ktemporary tension, Pulled muscles, or a lumbago usually pass within a few days, and normally do not require any medical clarification. Therapy is based on the symptoms. Are important here Protection, warmth, and Avoidance of the triggering movement. Since this causes pain, one is careful not to do it any more - and that is what our body wants to tell us with its pain reaction!

You should be clairaudient if you have back pain suddenly numbness, tingle, and Problems passing urine or bowel movements occur. This takes a immediate medical evaluation, as permanent damage can occur. If you cannot manage the pain with non-opioids such as ibuprofen or paracetamol, the doctor can do the same Prescribed opioids become. However, these should be taken with caution as they cause severe side effects such as addiction and drowsiness. Incidentally, among the non-opioids, paracetamol is the most suitable for use during pregnancy. However, you should always clarify an intake with your doctor.

Pain reliever therapy combats the symptoms, but in some cases it also helps operative interventions necessary to permanently eliminate the back pain. This is the case, for example, with a herniated disc, and also with all forms of permanent nerve compressionsas they can also arise from tumors or broken bones. However, operations are not a miracle cure either, and so many patients are frustrated after the operation because the pain is still there. At this point it is important that the surgeon provide realistic information, but also one physiotherapeutic follow-up treatment, and any Rehab. In combination, the greatest possible freedom from symptoms can actually be achieved for many patients.


Suitable for the prophylaxis of back pain regular exercise, and thereby Strengthening the back muscles. The muscles act like a shell that protects the skeleton and the underlying nerves and holds them together. Also you shouldn't be at one good mattress Save money and possibly seek advice from a specialist shop, as there are many different types of mattresses. In addition, is warmth (especially during sleep) important, draughty beds should be avoided. Last but not least, you should always focus on one, both during sport and at work correct movement execution, and a comfortable sitting and working position be respected. In this way, back pain can be effectively prevented.