Back pain is one of the most common reasons for patients to come to my practice. By back pain I mean the entire spine – from the cervical, thoracic, and lumbar spine. In other words, the cervical, thoracic, and lumbar regions.
Very rarely, the cause of back pain is a serious illness such as osteoporosis, tumours, inflammation, rheumatism, infections, injuries, or very severe degenerative changes. Most back pain – more than 90% – is actually muscle pain. And that is mechanical in origin, in other words caused by poor posture. Even if an MRI happens to show changes in the spine, these changes are only rarely the true cause of the pain. The true cause lies in the muscles and posture – in biomechanics, in physics.
With a healthy spine and a healthy upright posture, we have a vertical load-bearing axis. That means if we hold ourselves upright, the spine only has to bear the simple weight of the upper body. No problem. But to understand what happens when we hold ourselves crooked, we need to briefly remind ourselves of the law of the lever.
The lever law applied to your spine
Now let us assume that we bend forwards by only a small amount – 20 cm. The spine (intervertebral disc) has a diameter of 2 cm. Let us take a typical upper body weighing 30 kg.
„Force × effort arm = load × load arm"
Putting that into the formula:
30 kg × 20 cm / 2 cm = 300 kg
You bend forwards only a little, and the load on the spine has increased from 30 kg to ten times that – namely 300 kg. If the lever is lengthened tenfold, the load also increases tenfold. If we now sit for hours on a chair with the upper body bent forwards, the spine has to withstand a continuous load of 300 kg for hours on end.
Try this yourself – use the interactive lab below to see exactly how much force builds up on your spine with every shift in posture:
The musculature counters these forces constantly so that we do not topple forwards. Think of it this way: try holding a one-kilo weight in your hand with your arm outstretched. After just a few minutes, the pain in your shoulder becomes unbearable. And yet that is what we expect of the spine for hours, days, and years.
90%
of back pain is muscular
10×
load increase from 20 cm lean
1,000 kg
peak load when lifting with outstretched arms
Not only tilting the head forwards but also jutting it forwards places enormous strain on the neck muscles. As a rule of thumb: the ears should be roughly in line with the shoulders when viewed from the side. So tuck your chin in – make a double chin. Then the head is not thrust forwards and the musculature can relax.
Therefore, to counter back pain, you have to keep reminding yourself of correct posture always and everywhere, above all in everyday life. This includes stretching the muscles at the front of the body – especially the chest muscles and hip flexors – because shortened front muscles keep pulling us forwards into the wrong posture.
And keep the back straight when carrying something. Add another 20 kg carried 20 cm in front of the body to the upper body weight and we are at a load of 500 kg on the spine. If the lever arm becomes 40 cm – for example when lifting a suitcase into the boot – the load can quickly reach 1,000 kg. A classic in everyday orthopaedic practice: acute lumbago when lifting a suitcase.
„Child, stand up straight!" – Our grandmothers were right all along.
Back pain: what you can do
Do you have back pain? Don't worry. The good thing about back pain is that there is something you can do about it. If you also understand where it comes from and what the most common causes are, it goes away twice as fast.
What nobody really wants to accept is that most pain would go away with water. Yes, exactly – water. Most joint and muscle pain is a sign of dehydration. The greatest pain is often caused by our connective tissue. Connective tissue conveys not only nutrients, but sensations as well. If the connective tissue is stuck together, it is as if you had a plaster firmly stuck to the skin – and every movement tears that plaster off. Those are the pains we feel. Adhered tissue, torn apart with every movement. Joints also dry out when we do not drink enough, and simply run "dry".
Two things happen when you start moving. First, tissue fluid flows to the place where the "plaster" has just been pulled off – which is why pain subsides over the first few steps. Secondly, the body begins to lubricate itself with every movement.
Do you know how to remove a plaster painlessly? You get it really wet first. That is exactly the trick you have to apply to your back pain.
You must drink a lot and hydrate the tissue – or keep it hydrated. If you drink a genuinely large amount for a few days, you will feel considerably better. What counts as a lot?
50 ml per kilogram of body weight. That means:
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Movement is also of great importance. Five minutes every day already has an effect. For this reason, the 5-minute back training and the 5-minute fascia training are highly recommended as a starting point.
Back pain – only movement helps
Now it has been proven. A large, detailed meta-analysis evaluated 4,657 scientific publications, distilling the 85 most meaningful studies. The result? The only lasting and statistically significant effective form of treatment for back pain is movement.
Not bed rest. Not passive therapy alone. Not waiting it out. Movement.
And this can be done with joy and fun in good classes with good trainers. Even if you have little time, a 5-minute training session a day helps a great deal. With this study, the matter is settled once and for all.
🏃 Movement first
The only long-term effective treatment for non-specific chronic low back pain, confirmed across 85 high-quality studies.
⏱️ Even 5 minutes count
Short daily training sessions are significantly more effective than rest and passivity – consistency beats duration.
😊 Make it enjoyable
Group classes, good trainers, and variety increase adherence – and adherence is what actually makes the difference long-term.
Common questions about back pain
Why does back pain occur during menstruation?
During menstruation, cramping occurs in the uterine muscles. This can radiate into the lower back and lead to painful tension there. Heat helps to relieve this pain, because it loosens the cramps and the muscles can relax more easily again.
Why does back pain occur during flu?
During a viral infection, prostaglandins are released in the body. These special messenger substances are essential for the activity of the immune system – but they also trigger pain stimuli in the nerves. This results in the familiar aches and pains in the limbs, which can also manifest in the back. Added to that, spending a lot of time lying down causes tension through lack of movement.
Why does back pain occur with gastrointestinal complaints?
The deep back musculature in the lumbar spine area is very close to the large intestine. If this takes up more space than usual – for example due to flatulence – irritation can occur and lead to back pain. The unusual activity of the abdominal muscles during cramping can also affect the opposing back muscles.
Why do people often feel back pain after sleeping?
Morning back pain is usually caused by tension. This arises from poor posture in everyday life, but also from a mattress or pillow that does not suit your sleeping habits. To get rid of overnight tension, it is advisable to start the day with some gentle movement.
What are the different forms of back pain?
Back pain is classified according to where it occurs. The most common is pain in the lumbar vertebral area – sudden stabbing pain there is referred to as lumbalgia, or colloquially, lumbago. The neck area is the second most commonly affected; pain in the cervical spine is called cervicalgia.
By far the most common cause is tension from poor posture and loading – muscular causes. However, it can also arise from disc problems (bulging, prolapse) and the nerves trapped as a result, or from organ diseases whose pain radiates into the back.
When should you see a doctor?
If back pain is unusually severe, does not ease but worsens, or if numbness or signs of paralysis occur in the extremities – always consult a doctor without delay.
Quellen
1: Bredow J, Bloess K, Oppermann J, Boese CK, Löhrer L, Eysel P. Conservative treatment of nonspecific, chronic low back pain: Evidence of the efficacy – a systematic literature review. Orthopade. 2016 Jul;45(7):573–8. doi: 10.1007/s00132-016-3248-7.
