Have you had acupuncture for back pain?

Dr. Dr. med. (Univ. Ancona) Uwe B. Siedow

Synonyms

Back pain, chronic back pain, lower back pain, intervertebral disc pain, intervertebral disc syndrome, sciatica, sciatica, sciatica, lumbar pain, lumbago, lumbar syndrome, lumbar root irritation syndrome, compression syndrome, lumbar, lumbar disorder, cystic nerve syndrome, spinal nerve syndrome, spinal nerve syndrome, spinal syndrome Syndrome, thoracic spine syndrome, lumbar spine syndrome.

General information

By back pain we mean pain in the middle and lower lumbar spine. A distinction is often made between pure lower back pain and pain radiating into the legs (sciatica).

Back pain must be treated early and adequately to avoid chronification. In the case of chronic back pain, common painkillers alone are often no longer effective because a pain memory has developed. This means that the back pain has taken on a life of its own in the psyche of the person concerned. Therapy for back pain is then much more difficult. An interdisciplinary approach by orthopedists, anesthetists, neurologists, psychologists and physiotherapists in the context of multimodal pain therapy is often indicated here.

Surgery pictures - Percutaneous radiofrequency treatment on the vertebral joints. (click to enlarge)

Pictures from an operation - percutaneous nucleoplasty of the intervertebral discs. (click to enlarge)


Multiple herniated discs in a patient.
(click to enlarge)

frequency

The number of people who suffer from back problems or poor posture is increasing continuously. Around 80% of Germans have had back pain at some point in their life, 30% even suffer from chronic pain. The situation is now also dramatic for children and adolescents. 44% of fourth graders already complain of occasional back pain. These numbers are thought-provoking.

In the industrialized countries, many people suffer from low back pain. It is estimated that around 80 to 90 percent of all people will suffer from low back pain at some point in their life. The 30 to 50 year olds are most frequently affected. Due to the increasing life expectancy, however, more and more older people are impaired in their quality of life due to function-impairing chronic back problems. Disc damage is one of the 20 most common diagnoses in hospital patients. Sick leave due to back pain causes a total of around 50 million lost working days per year. And of course immense costs. In addition, almost one in five early retirees owes their early retirement to their back pain.

Further information - self-help

Take the old saying, "Movement brings blessings" to your heart. Try to find out from your relieving posture. Learn important rules of conduct for the physical cope with everyday life, for example in the back school and carry out these exercises continuously at home, thus on your own. The freedom from pain in your back depends in particular on your commitment.

If you were one of those people before the back pain who moved very seldom, then use this "warning shot" and move around.

Shorter distances can be covered on foot or by bike instead of by car.

Use the stairs instead of the elevator.

Walking, swimming and cycling also train the muscles without putting any strain on the back.

To get going again, you can take a pain reliever to begin with.

In particular, you have to learn to take care of your back during stressful activities (heavy lifting and carrying, sitting for long periods, one-sided strain ...).

If you are one of those people who deal with many tasks while sitting, you should relieve your back again and again in various phases:

Loosening and stretching exercises help to relieve and relax the back. Avoid one-sided loads. Wear weights only evenly, not on one side. Never stay in the same position for more than 30 minutes. Do not carry or lift with your back bent, but with your back straight. Reduce any excess weight, because this weight also puts a strain on your back. Exercise. On the one hand, sport offers the opportunity to build up muscles, but it also offers the opportunity to lose weight.

Bed rest in the form of absolute rest is not a suitable treatment for your back. It should therefore only be considered in exceptional cases. Even then, you should seek mobilization within the next two days. A pain medication can help with this. Please contact me about this.

In any case, the goal should be to move as actively or more actively as before the pain started.

You can find more information about this at Further treatments / therapies

Symptoms

Acute, sudden attacks of pain (lumbago, lumbago) with poor posture can be caused by blockages of the small vertebral joints or by a herniated disc. Blocked sacroiliac joints (ISG) are often the cause of shooting back pain. Accompanying but also as the sole symptom, pain radiating to the legs can occur. This can, but does not have to be, caused by a herniated disc. Overloading of the ligament structures, especially the lower lumbar spine, as well as ISG blockages can also cause pain radiating to the buttocks and legs. The chronic course is usually of a wavy character, i.e. phases with acute severe lower back pain are followed by phases of freedom from pain. However, these phases can become significantly shorter in the further course, so that persistent pain develops, even at rest. Due to wear-related protrusions of the intervertebral discs, nerve roots and ligament structures can come under pressure and trigger a characteristic pain that typically worsens when sitting. The nerves are irritated by the pressure, the pain radiation (sciatica) occurs in the area of ​​the skin and muscles supplied by this special nerve root. Similar pain also occurs with a herniated disc. The small vertebral joints can also develop increasing wear (facet arthrosis), similar to other joints in the human body, so that pain occurs especially when standing and walking. The symptoms typically increase when you lean back and when you lean forward and when you sit down.

diagnosis

Questioning and tests

A thorough orthopedic exam is necessary when diagnosing back pain. First, the doctor asks the person concerned (anamnesis), followed by a physical, orthopedic examination. Rare and dangerous causes of back pain should be recognized in good time. These include, for example, an enlargement of the main artery (aortic aneurysm) or shingles. The doctor examines the posture, shape and mobility of the spine and checks whether any nerves are impaired.

Examine optically

During the orthopedic examination to assess back pain, the spine is examined from behind and from the side (inspection). When looking from behind, the following can be seen:

  • Are the two shoulder blades the same height?
  • Is the waist symmetrical?
  • Is the row of spinous processes straight?
  • Is the pelvis upright?

Changes seen during the orthopedic exam may indicate scoliosis, with minor deviations from symmetry being normal. For example, the shoulder of the preferred hand (usually on the right) is one to one and a half cross fingers lower than the other for most people.

Looking at it from the side shows whether the inward curvature (lordosis) or outward curvature (kyphosis) of the spine is stronger than normal, i.e. a hollow back or hunched back is present. Usually there is a slight lordosis in the cervical and lumbar spine and a slight kyphosis in the thoracic spine. In the case of pronounced sliding of the vertebrae (spondylolisthesis), a "step" can be seen in the row of spinous processes. The upper part of the spine slipped forward a little.

Gait pattern

During the orthopedic examination, the orthopedic surgeon can often clearly identify postural defects (e.g. hollow back) that can lead to back pain, especially when the patient is moving. The doctor therefore also assesses the gait pattern by taking the patient up and down a few steps.

Scan

During the orthopedic examination, the doctor scans the row of spinous processes to determine any possible deviation from the axis. In addition, he examines the back muscles in order to detect tense or painful muscle areas. You can also feel where the pain is greatest by feeling your back.

Agility tests

Then the mobility of the spine is tested during the orthopedic examination to assess back pain. The patient bends to the right and left. This shows whether the spine is too little or too flexible in one or more areas.

»Schober test: This is a function test for the mobility of the lumbar spine. The patient stands and the doctor marks the spinous process of S1 (first coccyx vertebra) and a point ten centimeters higher with a point.

Then the back pain patient bends forward as far as possible with the knees stretched. This normally increases the distance between the two markings by five centimeters. If there are fewer, the flexibility of the spine is reduced. This is the case with Bechterew's disease, for example.

»Adams test: Bending forward also shows whether the patient suffering from back pain has scoliosis. The ribs protrude strongly on one side and form a hump.

Nerve test

The Lasègue test used as part of the orthopedic examination to diagnose back pain is a nerve stretch test; it shows whether the sciatic nerve (nerve roots of segments L4 / L5 or L5 / S1) is irritated.

The patient lies on his back and the doctor raises his / her extended leg by about 60 degrees. If the person concerned feels a sudden pain in the leg, the test is positive. The pain is caused by a stretching of the sciatic nerve. The reason is usually sciatica or a herniated disc.

Sacroiliac joint in the test

Changes in the sacroiliac joint can be the cause of back pain in the rump area. This can be recognized using a spine test, Patrick test or the compression of the sacroiliac joint.

Further investigations

They are necessary if the Lasègue test is positive and the back pain radiates into the leg. Various tests should show which nerve roots are responsible for the pain (radicular symptoms) or whether it is pseudoradicular pain.

If the pain occurs above the knee, for example, the nerve roots of the L3 / L4 segments are affected (3rd / 4th lumbar vertebrae). If the pain goes beyond the knee, the nerve roots of segments L4 / L5 or L5 / S1 are crushed.

The doctor checks whether the patient can walk on their toes or heels. Muscles are used that are supplied by nerves in segments L4 to S1. The patient must also lift the big toe or the entire ball of the toe. The nerves in sections L5 / S1 and L4 / L5 are tested.

In addition, the sensitivity is tested. Does the patient feel a touch on the edge or back of the foot on both sides in the same way? Here, too, individual skin areas are linked to the function of very specific nerves (dermatomes).

segmentAgility test
L2 - L4Walking is impossible
L4The foot cannot be lifted
L5Big toe cannot be lifted
L4 / L5Heel not possible
S1Walking toe not possible

If such tests are not possible in the context of an orthopedic examination due to pain, a neurological examination is necessary to rule out possible nerve damage. Various reflexes are tested, among other things.

Possible diseases

In the following section you will find a list of possible diseases for frequently described complaints in which these symptoms can occur, as well as examinations that contribute significantly to the diagnosis. The list of possible diseases is not complete and is not intended for self-diagnosis, but is intended to give a rough overview of the various causes of individual complaints.

Please contact me for an exact diagnosis.

Possible diseasesFurther investigations
Lower back pain (lumbago, lumbago)Orthopedic examination x-ray
disc prolapseX-ray Neurological examination Computer tomography (CT) Magnetic resonance tomography Electro-neurography (ENG) Electro-myography (EMG)
Spinal wear (osteoarthritis of the spinal joints)X-ray computed tomography (CT)
Inflammation of the spine (Bechterew's disease)X-ray blood test magnetic resonance imaging (MRI) bone scintigraphy
Shingles (herpes zoster)Physical examination
Acute prostate inflammationBlood test urinalysis
osteoporosisX-ray bone density measurement
Labor painsGynecological check
Kidney disease
Pelvic inflammationUltrasound examination blood test
Kidney stonesUltrasound examination, blood test, excretory urography
Heart and vascular diseases
Angina pectorisElectrocardiogram (EKG) cardiac catheterization
Heart attackElectrocardiogram (EKG) blood test
Aortic aneurysm (enlargement of the main artery)Ultrasound examination computed tomography (CT)
Inflammation of the heart muscle (myocarditis)Blood test Electrocardiogram (EKG) Echocardiography (heart ultrasound)
Inflammation of the pericardium (pericarditis)Blood test Electrocardiogram (EKG) Echocardiography (heart ultrasound)
Lung disease
lung infectionX-ray blood test
Pneumothorax (collapse of the lungs)roentgen
Pulmonary infarction (pulmonary embolism)X-ray lung scintigraphy
pleurisyX-ray blood test
Digestive tract disease
Inflammation of the esophagusGastroscopy
Esophageal spasmsGastroscopy
Rupture of the esophagusGastroscopy
Pancreatitis pancreatitisUltrasound examination Blood test Computed tomography (CT)
Tumors or daughter tumors
Lung (Pancoast tumor)X-ray computed tomography (CT) with contrast agent
SpineX-ray computed tomography (CT) with contrast agent
RibsX-ray computed tomography (CT) with contrast agent

Treatment / therapy

Scan

Immediate action

Depending on the symptoms and after the diagnosis has been completed, I have successfully used the following treatments / therapies for decades. For more information, please follow the links below.

Further treatments / therapies

Physiotherapy and "manual therapy"

As part of physiotherapy (exercise therapy, physiotherapy) one tries to reduce incorrect movement patterns. Exercises are carried out in which the damage to the musculoskeletal system is reduced. The most important thing here is that you, the patient, learn the various forms of exercise yourself and then continue to do it yourself at home. It is a utopia to believe that back pain will disappear permanently with one-off physiotherapy.

The forms of physical therapy include exercises for stretching, tensing, relaxing, etc.

In addition, everyday movement sequences should be rehearsed in order to protect the back on a daily basis.

You can only count on permanent pain relief if you permanently perform these learned exercises at home! The strengthening of the back muscles is based on constant performance of the exercises.

Physiotherapy and "manual therapy" While the cold is still perceived as beneficial in the acute initial stages, warmth is generally preferred after the initial stage has ended.

In general, warmth is very good for acute painful conditions. Warmth can be achieved permanently through appropriate clothing, such as wearing an undershirt or windproof and warm clothing!

Measures that have an external effect on the areas, such as bathing, saunas, mud packs, red light or drugs that promote blood circulation (ABC plasters, heat-generating ointments), can also generate heat.

Often the measures described (suitable clothing, external measures, blood circulation-enhancing medication) are combined with one another, not least because the effectiveness of warmth on existing back pain has now also been scientifically confirmed.

Please pay attention to possible side effects in all forms of application. When using rheumatoid ointments and ABC plasters, allergic skin reactions have repeatedly occurred. In particular, burns can occur due to red light, for example.

Move

The best way to prevent back pain is to exercise. For example, use the stairs instead of the elevator in everyday life. Just leave the car parked for nearby activities. Do these routes on foot. Go for a walk. Use the lunch break, for example, to exercise additionally.

The trend sports walking and Nordic walking can help to avoid or alleviate back pain. Swimming and / or cycling are also considered suitable sports for strengthening the back muscles.

Since it is difficult to get up to move, especially in acute phases of pain, a pain medication may be administered initially.

Painkiller

As already mentioned, the mobilization of the patient is of great importance. Acute painful states, however, tempt you to "take it easy" longer than perhaps necessary. In order to shorten this possibly longer-lasting "state of rest" and to get the patient moving again as quickly as possible, severe pain can be alleviated with painkillers.

It is important to mention, however, that painkillers only dampen the pain, but do not treat / eliminate the cause of the pain. They should really only serve to get the patient pain-free as quickly as possible so that he can move again. The attending physician should determine the intake of pain medication. He can individually decide on site which medication and which dosage appear sensible.

In addition to analgesic medication (e.g .: Paracetamol, Aspirin®, Diclofenac, Ibuprofen, Valoron N, Tramadol, muscle relaxants (muscle relaxing drugs) such as tetrazepam can be administered.

It must always be pointed out that drugs not only have effects, but also side effects. Some of the pain relievers in particular can cause stomach bleeding. A first indication of this is: black bowel movements. In such cases, you should consult a doctor immediately and stop taking any further medication for the time being. Not least because of the side effects, long-term use of pain medication is not recommended. They are only intended to help the patient "get back on their feet" as quickly as possible.

Prognosis - chance of recovery

The information about prognoses and chances of recovery can be found in the respective articles "Immediate measures".