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Reviewed by Dr Stephen Collins, GP

What is lumbago?

Weak muscles in the back and stomach increase the risk of backaches. Therefore, moderate exercise is highly recommended.

Lumbago is 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. Lumbago often occurs in younger people whose work involves physical effort and is not uncommon in people of retirement age.

What causes lumbago?

In the majority of cases, it is impossible to identify the exact cause of backache. In about 25 per cent of cases, however, it is possible to identify the cause. Often, these patients are suffering from conditions like a slipped disc, osteoporosis (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.
The pain is sometimes accompanied by a tingling sensation or numbness in the back or buttocks or leg.

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 turns numb, contact a doctor or Accident and Emergency department immediately.

If you suffer from backaches and notice reduced strength or muscle bulk in one or both legs, contact a doctor. These warning signs indicate compression of the spinal cord and its branches 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 painkillers. Special medicines for relaxation of muscles may sometimes be prescribed. NSAIDs (nonsteroidal anti-inflammatory drugs eg ibuprofen) and muscle relaxants relieve more pain than placebo.
Activity is beneficial. Stay active. Get on with your life within the limits of your pain.
Warmth 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 go away in a couple of days.

Chronic low back pain

If you have suffered backaches for a long period, you should consult your GP. Rarely does an X-ray benefit. Referral to a physiotherapist or chiropractor for spinal manipulation might be beneficial and may produce relief of symptoms, but may not be long-lasting.
Low back pain benefits from back exercises, back schools, behavioural therapy and multidisciplinary pain treatment programmes.
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.

Chiropractors usually perform a specially 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.

How is lumbago treated?

Acute low back pain

Beneficial: NSAIDs such as ibuprofen (eg Nurofen). Advice to stay active.
Likely to be beneficial: analgesics, 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.

Future prospects

These are good, provided the person remains active and receives early and correct treatment.

It is a fact that weak back and stomach muscles increase the risk of backaches. Moderate exercise to strengthen the muscles is therefore highly recommended.

References
Tulder; MW van; Koes BW. Low back pain and sciatica. Clinical Evidence June 2001;772-789.

Tulder MW van, Cherkin DC, Berman B, Lao L, Koes BW. Acupuncture for low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.

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.

Nelemans PJ, Bie RA de, Vet HCW de, Sturmans F. Injection therapy for subacute and chronic benign low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.

Gadsby JG, Flowerdew MW. Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.

Gibson JNA, Grant IC, Waddell G. Surgery for lumbar disc prolapse (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.

Waddell G, Feder G, McIntosh A, Lewis M, Hutchinson A. Low Back Pain Evidence Review London: Royal College of General Practitioners. Clinical Guidelines for the management of Acute Low Back Pain. Review Date: April 1998. ISBN Number 0 85084 229 8.

Based on a text by Dr Henrik Wulff Christensen, chiropractor and Jan Hartvigsen, chiropractor

Last updated 01.04.2005