What should you do if you have back pain?

Lack of exercise, poor posture and stress - these are the most common causes of the number one widespread disease. What can we do about back pain? Five experts give tips.

The orthopedist: Joachim Mallwitz

Back pain is predominantly muscular in origin. As a rule, they disappear again on their own. It is often caused by restricted movement of small spinal joints in conjunction with tension in the back muscles. Damage to nerves does not play a role in uncomplicated back pain. In the acute back pain phase, affected persons should remain in motion as much as possible. This improves blood flow to the muscles, thereby allowing an increased influx of molecules that supply energy to the cells (ATP molecules). This allows the back muscle to relax more quickly.

In addition, frequent changes in position between sitting, standing, walking and lying down improve the limited mobility of the spinal region that is disturbed by movement. Stretching exercises and heat applications (for example, a hot bath or shower, a visit to the sauna or a heat patch) also help to alleviate the symptoms. Rest or even bed rest for several days is not helpful for a speedy return to everyday life. In order not to lapse into immobility, temporary tablets (such as paracetamol) can be taken to alleviate the discomfort.

In the case of chronic back pain, stabilization treatment with back exercises for strengthening should definitely be carried out; this increases the efficiency of the trunk muscles. In addition, I advise exercising coordination as well as heart and circulation. If the back pain radiates into a leg and the leg pain clearly predominates, a doctor must be consulted in any case.

Dr. Joachim Mallwitz heads the Back Center at the Michel in Hamburg.

The sports scientist: Christiane Wilke

Exercise is the best medicine against back pain. It strengthens the muscles and helps the spine to remain intact in the long term. The intervertebral discs are also dependent on movement. They are our body's largest self-supply system and are supplied with vital nutrients such as amino acids, glucose and oxygen exclusively through the alternation of loading and unloading. This supply already starts during a walk.

Basically, any form of exercise that is fun is beneficial for the back. For people with frequent back pain, aqua fitness, Nordic walking and cycling are particularly suitable - provided that the bicycle is sufficiently cushioned. These sports largely avoid impacts to the spine, such as jogging. One advantage of aqua fitness is that important muscles are strengthened, but joints and spine are relieved at the same time. Nordic walking is a safe form of exercise that maintains long-term mobility. In cycling, the asymmetrical pedaling motion promotes deep back muscles. Specific spinal gymnastics can also provide relief.

The back extensors are also trained through intensive holding work. Those who play a game sport with a high proportion of running, such as handball, should add a unit of cycling to their weekly training to strengthen the deep back muscles. The optimum is to train two to three times a week for at least 30 minutes, preferably 45 to 60 minutes.

Dr. Christiane Wilke works at the Cologne Sports University.

The expert of the Alexander Technique: Meike Strohbach

The Alexander Technique is one of the oldest methods of holistic bodywork. It is based on the assumption that we have forgotten how to move and hold ourselves in a way that is appropriate for our bodies. Often our head, neck and back are exposed to too much strain. At the latest when pain occurs, it becomes clear that something is wrong. Then we try to hold ourselves "correctly", but in doing so - without realizing it - use even more muscle power in the wrong place.

To correct this, you should first observe yourself closely. For example: When do you unconsciously shift your head, pull your shoulder up, or tilt your pelvis? The next time you want to perform a movement consciously, pause for a moment. Notice which muscle tensions are released by this alone. Then perform the movement more consciously and with less force.

For acute back tension, I recommend lying on the floor for 15 minutes with your legs loosely apart. Support your head with books so that your neck is soft all around and does not tilt forward or back. Avoid all superfluous muscle work on the supporting surfaces. Notice how your breath spreads throughout your body. Think about how the floor supports you from below. This causes the intervertebral discs to fill with water again and better serve as a buffer. The tensions are released.

The psychologist: Julia Scharnhorst

If diseases such as a slipped disc, a tumor or osteoporosis have been ruled out, there is probably a so-called non-specific back pain. This is usually triggered by several causes: poor posture, lack of exercise and psychological factors such as stress, depression or problems at work.

Learning a relaxation method, such as autogenic training, can be helpful. This improves body awareness. Emerging tensions or bad posture can be recognized early and even prevented. At the same time, relaxation exercises counteract the feeling of helplessness in the face of pain.

It can also be useful to keep a back pain diary. In it, the severity of the pain is recorded every day (for example, on a scale from zero to 100). In addition, it is noted what one did during the day and whether there were any stressful situations. In this way, patterns can be identified over time: Is the pain perhaps related to stressful days at work? Does exercise help with the pain?

Also, it's important to distract yourself instead of constantly listening to yourself and waiting for the pain to come. It's better to schedule nice things into your daily routine that direct your awareness outward.

The fascia researcher: Stefan Dennenmoser

Recent scientific findings assign a significant role in the development of back pain to the connective tissue, the so-called myofascia. In this "packaging material of the human body", local hardening, adhesions and signs of inflammation are found in pain patients.

Often, these pain-causing lesions result from many years of incorrect posture, overloading or trauma, which can also be located far away from the back. For example, a previously sprained ankle, abdominal surgery, the sole use of one hand (dominant one-handedness), or an excessively loose pelvic floor can be the causes of fascial imbalances. These can lead to recurrent pain despite symptomatic treatment of the back.

Fascia loves mindful movements, elastic swings, slow massages, relaxing breathing exercises and active stretching. The following exercise helps against back pain: stand bent over in front of a chair and rest your hands on the seat. Breathe in and out deeply, rounding your back as you exhale. Do not tense the neck.

Complementary, the spine can make a small snake-like movement in the rounding. After a few repetitions, release the posture again and feel the "spinal snake". Helpful are also "fascia rolls" - quasi firmer swimming noodles (available in medical supply stores). They enable a clearly noticeable and pleasant self-massage. This improves the elasticity and water-binding capacity of the tissue.