Back pain is among the most common health problems worldwide – about 80% of all people are affected at least once in their lives. In Germany, according to nationwide surveys, around 27% of the population regularly report back pain. For a long time, poor posture, wear and tear, or structural changes were considered the main causes. However, research now shows a much more differentiated picture: back pain arises from a complex interplay of various factors – and that is exactly why modern, holistic treatment approaches are necessary.

Understanding Pain: More Than Just a Mechanical Problem

The now widely used biopsychosocial model of pain has fundamentally changed our understanding of back pain. It is not only about physical structures – psychological and social influences also play a central role in the development and persistence of pain.

A frequently cited review by Brinjikji et al. showed, for example, that even asymptomatic individuals often show findings such as disc herniations or degenerative changes in MRI scans. With increasing age, such findings were present in more than 80% of the people examined.

This finding highlights: structural changes are often part of a normal aging process – comparable to gray hair – and not necessarily the cause of pain.

Interestingly: while short-term rest can be reasonable in cases of acute back pain, current studies show that targeted and early movement promotes healing. A review in the journal Physical Therapy even indicates that too much rest increases the likelihood of pain becoming chronic. New therapy approaches in movement therapy therefore specifically aim to change negative pain experiences and promote positive movement experiences.

Multifactorial Causes of Back Pain

In the vast majority of all back pain cases – about 90% – physicians speak of “nonspecific” complaints. This means: no clear structural cause can be identified. Instead, various factors usually interact:

• Physical influences: lack of exercise, muscular weaknesses, recurring unfavorable strain

• Psychosocial aspects: stress, anxiety, negative beliefs like “My back is broken,” avoidance behavior

• Contextual factors: job dissatisfaction, low social support, past pain experiences

A meta-analysis published in The Lancet concluded that previous episodes of back pain, psychological stress, and catastrophizing are significantly stronger risk factors for chronic complaints than most biomechanical factors.

Taking Initiative: Effective Strategies for Everyday Life

Both the current guidelines of the German Society for General Medicine and Family Medicine and international recommendations emphasize the central importance of activity and self-management. Systematic reviews also confirm that especially multidisciplinary, biopsychosocial rehabilitation programs significantly contribute to pain reduction and improved function:

• Stay active: Daily, moderate physical activity is considered one of the most effective measures against back pain. Start with short walks and gradually increase duration and intensity.

• Targeted strengthening: Regular exercises for the core muscles improve stability and can noticeably reduce pain. A proven basic exercise is the so-called “bird dog” – in a quadruped position, the opposite arm and leg are alternately extended.

• Variety in movement behavior: Avoid staying in one position for too long. The best posture is always the next one – regularly change your position and try to stand up and move around every 30 minutes.

Long-Term Prevention: Preventing Back Pain

Regular physical activity is one of the most effective strategies for preventing back pain. A review in the American Journal of Epidemiology shows: people with moderate to high physical activity have a 33% lower risk of developing back pain.

Particularly effective is the combination of:

• Endurance training: Activities such as walking, swimming, or cycling strengthen the cardiovascular system and overall fitness.

• Strength training: Especially for the core muscles – they ensure stability and better posture.

• Stretching exercises: To maintain mobility and counteract muscular imbalances.

Contrary to earlier beliefs, there is no “ideal” or “perfect” posture that prevents back pain. Rather, regular switching between different positions is crucial – our body is made for movement, not for rigid stillness.

Conclusion: An Active Approach to Back Pain

Current research clearly shows: back pain is, in most cases, not a sign of severe physical damage – and it can usually be well managed. What matters is an active approach to pain, overcoming fear of movement, and understanding that pain is not necessarily equivalent to structural damage.

As physiotherapists and trainers, we support you in better understanding the causes of your complaints and developing targeted strategies for coping.

Our goal is not just the short-term relief of your pain, but above all your long-term self-efficacy and renewed joy in movement.

Do you have questions about your back pain or would you like to actively do something about it?

Then feel free to make an appointment at our practice – we look forward to accompanying you on your path to more mobility and quality of life.

Important: If you experience severe, radiating pain or numbness, medical advice is absolutely necessary. The same applies if the complaints persist despite targeted self-activity for a period of four to six weeks.

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