BACK PAIN — WHEN YOUR BACK HURTS, THE PROBLEM USUALLY LIES SOMEWHERE ELSE

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Everything Important You Really Need to Know About the Causes of Back Pain, Self-Help Exercises for Pain You Can Try at Home, and the Best Tips for Prevention

Do you get twinges in your back and feel pain with the slightest movement? Do you suddenly notice how much your spine is involved in all your movements? Most of us experience these feelings of pain because we all sit too much. In fact, sitting has become the new smoking. You can find out why in this article.

According to the Global Burden of Disease Study from 2010, back pain ranks among the top ten diseases and injuries responsible for permanent disabilities.1)Hoy D, March L, Brooks P, et al. The Global Burden of Low Back Pain: Estimates from the Global Burden of Disease 2010 Study Annals of the Rheumatic Diseases. 2014. In addition to that, one in three adults experience frequent or continuous back pain.2)Reith, Wolfgang. “Non-specific Back Pain and Chronification.” The Radiologist 60 (2020), pp. 117-122. Your discomfort may be high up or lower down — any area of the back can be affected. Sometimes the pain goes away quickly, but sometimes it can persist for much longer.

We explain why this is so. You can read all about

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)DAK Health Report 2019 (last accessed on the 24th of February, 2020 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)Reith, Wolfgang. “Non-specific Low Back Pain and Chronification.” The Radiologist 60 (2020), pp. 117-122. 

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.

Roland Liebscher-Bracht

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling self-help books on the treatment of pain conditions.

 
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Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, Dr. med. Petra Bracht, he has developed a revolutionary method to treat pain conditions. With the help of the so-called "osteopressure", where you press specific points on your body, and special stretching exercises, pain can be stopped entirely without medication or surgical intervention. This pain treatment allows you to alleviate pain by yourself. Find out how exactly this works in this article or our numerous YouTube videos.

Roland Liebscher-Bracht

Germany's best-known pain specialist and author of several bestselling books on self-help against pain.

 
Read more

Roland Liebscher-Bracht is Germany's best-known pain specialist and author of several bestselling books on pain treatment. Together with his wife, the physician Dr. Petra Bracht, he has developed a revolutionary new form of pain treatment: With the so-called "Osteopressur", in which certain points on your body are pressed, and special stretching exercises, pain can be stopped completely without medication or surgical intervention. It is particularly important that this pain treatment gives you the opportunity to help yourself against your pain in a self-determined way. You can find out exactly how this works in this article and in the numerous YouTube videos.

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.

back pain - cervical spine

© Magic mine | shutterstock.com

If you have pain in the cervical spine (neck), it could be one of the following:

  • Atlas vertebral pain — a blockage or misalignment of the atlas vertebrae (often with headaches, jaw pain, neck pain, restricted movement in the shoulder)
  • Cervical spine syndrome — tension in the neck muscles/ neck pain (can sometimes also affect the shoulder)
  • Cervical disc herniation — rupture of a disc in the cervical spine area
Image of the upper part of the spine highlighted in red.

© Magic mine | shutterstock.com

If the pain is in the thoracic spine area, you might be affected by:

  • Thoracic Spine Syndrome — chest pain
  • Rounded back — curvature of the upper spine (“hump”)
back pain-lumbar spine column

© Magic mine | shutterstock.com

The following pain encyclopedia articles will help with complaints in the lumbar spine or the lower back (lumbar region):

  • Lumbago/acute lumbago — dysfunction/acute lower back pain
  • Lower back pain — especially caused by office work
  • Lumbar pain — lower back pain
  • Sciatica/sciatic pain — compression of the sciatic nerve (often with pain in the buttocks or legs)
  • SI back pain — apparent blockage or tilting of the sacroiliac joint (often with pain in the buttocks, knees or groin area)
  • Pelvic misalignment — tilted pelvic girdle
  • Hollow back (lordosis) — spinal deformation/misaligned posture
human with back pain

© Magic mine | shutterstock.com

If you experience pain which affects your whole back, it could be you suffer from one of these pain conditions:

  • Osteoarthritis — cartilage wear
  • Prolapsed intervertebral disc — herniation or rupture of an intervertebral disc and leakage from its gel-like core
  • Fibromyalgia — causes pain all over the body
  • Slipping vertebrae (spondylolisthesis) — forward slip of one vertebra onto another
  • Bechterew’s disease — stiffening/ossification of the spine, inflammatory rheumatic disease
  • Osteoporosis — thinning of bone structure
  • Scoliosis — curvature/misalignment of the spine
  • Spinal stenosis — narrowing of the spinal canal
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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.

2.1 The Spine

Our spine carries the weight of the back and head, allows us to make a whole variety of movements, and at the same time, provides us with structural support. The spine has a characteristic double S-shape.

Consisting of 24 unattached, bony vertebrae and subdivided into the cervical spine (seven vertebrae), thoracic spine (twelve vertebrae), and lumbar spine (five vertebrae), the spine is the central element of our musculoskeletal system. Below this, there is also the sacrum and coccyx.

Unlike the 24 unattached vertebrae of the spine, the vertebrae of the sacrum and coccyx are fused together. The sacrum consists of five conjoined vertebrae. Beyond this, the coccyx, with its three to five vertebrae, forms the lowest part of the spine.

Illustration of the Spine

© Neokryuger | shutterstock.com (edited)

 

2.2 The Vertebrae

The vertebrae can be differentiated according to shape and size. The first two vertebrae of the cervical spine differ in shape from all the others.

  • The atlas (C1 or first vertebra of the cervical spine) looks like a bony ring.
  • The axis (C2 or second vertebra of the cervical spine) differs from other vertebrae in that it has a bony extension which protrudes upwards into the atlas.

Moving down towards the lumbar spine, the vertebrae are noticeably larger than in the upper part of the spine. The vertebrae in the cervical spine are smaller because they only have to support the weight of the head.

An illustration of the vertebra of the spine, showing the atlas and axis.

© stihii | shutterstock.com

A vertebrae with annotations.

© Alex Mit | shutterstock.com (edited)

 

Vertebrae typically consist of a vertebral body and a vertebral arch. The space in between is hollow, and this cavity serves as a spinal canal which encloses our spinal cord. Among other functions, this relays the commands governing our movements. Spinal nerve roots branch off from the spinal cord. These nerve roots consist of nerve fibers and are arranged in pairs. Their task is to convey information between the central nervous system (the brain and spinal cord) and the peripheral nervous system (the region beyond the brain and spinal cord).

Each vertebra has 

  • a single spinous process,
  • two transverse processes, and
  • four articular processes. These are arranged with two at the top and two at the bottom of the vertebra.
Anatomy of the spine and its vertebrae.

© Alila Medical Media | shutterstock.com (edited)

 

Ligaments, tendons, and muscles attach to the spinous and transverse processes. You can see and feel these spinous processes when looking at the spine. The spinous process of the seventh cervical vertebra is particularly prominent and easy to recognize.

The facet joints (vertebral arch joints) are located between the articular processes and behind the intervertebral discs. They are arranged in pairs and, together with the intervertebral discs and ligaments, represent the connection between the individual vertebral bodies. Facet joints enable the spine to bend forwards and backwards, and also allow rotation and lateral movement. At the same time, they provide us with structural stability. Their function also varies according to the spinal region they occupy. That’s why slightly different movements are possible in the cervical spine, thoracic spine, and lumbar spine. Mobility is greatest in the cervical spine, lateral movement in the thoracic spine, and rotation in the lumbar spine.

2.3 The Intervertebral Discs

Intervertebral discs form a flexible connection between the individual vertebrae. They are firmly attached to the periosteum of the vertebra above and below so that they cannot slip.

Each intervertebral disc consists of a fiber ring and a gel-like core. They act as a buffer for the spine to absorb shocks. Intervertebral discs require movement in order to remove waste materials, and so they can access a supply of nutrients. That means they have to be regularly compressed and released — rather like a sponge. This occurs whenever you bend and twist your torso.

Intervertebral disc in the spine

© Lightspring | shutterstock.com

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.

2.4 The Back Muscles

The muscles in your back lie on top of each other in several layers.

  • The deeper back muscles give the spine stability and allow it to twist and tilt.
  • The back extensor muscles run along the spine from the pelvis to the head and support your upright posture.
  • The superficial back muscles connect your spine with other parts of the skeleton. For example, they facilitate your arm and leg movements.
back pain musculature in the back

© SciePro | shutterstock.com

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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)Haußmann, A.: Diagnostik von akuten und chronischen Rückenschmerzen. In: Der Radiologe 60 (2020), p. 109-116.

However, 85 to 90 percent of all cases are non-specific back pain.6)Reith, Wolfgang. “Nichtspezifische Kreuzschmerzen und Chronifizierung.” Der Radiologe 60 (2020), p. 117-122. 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)DAK Health Report 2018 (last accessed on the 24th of February, 2020).

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.

Low Back Pain — What Exactly Does That Mean?

“My back is so sore!” This is a sentence everyone has probably heard or used before. But what exactly do we mean? Generally, we define low back pain as “non-specific deep-seated back pain.”

It is pain experienced below the costal arch and above the buttocks.8)Bundesärztekammer: Patienteninformation. Aktiv gegen dauerhafte Kreuzschmerzen (2018) (last accessed on the 24th of February, 2020). In principle, low back pain is nothing more than pain in the lumbar spine; in other words, lumbago, which is the most common of all back pain.

Non-specific means no cause can be found — at least at first glance. Excessive stress or loading on the spine or the muscles in the back is often part of the diagnosis. We know muscular-fascial tension is one cause that our exercises can permanently eliminate. Find out more about low back pain in our extensive pain encyclopedia articles.

A man gripping his lower back in pain.

© Prostock-studio | shutterstock.com

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)Liebscher-Bracht, Roland; Dr. med. Petra Bracht: Deutschland hat Rücken. Wie es so weit kommen konnte. Warum jetzt Schluss damit ist. Was Sie selbst dagegen tun können. München 2018.

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)Liebscher-Bracht, Roland; Dr. med. Petra Bracht: Deutschland hat Rücken. Wie es so weit kommen konnte. Warum jetzt Schluss damit ist. Was Sie selbst dagegen tun können. München 2018.

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?

Fascial network

© Photobank gallery | shutterstock.com

Fascia primarily consists of water, collagen, and elastin. This combination ensures fascia threads are sufficiently tear-resistant whilst at the same time also remaining elastic.

Let’s also look at our cells — or, more precisely, the intercellular space. This is filled with intercellular fluid, which circulates continuously. This fluid removes waste materials from our cells and replenishes important nutrients.

To ensure this fluid gets to flow through the narrow passages between muscles and fascia, we have to move. This is also how we start the production of fascia, since the liquid flows along the cilia of the fibroblasts, bends them, and thus stimulates them to work.

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.

Perhaps you have remained in one position for too long (maybe squatting and bending forward while gardening). When you try to straighten up, pain in your back prevents you from doing so. But if you allow your body a little more time to straighten up, your front muscles and fascia can give way a little. As a result, the load on your spine and intervertebral discs decreases. The body registers this fact immediately, stops the pain, and you can then stand up straight again.

But what if you have back pain for longer, and not just shortly after a jerky movement (lifting a box, or twisting sideways)? Again, the answer is quite simple because the principle is the same: the front muscles and fascia are extremely tense. Your back extensor muscles then have to exert enormous forces to keep your upper body upright. But the casualties are your intervertebral discs, so your body has to protect them by triggering a pain. This can happen, for instance, with a lumbago or herniated disc.

Back pain - gardening

© sirtravelalot | shutterstock.com

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.

Your everyday life is unlikely to be back-friendly because your back will tend to be under constant tension. Your muscles and joints will lack:

  •   the full range of flexibility in your hip joints and torso
  •   the ability to hyper-extend your hips and torso, as well as
  •   the ability to twist your torso and bend sideways

These allow you to sit for long periods or compensate for one-sided movements and ensure that your muscles and fasciae become more flexible again — which will also do your back extensor muscles a lot of good too.

A woman bending backwards during an exercise

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.

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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)Janssen, Frank. Rückenschmerzen — Das konservative Therapiespektrum ausschöpfen. Fortschritte der Medizin, 161 (2019) (episode 581), p. 44-52.

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.

A woman does back training

As just mentioned, it is important that you roll very slowly. This means you will push the intercellular fluid through the small gaps, rather than just rolling over them. At the same time, you should apply constant firm pressure and always move the fascia roller in one direction — towards your heart. This takes into account both lymph flow and any possible backflow of blood through your venous system. 

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.

A woman does osteopressur against back pain

You will notice these points are sensitive to pain. But press just hard enough to allow yourself to continue to breathe — we call this your personal level of pain and well-being. Stay at that level until you feel the pain go away — that means your brain is responding and normalizing your muscle and fascia tension. If the sensitivity decreases, you can then press a little harder. However, you shouldn’t linger at any one location for more than two minutes.

You can use osteopressure to quickly relieve your pain. But bear in mind that the cause of your pain has not yet been resolved. Regular use of our exercises is important for permanent freedom from pain.

📌 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.

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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.

Sport and Back Pain

Movement is important, even with back pain. So don’t give up on sport unless your doctor advises against it on health grounds.

You can still do well at sports such as yoga, Nordic walking, swimming or aqua gymnastics, even if you suffer from back pain. However, with swimming, you’ll find that backstroke or freestyle are more back-friendly than breaststroke.

Generally speaking, it’s important your movements are not too one-sided. That’s one reason we advise you to combine your favorite sport with our exercises.

A swimmer doing back strokes.

© Microgen | shutterstock.com

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)Haußmann, A. “Diagnostik von akuten und chronischen Rückenschmerzen.” Der Radiologe 60 (2020), p. 109-116. However, in many cases, there will be nothing visible.13)Janssen, Frank. “Rückenschmerzen — Das konservative Therapiespektrum ausschöpfen.” Fortschritte der Medizin, 161 (2019) (Folge 581), p. 44-52. 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.

Two syringes and a handful of pills.

© Zadorozhnyi Viktor | shutterstock.com

Let’s think back to our signal pain: Our body tries to warn us about a certain movement to avoid damage to our body structures. In an interview with FAZ, a specialist even referred to pain as a “vital warning signal” .14)FAZ — Kein Schmerzmittel sollte frei verkäuflich sein. Schmerztherapeut im Gespräch von Denise Peikert (2017) (last accessed on the 24th of February, 2020). So what happens if we remove this pain? It’s no longer able to inhibit damaging movements. Using pain relievers, you run the risk that such damage may occur simply because you deliberately numb your body’s warning signals. 

However, your sister may be getting married, your grandma might be turning 90, or you yourself may perhaps be celebrating an important ‘milestone’ birthday. In which case, there’s nothing wrong with resorting to painkillers to get you through such special events. But it should always remain a one-off option, and not become a permanent therapy. Nevertheless, this is exactly what can happen when patients take over-the-counter medications for too long.15)FAZ — Kein Schmerzmittel sollte frei verkäuflich sein. Schmerztherapeut im Gespräch von Denise Peikert (2017) (last accessed on the 24th of February, 2020). This will always increase the risk of dependency.16)Schutter, Ulf, Dr. med. “Rückenschmerzen — Sichere Schmerztherapie in Klinik und Praxis.” Schmerzmedizin  34 (3) (2018), p. 28-31. In total, almost half of all painkillers purchased in pharmacies are supplied without a prescription.17)DAK-Gesundheitsreport 2018 (last accessed on the 24th of February, 2020).

 

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)DAK Health Report 2018 (last accessed on the 24th of February, 2020). A German health insurance provider describes eight out of ten back surgeries as unnecessary.19)Die Techniker: Rücken-Operation. Acht von zehn Rücken-Operationen sind überflüssig (last accessed on the 24th of February, 2020).

back pain surgery on the back

© Roman Zaiets | shutterstock.com

Nevertheless, hospital stays due to back pain continue to increase significantly. However, the number of in-patient stays which do not involve surgery is also on the increase.20)Zich, Karsten; Thorsten Tisch. Faktencheck Gesundheit — Faktencheck Rücken. Rückenschmerzbedingte Krankenhausaufenthalte und operative Eingriffe. Bertelsmann Foundation (2017). A surgical intervention is often followed by physiotherapy or some other movement therapy.


Once again, the problem is this method of treatment does not remedy the cause. The intervention is carried out on the structure — but as we have already explained, this is not the reason for the pain.

Persistent pain after surgery is not uncommon. According to one study, the success rate is around 35 percent.21)Baber, Zafeer; Michael A. Erdek. Failed Back Surgery Syndrome: Current Perspectives. Journal of Pain Research 9 (2016), p. 979-987. And some patients are pain-free for some time afterward, but then their symptoms return. Why should that be? Quite simply: All muscles relax in response to the general anesthesia given during an operation. And a local anesthetic affects the surrounding muscles. This ensures all muscle tensions subside, and the signal pain disappears.

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.

Heat

Patients are often advised to treat their back pain with heat. And whether that means an infra-red light, a hot water bottle, or a heating pad — warmth feels pleasant when you have muscle tension. Therefore, there can be no objection to heat treatment as a first response. But bear in mind it only has a short-term effect. Heat acts as an analgesic because it boosts the blood and nutrient supply. But this has only temporary benefits. 

So our advice is: If you notice heat is good for you, then use it. Perhaps you could also take a hot bath to relax. And for permanent freedom from pain, simply combine your heat therapy with our exercises.

back pain conservative treatment with warmth-breakdown

© goir | shutterstock.com

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.22)Straube, Sebastian; Markus Harden; Heiko Schröder; Barbora Arendacka; Xiangning Fan; R. Andres Moore; Tim Friede. Back Schools for the Treatment of Chronic Low Back Pain: Possibility of Benefit But No Convincing Evidence After 47 Years of Research — Systematic Review and Meta-Analysis. Pain 157 (10) (2016), p. 2160-2172.

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.23)O’Sullivan, Peter B.; JP Caneiro; Kieran O’Sullivan; Ivan Lin; Samantha Bunzli; Kevin Wernli; Mary O’Keeffe. “Back to Basics: 10 Facts Every Person Should Know About Back Pain.” British Journal of Sports Medicine, December 2019. 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.

Woman does Stretching exercise for pain

Free EXERCISES TO RELIEVE your PAIN

Sign up now for our weekly advisory newsletter to receive the latest exercises to help with your pain. You can easily do all of them at home, too. The best thing: our newsletter is completely free!
 
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Sources & Studies   [ + ]