Back pain

Definition

What is back pain?

Back pain refers to any painful conditions that occur in the different regions of the back. Back pain is a widespread health problem that affects people of all ages and is among the most common disorders worldwide. It arises when muscles, fascia, ligaments, intervertebral discs, nerves or vertebrae in the spine are affected. Back pain is assessed according to various criteria.

Location

• Lower back pain in the area of the lumbar spine (LWS)
• Middle back pain in the area of the thoracic spine (BWS)
• Upper back pain in the area of the cervical spine (HWS)

Duration

• Acute back pain: Back pain lasts for a maximum of 6 weeks.
• Subacute back pain: Back pain lasts for 6–12 weeks.
• Chronic back pain: Back pain persists for longer than 12 weeks.

Frequency

• Single acute episode of back pain
• Recurrent back pain
• Persistent back pain

Intensity

• Minimal back pain
• Intermittently severe back pain
• Moderate back pain
• Excruciating back pain

Cause

• Non-specific cause: No precise cause can be identified.
• Specific cause: Precise causes of back pain can be named here, such as lower back muscle tension, vertebral blockage, SIJ syndrome, herniated disc, osteoporosis, etc.

Causes of back pain

Back pain is one of the most common complaints in our modern society and can increasingly be traced back to changed environmental conditions related to the widespread sedentary lifestyle and lack of physical activity in everyday life. These factors interact on multiple levels and negatively affect the health of the spine and the surrounding muscles, fascia, ligaments and discs.

Today’s work and living environment differs fundamentally from previous generations and from our ancestors, who were hunter-gatherers. Technological advances have greatly reduced physically demanding work but have also limited natural movement variety. The use of computers, smartphones and automation means many tasks are performed in static and often non-physiological positions. Environmental stressors such as noise, stress and time pressure further hinder conscious care of the musculoskeletal system, which has long-term negative effects on the back. In addition, hard, flat floors and wearing shoes with stiff soles have changed gait patterns and loading on the musculoskeletal system, which negatively affects the back. The following describes the effects of these factors on the development of back pain.

Most people spend a large part of their day sitting—at the office, commuting or during leisure time. This persistent static posture stresses the spine and often leads to muscular imbalances. While trunk and back muscles are strengthened during movement, they weaken during hours of sitting, which can lead to pain (e.g. back muscle pain). An unergonomic sitting posture is particularly problematic, as it not only causes back pain (e.g. lower back pain) but can also cause long-term damage such as herniated discs. The following outlines how these factors contribute to the development of back pain.

Lack of movement and sedentary lifestyle

The modern lifestyle, characterized by lack of movement and a sedentary way of living, leads to incorrect loading of the musculoskeletal system. Physical inactivity and prolonged sitting cause bodily adaptations that can produce severe back pain. The following changes play a major role and are therefore causes of unpleasant back pain.

• Weakened muscles and muscular imbalances

  Regular movement is essential to strengthen the trunk and back muscles and thereby stabilize the spine. Lack of movement leads to muscle weakening, particularly of the deep stabilizers such as the deep abdominal and spinal muscles. At the same time, muscular imbalances can develop. Certain muscle groups, such as the chest muscles, become shortened by sitting posture, while others, like the back muscles, become overstretched and weakened. These imbalances increase the load on the spine and cause back complaints such as lower back pain, neck tension or sharp pains in the back.
  

• Poor posture and overload of the spine

  Prolonged sitting, especially in an unergonomic position, often does not maintain the natural S-curve of the spine. A rounded posture (kyphosis) or leaning to one side places uneven stress on the discs and facet joints. The lack of movement intensifies this effect because the spine is hardly dynamically relieved. Persistent poor posture can lead to chronic back pain and long-term structural damage such as herniated discs or vertebral osteoarthritis. For this reason, the cause of back pain should be addressed as quickly as possible to prevent chronic back pain from developing.
  

• Foot deformities

  The connection between the feet and the back may not be obvious at first glance, but it is crucial for overall body alignment. Foot deformations such as flat feet, valgus (pronated) feet or high arches negatively affect body posture and can cause or exacerbate back pain. They lead to uneven weight distribution, which can tilt the pelvis and distort the spine’s natural alignment. This produces postural faults that particularly stress the lumbar spine. Foot deformities cause muscular imbalances because some muscles become overloaded while others weaken, affecting spinal stability and the intervertebral discs. Moreover, an intact foot arch acts as a shock absorber. With foot deformities, this function is lost, so shocks from each heel strike are transmitted directly to the joints and spine, promoting wear and pain in the long term. A changed gait pattern also leads to asymmetric movements that can cause tension and chronic back pain.
  

• Reduced circulation and disc nutrition

  The intervertebral discs, which act as shock absorbers between the vertebrae, depend on good nutrient supply mainly via diffusion stimulated by movement. Lack of movement disrupts this process, causing discs to dehydrate and lose elasticity. This can not only cause back pain (e.g. lumbar disc pain) but also increase the likelihood of herniated discs.
  

• Shortened and tense structures

  Lack of movement promotes shortening of certain muscle groups, especially the hip flexors and the posterior thigh muscles. These muscles influence pelvic position, which directly affects loading of the spine and can trigger or exacerbate back pain. In addition, prolonged sitting often causes tension in the neck and shoulder muscles, which can lead to pain in the thoracic and cervical spine as well as headaches.
  

• Fascial dysfunction

  Fascia can change their original structure and become brittle when they are loaded irregularly and non-physiologically. Tension, adhesions and blockages of the fascia are the result. This increases tension on the spine and surrounding structures, making them more susceptible to inflammation and injury.
  

• Joint stiffness

  Due to lack of movement and a sedentary lifestyle, the joints are insufficiently mobilized through their full available range of motion. A natural stiffening of the joints follows and can lead, for example, to back pain when bending. Immobile joints increase the forces acting on the spine and surrounding structures, thus causing further misloading and overload. Joint stiffness can therefore also be a cause of back pain.

Hard, flat floors and inflexible, supportive shoes

Hard, flat floors and inflexible, supportive shoes have a significant impact on the musculoskeletal system and can cause or exacerbate back pain. The following factors play an important role in the development of back pain.

• Reduced shock absorption and increased force impact

  Because hard floors such as concrete or tiles are rigid and because conventional shoe soles are stiff, the impact forces at each step are reflected rather than absorbed. The lack of shock absorption increases force impact and loading on the joints and the spine. Furthermore, due to the increased and early force impact, the possible reaction time of the relevant muscles is shortened. If the muscles cannot contract in time, the respective joint will be insufficiently stabilized, which likewise leads to misloading and overload. The muscles around the back and underlying structures help protect the spine. Over time, the lack of cushioning combined with increased force impact can cause wear in the spine and painful overloads.

• Restricted foot function and muscle weakening

  Shoes with rigid soles or stronger supports prevent the feet from expressing their natural mobility. The foot muscles are thereby less activated, leading to weakening of the foot arch and stabilizers. A weak foot arch negatively affects overall body alignment and can promote postural faults that cause back pain. Furthermore, a weakened foot arch changes load distribution in the legs and spine.
  
  In addition, altered body alignment often leads to compensatory movement patterns. For example, a pronated foot position can cause the pelvis to tilt and the spine to assume an unnatural curvature. This increases the load on certain spinal segments and muscles, which in the long term can promote back pain (e.g. lower back pain). Poor foot function also affects deep muscles and overall postural control. Since the feet form the foundation of posture, imbalances in the feet can significantly impair the body’s ability to keep the spine stable.
  

• Altered gait and roll-off movement

  Inflexible shoes and hard, flat floors affect the natural roll-off behavior of the feet. If the feet cannot actively and physiologically roll off, the natural sequence of motion is interrupted. Without a proper roll-off, the arising forces cannot be reliably absorbed, increasing the load on the structures above. Additionally, the relevant muscles cannot sufficiently stabilize during an undamped heel strike because the force impact rises rapidly. This causes the foot to collapse uncontrolled downward. The so-called collapsing foot increases the load on the entire musculoskeletal system. Instead of a dynamic movement, the step when walking on hard, flat floors and in inflexible, supportive shoes is often stiff and unnatural, causing incorrect load distribution. This misloading can extend to the knees, hips and spine, producing various types of back pain (e.g. lower back pain, mid-back pain in the thoracic area, upper spine pain in the cervical area).

Symptoms of back pain

Because the causes of back pain can be very individual and numerous dysfunctions and symptom patterns exist, the symptoms of back pain can vary greatly. Back complaint symptoms can, for example, cause a stabbing pain in the back, a dull ache or even lead to paralysis. Often back pain can also radiate into adjacent regions. Symptoms depend on factors such as pain perception, cause and degree of injury, physical constitution, etc. To obtain a definitive diagnosis, a physician should be consulted. Below is an outline of the symptomatology of the most common types of back pain:

Muscle tension
Possible throughout the back. Often in the lumbar area (lower back muscle tension) and shoulder/neck area.

• Dull pain
• Tenderness to pressure
• Reduced range of motion

Acute lumbago (“Hexenschuss”)
Pain in the lumbar spine area (i.e. lower back pain).

• Severe, shooting and sudden lower back pain
• Greatly reduced mobility
• Pain eases when lying down with legs elevated

Herniated disc (disc herniation)
Often occurs in the lumbar spine with pain in the lower back (i.e. lumbar pain). It can also occur in the cervical spine with neck pain.

• Severe back pain
• Pain radiating to the buttock or leg, or to the arm or hand
• Tingling in the leg or hand (pins and needles)
• Paralysis symptoms
• Cold sensation in the buttock or leg, or in the arm or hand

Sacroiliac joint (SIJ) syndrome
Sensed in the area of the sacroiliac joint and the hip.

• Usually sudden pain when bending or twisting the trunk
• Blockage in the SIJ area and hip
• Similar radiating pain to a herniated disc
• Back pain lower right, lower left or even on both sides

Conventional therapies and treatments - What helps with back pain

There are several approaches to treat acute and chronic back pain. Below are some commonly used back pain therapies. The list is not exhaustive. Various measures can also be combined to treat back pain. Consultation with a physician is recommended to determine the appropriate therapy for back pain.

• Exercise therapy: Regular physical activity and specific exercises to strengthen the back muscles and improve mobility.
  
• Physiotherapy: Professional treatment by physiotherapists using techniques such as massage, manual therapy and targeted exercises to relieve pain and improve function.
  
• Medication: Use of painkillers for short-term relief of acute pain. In some cases, muscle relaxants or anti-inflammatory medications may be prescribed.
  
• Heat and cold therapy: Application of heat (e.g. heating pads, heat packs) or cold (e.g. ice packs) to relax muscles and reduce inflammation.
  
• Acupuncture: Traditional Chinese method in which fine needles are placed at specific points on the body to relieve pain and promote healing.
  
• Chiropractic: Manual therapy in which chiropractors correct spinal misalignments with targeted maneuvers to relieve pain.
  
• Back school: Specialized education programs that teach patients techniques for correct posture, movement and back protection.
  
• Occupational therapy: Support in adapting daily life and the work environment to prevent acute and chronic back pain and to improve quality of life.
  
• Surgery: In severe cases such as herniated discs or spinal stenosis, surgical intervention may be necessary. This option should always follow a series of conservative treatments if they have not led to improvement.

Often these measures unfortunately do not lead to a long-term reduction in back pain because the underlying causes are not eliminated. The goal of any treatment should therefore be to eliminate the causes of back pain. As described above, lack of movement, sedentary lifestyle, hard flat floors and inflexible, supportive shoes should be addressed. The kybun mode of action appears to be a suitable therapy for back pain because it can eliminate the mentioned causes.

kybun mode of action - What helps with back pain

The kybun products aim to eliminate the health-damaging effects of hard, flat floors and inflexible, supportive shoes and to actively counteract lack of movement and a sedentary lifestyle. Due to the elastic-springy properties of the kybun materials, the musculoskeletal system is both relieved and activated. The relief provides an initial reduction in back pain. Through activation, the causes of acute and chronic back pain are addressed so that complaints can be resolved in the long term. Thus kybun shoes are well suited for back pain, as they help treat back pain through the following mechanisms:

• Promotion of movement and reduction of sitting time

  It is well known that movement has positive effects on back pain and that inactivity usually worsens complaints. Moderate movement encouraged by the elastic-springy kybun products promotes enjoyment of movement, because walking and standing on the unique material relieves the back and surrounding soft tissues. The following are numerous advantages associated with promoting movement. Since the use of kybun products can also reduce the duration of sitting, harmful shortening and blockages of the myofascial structures can be avoided—these can be a cause of acute and chronic back pain. Increased walking and standing stretches and lengthens often shortened hip flexors and the posterior chain including calves and thigh muscles, which can positively affect vertebral angles and the tensile and compressive loads on surrounding soft tissues.
  

• Activation and strengthening of muscles due to elastic-springy property

  When standing and walking on elastic-springy material, the whole body must work on the unique surface so that both the muscles around the feet and the deep muscles of the entire musculoskeletal system are activated and strengthened. This can lead to improved muscle function, which positively influences stabilization and guidance of the spine and surrounding soft tissues.

Balance and EMG

Balance ability was measured on a force plate by the movement of the center of mass from front to back (ant-post) and side to side (med-lat) while standing. In parallel, electromyography (EMG) recorded muscle activity.

By activating and strengthening the foot muscles, foot deformities such as splayfoot, pronation or collapsed arch—which often result from muscular deficits—can be counteracted. Because an intact longitudinal arch reduces forces at heel strike, the individual vertebrae and soft tissues are thereby relieved. As collapsing of the foot inward or outward is prevented, the leg axis remains in its physiological position and the back and adjacent structures are protected from additional misloading and overload. When the heel slowly and controlled sinks into the elastic-springy material, a myofascial pre-tension occurs in the involved muscles. Through this pre-tension and improved muscular activity, the spine can be stabilized and guided earlier, which reduces force impact on the back and surrounding soft tissues.

• Reduction of force impact from hard, flat floors due to damping effect

  At heel strike in kybun shoes, the elastic-springy material is compressed. This rebound effect of the sole means part of the occurring forces is absorbed and can be released again during the roll-off phase. The kybun sole’s capacity to absorb force leads to damping and thereby protects the back and surrounding structures from excessive force impact. The reduced force impact lowers the load and reduces the risk of back pain. In addition, due to the slow sinking of the heel into the elastic-springy material, the body has more time to tense the relevant muscle groups. Through improved baseline muscle tone the individual joints can be stabilized and thus the force impact on the spine and surrounding structures reduced.

Furthermore, because the heel sinks slowly into the elastic-springy material, the body has more time to tense the relevant muscle groups. Through improved baseline muscle tone, the individual joints can be stabilized and thus the force impact on the spine and surrounding structures reduced.

• Natural roll-off thanks to muscle activation and roll-off function

  At heel strike in kybun shoes, the elastic-springy material is compressed. Due to this slower sinking into the kybun sole, the time of maximum force impact is delayed. This extra time allows the muscles to contract in time to set the foot down in a controlled manner after heel strike. This prevents the harmful collapsing foot and allows the foot to transition into a natural roll-off. Through active roll-off over the forefoot, the acting force is partly diverted into forward motion. On the other hand, active roll-off produces an increased range of motion of the joints above, ultimately causing rotation of the upper body. Through rotation, lower back pain, muscular tension and blockages can loosen. In addition, using the full range of motion of the feet and the joints above induces an active gait that returns the thigh-hip-back mechanics to a physiological position. Through the cooperation of all joints, force distribution across the whole body improves, which ultimately relieves the back and adjacent structures.

• Care and protection of the fascia

  Fascia practically surround the whole body and are interconnected. They hold our body together and give it form. Fascia are responsible for force transmission and the degree of stretch during all movements. They keep muscle fibers gliding smoothly. If fascia are tense, adhered or matted, they can no longer or only incompletely perform their function. Lack of movement as well as unnatural movements on hard, flat floors and in inflexible, supportive shoes can change the structure of the fascia and thus affect their function. Around the back, tense fascia can increase the pull on sensitive soft tissues (muscles, nerves, discs etc.) and thereby lead to pain. Tense fascia can also reduce the natural range of motion of the vertebrae and surrounding soft tissues. This limitation results in increased use of the remaining available range during any movement. For example, due to changes in fascial structure certain muscle groups may not be able to work through their full range. Adhesions of different fascial layers can also involve muscle groups that should not be active in a specific movement. In both cases the result is misloading and overload of individual vertebrae and surrounding soft tissues. The elastic-springy material promotes movement and ensures a natural and physiological loading. This cares for the fascia and protects them from structural changes.
  

• Improved circulation through increased activity

  Injured structures in and around the back require numerous nutrients for healing. These nutrients are transported to the tissue by blood and joint fluid. Additionally, anti-inflammatory substances are transported to the back and surrounding soft tissues via the blood, while harmful and pro-inflammatory signaling molecules are removed. Through this continuous fluid exchange, the relevant structures are supplied. The elastic-springy kybun materials promote movement and thereby activate the muscles around the spine. This increases blood circulation, which in turn supports the advantages mentioned above.
  

• Optimized pressure distribution

  The entire sole of the foot is surrounded by this unique elastic-springy material. This leads to optimized pressure distribution in the feet and can thus reduce point loads on the back (e.g. discs) and surrounding soft tissues. Additionally, constant gentle movement when using kybun products enlarges the contact area, which can also reduce individual pressure points. In this way, the back can be protected from overload and injury.

Usage tips for shoes against back pain

Before wearing kybun shoes for the first time, you should consider some usage tips. Correct use can help relieve back pain. In addition to using kybun shoes, acute and chronic back pain should be treated with a targeted back pain therapy, which is explained in the next section.

• Wear kybun shoes initially only as long as your body tolerates. Introduce wearing breaks if back problems (e.g. lower back pain) increase or if fatigue of the musculoskeletal system occurs. Treating back pain takes time. Because kybun products have an activating effect, the muscles are trained, which can especially at first lead to so-called initial reactions.
  
• With back complaints, you should mainly walk rather than stand. It is not uncommon for people with back problems to report pain when lying down, back pain from lying down, morning back pain, back pain while sitting, back pain after sleeping, etc. All these static positions typically worsen back pain because the constant pressure on the discs increases the back problems.
  
• Try to actively roll off over the forefoot as much as possible. By increasing the range of motion of the feet, more movement is generated in the back, which helps especially with myofascial tensions and blockages.
  
• Vary walking speeds. Brief quicker trotting increases trunk rotation, which often has a positive effect on back pain. The oscillations of the elastic-springy sole can help release muscle tension in the back. Tensions in the lower back particularly benefit from trampoline-like movement.
  
• Try to reinforce the effectiveness of kybun shoes and increase the likelihood of recovery with the following exercises. These are intended as a complementary therapy for back pain and should be part of the overall treatment for back pain.

Helpful exercises for back pain

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from back pain, we recommend performing the following exercises for acute and chronic back pain. The exercises also address the causes of back pain. The selection of exercises is not exhaustive and can be supplemented with further back pain exercises. As a rule, none of the exercises should increase back problems. If any exercise worsens the pain, it must be stopped. Pleasant and relieving “pain” sensations are desirable. The exercises are generally intended for back problems (acute and chronic) and not specific to any single diagnosis. Additionally, due to myofascial connections throughout the body, the site of back pain symptoms is not necessarily the site of the cause. For example, shortening of the hip flexors due to a sedentary lifestyle can cause lower back pain. Treatment therefore focuses on releasing the hip flexors to eliminate lower back pain.

The back pain exercises are divided into the following areas: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, the different areas are used complementarily as therapy for back pain.

Correct walking in kybun shoes

The quality of each step is crucial for treating back pain in order to reduce pain and eliminate mis- and overload. kybun shoes therefore offer an ideal therapy for back pain.

Active heel strike

• Press the heel deep into the elastic-springy material to feel the cushioning property of the kybun sole.
• Maintain a controlled foot posture so the foot does not roll inward or outward.
• Set the midfoot and forefoot down in a controlled manner to reduce force impact on the body.

Active foot roll-off

• Actively roll off over the forefoot while using the maximum range of motion.
• Using the maximum range of motion is important so that a physiological coupling from the pelvis to the back can occur.

Muscle length training

Muscle length training is crucial in treating back pain because pain often results from shortening, tension and blockages of the posterior chain (including plantar foot, calves and posterior thigh muscles). Targeted stretching exercises can actively address these shortenings, tensions and blockages and thus are an ideal therapy for back pain.

Balasana

• Start in a four-point kneeling position.
• Move the body backward by placing the buttocks on the heels and the torso on the thighs.
• Actively stretch the arms forward.
• Hold the position 3 × 30 seconds.
• Perform 1–2 × daily.

Gluteal stretch across the body

• Start lying on your back.
• Extend both arms at a 90-degree angle to the sides and place the left leg bent over to the right side.
• Use the right hand to press the bent knee downward.
• Ensure both shoulder blades remain on the floor.
• 3 × 30 seconds per side.
• Perform 1–2 × daily.

Fascia roller

Fascia rolling with a foam roller is important in treating back pain because it often arises from shortening, tension and blockages of the posterior chain (including plantar foot, calves and posterior thigh muscles). Regularly rolling out the shortened and tense myofascial chain makes the foam roller a useful active therapy for back pain.

Spinal extensor roll

• Start position: lying on your back with knees bent.
• Place the foam roller under the back.
• Slowly and controlled roll from above the buttocks up to under the shoulder blade.
• Adjust pressure to personal tolerance, but go to a tolerable pain threshold.

Gluteal muscles

• With both legs bent, roll the relevant half of the glute with the fascia ball. Increase pressure by placing one leg on top of the other. If wrist pain occurs, the exercise can also be performed on the forearms.
• Perform slowly and in a controlled manner.
• Adjust pressure to personal tolerance, but go to a tolerable pain threshold.
• Roll out focal adhesions more intensively or hold the position at that point.
• 3 minutes per side.
• Perform 1–2 × daily.

Strengthening

Targeted strength training helps stabilize the trunk and thereby relieve the spine. Strengthened muscles can better absorb forces acting on the back during every movement. Furthermore, muscles stabilize individual joints and protect them from mis- and overload. Strengthening exercises are an effective therapy for back problems and help reduce pain in the long term.

Quadruped

• Start in a four-point kneeling position.
• Place hands shoulder-width under the shoulders and knees hip-width under the pelvis.
• Extend the right leg backward and the left arm forward.
• Keep a straight and stable back.
• Then bring the right leg and left arm together and extend again.
• 3 sets of 8–12 repetitions.
• Perform 2–3 × weekly.

Plank

• Start in a forearm plank.
• Place forearms shoulder-width and legs hip-width apart.
• Maintain a straight line from head to feet without the pelvis sagging up or down.
• 3 sets of 30 seconds up to 2 minutes. Duration adapted to fitness level.
• Perform 2–3 × weekly.