What is Lumbago?

Lower back pain is sometimes referred to as lumbago and this condition affects millions of people each year, sometimes through acute back trauma or strain and sometimes due to chronic wear and tear. The majority of lower back pain (lumbago) resolves itself over six weeks or so, but for an unfortunate number of patients it can become a chronic and debilitating problem. The presence of continued lower back pain does not immediately implicate degenerative tissues as some physical degeneration, such as a herniated disc, can remain asymptomatic for many years whereas acute muscle strain may cause intense pain and suffering. Where a continuous problem is experienced it is important to rule out any persistent exacerbation, such as poor posture, muscle strain through overuse, or even problems with a draughty workplace or uneven shoes.

Spinal Stenosis and Lumbago

Diagnosing the underlying cause of lumbago can be very difficult, and spinal stenosis revealed on an X-Ray or MRI scan does not necessarily explain the problem in all cases. Many people have some degree of spinal stenosis, particularly as they age, and suffer no ill-effects from the slight narrowing of the spinal canal. For others, with additional factors at play, spinal stenosis may be at the root of their lumbago, with nerve compression causing pain like sciatica in some cases. Other tissues may be involved in the lumbago however, with soft tissues such as muscles, ligaments, and tendons all liable to degeneration over time and acute strain and inflammation if put under disproportionate stress. The bones in the lower back (the lumbar spine) can also suffer from injury or degeneration, with the facet joints possibly grinding against each other if the synovial fluid becomes insufficient, or with osteoporosis causing microfractures and structural problems with the spine. Discs between the vertebrae are a common cause of problems in the lumbar spine and are often implicated in lumbago as they may bulge or herniate and cause nerve root or spinal cord compression.

Referred Pain and Radicular Pain

The complexity of the nerves running through the spinal column make it incredibly difficult to discern muscle strain from a damaged disc and oftentimes the use of diagnostic imaging can shed no light on the matter either. Selective nerve root blocks may be helpful in isolating the troublesome cause of lumbago where it is thought that a pinched nerve is the origin of the radicular pain. Those with referred pain rather than radicular pain are less likely to be considered surgical candidates and more likely to respond to conservative treatments as no specific nerve compression is indicated in most cases. Instead, the referred pain is a response from the network of nerves in the low back, pelvis, buttocks, and thighs and the pain frequently moves around. Radicular pain is usually consistently felt in the lower leg, buttock, or thigh and is normally reproducible by adopting specific positions or movements.

Assessing Different types of Lumbago

Obtaining a diagnosis of sciatica or lumbago is not particularly helpful then in addressing the condition as these are both due to a wide variety of causes, such as referred pain or radicular pain, which would require different treatment options. Pain may also be felt differently in two patients with seemingly identical conditions due to physiological and psychological differences, expectations, responsibilities, and biochemistry involving neurotransmitters and pain signalling. Those with fibromyalgia, for example, may have a higher sensitivity to lumbago due to chronically high levels of Substance P in their spinal canal which heightens nerve pain signal transmissions. Determining the type of pain felt, such as acute back pain, a dull ache, or pain on movement, and the distribution of lower back pain can help a diagnosing physician assess the likelihood of different causes of pain. In cases where lumbago is accompanied by fever and chills, unexplained weight loss, severe trauma, incontinence, or significant and escalating weakness in the legs it is extremely important to seek immediate medical attention.

Lumbago Treatment

Diagnostic imaging may reveal abnormalities in the lumbar spine, such as spinal stenosis, but these cannot be presumed the cause of the lumbago as such changes may exist without symptoms arising. Once a serious underlying medical issue is ruled out however, the patient is likely to be recommended to have a few days of rest prior to undergoing physical therapy along with analgesic medications where desirable. Axial low back pain that commonly occurs when engaging in sports or physical activity usually resolves within six weeks or so, but longer term pain requires more thorough investigation. Back surgery may be indicated for some patients with spinal stenosis and lumbago although patients are usually not considered as surgical candidates unless the lower back pain is severely affecting their normal routine and the pain is unmanageable through conservative treatments.

Surgery for Lumbago

Surgical treatment, such as laminectomy, is not usually successful in resolving referred pain but may be considered if other options are unavailable or if there are confounding factors. Radicular pain usually has a structural cause such as disc herniation, spinal stenosis such as foraminal stenosis, scar tissue in the spine from previous surgery, or pathological changes from nerve root injury or diabetes. Treatment of lumbago from such causes will likely be conservative initially with back surgery possible should physical therapy, analgesics, and cryotherapy/thermotherapy fail to resolve the problem. Investigating the root of the lower back pain is key in determining appropriate treatment, with lumbago a many-faceted condition with numerous underlying causes.

Last Updated: 06/03/2011