Widespread back pain

"Our lifestyle today is no longer back-friendly. And because we are getting older and older, back pain is correspondingly common," says Prof Stephan Gadola, Head of Rheumatology and Pain Medicine at Bethesda Hospital. The most common reasons for this are poor posture due to sedentary behaviour. Individual muscle groups are shortened, others lose strength and trunk stability decreases. "All of this weakens the muscle corset that supports our spine."

Intensive mobile phone use can also contribute to poor posture because it causes unnatural curves in the lumbar and thoracic spine, which can lead to headaches and neck pain. Back pain always has one cause, and often several, emphasises Gadola. "We first have to understand the pain before we can do anything about it." The lower lumbar spine is most frequently affected. "The further down, the greater the physical strain. The lower intervertebral discs carry hundreds of kilos under some loads."

Chronic poor posture favours the development of osteoarthritis, which causes pain particularly when standing for long periods or walking slowly. Pain often also occurs in the buttocks, as this is where the spine joins the sacrum, which in turn is wedged into the two pelvic bones. "This is a delicate area that needs to be well stabilised. Disc hernias, where part of the disc pushes backwards towards the spinal canal, can also be painful. Lack of exercise and malnutrition can lead to muscle atrophy and osteoporosis in a relatively short space of time in old age," warns rheumatologist Gadola. This favours the risk of vertebral fractures. A sufficient intake of calcium and protein, combined with sufficient exercise, is therefore also important in old age.

Exploit all possibilities

"Once the problem has been localised, we work on an interdisciplinary basis with various specialist areas. Physiotherapy plays an important role in balancing and correcting muscular imbalances and incorrect posture." This requires a great deal of motivation and discipline on the part of the patient. It is also important to reactivate the lost body awareness in the lumbar region. Activities such as dancing, yoga or Pilates can be helpful and fun. Customised medication is used to combat the pain. According to Prof Gadola, medication is of "very little to no use" for the very common pain in muscles and fasciae, but it does help with pain caused by vertebral joint arthrosis or disc hernias.

"In these cases, we have the option of using pinpoint infiltrations to deliver medication locally to the site of the problem. If the effect of these infiltrations wears off too quickly, the nerve supply lines can be treated using targeted electrical treatments." Surgery sometimes has to be considered as a last resort. Before this, it is worth clarifying the pain again in detail and treating it with intensive therapy during an inpatient stay, which can sometimes delay or avoid surgery. "At Bethesda Hospital, we have an ideal interdisciplinary setting with a large physiotherapy department (with medical training therapy and an exercise pool), musculoskeletal rehabilitation, our neurologists, radiologists and finally spinal surgery.

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