Back Pain: When your back hurts, the problem usually lies somwewhere else

Collectively, musculoskeletal disorders top the list of the most common types of disease. Back disorders constitute a major group within this category and are the second most likely condition to be diagnosed. Intervertebral disc damage is also common and is not just age-related because many young people also suffer.³⁾ Back complaints are one of the primary causes of disability and early retirement. Seven to ten percent of patients suffer long-term disability or are permanently unable to work.⁴⁾ 

But does it have to be like this? Is back pain inevitable these days? At Liebscher & Bracht we say no — you don’t have to put up with your back problems, no matter whether you’re young or old. We explain how you can actively deal with them in everyday life, or more specifically, how you don’t have to suffer back pain at all. And all without surgery or pain medication.

1. Where Does Your Back Hurt?

Pain can be felt anywhere in your back, and radiating pain can travel to your legs, arms, shoulders, or neck. It can be tricky to identify the exact source of the pain. Nevertheless, this is precisely what you need to know to get the best possible help for your condition.

    1. So first of all, try to sense exactly where the pain is in your body. 

    2. Our special Encyclopedia of Pain articles will give you the information and exercises you urgently need concerning the source of your pain. We explain where your pain comes from and what you can do about it.

If you want to understand the basics of how your back is structured, how it functions, and how almost all forms of pain develop, it’s best to read about this in chapter 2.

2. The Back: Structure and Function

Spine, intervertebral discs, muscles: we have heard of all these different back components. But how exactly do these elements interact? And, in practical terms, how does your back actually function? Pain specialist Roland Liebscher-Bracht explains all this in an easy-to-understand video, using many examples from everyday life you are sure to recognize.

If your movements are too one-sided and you sit most of the day, you compress your intervertebral discs more towards the front of your spine, but don’t release them enough. The result is an imbalance of forces — too much forward movement and not enough backward movement. Your intervertebral disc can then start to deform, resulting in a bulging effect (protrusion). In addition, the disc is literally “starved” because it no longer receives fresh nutrients. If the pressure and under-supply become too severe, there is a risk of sustaining a herniated disc.

3. Causes of Back Pain

3.1 Development of Back Pain — The Conventional View 

Doctors distinguish between specific and non-specific back pain:

• Specific back pain has a clear cause. So, for example, it could be the result of a fall, an accident, or some organic or structural change.
• Non-specific back pain has no structural cause. No signs of damage can be seen on an X-ray or MRI scan. And after a while, non-specific back pain often disappears on its own.

Among other things, accidents or falls can cause broken bones, and organic change can be brought on by diseases such as cancer. If you experience frequent and/or increasing pain, please visit your doctor for a thorough examination to rule out such causes. 

🚩 The “Red Flags”

Doctors use the term “red flags” when referring to some characteristic warning signs, which may suggest the presence of a serious cause requiring urgent action. These are matters on which you should always seek medical advice. Here are a few examples which may be related to back pain:

• sensory disorders (for example deafness)
• paralysis (or symptoms of paralysis)
• incontinence
• fever and chills, signs of infection
• previous medical conditions (for example tumors, diseases of the kidneys or other organs, metastatic growths)
• trauma (following a car accident, for example, or falling from a great height)⁵⁾

However, 85 to 90 percent of all cases are non-specific back pain.⁶⁾ Common reasons frequently mentioned for this type of pain include muscle rigidity or poor posture, and more specifically, undue muscular stress. Muscular irritation, overstretching, or hardening of the muscles can also sometimes lead to back problems.

Conventional medicine divides back pain into categories according to the duration of the pain:

• Acute back pain lasts less than six weeks. It occurs for the first time, or after more than six months without pain, and can be specific or non-specific.
• Sub-acute back pain extends over a period of six to twelve weeks.
• Chronic back pain is defined as back pain, which lasts longer than twelve weeks and may last for several years. A distinction is also made between persistent chronic pain and chronically recurring pain. The severity of the pain can vary, and doctors speak of the concept of pain chronification. 

We have found a reason why so-called non-specific back pain occurs. We’ll explain that to you in a moment — but just note this: It has to do with your muscles and fascia, which are extremely overstretched.

Incidentally: Most pain occurs in the lumbar spine region. This accounts for around 50 percent of all cases of back pain.⁷⁾

The distinction between acute, sub-acute, and chronic back pain is of secondary importance to us. We are convinced the cause is almost always muscular-fascial. Further on, we will show you some exercises you can try no matter how long your pain has been present. We also consider that chronic back pain is simply back pain, which has not yet been properly treated. In our opinion, there is no such thing as chronification.

The Clinical Presentation of Pain

Thinking about pain, which could not be explained, led to the emergence of the theory of pain memory. This suggests that pain can lodge in the brain and become an independent entity. It is thus an illness in its own right — and a search for the cause is therefore redundant because the diagnosis will always be that “pain” is both the cause and the outcome. 

However, we don’t believe the concept of pain should be viewed as entirely decoupled, because that would mean that it has no function. On the contrary: it has one very important function which prevents you from continuing to carry out movements which harm you. We’ll now explain more about this so-called signal pain. This type of pain has nothing to do with pain memory. It will subside if you can reduce the level of hypersensitivity, and there is no longer any risk to your intervertebral discs or other structures.

Age or Obesity — Could These Be a Cause?

Being overweight is a common cause of back pain. Yet excess body weight does not automatically lead to back pain. There are many overweight people who do not suffer back pain, as well as many slim people who do. Nevertheless, we do advocate losing weight for health reasons. But our pain therapy does not take weight into consideration. What is much more important is that you learn to balance one-sided movement patterns in your everyday life through regular practice. Pain specialist Roland Liebscher-Bracht sums it up as follows:

“If your back or spinal movements are varied in accordance with the ‘built-in’ options, there is no reason for pain to develop. Apart from accidents involving external forces, there is nothing to cause the spine to develop damage. There is no reason to suffer bulging or even herniated discs. There is no reason for the spinal canal to become more and more blocked because of pressure from intervertebral discs or due to the extrusion of the interior gelatinous nucleus. There is no reason for a slipped vertebra. There is no reason for facet joint osteoarthritis or inflammation of these small vertebral joints.”⁹⁾

Back pain is often attributed to a patient’s age — according to this view, older age is synonymous with “back pain.” However, this assumption is unsustainable. After all, more and more children and adolescents now suffer from back pain, while many older people remain symptom-free.

“A spine is built to last a lifetime. It doesn’t matter whether we are 50, 75, or 100 years old or even older.”¹⁰⁾

3.2 The Cause of Your Back Pain Lies at the Front

Glued Fasciae

You already know about the structure of your back muscles, but one important element is still missing: Every muscle and every muscle fiber is wrapped in a layer of fascia. So countless fascia threads run throughout your body. This creates an elastic network, which is very stretchy so we can perform all kinds of movement. Yet, at the same time, it is constantly changing. Fibroblasts, which you can imagine as tiny arachnids within your connective tissue, weave new threads all the time.

They are influenced by impulses transmitted via our body movement.

This fascia network gives the body stability. Without fasciae, your body would simply collapse as it tried to hold muscles, organs, and everything else in place. But if only bones and fasciae remained, your body would both keep its shape and still look as it did before. Fascinating, isn’t it?

So what are the implications of all this? 

Lack of exercise ensures that:

• less nutrient transport can take place in the intercellular space, and
• less stimulation means fibroblasts are less inclined to weave new threads.

This means that if we sit a lot in our everyday life — in the car, at work or at university — certain muscle regions such as the hip flexors, pectoral muscles, and especially your abdominal muscles, are constantly “shortened.” So these muscles are seldom stretched to their full length, which means their fascia remain under-supplied. 

📌 When we speak of “shortened” fasciae, we mean that the corresponding muscle or fasciae region no longer slackens, or is unable to slacken It is thus said to be “glued” or “matted,” and this increases the tension in the tissue.

Back Extensors in Permanent Stress

Now your back extensor muscles come into play. They try hard to keep your posture aligned. The greater the tension on the front of your torso (due to the shortening), the more these muscles have to tighten.

What happens then can be quickly explained: Great forces pull in different directions from two sides — back and front. This, in turn, exerts a lot of pressure on your spine and on your intervertebral discs. Your body permanently measures this pressure via receptors designed to pass such information on to your brain.

Signal Pain as a Warning Sign

When muscle stress levels persist, your body has devised a system to protect your spine and intervertebral discs from damage — it triggers pain. At Liebscher & Bracht, we call this type of pain a signal pain. It’s a kind of warning system for your brain, which strongly encourages you to stop potentially dangerous movements.

Signal Pain and Overload Pain

We differentiate between what a signal pain and an overload pain is. As the name suggests, this arises when your muscles become overworked. This feels like a burning pain, for example, when you stand for a long time while washing your clothes. At some point, your back extensor muscles become overloaded in this position and start to burn — so you then need to shift your posture.

Pain is often a combination of signal pain and overload pain. But it’s important for you that neither should cause structural damage.

Structural Damage Is Not Usually to Blame

Now let’s look at the following example to make things clear:

Where does that sudden back pain come from when you get up from a sitting position?

➡ You are too one-sided in your everyday life and sit down most of the time at work. 

➡ Your fascia are not sufficiently stretched in all directions — they have become hard and matted.

➡ When you stand up, your back extensors and gluteal muscles apply an extremely strong pulling force that works against your shortened fascia at the front.

➡ Due to the tension in your back extensors, the pressure on your intervertebral discs becomes too great, and there is too much strain on your spine.

➡ A signal pain in your back inhibits your upright movement. This helps to protect your intervertebral discs from damage.

What this means is that the pain first occurs independently at the back — while the problem is actually at the front. Once the excessive tension is removed, the pain disappears. This demonstrates that, in most cases, there is no direct connection between pain and damage to structures in your back.

The frequently changing intensity of the pain also argues against any structural damage. If something were actually damaged, why should the pain become more or less severe?

There are also instances where a pain suddenly disappears, although the alleged problem, such as the protrusion of an intervertebral disc, is still there. The fact that certain movements often trigger pain likewise suggests overstretched muscles and fascia rather than damage. 

So What Happens With a Block?

If a certain movement is no longer possible, or only possible to a limited extent, this is often described as a block. This is a kind of movement lock.

Blocks are usually associated with bones — a blocked vertebra, for example.

We don’t believe such blockages usually involve bony structures. It’s mostly muscles and fascia, which are so overstretched they restrict your movement. So just try to remedy your block by using our exercises.

What About Pinched Nerves?

“Irritated or pinched nerves” are often cited as the reason for the development of back pain, which radiates into different areas. For both herniated discs and sciatic pain, conventional wisdom suggests there is irritation or compression of the nerves and nerve roots. With a herniated disc, the escaping gelatinous nucleus should, therefore, exert pressure on the spinal cord and the nerves and nerve roots coming from it, or on the spinal end of the sciatic nerve.

Spinal stenosis, i.e., the narrowing of the spinal canal, is another common diagnosis for back pain. The pain is said to arise when a protruding or herniated disc, for example, presses against a nerve root, which then causes irritation.

We believe strained muscles and fascia are the real cause of the pain. After all, how could the soft gel mass inside an intervertebral disc so badly affect a nerve as thick as your finger? And why is a herniated disc often discovered by accident in many people who experience no pain at all?

In the case of sciatic pain, we believe it more likely that the gluteal and piriformis muscles irritate the sciatic nerve. The gluteus muscle is the largest hip extensor and has to counteract the strong tensile forces exerted by the hip flexor muscle. This restricts flows within the blood vessels serving the sciatic nerve.

4. Exercises, Treatment, and Prevention

4.1 Simple Exercises for Back Pain

Those who suffer from back pain tend to be very cautious and careful. But that’s the wrong approach.

“Bed rest is an unsuitable treatment for non-specific low back pain.”¹¹⁾

This applies not only for lower back pain but for most other types of back pain too. Bed rest is not an appropriate way to relieve your discomfort.

It’s most important for you to keep moving. In our video, Roland reveals some simple exercises you can do quickly and easily at home — particularly in the morning. If you don’t have any red flag symptoms and have consulted your doctor, you can get started immediately and treat your back pain yourself in a natural way.

Regular stretching will ensure you permanently eliminate the cause of your pain. These exercises will help you balance the one-sided movement patterns which occur in your everyday life.

•     What is special about our exercises is that you actively stretch into the pain. This is the only way to create change stimuli for your muscles and fascia.
•     Another characteristic of these exercises is the duration of a stretch. You should stay in one position for one and a half to two minutes to allow time for your fascia to ease and give way.
•     Practice as often as possible, preferably six days a week. Set aside around 15 minutes to integrate these exercises into your daily routine. Consistent stretching reduces excess tension and expands your range of movement.

Do you have severe pain you cannot get rid of in spite of the exercises? Or does severe pain prevent you from completing the exercises properly? Then it’s best to try using our osteopressure, a technique where pressure is applied to specific areas of bone. Most patients experience significantly less pain after the first round of osteopressure, or may even become pain-free. We can also offer you the following self-treatment options:

Foam Rolling: Learn How to Roll to Make Your Fasciae Flexible Again

The movements we make in our everyday life are too one-sided, so our intercellular fluid won’t circulate enough to remove all waste materials. These deposits create excess tension. You can remove them with regular stretching exercises, though you can achieve faster results if you use a foam roller. 

Rolling compresses the fascia to some degree, which means the tissue is able to soak up fresh water like a sponge. In addition, the fascia can then bind more water because the over-acidified intercellular fluid becomes more alkaline. Fascia layers start to slide better, and adhesions dissolve. Another effect is that, as long as you roll slowly and intensely in one direction, fibroblast cilia will also move. This breaks down collagen — so your connective tissue becomes much more flexible.

Osteopressure: How to Compress Your Back Without Pain

Osteopressure deactivates the receptors responsible for signal pain. These are points located on the periosteum (tissue protecting your bones) — so we are squeezing bones, not muscles.

By pressing these signal pain receptors, we can adjust the brain programs responsible for creating excess tension in your muscles and fascia — essentially, a kind of reset.

📌 Checklist for the Liebscher & Bracht Exercises

To make our exercises even easier to perform correctly, we have summarized the most important information in a checklist. This gives you all our tips at a glance and will help you to practice with confidence.

✅ Always orient your efforts on a personal pain scale from one to ten. You’ll get the best results if you work at a level of eight or nine for each stretch. Nine means: Though you feel intense pain, you can still breathe calmly while stretching, and do not feel tense. 

✅ Practice six days a week and do the exercises at least once a day. If you want to support the calming repair processes in your muscles and fasciae even more, you can repeat the exercises every 12 hours: once in the morning and once in the evening.

✅ You should spend between two and two and a half minutes on each exercise phase and hold the respective stretch for at least 90 seconds.

✅ Always use professional tools to treat your pain. If you rely on cheap or even defective products, it might have a negative effect. That’s why we have taken great care in the development of our aids, which are designed especially for pain treatment.

✅ Avoid taking painkillers wherever possible. Our exercises use your pain as a starting reference point for daily comparisons. So you should not suppress it artificially, but use it as an orientation to guide your exercise and stretch intensity. Pain relievers would distort your progress and give you a false impression of your pain.

✅ Be patient — even though rapid results are not uncommon. It may take some time for your brain to learn new exercise programs for your metabolism to normalize and for the tension created by the pull of opposing muscles to decrease.

✅ There is no need to panic if your pain actually increases when you start to exercise. An initial worsening of your pain can be due to your body’s natural reaction. When your entire body statics change through regular training, your musculoskeletal system will adapt gradually. If you feel worse instead of better after your exercises, this is a signal from your body signal that you may be overdoing things. So just take a break for a day or two and/or reduce the intensity a little during your next training session. You can then ramp things up again in smaller steps, and thus gently lead your body back up to the correct eight or nine on your pain scale.

4.2 Prevention

The Best Sleeping Position for Your Back

How do you sleep at night? That may sound a strange question in relation to back pain, but it is actually very relevant. Many of us sleep on our side with our knees drawn up; in other words, in the embryo position. This posture is no different to the way we sit every day. So that means your hip flexors, calf muscles, and pectoral muscles are not only shortened during the day because of your sleep posture. The same happens at night too. 

We, therefore, recommend you revise your sleeping posture. It’s best to sleep on a hard mattress, without pillows. You should lie on your back with your legs straight. This will bring your muscles and fascia to their full length — while you are asleep. Your body can then rebalance your everyday position throughout your sleeping hours.

Roland explains all this again in the video:

Are you wondering how you can sleep like this all night? Well, don’t worry, of course, you will move around in your sleep. This is normal and important for your metabolism. But if you wake up half-asleep and realize you’re lying on your side again, just turn over onto your back. Don’t give up on this, and keep thinking about your goal. It may be difficult at first, but it’s all a matter of training.

Nutrition

Back pain is often related to your everyday lifestyle — including your diet. Healthy eating has a positive effect on healing processes and is, therefore, back-friendly. We recommend you do not have breakfast too early and don’t eat late in the evening. Also, avoid processed foods and focus on fresh, organically grown products instead.

Other Preventive Measures

You can do something good for your back every day. For example, avoid negative stress — though that’s often easier said than done. Nevertheless, take some time out for yourself every day, so you get the chance to relax properly.

Treat yourself to a hot bath or shower, take a walk in the fresh air, and soak up plenty of sun. Get a good night’s sleep. These are all secondary factors that can contribute to your back health. If your body feels good, it can help you relax.

Our video also shows you which exercises you can incorporate into your morning routine to prevent back pain:

4.3 Conventional Treatments

In addition to a general clinical examination, imaging methods such as X-rays are often used for diagnostics. And computerized tomography (CT) and magnetic resonance tomography (MRI) technologies may also be called upon for specific clinical investigations.¹²⁾ However, in many cases, there will be nothing visible.¹³⁾ This is easy to understand once you realize muscles and fascia don’t show up with these methods — even though this is the cause in the majority of cases.

Depending on what the clinical picture reveals, the spectrum of conventional treatment options is even more diverse than the diagnostics: massage, physiotherapy, support bandages, chiropractic, osteopathy, movement therapy, and spinal gymnastics are just a few of the treatments available. So let’s briefly explain a few of the most common conventional treatments.

Injections and Pain Relief

Pain relievers, whether injected or taken orally, are often the drug of choice for eliminating back pain. However, they have numerous side effects and only address the symptoms, not the cause.

Surgery

One thing to say at the outset: There are, of course, operations which are sensible and necessary. But this is not always the case. According to a health report, half of all “sundry intervertebral disc damage” (intervertebral disc damage which does not affect the lumbar spine) is operated on.¹⁸⁾ A German health insurance provider describes eight out of ten back surgeries as unnecessary.

The pain-free outcome of an operation may not last for long. Once the movement patterns in place before the procedure are resumed, the pain will return sooner or later.

So be sure to try out our exercises before you opt for surgery or decide to inject yourself! If you practice regularly, there is a good chance you’ll be able to manage your back pain independently — without surgery.

Acupuncture

The situation is much the same with acupuncture. In our experience, it can improve things for a while, but the pain often returns. So if you are keen on acupuncture, we recommend you combine it with the stretching exercises in your personal treatment plan.

Back Schools

Back schools train your core muscles, which means the back, abdominal, and chest muscles. However, this training only strengthens the backward and forward pulling forces. An evaluation of various studies showed that back schools often fail to achieve their desired objective. Hence the conclusion that the benefits of back schools remain unproven.²¹⁾

To effectively combat your back pain, you should eliminate pulling forces rather than have one strong force acting against another.

Weight Training

Patients suffering from back pain are often advised: “You have to strengthen your back muscles.” So weight training often becomes the go-to option. 

But as you now know, the problem lies not with your back muscles, but with those at the front. Your back muscles are already strong enough because they are actually ‘in training’ all day long. If you start this kind of one-sided strength training for your back, the pressure on your spine will only increase even more.

Our exercises also strengthen your back — but through stretching. Such strengthening is thus effected through counter-tension, which you apply briefly during each exercise before intensifying the stretch even further.

Step Positioning

Many are recommended to try step positioning as a quick way to alleviate acute back pain. But let’s take a closer look at this position: You lie on your back with your legs bent at a 90-degree angle, supported by a stool or something similar. In effect, you adopt exactly the same position as when you sit at your desk every day. That means step positioning actually contributes to the shortening of your hip flexor muscles.

You begin with step positioning as a kind of protective posture. When you’re lying down, your body won’t try to keep you upright, so it has no need to use your front muscles to fight the strong tensile stresses. As long as you are in this position, you’ll be pain-free. But as soon as you get up, your pain returns.

Still not convinced? Then learn more about the dark side of strength training and step positioning in this video:

And Finally: 10 Facts About Back Pain

A team of doctors from Australia and Ireland is clearing up ten common misconceptions about back pain with its “Back Facts” campaign.²²⁾ The opinion of these international experts significantly overlaps our own experience and the outcomes from 30 years of pain therapy. We have collated some of the similarities and differences for you below:

Fact 1: Persistent back pain can be worrying for the patient, but is rarely dangerous. Those affected are unlikely to end up in a wheelchair.

Persistent back pain does not automatically mean your back is damaged. It only shows your muscles and fascia have become inflexible due to everyday movement patterns, which are too one-sided. Paralysis or other injuries that might consign you to a wheelchair are unlikely to be the cause. You should still visit your doctor to clarify any serious incapacity. 

Fact 2: Increasing age is not a reason for back pain.

Our spine is designed to serve us well into old age. That means you can stay free of back pain all your life as long as you’re doing your back some good by regularly balancing one-sided movement patterns.

Fact 3: Tissue damage (due to an accident, for example) is rarely the cause of persistent back pain. Everyday factors such as stress, tension, inactivity, or unusual activity are what makes your back sensitive.

Pain is supposed to prevent such occurrences — damaging your intervertebral discs by jerky movements, for example. In some rare cases, back pain may be the result of structural damage. If this is suspected, you should arrange to see your doctor for an examination. Your back won’t become more sensitive, but your muscles and fascia will be overstretched. Thus your spine will be under constant pressure. So it is important to relieve that pressure on your spine.  

Fact 4: Imaging procedures rarely reveal the cause of back pain.

You cannot see overstretched muscles and fascia on an X-ray. Perhaps a herniated disc or osteoarthritis may be discovered accidentally and then mistakenly identified as the cause of your pain.

Fact 5: Any back pain associated with certain exercises and movements does not mean you are harming yourself. These are only signs of your back’s sensitivity. They will decrease as you move more.

Movement does not harm back pain. On the contrary, lack of movement, and movements which are too one-sided are the real reason for your back pain. If your back hurts during certain movements, it is once again a signal pain to alert you. If you counteract your one-sided movements and release the tension, the pain will subside. So this is not a sign of heightened sensitivity.

Fact 6: Back pain does not result from poor posture. Even if some positions hurt, crooked or straight sitting or standing are not the cause.

A curved posture, for example, due to sitting at your desk for too long during everyday office life, ensures you will develop shortened and matted fascia. Thus your back extensor muscles have to work very hard to keep you upright. It’s, therefore, important to compensate for such crooked sitting or standing habits.

Fact 7: Weak core muscles are not the reason for back pain.

Our back muscles are strong enough — after all, we train them 24 hours a day. Intensive back training can increase the tensile forces, which exert great pressure on your spine.

Fact 8: Your back won’t wear out due to daily strain and bending.

Your back is designed so your vertebral joints won’t automatically wear out. So there is nothing wrong with daily exercise and normal stress. On the contrary, your fascia and joints need regular exercise, which won’t lead to wear but will actually prevent it.

Fact 9: A sudden flare-up of pain doesn’t mean you’re damaging your back. This can often be the result of poor sleep, stress, tension, worry, a bad mood, inactivity, or unusual activity.

When acute pain suddenly occurs, it is a signal pain. That doesn’t mean your back is damaged, but it is a warning you could cause yourself a serious injury. However, some secondary factors can influence back pain.

Fact 10: Surgery, injections, and strong medication are rarely optimal remedies.

Pain often returns after a surgical procedure — because the tension will recur if you don’t then adopt more flexible movements. Pain relievers are also not a permanent solution. Apart from the risk of side effects and addictive factors, they don’t address the cause, but only remove the symptoms for a short while. Assuming your body is using pain to warn you of harm, this could even be dangerous.