Back pain caused by poor posture

Around 1.2 million people (14%) in Switzerland suffered from joint pain for at least one week last year. The lower back and neck are the two most common sites of joint pain, ahead of all other joints.

Common causes of back pain 
Poor posture is the most common cause of back pain. This causes strain on muscles, joints and intervertebral discs. A muscle strain manifests as tension and stiffness, known as myogelosis or muscle ache. In the past, it was assumed that muscle soreness was primarily caused by an accumulation of lactic acid. We now know that muscle soreness is often caused by micro-tears in the muscle, which means that muscle soreness is a warning sign of injury due to overexertion and poor posture.

Excessive strain on the discs usually occurs when the head is bent forward at a sharp angle. Excessive strain on the spinal joints often occurs when the head is bent backwards at an extreme angle. Bending your head forward is particularly risky: increased strain on discs leads to disc degeneration, also known as intervertebral osteochondrosis.

Test your own head posture to see how well it is aligned 
Try the four-finger test: position your hand so that your index finger is under your chin. Now tilt your head forward until your little finger touches your sternum (breast bone). At this point, your head is tilted forward by about 45 degrees and the pressure on your cervical vertebrae has quadrupled. In the long term, this position is not good for the intervertebral discs or the neck muscles. Keeping your head in this position frequently will inevitably result in neck pain. The head should only rarely be tilted to the point where your little finger touches the sternum (45° or more).

Diagnosis 
The first step in diagnosing poor posture is observing yourself in your day-to-day life. To assess its severity, we recommend that you consult your GP. They are the first and most important point of contact for assessing back problems. If you have had back pain in the same place every day for six weeks or more, or several times a week for three months, you should consult your GP. Depending on the severity, you may also need to see a spinal specialist. You should consult a doctor immediately if you experience any of the following: sudden severe back pain; additional pain in your arm or leg; paralysis; or bladder or rectal disorders. In order to make a diagnosis, it is essential to take a detailed description of the symptoms and carry out a manual examination of the spine. In many cases, it is also useful to examine the spine using X-rays or an MRI scan.

Main types of therapy 
If you suffer from back pain, it is important to obtain a diagnosis first. It is only then that the correct treatment can be determined. Treatments are often decided on without knowing the diagnosis, which can make the symptoms worse. If you are diagnosed with poor posture and back pain, the following therapies may be useful, depending on the site and severity of the symptoms:  

• Posture correction and posture training as part of physiotherapy and osteopathy. 
• A number of natural ingredients can support the recovery/regeneration of joints, nerves and muscles (for example: L-carnitine,5 glucosamine/chondroitin,6 alpha-lipoic acid/gamma-linolenic acid7). 
• Infiltration (analgesic injection) at the main site of the pain. 
• Plasma treatment (autologous conditioned plasma, ACP). 
• Medical hypnosis, thermal and relaxation therapies. 
• In cases of severe misalignment and advanced disc degeneration, surgery to replace a damaged disc may be necessary. 
• Non-steroidal anti-inflammatory drugs are recommended for use as painkillers. Strong opioids such as oxycodone, which have a high potential for causing addiction, should be avoided at all costs and are no longer recommended. 

Example patient 
Ueli Graf (33 years old, name has been changed) had been suffering from neck pain for over a year, with pain in both shoulders and his left upper arm. He took pain relief twice a week. He noticed that he had tight neck muscles when his head was tilted significantly and also during work. During the course of the day, his pain reached 7 out of 10 on the pain scale. Posture training and relaxation exercises significantly improved his neck pain, but he continued to experience persistent pain in his left upper arm and shoulder. An X-ray revealed significant wear and tear of the C5/6 intervertebral disc, unusual for his age, with moderate narrowing of the 6th cervical nerve. Injecting a painkiller into the 6th cervical nerve eased the discomfort in his left upper arm, but unfortunately only for two weeks. Given this situation, Ueli Graf was recommended an artificial disc replacement by the specialist. The surgical procedure took 90 minutes, and the patient was able to return home after two days in hospital. The pain in his arm disappeared after the procedure, and the pain in his neck eased after six weeks of light physiotherapy. Two years after his surgery, Ueli Graf continues to ensure he maintains a good posture in his day-to-day life and is once again active at work and during his free time.

Tried and tested teamwork 
For back pain to be treated successfully, it is crucial that the patient works together with a treatment team that is both compassionate and knowledgeable.