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Ist mein Rücken krank? | 4 min reading time

Acute back pain – why does my back hurt so much but no one knows why?

Written by Theresia Lechner
Akute Rückenschmerzen an einer Wirbelsäule mit Schmerzpfeilen gezeichnet

85% of Germans will suffer from acute back pain at least once in their life [1]. But how does this pain occur? And do all of these people actually have a “broken” back? In this article you will discover fascinating information about why acute back pain occurs. This information will help you to treat your back in a way that will quickly make your pain go away.

The more intense the acute back pain, the worse the damage?

A lot of people think that the severity of their back pain reveals something about the extent of damage in their back. This is not true. Pain can be light or strong depending on the context [3].

Handballer im Wurf gezeichnet
Depending on the context, pain can be light or strong

Think of the 2019 Handball World Championship in Germany and Denmark, for example. When a player scores the deciding point, they are ceremoniously run down by their team members. The other players hurl themselves on top of the point scorer, who is subsequently burdened with a total weight of up to a tonne. But rather than screaming in pain, the player dusts themself off and continues playing. Sometimes even better than before.

For most instances of back pain in our population, the reverse is true. 70% of back pain instances are non-specific or idiopathic. That means it has not been possible to identify an injury that has caused the pain; neither a slipped disc nor any other injury to the structures in the back [10]. Actually, you would surely think, if there isn’t a broken structure, then there can’t be any pain [3].

Yet, the pain is there. We can feel it. Or is it all in our imagination?

Without exception, your pain always comes from the brain

Your back pain has nothing to do with imagination. All pain is real. Because all pain comes from the brain. It is your brain which decides whether your back hurts or not. To reach this decision, it receives a lot of information from your body. There are small sensors all throughout your tissue, which inform the brain about what is currently going on in your body [3].

Your sensors can pass on a danger signal via neighbouring nerve cells to the spinal cord (although this doesn’t yet produce any pain). Depending on the level of urgency, the danger signal is then passed on to the brain from the spinal cord [3].

Your brain then decides whether to produce pain or not [3].

In doing so, it makes use of a wide range of influencing factors. Such as your experienceyour current state of mind etc. [3].

Gehirn entscheidet ob akute Rückenschmerzen entstehen gezeichnet
Your brain decides whether to produce pain in your back or not

Is pain always a bad thing?

If, for example, you step on a shard of glass, the sensors in your foot will signal: Attention! Your skin and tissue have been damaged [3].

The brain and spinal cord analyse this danger signal and then decide whether pain is necessary to protect the body. In the case with the shard of glass, it is highly likely that pain will be generated. In this way, your brain prevents you from continuing to walk on for several kilometres with a shard of glass in your foot. Instead, you’ll check what is actually wrong with your foot. Your next step will be to remove the shard of glass, if possible, and take the weight off your foot. Et voilà: your body can begin the wonder of healing your wound [3].

This means that your body has a super warning system and pain is an absolutely life-essential thing [3].

After a few hours and days, the pain will subside more and more. Then, after a maximum of a few weeks, it will disappear completely. The wound on your foot will have healed and the pain will no longer be necessary [3].

Entstehung akute Rückenschmerzen erklärt mit Glasscherbe im Fuß, Rückenmark und Gehirn
Before pain can come to be, your brain is first informed about the potential danger

So, should I take it easy when I have acute back pain?

It is different with acute, non-specific back pain. In this case, the “shard of glass in the tissue” is missing. So there is no need for you to remain still. Quite the contrary. Moderate exercise and an active lifestyle are, in this case, the “best treatment” [4,5]. With most patients, the pain and the functioning of your back improve by themselves within 4 weeks [2].

If there isn’t any real cause, then why do I have acute back pain at all?

Essentially, there are triggers that can provoke back pain. For example, a stupid injury, fatigue, stress, anxiety or a combination of all of these. Even so, in a third of people with back pain, it is not even possible to find these triggers. The pain is just suddenly there, without any clear cause [5].

Scientists use various models to explain why the pain is there nonetheless and maybe also stays a while. I will briefly explain two of these models for you in simple terms:

  1. The principle of neuroplasticity

Neuro…what? Simply put, this principle dictates that, depending on the areas of the brain that are used, and to what extent, your brain adapts. If you look at the picture below this paragraph, you can see the map in your brain of your body [7].

The map shows you where the different parts of your body are located. If I now asked you to close your eyes, you would probably still be able to put your finger on your nose. The parts of the body that are used a lot in particular and in a distinctive way (such as your hands)appear larger on your map [7].

Homunculus gezeichnet
The map of our body in our brain

If you are relaxed in life and, throughout the day, you move and work a lot and do exercise, then your map will also be “trained”. The corresponding parts of the body, such as your back are then clearly and explicitly “displayed” on your map. In the moment in which you experience pain, you will probably start to move less, thereby protecting your back. As a result, the “back” part of the map will no longer be trained. This causes the picture of your back on the map to become blurry. In fact, this happens relatively quickly [7].

The more blurry the picture of your back becomes on the map, the more pain you will feel [7].

  1. The theory of acidic tissue

Further up in the text I spoke of the sensors in your body tissue, which can pass on danger signals to your brain. A certain type of these sensors reacts to chemical changes in your tissue. For example, a change in your PH level [8].

You may know about this value from your skin. If the PH value of your skin is right, then it offers a splendid barrier against external invaders. However, the PH value isn’t just important for your skin, but also for all types of tissue in your body. It also plays a role in the fasciae and muscles in your back [8].

If you stay in the same position for too long, no matter whether it’s lounging on the sofa or sitting in front of the PC at work, fluid is pressed out of the tissue in your back. This lowers your PH value. That means the tissue in your back becomes acidic [8].

In this case, unfortunately, you won’t be a happy Larry [8].

This small change causes your sensors to send danger signals to your brain: That is sometimes enough to trigger back pain [8].

 

Zitrone mit verzogenem Gesicht gezeichnet
Acidic tissue in your back can cause pain

Two different models – a miracle weapon against acute back pain

You can probably already imagine a potential solution for acute, non-specific back pain. Precisely: movement. At work, during your day-to-day activities, and even on holiday. And this doesn’t necessarily involve training with blood, sweat and tears. Small movement routines, as well as keeping active throughout the day help against back pain much more than “taking it easy” and resting in bed [7,8].  Why not try one of the following for example:

  • regularly changing your seating position at work
  • drinking your afternoon coffee standing up
  • taking a small daily walk

This helps to flush the accumulated acid out of your tissue and makes the map in your brain become clear and distinct again [7,8].

Sometimes we find it difficult to keep active throughout the day, especially when in full concentration at work. If you like, you can use the 8Clip to help and motivate you to move more.

What you have learnt about non-specific, acute back pain

You now know that back pain always comes from the brain. Imagined pain does not exist. Most cases of acute back in this country are non-specific. So your GP won’t find a cause for it. There are models that will trace your back pain back to a changed map in your brain and to over-acidic tissue. What can you do about the pain? Move.

Back up your knowledge

Pain can be influenced through external factors. In one study, people had a blood pressure cuff strapped to their arm so tightly that it hurt.

  • Information given to the first group: this is a test to determine your level of tolerance to pain. Keep the cuff on for as long as possible.
  • Information given to the second group: this is a new technique for strengthening the muscles in your upper arm. The longer the cuff stays on your arm, the more muscle mass there will be later.

The researchers discovered that the group who thought their muscles were being trained were able to keep the cuff on for twice as long as the first group. In addition, the brains of those in the second group released pain relievers produced by the body. So you see, positive convincing can help you to manage your pain better and, at the same time, make your body produce its own pain relievers [6].

Important to note:
This article contains general recommendations only and must not be used for self-diagnosing or self-treatment. It is not a replacement for visiting your GP.

[1] Schmidt,C.; Raspe, H.; Pfingsten, M. (2007): Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine 2007;32(18):2005-11.

[2] Wáng, Y., Wu, A. M., Ruiz Santiago, F., Nogueira-Barbosa, M. H. (2018). Informed appropriate imaging for low back pain management: A narrative review. Journal of orthopaedic translation15, 21–34.

[3] Butler, D.; Moseley, G. (2013): Schmerzen verstehen. 3. Auflage. Heidelberg: Springer.

[4] Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Nicht-spezifischer Kreuzschmerz – Kurzfassung, 2. Auflage. Version 1. 2017 [cited: 2019-06-06]. www.kreuzschmerz.versorgungsleitlinien.de.

[5] Australian Rheumatology Association: Low back pain. Reviewed December 2017. [cited: 2019-06-06]. https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2018/01/LowBackPain_0118.pdf

[6] Benedetti F, Thoen W, Blanchard C, Vighetti S, Arduino C. Pain as a reward: changing the meaning of pain from negative to positive co-activates opioid and cannabinoid systems. Pain. 2013;154(3):361–367.

[7] Louw A, Farrell K, Landers M (2016): The effect of manual therapy and neuroplasticity education on chronic low back pain: a randomized clinical trialJ Man Manipulat Ther. 2016;1–8.

[8] Moseley, G.; Butler, D. (2017): Explain pain supercharged. The clinician’s manual. Adelaide: Noigroup Publications.