Back pain and its cause

The cause of back pain is due to various reasons. The main distinction is whether there are congenital or acquired causes. About 10-20% of back pain is likely to be congenital or inherited, such as a fracture in the vertebral arch or ossification of the lower lumbar spine with the pelvis. In addition, many secondary factors were named, such as psychological strain, stress and heavy work-related activities. However, the main cause of back pain is likely to be in the area of muscular tension. The mattress as a reason of back pain is rather unlikely, after all, a large part of people do not have a high-quality mattress and still do not have back pain.

Scientific statements

Science has a very hard time assessing these main reasons. Two factors are responsible for this. The first factor is that muscular tensions are not detectable by devices such as X-ray or MRI, but here only the visibly incurred damage is perceived. By far the most important reason is ignored by science because it existed before science even addressed the problem of back pain.

Sitting makes back

About 200 years ago, the chair was introduced for the general public as a piece of seating furniture. Before that, people mainly sat on the floor in the natural squat. Many used small stools that supported squatting. Our modern medicine is about 150 years old. When the normal values of our Western orthodox medicine were developed, all people were already sitting for a large part of their lives.

People in our form of civilization have been sitting since early childhood, and in particular it is the many hours spent at school that program a sitting disease into people. This mechanism has never been scientifically studied in comparison with people who did not sit in school. Rather, studies have been conducted comparing people who have sitting and standing jobs, but both have sat in school.

Looking at the problem of sitting, most people believe that the immobility in sitting is the cause of the problem back pain. Many recommendations for treatments are based on this assumption. One should move more, he said. In addition, there is a persistent belief that sitting weakens muscles. These too weak muscles are then said to be responsible for back pain. Again, chair systems try to ensure that muscles are further strengthened.

Muscle shortening as a cause of disease

However, the actual mechanism of origin of back pain is likely to be different. When sitting, there is a significant shortening of muscles, which is much shorter compared to the natural posture, as it used to be even when squatting. It is not a single muscle that is affected, but rather numerous muscles that subsequently lead to problems in a certain chaining cascade.

Strictly speaking, muscle shortening is not an actual shortening, it is simply a loss of elasticity of the muscle at the end of full extension. Muscular shortening is actually the body’s protective mechanism to prevent a bony joint stop from occurring at the end of joint motion. This is to protect the joint from damage. However, if muscles are regularly moved in their range of motion to full flexion and full extension, the muscle adapts to this reduced range of motion. The braking function, which is intended to protect the joint, starts well before the bony joint stop is reached. This then makes the muscle less elastic, or in other words, shortened.

Stretching is not enough

Once a muscle has been shortened, it cannot be restored to its original length even by stretching exercises. The reason for this is a mechanism that is built into the bony tendon attachment of the muscle. The shorter the muscle, the higher the tension arriving there and then the higher the muscle tension reported to the brain. The brain then in turn increases the tension of the muscle itself, so it’s a vicious cycle. Stretching exercises increase this tension and thus lead to deterioration of elasticity. The more stretching is done, the more the counter-tension in the muscle is increased and the lower the stretching ability or elasticity is.

A muscle is capable of increasing in size when more force is needed, and it also decreases in size when less force is needed. This mechanism is used in a gym. During strength training, the muscle is made to believe that it needs more strength. The muscle grows. If the gym is no longer attended, the muscle will weaken again. What the muscle cannot do by itself is to restore its original elasticity or natural muscle length.

Muscle shortening happens on its own from sitting for hours on end. However, a detour is required to restore elasticity or muscle length. By applying pressure to the muscle insertion, it is possible to influence the fibrocartilage in the tendon insertion in such a way that the sensors built into it do not report increased muscle tension to the brain. In this case, the muscle can then be restored to its original elasticity or length.

The hip flexor muscle (psoas)

The first muscle shortening affects the hip flexor muscles, here the psoas muscle is affected first. The peculiarity of this muscle is that it is not located in the front or back of the body, but runs diagonally through the body from the front of the hip to the back of the lumbar spine.

This muscle course causes the muscle to shorten when sitting, but when standing up, the strong pull pulls the spine on the back into a hollow back and in there the intervertebral discs are squeezed. As a result, there is further muscle shortening in the hollow back. Here, both the outer and middle layers of the back muscles are affected. The shortening of the hip flexor muscle does not lead to increased pressure until the patient is standing. This is also the reason why 72% of usually pain-free people nevertheless develop back pain after 2 hours of standing at the latest, because the hip flexor only squeezes the intervertebral discs when standing. In contrast, the shortening of the outer two muscles of the back leads to a fixation of the hollow back even when sitting.

Emergence of muscles too weak despite muscle shortening

Due to the severe compression of the back of the spine by these shortened muscles, the bones on the back of the spine come very close together. This means that the deep layer of the back muscles can no longer work, as the suspension points are too close together and thus only dangle between the bones. As a result of this uselessness, the deep back muscles atrophy more and more and are eventually converted into fat, which later on also cannot be converted back into muscles.

Muscle strengthening is not necessary – The horse is put from behind

In order to strengthen the deep muscles of the back, the most common treatment is mainly aimed at training the abdominal muscles. In fact, abdominal training manages to easily reactivate the deep back muscles. However, this mechanism puts the cart before the horse. The correct way would be to make the shortened muscles elastic again via the mechanism described above by applying pressure to the sensing elements in the tendon or muscle insertion, thereby taking the tension out of the hip flexor and posterior back muscles. The rubbery intervertebral disc would thus unfold again by itself and could supply itself with nutrients from the environment like a sponge. Instead, abdominal training provides additional compression of the disc on the front of the spine as well. The only positive effect of this is that, via the hypomochlion of the posterior edge of the spine, the structures located far back on the spine can move further apart and thus the suspension points of the deep back muscles are again further apart. This allows the deep back muscles to re-engage between these two suspension points. However, the intervertebral discs are still squeezed and not relieved.

Function of a muscle

The function of a muscle is primarily to be able to contract, just as it must be able to relax. However, the muscle does not have the stabilizing function attributed to it. Bones are responsible for stability in the body, not muscles. If man were made only of muscles, he would not be stable at all, but would shrink to a minimal size. A muscle is always attached to two bones, and between these two bones there is either a soft disc or soft cartilage tissue.

The stronger the muscle becomes, the more the disc or cartilage is compressed. More muscles or more strength means at the same time more squeezing of the intervertebral disc. The feeling of increased stability and the decrease in pain due to more muscles is due to the decrease in friction. The stability achieved by more muscles exists in fact. However, the stability is actually an over-stability with crushing of the intervertebral discs or cartilage and not a healthy stability, as it would actually be given by the inherent tension of this tissue and would also provide freedom from pain, but this time a healthy one.

The bulging disc

In addition to squeezing the intervertebral disc, which initially manifests itself as a bulging disc and later as a herniated disc, the increased pressure of the muscles also leads to increased wear of the small vertebral joints located at the back (facet joint arthrosis), nerve outlet stenosis (neuroforaminal stenosis) and spinal canal stenosis (constriction of the main nerve canal) due to pressure-induced enlarged vertebral joints and osteochondrosis, i.e. the complete crushing of the intervertebral disc with painful rubbing of the vertebral body bones against each other.

As long as the deep back muscles have not yet completely transformed into fat and as long as there is only disc protrusion or other minor wear and tear of the disc, the formation mechanism described here can be reversed by improving the elasticity of the muscle. However, as described above, this is not achieved by strengthening the muscles but only by improving elasticity through pressure on the muscle insertion and subsequent regular daily exercises. In the case of severe changes in the spine, it may be necessary to first establish a therapeutic capability by means of measures, up to and including surgery.

After surgery on the back

At the latest after a back operation, the elasticity of the muscles must be restored in a painless state and then the elasticity must be maintained with permanent stretching exercises. Only as a last step does strengthening the muscles help afterwards, but in most cases it is then no longer necessary.

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