Because the back will only be healthy if we do something for it ourselves. Orthopaedist Matthias Manke knows what really helps against pain.
Back pain is one of the most common types of pain. What is going wrong between us and our back?
dr Matthias Manke: We always assume that our body is working and already working for us – no matter what we do. But when we sit all day, the shoulders and head thrown forward, the posterior muscles overstretched, losing strength and becoming tense. This means that we have to ensure movement compensation in order to activate the muscles and bring them back into balance. Otherwise there will be complaints.
But can I even compensate for hours of sitting with a few exercises?
Sure, you can and you must. Instead, grabbing the fascia roll every day is always only symptomatic therapy. If you do exercises that specifically strengthen your muscles, you don’t need the whole day to do it, but can compensate for your deficit in 15 to 30 minutes, making your body more stable, stronger and less sensitive to pain.
But before that you should go into the X-ray or MRI tube to check what’s going on in your back…
I think little of all the diagnostics that are used for back pain. There is specific back pain, where you might see a herniated disc or a narrowing in the imaging, and there is – and much more frequently – non-specific back pain where you don’t see anything. The problem is that healthy people also have a herniated disc, but it doesn’t cause any symptoms. The art of the orthopedist is to filter out who needs imaging diagnostics at all. To do this, I have to touch and examine the patient. However, 80 percent of orthopedists no longer do this, which is why many incorrect diagnoses are made.
Up to unnecessary operations.
Clearly. For a patient that I treat conservatively, I get 25 to 40 euros from the health insurance company. If I operate on him, 4,000 to 10,000. So there are financial incentives for more and more operations to be performed in Germany. Every operation on the back is one operation too many. Because every intervention weakens the system. You either remove tissue from a herniated disc or you screw in screws to stiffen vertebrae. As a consequence, however, the spine above and below will loosen, so that a few years later you will have to stiffen further vertebrae. The pain does not go away forever with an operation. In order to achieve this, the patient must cooperate.
And what kind of exercises are the right ones for this?
Our spine is like the mast of a sailboat and our front and back muscles are like the sails. In order for the mast to stand upright, it must be well anchored. That means we need a strong pelvic floor, good abdominal, back and lateral abdominal muscles. When this core is trained, we have a base stability. And by the way, this is not a question of weight: Even overweight people can have a stable core and be free of symptoms, provided they are shown the right exercises.
Do orthopaedists or physiotherapists know them?
Should you. But the doctors don’t talk about it, they simply write down three times six units of physiotherapy and often the people there are no longer treated properly, but only massaged. Instead of training the muscles, you relax them and no strength comes into the system. But the patients also expect to be massaged, and of course the physiotherapists only make money if people come to them and get what they expect. This is how the system closes: Everyone earns because things are bad for them.
Where do you see the way out?
You have to make it clear to people: back health is not something that is given to us by God or nature or that the doctor can restore with a few injections or a little physiotherapy, but something that you have to work on every day.
So you have to be active.
Yes, and most people have trouble with that, because it means work and you might even break a sweat. Of course, many prefer to lie down and have a massage. Or buy special pillows or acupuncture mats that stimulate blood circulation. The business with such questionable methods is booming, but in the long term none of them bring anything. With your back, it’s like a partnership: if you don’t do anything about the relationship, it will eventually die.
If I now start with the right exercises: How quickly will I notice an improvement?
That takes a little time. In order to work through the muscular imbalance, you have to stick with it for at least 30 days. After about three months, an equilibrium is almost restored, which then needs to be stabilized.
So the complaints will be gone by then at the latest?
If you have had back pain for a long time, you cannot expect a miracle cure. But if you keep at it, you realize step by step that it’s getting better.