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
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.
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.
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.
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.