Overview

Lumbago, or lower back pain, is one of the most common musculoskeletal complaints worldwide. Studies indicate that approximately 80% of adults experience lower back pain at some point in their lives, making it a leading cause of disability and work absence globally.

The lumbar region, consisting of five vertebrae (L1-L5) in the lower back, bears much of the body's weight and is involved in virtually every movement we make. This constant stress, combined with the complex anatomy of muscles, ligaments, nerves, and intervertebral discs, makes the lower back particularly vulnerable to injury and pain.

Lumbago can be classified as acute (lasting less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). While most cases of acute lower back pain resolve within a few weeks with conservative treatment, some individuals develop chronic pain that requires ongoing management.

Key Points

  • Affects 80% of adults at some point in their lives
  • Second most common reason for doctor visits
  • Leading cause of work-related disability
  • Most cases resolve within 6 weeks with conservative treatment
  • 10-20% of cases become chronic
  • Annual healthcare costs exceed $100 billion in the US alone

Symptoms

Lumbago symptoms can vary significantly in intensity, duration, and character. The pain may develop suddenly after a specific incident or gradually over time without an identifiable cause.

Primary Symptoms

  • Low back pain - The hallmark symptom, ranging from dull ache to sharp, stabbing pain
  • Hip pain - Often accompanies lower back pain due to compensatory movements
  • Side pain - May indicate involvement of lateral muscles or referred pain
  • Low back cramps or spasms - Sudden, involuntary muscle contractions
  • Leg pain - Can occur with nerve compression or sciatica
  • Muscle pain - Widespread muscle soreness and tension

Pain Characteristics

  • Location: Central lower back, may radiate to buttocks or legs
  • Quality: Aching, burning, stabbing, or throbbing
  • Timing: Constant or intermittent
  • Aggravating factors: Movement, prolonged sitting/standing, bending
  • Relieving factors: Rest, position changes, heat/cold

Associated Symptoms

  • Stiffness, especially in the morning
  • Reduced range of motion
  • Difficulty standing upright
  • Pain that worsens with coughing or sneezing
  • Difficulty sleeping due to pain
  • Tenderness to touch in affected areas

Red Flag Symptoms

Seek immediate medical attention if you experience:

  • Loss of bowel or bladder control
  • Progressive leg weakness
  • Numbness in the groin or genital area
  • Severe, unrelenting pain
  • Fever accompanying back pain
  • Unexplained weight loss

Causes

Lumbago can result from various factors, ranging from mechanical issues to systemic conditions. Understanding the underlying cause is crucial for effective treatment.

Mechanical Causes (Most Common)

1. Muscle or Ligament Strain

  • Heavy lifting with poor technique
  • Sudden awkward movements
  • Poor posture over time
  • Repetitive stress

2. Disc Problems

  • Herniated disc: Inner disc material pushes through outer layer
  • Bulging disc: Disc extends beyond normal boundaries
  • Degenerative disc disease: Age-related disc deterioration

3. Structural Issues

  • Spinal stenosis: Narrowing of spinal canal
  • Spondylolisthesis: Vertebra slips forward
  • Scoliosis: Abnormal spine curvature
  • Osteoarthritis: Joint degeneration

Non-Mechanical Causes

1. Inflammatory Conditions

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Psoriatic arthritis

2. Infections

  • Osteomyelitis (bone infection)
  • Discitis (disc infection)
  • Epidural abscess

3. Other Medical Conditions

  • Kidney stones or infections
  • Endometriosis
  • Fibromyalgia
  • Tumors (rare)
  • Osteoporosis with compression fractures

Contributing Factors

  • Psychological stress and depression
  • Sleep disorders
  • Sedentary lifestyle
  • Occupational hazards

Risk Factors

Several factors can increase your likelihood of developing lumbago:

Modifiable Risk Factors

  • Poor posture: Slouching, improper sitting/standing positions
  • Obesity: Excess weight stresses the lower back
  • Sedentary lifestyle: Weak core muscles, poor flexibility
  • Smoking: Reduces blood flow to spinal discs
  • Poor lifting technique: Bending from waist instead of knees
  • Lack of exercise: Weak supporting muscles
  • Psychological factors: Stress, anxiety, depression

Non-Modifiable Risk Factors

  • Age: Risk increases with age, peak 30-50 years
  • Gender: Men and women equally affected
  • Genetics: Family history of back problems
  • Previous back injury: Increases risk of recurrence
  • Pregnancy: Weight gain and postural changes

Occupational Risk Factors

  • Jobs requiring heavy lifting
  • Prolonged sitting (office workers, drivers)
  • Repetitive bending or twisting
  • Vibration exposure (construction workers)
  • High-stress work environments

Diagnosis

Diagnosing lumbago typically begins with a thorough medical history and physical examination. Most cases can be diagnosed clinically without imaging studies.

Medical History

Your doctor will ask about:

  • Pain onset, duration, and progression
  • Pain characteristics and location
  • Aggravating and relieving factors
  • Previous episodes and treatments
  • Occupational and recreational activities
  • Red flag symptoms

Physical Examination

Inspection

  • Posture and gait assessment
  • Spine alignment and symmetry
  • Muscle spasm or atrophy

Palpation

  • Tenderness over spine and muscles
  • Muscle tension and trigger points
  • Bony abnormalities

Range of Motion Testing

  • Flexion, extension, lateral bending, rotation
  • Pain reproduction with specific movements

Neurological Examination

  • Straight leg raise test
  • Muscle strength testing
  • Reflexes (knee, ankle)
  • Sensation testing

Imaging Studies

Usually not needed for acute lumbago without red flags, but may include:

X-rays

  • Shows bone abnormalities, fractures, alignment
  • Limited value for soft tissue problems

MRI (Magnetic Resonance Imaging)

  • Best for disc problems, nerve compression
  • Shows soft tissue detail
  • Indicated for persistent symptoms or neurological signs

CT Scan

  • Better bone detail than MRI
  • May be used when MRI unavailable

Laboratory Tests

May be ordered if inflammatory or infectious causes suspected:

  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • HLA-B27 (for ankylosing spondylitis)

Treatment Options

Treatment for lumbago aims to reduce pain, improve function, and prevent recurrence. A multimodal approach is often most effective.

1. Conservative Management

Activity Modification

  • Avoid bed rest beyond 1-2 days
  • Stay active within pain limits
  • Gradual return to normal activities
  • Avoid aggravating movements temporarily

Physical Therapy

  • Exercise therapy: Core strengthening, flexibility
  • Manual therapy: Mobilization, manipulation
  • McKenzie method: Specific directional exercises
  • Postural training: Proper body mechanics
  • Aquatic therapy: Low-impact exercise

2. Medications

Over-the-Counter Options

  • NSAIDs: Ibuprofen, naproxen for pain and inflammation
  • Acetaminophen: For pain without inflammation
  • Topical agents: Creams, patches for localized relief

Prescription Medications

  • Muscle relaxants: For acute muscle spasms
  • Nerve pain medications: Gabapentin, pregabalin
  • Antidepressants: Duloxetine for chronic pain
  • Short-term opioids: Severe acute pain only
  • Corticosteroids: Oral or injected for inflammation

3. Non-Pharmacological Treatments

Heat and Cold Therapy

  • Ice for acute injury (first 48 hours)
  • Heat for muscle relaxation and chronic pain
  • Alternating heat and cold

Complementary Therapies

  • Massage therapy: Reduces muscle tension
  • Acupuncture: May help chronic pain
  • Chiropractic care: Spinal manipulation
  • Yoga: Improves flexibility and strength
  • Tai chi: Gentle movement and balance

4. Interventional Procedures

  • Epidural steroid injections: For nerve-related pain
  • Facet joint injections: For arthritis pain
  • Trigger point injections: For muscle knots
  • Radiofrequency ablation: For chronic facet pain

5. Surgery

Reserved for specific conditions when conservative treatment fails:

  • Discectomy: Removal of herniated disc material
  • Laminectomy: Decompression for spinal stenosis
  • Spinal fusion: For instability
  • Disc replacement: Alternative to fusion

Prevention

Many cases of lumbago can be prevented through lifestyle modifications and proper body mechanics.

Exercise and Physical Activity

  • Core strengthening: Planks, bridges, bird dogs
  • Flexibility exercises: Hamstring, hip flexor stretches
  • Low-impact aerobic exercise: Walking, swimming, cycling
  • Regular activity: Avoid prolonged inactivity

Proper Body Mechanics

Lifting Technique

  • Bend knees, not waist
  • Keep load close to body
  • Avoid twisting while lifting
  • Get help with heavy objects

Posture

  • Maintain natural spine curves
  • Use ergonomic furniture
  • Take regular breaks from sitting
  • Sleep on supportive mattress

Lifestyle Modifications

  • Weight management: Reduce spine stress
  • Quit smoking: Improve disc health
  • Stress management: Reduce muscle tension
  • Proper footwear: Good arch support
  • Workplace ergonomics: Proper desk setup

When to See a Doctor

While most cases of lumbago improve with self-care, certain situations require medical evaluation.

See a Doctor If:

  • Pain persists beyond 2-4 weeks
  • Pain is severe and limits daily activities
  • Pain radiates down one or both legs
  • Numbness or tingling in legs
  • Pain worsens despite treatment
  • History of cancer, osteoporosis, or steroid use

Seek Emergency Care For:

  • Loss of bladder or bowel control
  • Progressive leg weakness
  • Numbness in groin or saddle area
  • Fever with back pain
  • Severe pain after trauma
  • Unexplained weight loss with back pain

Follow-up Care

  • Regular monitoring for chronic cases
  • Adjustment of treatment plan as needed
  • Preventive care education
  • Referral to specialists when indicated

Related Conditions

Several conditions may be associated with or mistaken for lumbago:

Spinal Conditions

  • Sciatica: Nerve pain radiating down leg
  • Spinal stenosis: Narrowing of spinal canal
  • Herniated disc: Disc material pressing on nerves
  • Degenerative disc disease: Age-related disc changes
  • Spondylolisthesis: Vertebral slippage

Inflammatory Conditions

  • Ankylosing spondylitis: Inflammatory arthritis of spine
  • Rheumatoid arthritis: Autoimmune joint disease
  • Psoriatic arthritis: Arthritis with psoriasis

Other Causes of Back Pain

  • Fibromyalgia: Widespread pain syndrome
  • Kidney problems: Stones, infections
  • Endometriosis: In women
  • Osteoporosis: With compression fractures
  • Myofascial pain syndrome: Muscle trigger points

References

  1. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
  2. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747.
  3. Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-2383.
  4. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367.
  5. Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH Task Force on research standards for chronic low back pain. J Pain. 2014;15(6):569-585.