Low back pain (Lumbago)
What is lumbago?
Pain in the lower part of the back is commonly referred to as Lumbago. It can be defined as mild to severe pain or discomfort in the area of the lower back.
The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.
Most people will experience lumbago at some point in their life. It can occur at any age but is a particular problem in younger people whose work involves physical effort and much later in life, in the elderly.
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In most cases it settles in a few weeks but for some it is a persistent problem.
What causes lumbago?
In the majority of cases, it is impossible to identify the exact cause of low back pain.
There may, for example, have been tiny strains or tears of some of the small muscles and ligaments, which can be difficult to pinpoint within the complex structure that is the human back.
In about 25 per cent of cases, however, a specific problem can be found.
Often, these patients are suffering from conditions like arthritis of tiny joints called facet joints between the vertebral bones, a slipped disc (prolapse of an intervertebral disc), a collapse or fracture of one or more vertebrae (this is more likely in older patients especially when they have fallen or there is osteoporosis or brittle bones), deformation of natural spine curvature (scoliosis) or more rarely, skeletal damage due to tumours or infection.
What are the symptoms of lumbago?
- Pain across the lower part of the back that sometimes radiates into the buttocks, the back of the thigh or to the groin. The pain is usually worse on movement.
- Limitation in movement of the spine especially bending forward and leaning back.
- Tense spasm of the muscles surrounding the spine and causing a stiff back.
- With severe pain and spasm, the back may tilt to one side causing a change in posture or a limp.
- The pain is sometimes accompanied by a tingling sensation or numbness in the back or buttocks or leg, which may pass right down into the foot. This is called sciatica. and it indicates irritation of the sciatic nerve, which passes down from each side of the spine to the feet.
What are the danger signs?
If you suddenly find out that you are unable to control your bladder or bowel movements or if the area of the lower back or legs suddenly turns numb or weak, contact a doctor or accident and emergency (A E) immediately.
If you suffer from backaches and notice reduced strength or muscle bulk in one or both legs, you should also get checked by a doctor.
These warning signs indicate that damage in the spine may be causing compression of the spinal cord and/or the nerves which branch out from it, and early treatment is essential if permanent damage is to be avoided.
What can be done at home to ease back pain?
Acute low back pain
- Use simple painkillers regularly. Your GP may also sometimes prescribe special medicines which relax the muscles of the back. Research shows that NSAIDs (nonsteroidal anti-inflammatory drugs eg ibuprofen ) and muscle relaxants relieve pain better than placebo. Some people prefer paracetamol. Painkillers should be taken regularly throughout the day, for a couple of days, not just when pain becomes intolerable.
- Activity is beneficial. Stay active. Get on with your life within the limits of your pain. This helps to keep the muscles that support the spine strong and prevents scar tissue from forming and causing stiffness.
- Warmth (such as hot packs or capsaicin heat creams) helps, as does swimming in a warm pool.
- Rest and sleep lying on a firm, flat surface, if possible.
- Avoid stooping, bending, lifting and sitting on low chairs.
- Bear in mind that backaches are rarely caused by a serious illness and usually settle in a few days.
Chronic low back pain
If your backache persists for a long period, more than a few weeks, you should consult your GP who can advise on what to try next.
They are unlikely to suggest an X-ray or other type of scan as these are rarely of any help.
National recommendations advise that patients with persistent low back pain (which has lasted more than 6 weeks) should be offered their choice of one of several treatment options:
- a structured exercise programme, which should be tailored to the person and comprise of up to a maximum of 8 sessions over a period of up to 12 weeks
- a course of manual therapy (such as physiotherapy, or treatment from an osteopath or chiropractor)
- or a course of acupuncture.
Low back pain benefits from regular activity, attention to posture and seating, back schools, behavioural therapy and multidisciplinary pain treatment programmes. Your GP can refer you if appropriate.
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There is no evidence that use of antidepressants. traction, facet joint injections and EMG (electromyography) feedback are effective.
How does the doctor make a diagnosis?
In most cases, a back problem can be diagnosed by a doctor from the information given by the patient, although they may not be able to establish the cause.
Physiotherapists and chiropractors usually perform an especially thorough examination and will observe the movement of the joints in the spine, pelvis, and hips; perform orthopaedic and muscle tests and check to see if any nerves are trapped in the spine.
Generally speaking, it is seldom necessary to take X-rays, scans or blood tests in order to rule out more serious underlying causes of back pain.
However in some cases an X-ray or MRI of the spine can be very useful to assess the health of the intervertebral discs, check for fractures and look for compression of the nerves.
How is lumbago treated?
What does the research tell us about how effective treatments are?
Acute low back pain
Shown to be beneficial by research:
Likely to be beneficial:
- other simple analgesics such as paracetamol
- spinal manipulation
Trade off between benefits and harms: muscle relaxants.
Effectiveness unknown: colchicine, antidepressants. epidural steroid injections, facet joint injections, back schools, behavioural therapy. EMG feedback, back exercises, multidisciplinary treatment, lumbar supports, physical treatment, TENS (trans electrical nerve stimulation).
Likely to be ineffective or harmful: bed rest, traction.
Chronic low back pain
- Beneficial: back exercises, multidisciplinary treatment.
- Likely to be beneficial: analgesics, NSAIDs, triggerpoint and ligament injection, back schools, behavioural therapy. spinal manipulation.
- Unknown effectiveness: colchicine, antidepressants, muscle relaxants, epidurals, steroid injections, acupuncture, TENS, physical treatments, lumbar supports, advice to stay active.
- Unlikely to be beneficial: bed rest, EMG biofeedback.
- Likely to be ineffective or harmful: facet joint injections, traction.
These are usually good, provided the person remains active and receives early and correct treatment.
It’s a fact that weak back and stomach muscles increase the risk of backaches. Moderate exercise to strengthen the muscles is therefore highly recommended.
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Tulder; MW van; Koes BW. Low back pain and sciatica. Clinical Evidence June 2001;772-789.
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Tulder MW van, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.
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Based on a text by Dr Henrik Wulff Christensen, chiropractor, Jan Hartvigsen, chiropractor
Last updated 25.02.2014