Causes of back pain
Our cross to bear: the legacy of our ancestors
The back is a central component of the human musculoskeletal system. Its passive and active structures form a complex system of muscles, bones, joints, tendons, ligaments and connective tissue that work together in perfect harmony – normally. Our modern lifestyles, however, mean that we have more muscle imbalances in our backs and we develop functional disorders.
To understand the reasons behind this, let’s take a look back at human evolutionary history. When humans switched to walking upright millions of years ago, the distribution of body weight changed. Compared to four-legged locomotion, all weight rests on two legs when walking upright.
However, the structure of the human hip joint still corresponds to the hip joint of a quadruped: its resting point is at a flexion of about 90 degrees. For us to walk upright, the hip joint must extend well beyond the right angle while the pelvis tilts forward. To compensate for the tilted pelvis, the lumbar spine is curved backwards – known as lordosis in technical terms. Furthermore, ligaments and muscles ensure that the spine is kept stable even when moving in an upright position – this is comparable to the taut ropes of a ship that always keep the ship’s mast in place, even in stormy seas.
Acute pain is a symptom
Back pain is often referred to as a ‘common illness’ – but does back pain truly mean you are ill? What are the characteristics of a healthy back? And what exactly must we do to specifically prevent back problems?
As long as they can’t feel their back, most people think that their back health is absolutely fine. If, however, a strong pain suddenly and unexpectedly shoots through the back, the fear of a serious back injury or illness immediately arises. Neither is necessarily right: even if there are no anatomical abnormalities, your back may sometimes hurt a lot. The reverse is also possible: even if the spine shows changes that could be described as medically ‘abnormal’, the affected person may still live completely comfortably.
Acute back pain is therefore not an illness, but a symptom. Pain is basically an alarm signal sent by the body to protect itself from harm. If back pain occurs, the body is indicating a disruption in the interaction between muscles, tendons, joints, vertebrae and intervertebral discs. The cause of these symptoms is only ever a specific illness in rare cases. Triggers can be physical changes or loads as well as psychological stress and nervous tension. Sometimes, however, a back pain attack occurs without an apparent reason.
A common cause is inactivity
If pain occurs as a result of back dysfunction, the causes won’t be found in the past of human history, but rather in the present. The 21st century has been shaped by technological progress. We live in a high-tech world in which automation is increasing rapidly – it makes many things easier and, above all, more convenient for us.
There’s no question about the fact that our digitised lifestyle has many advantages. However, the other side of the coin is that our backs suffer. This is because we hardly move anymore. Instead, our bodies stay in the same position while we stare at the screen of our computer or smartphone for hours. Our bodies are thus subject to unbalanced loads, resulting in misalignment and increasing difficulties in maintaining vital functions and staying healthy. This means that if natural, varied movement is missing in our everyday lives and we cannot compensate for it, we pay a high price with the degradation of our health. The results are physical discomfort, a declining quality of life, depression and pain.
Sitting is the main problem
Our bodies are made for movement. When ‘Homo erectus’ (Latin for ‘the erect human) first walked on two legs a few million years ago, there was no supermarket or pizza service – they still relied on gathering food and hunting animals. A lot has changed since the Stone Age, but some things have stayed the same. The human body is still designed for the high physical strain of hunting and gathering.
Our modern everyday lives, however, look completely different. We mainly sit – in the morning, we sit in the car or on the bus, drive to the office, sit for hours in front of a computer before getting back in the car at the end of the day, driving home, having fast food delivered to us and we then spend the evening on the couch in front of the television. Movement only takes place to a tiny extent. This has devastating consequences for our whole bodies: blood circulation slows down, vessels clog, sugar and fat metabolism becomes sluggish, inflammatory processes develop in the body, fat cells fill up and muscles break down.
Unbalanced loads
The spine in particular is affected when you sit a lot: the load is too unbalanced and static. In addition, it’s not just sitting that creates a problem, but also the unphysiological posture – for example when using our smartphones: your upper back is rounded and your head drops down. Over time, this leads to what some call ‘mobile phone neck’, which leads to painful tension. This is because lowering your head by 45 degrees corresponds to a load of over 20 kilograms. As a result, the cervical spine is constantly subjected to excessive pressure. Ligaments overstretch, muscles tense and blood circulation is impaired.
Our intervertebral discs also suffer under unbalanced loads. After all, they are almost completely free of blood vessels. They rely exclusively on the intake and release of fluids to function. This means that the spine requires loads and movement to ensure supply to the intervertebral discs. Both insufficient and excessive loads mean that intervertebral discs cannot absorb nutrients and, like a dried out sponge, become porous and lose elasticity. As a result, they can no longer fulfil their function as shock absorbers and flexible connections between the individual vertebrae, thus becoming prone to injuries.
Use it or lose it
Furthermore, a lack of movement causes the body to break down muscles. Why is that? The body is a smart spender. The body wants to get rid of anything we don’t use to save valuable energy. This, too, is part of our genetic heritage from distant times, when food was not yet available in abundance. In the event of unsuccessful hunting and gathering, it was necessary to survive long periods of fasting – and muscles require a lot of valuable energy. Loss of muscle is the body’s natural strategy to ensure its own survival and prepare for hard times.
However, the loss of muscle mass is not the only result of too little exercise as you may also develop poor posture, leading to shortened muscles and fascial bands. This creates an imbalance that misaligns the statics of the body, becomes ‘cemented’ and disrupts back function. If such a dysfunction already exists and the individual is subjected to incorrect or excessive loading, pain occurs. For fear of further discomfort, the affected person may avoid movement and assume a relieving posture. This makes the body weaker, impairs the interaction between muscles, tendons and bones, and reduces coordination skills. A vicious cycle of pain ensues.
Psychological aspects
When it comes to back pain, it’s not just physical factors that are decisive – psychological aspects also play a major role. For most of those affected, the main issue is stress in everyday life. Our lives are characterised by constant availability, numerous appointments and immense pressure to perform, putting the body in a perpetual state of alarm.
Jobs with high-pressure deadlines and performance demands can mean that you spend eight hours a day in deep concentration and a rigid, constant position at your desk. Neck and back problems thus become inevitable. This is because stress leads to increased muscle tension. If the high stress level persists throughout the day and the person affected is unable to recover by getting enough sleep, pain will arise from the muscle tension.
It is therefore important to be aware that the body is in constant communication with the psyche. All emotions such as stress, fear, anger and sadness are reflected in our postures. The perception of your own body and the effect of stress on muscle tension are key factors for preventing back pain. Once they achieve this awareness, the person concerned can train their ability to control muscle tension themselves and keep it as low as possible even in times of high stress.