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A Healthy Back – All a Matter of Prevention

Background and Facts for the German “Day for Healthy Backs”, celebrated on the 15th of March

  1. Background research: How did the “Day for Healthy Backs” start?
  2. Fundamentals of back health
    1. A short anatomy lesson
    2. Why do we experience back pain?
    3. The most common causes of back pain
      1. Spinal discs
      2. Muscle Tension
      3. The Sciatic Nerve
      4. Shoulder-Arm-Syndrome
  3. Treatment Options
  4. Interview – Fast Facts

The 23rd of April is “World Book Day”, the 15th of May is the “International Day of Families” and the international calendar is even marked by an “International Beer Day”. Beer Day is celebrated on the first Friday of August and is mostly about appreciation and good company, but the 1st of May heralds a more serious theme: “International Workers’ Day” or “Labour Day”, a celebration of labourers and the struggle of the working classes. Such days of action are generally accompanied by related events, organised by affiliated groups. It can safely be assumed that German physiotherapists, health insurance workers, general practitioners and orthopaedic surgeons have also marked the 15th of March in red. For in Germany, the 15th of March is the “Day for Healthy Backs” – it is celebrated as well. In a society where back pain has become an epidemic, this day of action is gaining more international significance and recognition every year.

1. Background Research: How did the “Day for Healthy Backs” start?

The idea was conceived during the 2002 “Pain” forum, organised by the German Green Cross. Since then, the German Association of Back Education (BdR e.V.) took on central authority of the initiative and is responsible for organising Germany-wide events on the Day for Healthy Backs. This day of action serves to remind that a healthy back cannot be taken for granted and is a result of consistent exercise and maintenance. The Day for Healthy Backs aims to disseminate the message that back health calls for active preventative measures, and not only on the day dedicated to it. In addition, an annual conference of back health experts collaborates on and releases up-to-date information for German back education centres. Apart from this centralised initiative, there are also countless regional events that take place throughout the year.

2. Fundamentals of Back Health

To understand what a healthy back is and identify the early signs of a problem, it is necessary to have a basic understanding of how the back works.

2.1. A Short Anatomy Lesson

The Regensburg-based orthopaedic surgeon, Dr Christian Merkl, works with back health every day and is regularly published on the issue in scientific journals. He describes the structure of the spinal column as follows: in total, 30 differently shaped bones make up the spinal column from the neck to the chest and lower back. The double-S shape of the spine functions as a shock absorber for the body. “Your first 24 vertebrae are moveable. After that, there are five joined vertebrae in the sacrum at the lower end of the coccyx [lumbar region].” The term “column” suggests a fixed, stable structure, but in fact, the opposite is true. “Rather, the 24 articulated, elastically joined discs allow us to resist and compensate for impacts, pressure and countermotion.” It is for this reason that we can carry and lift things, run, sit, bend and twist. “The intervertebral discs are situated between the vertebrae. They cushion the vertebrae and enable movement”.

Of course, every load-bearing apparatus needs an appropriate support, and the spinal column is no exception. Similar to the rigging of a sailing ship, the structure of vertebrae and intervertebral discs is surrounded by muscles, fascia and bands. When this system functions uninhibitedly, it becomes an effective guard against incorrect posture.

“Walking upright is not just a mechanical feat of the skeleton but also a masterpiece of the brain and nervous system”, Merkl continues. “Without uninterrupted calculation and the constant feedback of the sensory organs and bodily reactions, we would lose our sense of balance and simply fall over.” Walking also puts pressure on the torso, vertebrae and muscles. An ergonomically correct posture, which removes strain from the spinal column, thus requires a sufficiently developed musculature. For the spinal discs, regular movement is indispensable. “They [the spinal discs] are primarily composed of water and are nourished through diffusion, an interchange of nutrients. Under little pressure, such as when lying down, the spinal discs take in fluids and nutrients, whereas a high degree of pressure causes fluids and metabolic waste to be squeezed out. Only when pressure and relief are alternated can sugars, proteins and salts reach areas of nutrient need.” Of course, pressure on the discs should not be too great, Merkl concludes.

2.2. Why do we experience back pain?

According to the German AOK (a leading health insurance provider, which insures one third of the German population), a third of all Germans claim on back pain at least once a year. Back problems are statistically the second most common cause of doctor’s appointments, preceded only by respiratory illness, and are also the reason for 15 percent of all medical leave from work. The economic consequences of this back pain epidemic are also considerable, although not all backache becomes chronic. The AOK reports that most back pain appears on a temporary basis. However, sometimes it does become permanent. “The reasons for this are varied. Too much strain on the body or unilateral movement, but also psychological burden and stress are possible causes. Incorrect bending, lifting, carrying and sitting, which put undue strain on the body, can induce or worsen back problems”, according to an AOK press report. “Prevention is therefore paramount”, the report continues. “This includes regular movement, postural exercises and avoiding excessive weight.”

Merkl has more detailed information: “Approximately 85 percent of the human population is not disposed of symmetrical biomechanics and is thus under high risk of spinal disc problems.” Posture-related factors are also significant. Merkl names inactivity, a sedentary lifestyle and unilateral pressure as well as the psyche as contributors to back pain. According to Merkl, the psyche has a significant influence on the development and remission of chronic back problems. Incidentally, the AOK identifies desk workers as a particularly high-risk demographic. In a recent press report, the AOK stated: “Aside from overburden through physical work, poor workplace conditions put strain on the spinal column. Staring at a desk for hours on end and sitting for long periods without regular posture change are ultimately detrimental to the back.”

2.3. The Most Common Causes of Back Pain

2.3.1. Spinal Discs

If weight is lifted incorrectly, the intervertebral discs can be forced to bear up to 250kg of pressure. Wear of the intervertebral discs occurs inevitably over the aging process. If discs continue to be subjected to the wrong kind of pressure, serious injury can result. Through incorrect movements, such as looking over your shoulder or bending over, a tear in the annulus (fibrous ring) can cause gel-filled nucleus material to escape from the disc. Depending on the location of the torn disc, the exit of the gel can be unnoticeable or result in intense pain.

2.3.2. Muscle Tension

Stress, incorrect posture and an uneven distribution of weight are common causes of muscle tension. If muscles remain tense for an extended period, they will not get as much oxygen as they need. The result is that the muscles tighten even more, which begins to draw tendons into the problem. Because the muscles are compromised in their natural stretching, they pull at the tendons, culminating in more pain.

2.3.3. The Sciatic Nerve

The sciatic nerve – also known as the hip nerve – begins in the lower back, runs through the buttocks and ends in the thigh. It is the most powerful nerve in the body, so irritation thereof can be very painful. If tight muscles or even a spinal disc come into contact with the sciatic nerve, pain can be felt in the sacrum, through the gluteus maximus and along the posterior of the thigh towards the knee.

2.3.4. Shoulder-Arm-Syndrome

If you experience pain in the neck area and it radiates into the arms, hands and fingertips, it was probably caused by muscle tension due to air draughts or a stiff upper neck. Whilst this is the most common type of back pain and is reasonably painful, it is relatively easy to treat.

3. Treatment Options

There is one thing that health professionals of all disciplines agree on unanimously: fight the pain first – use painkillers. If a patient avoids medication, the afflicted muscles will continue to build tension. Instead of enabling natural movement patterns, additional strain mounts on the tendons, which generally makes pain worse. The body then resorts to the least painful posture available to it, making natural movement patterns, an essential for a healthy back, impossible. The affected area should be kept warm, but cold can also help in the case of the sciatic nerve. If the pain does not recede after three to four days, consult your general practitioner. See a doctor immediately if the back pain was caused by an accident or is associated with a loss of movement, a loss of feeling in the extremities or lameness.

Due to the varied causes of back problems, their differing scope and their effects on everyday function, a detailed commentary on individual treatment methods is impossible. Moreover, conventional medical practitioners advocate a different approach to osteopaths, for example. However, all health professional agree that regular movement is the only reliable preventative measure against back pain. As a general rule, the more time you spend sitting each day, the more you should engage in high-frequency and targeted movement.

In Germany, this subject is dealt with in depth on the “Day for Healthy Backs”. Otherwise, health insurance providers and general practitioners have information on back education centres and treatment.

With reference to back pain, the 2015 “Day for Healthy Backs” put forward an interesting motto. The German Association of Back Education (BdR e.V.) and the Campaign for Healthier Backs increasingly promoted the theme of “resilience”. This defines the principle of resistance in the face of adversity and highlights the opportunity to see back pain as a chance for self-improvement. “The occurrence of acute back pain should also be used as an occasion to change perceptions and judgements of pain and to work towards a back-friendly lifestyle in the long-term”, reports the homepage of the “Day for Healthy Backs”.

4. Interview – Fast Facts

Dr. Christian Schneider is the senior doctor at the “Schön Klinik München Harlaching” private hospital. He briefly explains the anatomy of the back.

How does the back work?

The back is a stable yet flexible support for the entire body. It enables us to walk upright. There are many elements that work together in enabling upright movement: individual vertebrae are flexibly connected through intervertebral disks, and the double-S shape of the spine ensures balance. Thus, only a few components are needed for maximum stability.

What does a healthy back need?

Apart from the mentioned components, a strong musculature is a key factor in correct movement. Active muscles can ensure that all individual parts are working together seamlessly. An office chair should stimulate the muscles but should also support them.

Why do so many people suffer from back problems?

Muscles atrophy because in general, people do not get enough daily movement. Hence, the interaction between the muscles and spine becomes sub-optimal. We have to reverse this trend!

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