Relaxation for Back Pain Relief

Entspannung hilft gegen Rückenschmerzen

In the treatment of back pain, full attention is usually automatically paid to the treatment of physical causes. However, the complex interaction of different causes that influence the development of back pain is hardly taken into account (see bio-psycho-social model).

Overstraining, incorrect movements, but also permanent tension due to stress can lead to muscle tension, which can play a decisive role in the development and persistence of back pain.

There is a close interaction between muscle tension and pain, which can reinforce each other in the long run and promote the development of chronic pain. This is why it is often helpful in the treatment of back pain to release muscle tension in order to break this cycle.[1]

This article provides an overview of relaxation procedures for back pain and muscle tension in the back and shows how you can effectively relieve tension or tension using both physical and mental relaxation procedures.

How does tension in the back occur anyway?

Muscle tension in the back can occur for a variety of reasons. Physical causes can be: a monotonous posture, for example when working at the desk; unusual movements, for example when packing furniture for a move; cold drafts when the window is open at night; or muscular imbalances, which means an imbalance between different muscle groups.

Tension can also be a protective reaction of the muscles to existing pain. This pain results in postures which can cause the muscles to become even more tense.

On the other hand, however, psychological causes can also spark muscle tension, for example excessive demands, stress, anxiety or other emotional stress.[2,3,4]

What complaints do muscle tensions cause?

The main complaints of muscle tension are acute pain in the affected muscle group. The permanent tension of the muscles leads to reduced blood circulation and reduced oxygen supply to the muscle.

Due to the pain, movement restrictions can occur, which often automatically result in a posture in which the pain is as little as possible. This posture can result in permanent relieving or incorrect postures, which in turn lead to further tension in other muscle groups due to overstraining.

In the long run, the muscles lose their natural ability to return automatically to a relaxed state after tension.

This cycle must be broken; physical, medicinal or mental relaxation techniques can be used.[5,6]

Physical procedures to relax the back

There are some physical therapy procedures that can serve as short-term aids for muscle tension.

Acupuncture can lead to short-term pain relief through muscle relaxation. Acupuncture should take place in as few sessions as possible and should not become a permanent therapy. Although acupuncture alone provides short-term pain relief, acupuncture does not improve physical function. In the best case, treatment with acupuncture is therefore used in combination with exercise therapy.[7]

The use of classic massages can also relieve tensions at short notice and relieve acute pain. However, studies show that massages do not add value in the long term compared to other therapies because the effect is comparatively short. They can be used well in combination with activating movement therapies.[8]

Manual therapies, such as manipulation or mobilisation of the muscles and joints, can alleviate the acute pain and release blockages or restrictions of movement. They are considered a relatively safe procedure if they are carried out professionally and often improve the complaints at short notice. In the long term, compared to active methods, they offer no advantage in the therapy of back pain due to tension – therefore manual therapies in combination with movement are also most effective.[9]

Stretching exercises can be used actively against tension and have proven to be effective in the treatment of tension. Muscular imbalances or shortened muscles can be compensated by regular stretching exercises. In the long term, the general muscle tension decreases and the musculature’s ability to relax increases.[10]

Are painkillers, ointments and medication useful against tension?

For acute back pain caused by muscle tension, the use of heat in the form of ointments or patches is recommended. Studies confirm that heat application relieves tension, promotes blood circulation in the muscles and relieves acute pain.[11,12]

On the other hand, taking painkillers is not a cure for tension. However, if they become necessary because of pain or limited mobility, so-called non-steroidal anti-inflammatory drugs (NSAIDs) are usually recommended at the beginning of treatment. These are painkillers with anti-inflammatory effects. These should be taken in the lowest effective dosage and as briefly as possible, as the side effects are sometimes considerable. Examples of NSAIDs are ibuprofen, diclofenac or naproxen.[13]

Drugs whose special goal is the relaxation of muscles are referred to as muscle relaxants by physicians. Most of these drugs are only approved for pathological muscle tensions such as spastic paralysis. They are rarely used for back pain due to their sometimes pronounced side effects and are only recommended for very painful muscle tensions for a short period of time. [14,15]

How are mental and physical tensions and relaxation connected?

It is not only physical causes that can lead to muscle tension. There can also be increased muscle tension due to psychological stress, such as stress and overstraining or emotional stress, such as worries and fears. Emotional tensions are involuntarily accompanied by increased muscle tension. For example, anxiety or stress can cause the shoulder and neck muscles to contract.[16]

If the strain then persists over a longer period of time, a generally increased level of muscular tension and permanent muscle tension can occur. A cycle of stress, permanent tension, muscle tension, muscle hardening and pain develops.

To break this cycle it also makes sense to take a look at psychological stress or other causes of stress. Mental, i.e. mental relaxation procedures can help to relieve muscle tension as well as to facilitate the handling of stress and other psychological strain. [17,18]

Relaxation techniques

Relaxation procedures are an important component in multimodal pain therapy and are often used especially in pain psychotherapy – but they are also effective outside such intensive therapies.

A “relaxation reaction” can be induced by the application of relaxation procedures. This results in a reduction of the physical and psychological tension level, also called “arousal”.

The “relaxation effect” often only comes about through regular (mostly daily) practice. At the beginning it can also happen that restlessness or nervousness may occur – this should not make you feel insecure. The first effects are usually only noticeable after two weeks of daily practice.[19]

So what happens in the body during a relaxation exercise?

During the relaxation exercise, changes occur at different levels because the so-called parasympathetic nervous system is activated. This is the nervous system, which is also active during sleep and is responsible for the recovery of the body.

Depending on the relaxation procedure, the effects are first noticeable on nerves and muscles, the respiratory or cardiovascular system, which means, for example, that breathing becomes deeper, the oxygen supply to the body increases, the heartbeat slows down and the blood circulation in the body increases. In addition to the physical relaxation reactions, the exercises also have a stabilizing effect on the mood and reduce the stress experience.[20]

What will change in the long term as a result of relaxation procedures?

Reduction of muscle tension: Regular use of relaxation techniques improves one’s own body perception. Tightening or tension of muscle groups can be perceived in time and one can react to them at an early stage, for example by conscious relaxation of the muscles.

Stress reduction: Through the experience of being able to relax actively and consciously on one’s own initiative, the so-called internal conviction of self-efficacy is strengthened – this means regaining confidence in one’s own abilities in dealing with pain or stress. It is easier to deal with stress and it will be easier to “keep a cool head” in the future.

Reduction of emotional stress: Over time you develop a calmer and more relaxed attitude. Pain, everyday stress or overstrain situations will no longer throw you off course as quickly.

Improvement of sleep disorders: Relaxation procedures are also one of the most important techniques for falling asleep or sleep disorders. [11,18,21]

What relaxation methods are there?

There are various relaxation techniques that can trigger a “relaxation reaction” with the help of different techniques and objectives.

  1. Autogenic training:

Autogenic training has its origin in hypnosis. Through the inner audition of positive self-instructions such as “I am completely calm and relaxed”, the relaxation reaction is brought about. Experts also call this technique “autosuggestion”.

  1. Meditation procedures or mindfulness exercises:

There are various meditation procedures that are based on the originally Buddhist idea of mindfulness. Their common goal is to concentrate as much as possible on the present moment. A group of mindfulness exercises are, for example, respiratory meditations. By observing the breath and focusing attention on the sensations during breathing, the relaxation reaction is triggered.

  1. Progressive muscle relaxation (PMR):

Progressive muscle relaxation according to Edmund Jacobson induces a relaxation reaction through the technique of alternating muscle tension and relaxation. One after the other, different muscle groups are consciously tensed and then relaxed again. The procedure is used to learn how to consciously relax muscles, while at the same time training the conscious perception of tension and relaxation.

  1. Imaginative methods:

Imaginations are comparable to simple ideas or daydreams. Texts read aloud are used to create inner images of certain situations or events, such as a walk on the beach. A pleasant state of rest and relaxation is achieved solely through the imagination and activation of various sensory impressions. [19,22]

Can relaxation methods help against back pain?

Some of the relaxation methods mentioned above have proven themselves in the treatment of back pain. Relaxation is an important strategy to break the cycle of stress, permanent tension, muscle tension, muscle hardening and pain. If relaxation procedures are used actively and regularly over a longer period of time, muscle tensions can be released and pain can be reduced.

Which relaxation methods help against back pain?

Autogenic training is still used very little in pain therapy. However, initial studies have shown slight improvements in pain perception.[23]

The use of mindfulness and breathing exercises in the context of mindfulness based stress reduction can also alleviate pain symptoms. The exercises are particularly helpful in dealing with pain in chronic back pain.[24,25]

Progressive muscle relaxation is the most commonly used approach in pain therapy. The effectiveness of this relaxation method in the treatment of back pain has been confirmed in several studies. Muscle tensions can be deliberately reduced, which lowers the frequency and intensity of back pain.[26]

Imagination procedures can be helpful in diverting attention away from pain and thus making a short-term reduction in pain possible. So far, however, the procedure has not been examined much in pain therapy.[27]

There are some scientific studies that confirm the effectiveness of relaxation procedures in the treatment of back pain. The efficacy of the treatment of chronic back pain has been particularly well studied to date.

Even with acute pain, relaxation procedures are often helpful strategies to prevent permanent stress from the pain – because chronic stress, emotional stress or sleep disorders can be reasons why acute back pain can become chronic.

Relaxation methods also help here. In order to protect against back pain becoming chronic, the National Guideline for Low Back Pain  recommends regular use of relaxation procedures, above all progressive muscle relaxation.[15]

Try yourself – breathing exercise for relaxation:

Abdominal respiration:

“Put one hand on your stomach and the other on your upper chest. Then take several breaths the way you always breathe. Now watch how your hands move. Watch your hands rise and lower, then concentrate on raising your hand on your stomach and breathing deep into your stomach. Breathe in and out deeply several times and try to relax the shoulder, neck and back area. If you’re a little more experienced, exhale twice as long as you inhale. Practice several times a day.” [1]

If you are interested in relaxation training at home, check out the Kaia-Health App. It contains 150 back exercises in combination with relaxation exercices, which were created in cooperation with the pain specialists of a large pain centre and uses them to create an individual training plan.

References
1: Sendera, M., & Sendera, A. (2015). Chronischer Schmerz: Schulmedizinische, komplementärmedizinische und psychotherapeutische Aspekte. Springer-Verlag.
2: https://www.aerzteblatt.de/treffer?mode=s&wo=17&typ=16&aid=175568&s=muskelverspannungen
3: http://www.patienten-information.de/patientenleitlinien/patientenleitliniennvl/html/kreuzschmerz/kapitel-5
4: http://www.sciencedirect.com/science/article/pii/S1356689X05001104
5: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454540/pdf/586_2006_Article_1071.pdf
6: Brune, K., Beyer, A., & Schäfer, M. (2013). Schmerz: Pathophysiologie—Pharmakologie—Therapie. Springer-Verlag.
7: https://www.ncbi.nlm.nih.gov/pubmed/23269281
8: https://www.ncbi.nlm.nih.gov/pubmed/18843627
9: https://www.ncbi.nlm.nih.gov/pubmed/22972127
10: Brenke, P. D. R. (2012)  Funktionelle Schmerztherapie des Bewegungssystems. Springer Berlin Heidelberg.
11: https://www.ncbi.nlm.nih.gov/pubmed/16437495
12: https://www.ncbi.nlm.nih.gov/pubmed/28192789
13: https://www.ncbi.nlm.nih.gov/pubmed/18253976
14: http://enniscentre.com/wp-content/uploads/2012/06/Muscle-Relaxants-for-Nonspecific-Back-Pain.pdf
15: http://www.leitlinien.de/nvl/html/kreuzschmerz/kapitel-6#section-0
16: http://www.sciencedirect.com/science/article/pii/S088761850800090X
17: von Wachter, M., & Hendrischke, A. (2016). Das Manual–Psychoedukation bei chronischem Schmerz. In Psychoedukation bei chronischen Schmerzen (pp. 29-37). Springer Berlin Heidelberg.
18: Nobis, H. G., Rolke, R., & Graf-Baumann, T. (2012). Schmerz–eine Herausforderung. Informationen für Betroffene und Angehörige, SpringerMedizin.
19: Diezemann, A. (2011). Entspannungsverfahren bei chronischem Schmerz. Der Schmerz, 25(4), 445-453. https://link.springer.com/article/10.1007/s00482-011-1019-2
20: Wittchen, H. U., & Hoyer, J. (Eds.). (2011). Klinische Psychologie & Psychotherapie (Lehrbuch mit Online-Materialien). Springer-Verlag. S. 588.
21: Heinrich, M., Monstadt, D., & Michel, C. (2009). Psychologische Interventionen in der Behandlung chronischer Rückenschmerzen. Der Orthopäde, 38(10), 937-942.)
22: Zarbock, G. (2010). Praxisbuch Verhaltenstherapie.
23: http://www.sciencedirect.com/science/article/pii/S1353611700904736
24: https://www.ncbi.nlm.nih.gov/pubmed/28437793
25: https://www.ncbi.nlm.nih.gov/pubmed/28537422
26: https://www.ncbi.nlm.nih.gov/pubmed/28192789
27: Kröner-Herwig, B., Frettlöh, J., Klinger, R., & Nilges, P. (2011). Schmerzpsychotherapie. Auflage Berlin: Springer Verlag.