Lower Back Pain
Lumbago
Of all back complaints, those low in the back are the most common. ‘Lumbago’ is a harmless-sounding name for a condition where pain suddenly ‘shoots’ in the lower back and the back muscles stiffen. Movement of the lumbar spine is severely limited by the stiffness, sometimes made completely impossible. This symptom pattern is also called an ‘acute stiff back’ or, in medical jargon, ‘acute lumbago’. Usually, the complaints are temporary and the body recovers (almost) fully.
Hernia
A hernia is a torn intervertebral disc. The liquid inner part pushes through tears in the outer part, which consists of strong fibers. This can cause the liquid part to come outside the disc and possibly compress a nerve. This results in severe pain or numbness in the leg. The symptoms depend on the location in the back and whether or not a nerve is compressed. Usually, there is a lot of pain and stiffness in the back and sometimes in the leg.
Muscle Pain
Back pain is often interpreted as a problem with the back muscles. Sometimes this is the case, but in other cases, the muscles themselves are not the source of the complaints. Imagine there is a nail in the back. The person involved will adjust their posture to feel the nail as little as possible. The muscles become hard and painful. However, the conclusion should not be that the muscles are the cause of the complaints; the muscle pain is rather the result. In reality, there is never a nail in the back, but a tear in the intervertebral disc or in a ligament can have the same effect. Also, blockages in the vertebral joints can cause hardening and, over time, pain in muscles.
Pelvic Joints
Problems in the pelvic joints can also lead to lower back pain. Especially the ligaments of the joints between the sacrum and both halves of the pelvis are a notorious source of complaints.
Non-specific Lower Back Pain
In many cases of lower back pain, the cause cannot be determined. X-rays show no significant abnormalities and other tests also yield nothing. Then the complaints are called ‘non-specific lower back pain’. However, this does not mean there is no clear cause or that the complaints are ‘psychological’. It only means that the cause cannot be identified. Unfortunately, this occurs regularly.
The most likely cause of this non-specific lower back pain is small tears in the intervertebral disc. These are not visible on an X-ray and can often explain the symptoms very well.
Upper Back Pain
Just like in other parts of the back and neck, complaints in the upper back can occur due to irritation of muscles, tendons, ligaments, intervertebral discs, and vertebral joints. In the area between the shoulder blades, there is an additional important source of problems: the connections between the ribs and the spine. These connections include joints, which, like any other joint in our body, can cause complaints.
This is hardly ever recognized by the person involved. No patient ever comes to the doctor saying: ‘Doctor, I have trouble with my 3rd rib-vertebra connection.’ Yet these complaints are common. They are recognizable by a vague, irritating pain behind the shoulder blade with a ‘strange feeling’ radiating to the arm, under the armpit, or extending to the front of the chest.
If the latter occurs, it understandably sometimes resembles a (threatening) heart attack, especially if the complaints are on the left side. Blockages in the rib-vertebra connections can result from sitting postures where the shoulders are pushed forward for a long time (slouching in a corner of the couch) or from a wrong sleeping posture where the shoulders also hang forward for a long time (side sleeping with the forearm on the mattress). Sometimes, with blockages in the rib-vertebra connections, there is no pain behind the shoulder blade but only a strange feeling somewhere deep in the shoulder and/or radiating into the arm.
Back Pain Radiating into the Arm
Back Pain and Sleeping Position
Whether the source of the back pain is in the muscles, tendons, pelvis, or vertebral joints, the sleeping position is almost always important. It’s actually simple: if the spine is in a neutral, relaxed position and the pelvic joints are not under tension, the irritated tissue can recover as well as possible. In non-neutral positions, the complaints can actually increase.
If the sleeping position is good, one wakes up in the morning with fewer complaints (pain and/or stiffness) than when going to bed. On the other hand, if one wakes up with more complaints than the night before, especially if the back is extra stiff, this is a strong indication that something is wrong during sleep. This could be the posture itself (for example, sleeping on the stomach), but it could also be due to an incorrect mattress, pillow, and such. The latter needs to be investigated; see tips and information elsewhere on this site.
For complaints between the shoulder blades, the same applies as for many lower back complaints: preferably sleep on the side with an extra pillow for the chest where the upper arm rests. This reduces the forward pull of the shoulders and thus significantly reduces tension on the rib-vertebra connections. This is a simple yet effective aid.
A wrong sleeping position with upper back complaints does not so much lead to extra stiffness of the back, or at least, it is not experienced that way. The back and rib-vertebra connections do become stiff, but this is not noticed as a back problem, but more as a stiff neck. This is because the upper thoracic vertebrae and upper rib-vertebra connections move along when the neck turns. If there are blockages there, the neck turns less far, which is noticeable when looking over the shoulder. The stiffness is then felt low in the neck, in the neck-shoulder area. This is present immediately upon waking. This can be accompanied by a deep, vague feeling somewhere behind and in the shoulder or in the arm, sometimes radiating under the armpit to the chest. Over time, the frequency, intensity, and radiation area increase. Some people go ‘crazy’ from it. These complaints are hardly recognized in conventional medicine: stuck rib-vertebra connections are still a big blind spot.
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To maintain a neutral position of the lumbar spine in side lying, an extra pillow is recommended to be placed between both knees. This ensures that the legs stay aligned and the pelvis, and thus the base of the spine, lies straight. For complaints in the pelvic joints, it is also good to place a pillow between the knees. If this is not done, the legs will ‘scissor’ and extra tension will arise in the pelvic joints. Instead of two separate pillows (one for the chest and one between the knees), one long and flat body pillow is recommended. This usually stays in place better than two separate pillows.
When sleeping on the back, the lower back is slightly arched, especially on a hard mattress. If there are lower back complaints, this arched position of the back can worsen the complaints. By placing a pillow, preferably a thick one, under the knees, the arch is reduced somewhat and the tension in the back is decreased. A thicker and softer mattress or a mattress topper (an extra mattress on top of the regular mattress) can also help here. The idea that it is best for the back to maintain its ‘natural’ S-shape on the mattress is not correct. The S-shape is not a neutral position for the lower back. A slight C-shape of the entire back comes closer to a neutral position for the lower back. This C-shape is easily achieved in side lying, but never in back lying.
With an acute stiff back, the pain can be so severe that even with strong painkillers, hardly any pain-free position can be found. The following position is then still the best: lying on the back with the thighs at a 90º angle to the back and the lower legs at a 90º angle to the thighs. The lower legs should rest on a sturdy large box or crate with some pillows on it, so that the construction is stable and the legs can rest without muscle tension. The tension on the lower back is then minimal. Of course, this is not a position to maintain for days, but in such an acute phase, it can help. It is also good to gently move the pelvis and lower back regularly in this position to keep the joints loose and promote recovery.