Maintaining a strong spine

Almost everybody, sportspeople included, will be affected by back pain at some point in their lives. However, in the vast majority of cases, the symptoms can be remedied by means of targeted strengthening of the back muscles. Surgery is required in very rare cases only.

Dr. med. Ulrich Kraus, specialist in neurosurgery and spinal surgery

02. July 2024

In den allermeisten Fällen reicht eine konservative Therapie, um die Beschwerden in den Griff zu bekommen. (Foto: Pexels)

Sometimes all it takes is a tiny movement. Picking up a piece of paper, stowing a bag in the back seat of the car, inserting a belt in your trousers – and it happens: a sharp pain shoots through your back like a bolt of lightning and every movement, no matter how small, turns into agony.
The incidence of back problems has shown no sign of decreasing in recent years, especially in Western countries. This is because we are becoming less active and are also getting older. But what should you do if you experience sudden back pain? How can we categorise the pain, distinguish between acute and chronic conditions, what can we do to counteract it and, most importantly, how can we avoid it in future?

Back surgery is almost never needed
Lumbago resolves itself within a few days, whereas a slipped disc is more stubborn. But regardless of whether it's lumbago, sciatica or a disc issue, I recommend taking it easy, having patience and controlling the pain with medication. For as long as it is only your back that is affected, you should simply wait it out and manage the pain.

In the vast majority of cases, it is usually enough to treat the symptoms by taking a conservative approach. My advice is not to panic, even if the pain is acute. Surgery is almost never required in the short term and only very rarely in the long term. We only become immediately concerned if the patient is no longer able to urinate or have a bowel movement or if symptoms of paralysis occur below the knees. Apart from that, however, I would definitely recommend that patients first try a conservative approach based on gentle exercise and targeted development of the core and back muscles. And an MRI only needs to be carried out after a period of eight weeks at the earliest if the pain has not subsided significantly by then.

However, if surgery is needed in extreme cases, it can take three months before the spine can properly bear weight again and, in the case of sportspeople, even think about competing. In our experience, the success rate is high, as is expressed in figures: 40% are completely symptom-free after an operation, 40% very satisfied, 10% satisfied and 10% dissatisfied. In addition, patients who have undergone surgery have the same risk of symptoms coming back after three months as those who do not have surgery.

Muscles are crucial
That said, a surgical procedure is only really necessary in absolutely exceptional cases and the success rate of conservative treatment is equally high. This is because the cause of back pain and a slipped disc is almost always weak back muscles. We only very rarely see fit and very sporty people as patients, whereas patients who are overweight, who smoke and who do not exercise are more common.

The spinal column consists of 24 vertebrae, which are connected by 23 flexible intervertebral discs, and 8 to 10 vertebrae that are fused to form the sacrum and coccyx. Because the spine has to support almost all of the body's weight, it is slightly thicker at the bottom than at the top and is curved several times (double S) to maximise shock absorption. The intervertebral discs function as spacers and shock-absorbing elements. With age, they tend to lose their fluid content - which reduces their elasticity. If excessive strain is placed on a disc and it is pressed into the spinal canal, pressure is put on the nerves causing pain - this is called a slipped disc.

To prevent this from happening in the first place, the muscles that can compensate to a large extent for (age-related) weakness in the discs need to be called into action. The spine is stabilised primarily by what are known as the autochthonous (erector spinae) back muscles, which extend along both sides of the spine. You have to imagine them as an elongated balloon. If the balloon has no air in it, it does nothing and just lies there, but if it is filled with air, it protects and stabilises the spine so effectively that hardly any discomfort can be felt. The air in the balloon is the equivalent of strong muscles.

Exercise is essential
For this reason, it is obvious that physical training and preventing back pain play a crucial role. Unfortunately, there is no escaping the hard work. Exercising, staying active and cutting out smoking are changes that you should implement in the long term if you want to keep your spine happy. And this applies all the more the older one gets. Weight training in particular is key.

In addition to targeted weight training, I recommend neutral sports such as cycling, swimming or Nordic walking. Running is another option, but tends to be less suitable. Stop-and-go sports should be avoided, especially those that involve twisting movements such as football, squash or badminton.

Patience and motivation
What is equally important in achieving relief from symptoms is the patient's own motivation and patience. Even in cases of mild paralysis, non-surgical treatment has the same chances of success as surgery if the patient is willing to work at it and has the necessary patience, even if progress is only gradual. My own experience shows: patients with back problems can achieve a great deal if they are motivated and determined.

However, patience is not the number one virtue among many sportspeople because they want to get back to training as quickly as possible. I see the same thing in my own practice. Sometimes we doctors have to proceed like therapists and explain the situation to our patients. We have to make them understand that when it comes to disc problems, they have to give it time. Sportspeople need to realise that things will work out, but only if they have enough patience. Once patients are free of symptoms again, there is nothing to stop them from returning to their usual sporting activities, as long as the supportive strengthening measures are not suddenly abandoned, but are firmly integrated into their exercise programme.