LWS – lumbar spine

Anatomy and function of the lumbar spine

The lumbar spine consists of five vertebrae (L1-L5), which are connected to each other via intervertebral discs, small vertebral joints and strong ligaments. Nerves that supply the muscles and skin of the legs run through the spinal canal. The interaction of bones, intervertebral discs, joints, muscles and connective tissue ensures stability and mobility.

• Vertebral bodies L1–L5: carry loads and, together with the intervertebral discs, form the main support
• Intervertebral discs: fibrocartilaginous buffers between the vertebrae to distribute pressure
• Facet joints: small vertebral joints that lead movement and can become painfully inflamed
• Spinal canal and nerve roots: carry signals to the legs and feet
• Muscles and fascia: stabilize deep core muscles; Fascia transmits forces
• Ligaments: limit movements and provide guidance
• Sacroiliac joint (SIJ): connection between the sacrum and pelvis, a common source of pain

Functionally, the lumbar spine combines stability with mobility: it transfers forces between the upper body and legs, protects nerve structures and enables everyday activities such as lifting, walking and sitting.

Typical symptoms and common causes

Lumbar spine complaints manifest themselves in very different ways. What matters is whether pain remains local or radiates into one leg, whether there is numbness or muscle weakness and how the symptoms react to movement.

• Local lumbar spine pain: dull, pulling, often dependent on stress
• Radiation into the buttocks/legs (sciatica): stabbing, burning, sometimes with tingling
• Morning stiffness or start-up pain
• Stress-related complaints when standing/walking (e.g. spinal canal stenosis)
• Increase in rotation/extension movements (often facet joints or SIJ)

Causes range from functional disorders to structural changes. Often several factors are involved.

• Myofascial imbalances and tension (most common cause of acute back pain)
• Irritation of the facet joints (facet syndrome)
• Disc wear, bulging or prolapse with nerve root irritation
• Spinal canal stenosis (narrowing of nerve structures)
• SI joint dysfunction or blockage
• Spinal slip (spondylolisthesis)
• Rare: inflammation, osteoporosis-related fractures, tumors or infections

Diseases of the lumbar spine – overview & subpages

The following subpages delve deeper into the most important clinical pictures of the lumbar spine. They explain symptoms, diagnostics and conservative and, if necessary, surgical options.

• Lumbar myofascial pain syndrome – muscular-fascial tension and trigger points
• Lumbar disc herniation – acute radicular pain, possibly numbness or weakness
• SIJ blockage – deep back pain, often concentrated on the sides and noticeable when standing up
• Spinal canal stenosis of the lumbar spine – stress-dependent leg symptoms when walking/standing
• Spondylolisthesis – spondylolisthesis with back pain and possibly radiation
• Cervical spine – Overview of complaints in the neck area
• BWS – thoracic spine – causes and therapy for moderate back pain

Diagnostics: From conversation to imaging

A targeted diagnosis begins with a detailed conversation and a careful examination. Imaging is used according to indication – not every episode of back pain requires an MRI.

• Laboratory tests only if inflammation/infection or rheumatic causes are suspected
• Imaging is used to confirm clinical findings; many signs of aging are asymptomatic
• Progress is assessed clinically – not just based on pictures

Warning signs – when should you seek medical advice immediately?

Certain symptoms indicate emergencies or serious causes and should be sought medical attention immediately.

• Newly occurring significant muscle weakness in the leg (e.g. weakness of the dorsiflexor foot)
• Numbness in the saddle area (perineum), stool/urinary retention or incontinence
• Severe pain after accident/trauma
• Fever, chills, general feeling of illness with back pain
• Unexplained weight loss, history of tumors or immunosuppression

Conservative therapy is the priority

The vast majority of lumbar spine complaints improve with conservative measures. The aim is to relieve pain, restore everyday function and avoid chronicity. Staying active – adapted to the symptoms – is key.

• Education and activation: measured movement instead of protective posture
• Physiotherapy: mobilization, stabilization (core training), posture training
• Home exercises: simple, regularly performed exercises for the trunk and hips
• Heat/cold depending on the phase, short-term TENS as an option
• Medications for a limited time and according to the indication (e.g. NSAIDs, muscle relaxants if necessary)
• Manual therapy/soft tissue techniques for myofascial complaints
• Ergonomics advice: workplace, lifting/carrying, break structure
• Infiltrations if necessary and with a clear indication (e.g. facet, ISG, periradicular) for short-term relief and gain in function

If the pain persists or is complex, multimodal pain therapy can be useful - a combination of exercise therapy, education, behavioral therapy elements and, if necessary, medication support.

Targeted injection therapies of the lumbar spine (if necessary)

Injections can identify individual sources of pain and provide temporary relief. They do not replace active therapy, but they can make it possible.

• Facet joint infiltration: for facetogenic pain, if necessary with local anesthesia/cortisone
• Periradicular therapy (PRT): image-guided injection near the nerve root for radicular pain
• ISG infiltration: with a secured ISG source
• Radiofrequency therapy (denervation) in selected cases after a positive test blockade

Benefits and risks are weighed individually. Repetitions are carried out cautiously to avoid side effects.

Regenerative processes: What is possible and useful for whom?

Biological procedures such as PRP (autologous blood plasma) or proliferative injections are discussed, aim at tissue healing and pain reduction and can be considered as a supplement for certain lumbar spine complaints. The evidence is heterogeneous; Careful indications and information are essential.

• PRP for irritated facet joints or SIJ: possible option if conservative measures have been exhausted
• Proliferation therapy at ligament/tendon attachments: in individual cases
• Not suitable as a “cure-all” or as a replacement for training, weight management and ergonomics

We discuss opportunities, limitations, possible side effects and alternatives transparently. There is no guarantee of success; The decision is made jointly and individually for each patient.

Surgery – rarely necessary, but sometimes useful

A surgical procedure can be considered if conservative therapy does not help sufficiently or if there are neurological deficits. The goal is to relieve pressure on nerves and restore function - after clearly weighing up the benefits and risks.

• Indications: progressive paralysis, cauda equina sign (emergency), severe pain refractory to therapy, relevant spinal canal stenosis with significant limitation
• Interventions: microsurgical discectomy, decompression for stenosis, stabilizing procedures (e.g. spinal fusion) for instability

The decision is made interdisciplinary and individually. After surgery, active rehabilitation and prevention remain central.

Everyday life, training and prevention

Many lumbar spine complaints can be positively influenced by regular exercise, strengthening exercises and good everyday habits. Continuity and moderate stress management are important.

• Prioritize exercise in everyday life: short walking breaks, stairs instead of elevators
• Train core stability: adapted core exercises, slowly increasing progression
• Strengthen hip and leg axes: glute and hip rotator training
• Endurance-friendly: walking, cycling, swimming
• Ergonomics: seat height, screen, lumbar support, regular position changes
• Lifting/carrying: load close to the body, stand up with the legs
• Regeneration: sleep, stress management, nicotine abstinence, moderate body weight

Simple, often well-tolerated exercises (in the case of acute pain, gently at first):

• Mobilization in a pain-free area (e.g. gentle pelvic tilting while lying down)
• Trunk tension in the supine position (coupling breathing, short holding times)
• Hip flexor stretch moderately without working into pain

Stop exercises if there is significant pain provocation or neurological symptoms and seek guidance - ideally through physiotherapy.

Your orthopedics for lumbar spine complaints in Hamburg-Winterhude

In our orthopedic specialist practice at Dorotheenstrasse 48, 22301 Hamburg, we take the time for a structured assessment and individual, conservative therapy planning. You can easily request appointments online or by email.

• Structured anamnesis and lumbar spine-specific examination
• Indication-related imaging, only when appropriate
• Conservative therapy first: exercise, physiotherapy, education, ergonomics
• Targeted injections if necessary and with a clear indication
• Transparent advice on regenerative procedures without any promise of salvation
• Interdisciplinary collaboration and clear aftercare

The aim is to restore your ability to function in everyday life and prevent relapses - evidence-based, comprehensible and tailored to your life situation.