Why is my back pain getting worse

Why does back pain occur?

Back pain is common. Almost everyone knows them and many visits to the doctor in Germany can be traced back to back pain. The causes are manifold. Most of the time, back pain reflects a discrepancy between aspiration and reality. We demand performance from our back that it cannot cope with due to our level of training. Our back is designed for movement (e.g. walking, running, climbing), but we mainly require static performance (e.g. sitting, standing, forced postures). We sit in the office every day, but want to hike on vacation. Our performance decreases with increasing age (approx. From the age of thirty), but we demand the same performance without additional training. In addition, emotions (fear, mood, joy) and stress on the back are reflected by increased muscle tension.

Back pain is therefore a mirror of our realities in life. With rare exceptions, they are not dangerous, always annoying and show us that we should do something differently.


Where does back pain come from?

Most of the pain comes from the muscles (myofascial pain). The required performance (claim) cannot be provided by the existing muscles (reality). An overwhelmed muscle always reacts in the same way. There is increased tension (entire muscle = muscle tension; individual muscle fibers = trigger points). The increased muscle tension reduces the blood flow to the muscle, which ultimately triggers the pain. In addition, permanent muscle pull (tension also means that the muscle is shorter than normal) overloads tendons and tendon-bone transitions (insertion tendinopathies). Muscles not only hurt locally, but can also trigger pain in distant places (radiation of pain).

Anyone who does not believe that muscles can cause such severe pain should realize that the pain of a heart attack is also triggered by a muscle with poor blood supply (heart muscle).

The causes of the incorrect strain on the muscles are a poor training condition of the muscles, non-optimal movement sequences or an imbalance (imbalance) between the stabilizing and moving muscles. An overload of the muscles can also result from permanent tension, e.g. in the case of stress, a reduced ability to relax or fear (psychophysical permanent tension).

Coordination disorders and a weakness of the stabilizing muscles lead to typical bad posture (e.g. head and shoulders are pulled forward, hollow back, pelvis tilted forward) and thus to incorrect strain on the spine and joints. Typical consequences are painful blockages (e.g. blockages of the head joints or the sacroiliac joint, rib blockages) and, in the long term, degenerative changes or overloads (intervertebral disc damage, osteochondrosis, arthrosis of the intervertebral joints). These degenerative changes are usually not painful and become more common with age. In only 5-10% of cases, the degenerative changes in the spine are the cause of back pain (specific back pain); they are usually incidental findings in X-ray or MRI images.


What does chronic back pain mean?

Chronic and acute back pain are differentiated based on the chronological sequence. Up to 6 weeks one speaks of an acute, then of a chronic back pain. The transitions are fluid. Furthermore, repeated episodes of back pain (3x / year or pain in 3 consecutive years) are referred to as chronic back pain.

In the case of acute back pain, you can often find a clear relationship between the individual causative findings (e.g. trigger points in the muscles) and the pain.

In the case of chronic back pain, there is no such clear cause-effect relationship. Although there is often a clear trigger ("I lifted myself up"), the pain is usually due to a mixture of different findings, e.g. high muscle tension due to stress combined with poor muscular stabilization of the spine and overloading of the intervertebral joints . In addition, there are changes in the processing of pain stimuli in our brain (pain memory).


Which diagnostics are useful for back pain?

As with a cold, in most cases no diagnosis is necessary.

If so, the most important measures are a medical consultation and a clinical examination. This is where the course is set as to whether further diagnostics (multimodal interdisciplinary diagnostics, MRI, X-rays, etc.) are necessary.

X-rays or MRI images that are performed without a good medical examination (“to take a look”, “just to be sure”) are not only unnecessary, but also dangerous. Unnecessary images are one of the causes of chronic back pain and often lead to unnecessary, potentially harmful, diagnostic and therapeutic interventions!

Chronic back pain has a variety of causes. A single finding often seems insignificant, but in combination with other factors it becomes more important for back pain ("it's all in the mix"). Chronic back pain requires interdisciplinary collaboration between several professional groups, doctors, psychotherapists, physiotherapists and training therapists. Multimodal diagnostics, the merging of the findings and the joint evaluation in the team are the prerequisites for the diagnosis and therapy planning. Multimodal interdisciplinary diagnostics are carried out in special therapy centers (e.g. back centers).

When do I have to see a doctor?

Numbness, paralysis, problems with bowel movements and urination should always be clarified by a doctor. Symptoms such as weight loss, unexplained elevated temperature, pain, especially at night, also require further medical diagnosis. If the pain persists for more than 6 weeks or if back pain occurs frequently (more than 3 times a year or 1-2 times a year over a period of 3 years), you should consult a doctor.


Who Treats Back Pain?

Offers against back pain are diverse and confusing. Doctors, naturopaths, physiotherapists, osteopaths, QiGong, TaiChi, yoga, neural therapy etc., some offers are not reliable, many have not been scientifically confirmed in their effect and often one finds unrealizable healing promises.

The question of who treats seriously is not easy to answer. As a rule, healing promises are problematic and should be questioned. A commitment to individual procedures (e.g. syringes and catheters, craniosacral therapy) should also be treated with caution.

A detailed survey (anamnesis) and a good physical examination should be the basis for further diagnosis and treatment and are an indication of a serious approach. The first therapeutic step is always a detailed consultation and weighing up therapeutic options. Only then can a patient make an informed and conscious decision on his path. If you are unsure, always get a second opinion!


Which therapies are useful for back pain?

Injection, tablet and rest were the classic therapies for back pain. If that didn't help, an operation could still be done. This strategy is still widely used today. On the other hand, it is not helpful and is often an effective way to make back pain chronic.

In the case of acute back pain, active handling (keeping moving, short periods of rest), if necessary a simple pain reliever and warmth, are usually sufficient to relieve the pain quickly. It helps to understand the acute pain as an indication, for example, of a reduced level of training or an increased stress load and to counteract this. The back has to be stressed in order to stay or become healthy, relief leads to more pain and problems in the long run.

If painful dysfunction of the musculoskeletal system is responsible for the acute pain, these can be addressed through manual medical, osteopathic or physiotherapeutic treatments. It is even easier and faster to treat yourself through self-mobilization (pain therapy emergency kit). A regular exercise program will help prevent these painful findings from returning.

Chronic pain requires a differentiated strategy. This should be determined on the basis of multimodal interdisciplinary diagnostics. A multimodal interdisciplinary pain therapy, i.e. treatment by a team of doctors, psychotherapists, physiotherapists and training therapists and the use of various therapy modules such as information, training, physiotherapy, medical and psychotherapeutic treatments, is often required to be successful. What matters is what a patient does differently in his or her everyday life. The pain can only change if something is done differently in everyday life (e.g. more training, taking breaks).


What is the importance of syringes and operations?

In most cases of acute and chronic back pain, neither injections nor operations make sense or are necessary.

Many scientific studies have shown that injections do not lead to a long-term improvement in back pain. However, due to short-term effects, they are still very popular with doctors and patients. Sometimes it can be helpful to give a patient improved (short-term) trainability with a syringe. It is important to weigh the medical risks (e.g. infections) against the potential benefits and note that a considerable part of the effect is based on the placebo effect (sham effect, approx. 50-80%). Repeated and regular injections are never medically beneficial.

There are two reasons for operating:

  1. If nerves are damaged by structural findings (e.g. a herniated disc), surgery can quickly relieve the stress and thus recover the affected nerves. The back pain is not the therapeutic goal of the operation, but to save the nerve. The back pain often persists or can be increased due to damage to the local muscles.
  2. The second reason for surgery is segmental instability of the spine. As a rule, the spine should be adequately stabilized by the own muscles. If intensive, continuous and consistent training is not enough to ensure sufficient stability, a spinal column segment can be surgically stabilized (spinal fusion). This is only the second best option! The training must be continued after the operation in order to maintain and improve the stability of the other spine sections.

You can also read our blog posts about this:
When the pain becomes chronic
What to do with back pain
Back pain in children and adolescents
An MRI is usually not necessary for back pain