Spine

Why the spine is so important

The spine is the central axial skeleton of the body. It protects the spinal cord, enables mobility in all directions and directs forces between the arms, torso and legs. At the same time, it reacts sensitively to one-sided strain, stress, lack of exercise or injuries. The aim of modern orthopedic treatment is to alleviate symptoms, identify triggers and increase resilience in the long term - if possible without surgery.

• Resilient but sensitive: balance between stability and mobility
• Common cause of pain in everyday life and at work
• Usually can be treated conservatively with training, physiotherapy and pain management

Anatomy of the spine – briefly explained

The spine consists of 24 free vertebrae as well as the sacrum and coccyx. Intervertebral discs act as “shock absorbers” between the vertebrae. Articulated connections (facet joints), ligaments and muscles stabilize and control movement. The spinal cord runs through the spinal canal, from which nerve roots emerge on both sides.

• Cervical spine (cervical spine, 7 vertebrae): high mobility, sensitive to tension
• Thoracic spine (BWS, 12 vertebrae): connected to the ribcage, rather stable
• Lumbar spine (lumbar spine, 5 vertebrae): carries a lot of load, frequent location of pain
• Intervertebral discs: fibrous ring and gelatinous core for pressure distribution
• Facet joints: small vertebral joints, a common source of pain in old age
• Nerve roots: supply arms (cervical spine) and legs (lumbar spine)

Common complaints and key symptoms

• Neck pain, possibly radiating to the shoulder/arm, headache
• Tension between the shoulder blades, breathing-dependent pain
• Deep back pain, morning stiffness
• Radiating pain into the leg (“sciatica”), tingling or numbness
• Stress-dependent pain when standing/walking, better when sitting
• Sudden feelings of blockage, limited mobility

Important: Radiations, numbness or muscle weakness can indicate nerve irritation. If there is any evidence of a neurological deficit, medical attention should be sought promptly.

Common diagnoses at a glance

• Non-specific back pain: most common finding, muscular-functional
• Cervical syndrome: Neck pain with/without radiation
• Facet joint syndrome: Wear-related pain in the vertebral joints
• Disc bulge/herniation: Irritation of a nerve root possible
• Lumbalgia/Lumbosciatica: Back pain with/without leg pain
• Spinal canal stenosis: Narrowing of the nerve canal, dependent on stress
• Spinal slip (spondylolisthesis): Segmental instability
• Scoliosis/Scheuermann: variant forms, some requiring treatment
• Osteoporosis-related vertebral body fracture: sudden onset of pain

Not every imaging finding explains pain – and not every pain requires surgery. What is crucial is the overall view of complaints, examination and, if necessary, imaging.

Diagnostics: thorough and targeted

An MRI is useful if there are severe symptoms, persistent radicular pain or suspected serious causes. For acute, uncomplicated back pain, conservative treatment according to guidelines without immediate imaging is usually sufficient.

Conservative therapy – step-by-step plan

The aim is to reduce pain, improve functionality and return to activity. Measures are combined individually and adapted to the course.

• Heat: promotes blood circulation when there is tension
• Cold: reduces acute irritation/swelling
• Aids limited in time: e.g. B. Lumbar bandage for peak loads
• Sports that are often well tolerated: walking, cycling, swimming, moderate strength training

For chronic complaints, multimodal concepts (combination of physiotherapy, training, pain and behavioral therapy) can be useful.

Targeted injections – when appropriate

If basic conservative measures are not sufficient or there is a clear source of pain, targeted injections can provide temporary relief and enable therapy. The decision and implementation are made after careful information.

• Facet joint infiltration for vertebral joint pain
• Periradicular therapy (PRT) for nerve root irritation
• SIJ infiltration with sacroiliac involvement (distinction from lumbar spine complaints)

The effectiveness varies from person to person. Injections do not replace active therapy, but can open a window of opportunity for training and rehabilitation.

Prevention: everyday life, ergonomics and self-help

• Regular exercise: 150 minutes of moderate exercise per week plus 2-3 strength training sessions
• Core training: core stability increases resilience
• Workplace: sitting height, monitor at eye level, dynamic sitting, standing phases
• Microbreaks: change positions and short mobilization every 30-60 minutes
• Sleep: fixed routine, medium-firm mattress to suit your body type
• Stress management: relaxation procedures, breathing exercises
• Weight management: reduces pressure on intervertebral discs and joints

Regularity is important: small, frequent sessions have a more lasting effect than rare, intensive stress.

Cervical spine, thoracic spine and lumbar spine at a glance

Typical causes, symptoms and treatment focuses vary depending on the region. You will find more detailed information on our subpages.

• Cervical spine – cervical spine: neck pain, dizziness, arm symptoms – see underside cervical spine
• BWS – thoracic spine: blockages, breathing-dependent pain – see BWS subpage
• LWS – lumbar spine: lower back pain, sciatica, spinal canal stenosis – see underside LWS

Sport and return to activity

Movement is therapy. After acute phases, the following applies: start early and increase the load gradually. Decision based on symptoms and functional status.

• Start: walking, cycling, aqua fitness; later a variety of strength training
• Technology before load: clean execution, adjusted volume
• Criteria for progression: pain ≤ 3/10, no increase the following day, stable trunk control
• Slowly build up sports with rotation/shock load (e.g. tennis, jogging)

When to see a doctor? Take warning signs seriously

The following situations should be clarified quickly by a doctor. In the event of an emergency, please seek medical help immediately.

• New onset paralysis, severe muscle weakness
• Numbness in the buttocks/private area, bladder or rectal disorder
• Severe, persistent pain after an accident/fall
• Fever, feeling sick, unknown source of inflammation
• Unexplained weight loss, pain at night at rest
• Known osteoporosis or tumor disease with new spinal pain

This is how the treatment works in our practice

Our location: Dorotheenstraße 48, 22301 Hamburg. We work according to guidelines, explain things transparently and decide together with you about the next steps - without promising any cure.