Lumbago or back pain? A doctor with 40 years experience explains

What is lumbago?

What is the difference between low back pain, lumbar pain and lumbago? 

Lumbago definition

Lumbago is a non-specific form of low back pain

Lumbago is simply another term for a non-specific low back pain or discomfort that occurs in the lumbar portion of the spine, ranging from mild to severe, sharp to dull, occasional to constant; sudden to gradual onset that may or may not radiate pain into the buttocks or legs.  It is not a descriptive term and can be used regardless of the cause of the lower back pain.  In fact, lumbago is a preferred term by some clinicians when the cause of the problem is unknown. It may also appropriately be used to refer to the general feeling of achiness and uncomfortable stiffness of the back upon getting out of bed in the morning.

The term lumbago appears to be falling out of popular use, at least in the United States and still continues to be used in other parts of the English speaking world.  The phrase “lower back pain” is much more commonly substituted for lumbago in the last 30 years; still the two terms are often used interchangeably.

Causes of lumbago

Lumbago or lower back pain can arise from a variety of problems.  While a diagnosis is always difficult to make and often an educated guess, the cause of lumbago can be suggested by the speed of onset of complaints.  Using this information can help determine the cause and point to the correct treatment.

Sudden onset:

  • Muscle and ligament strain or sprain
  • Muscle spasm due to injury, overuse and abuse
  • Lumbar disc herniation
  • Facet joint inflammation
  • Sacroiliac joint pain
  • Aggravation of a chronic low back problem

Gradual onset:

  • Poor muscle and ligament tone of back and core muscles
  • Fatigue and abuse of low back soft tissue by work and sports activity
  • Postural stress caused by congenital leg length difference
  • Postural stress caused by pelvic and spinal misalignment, exaggerated lordosis or scoliosis
  • Spondylosis, spondylolysis, spondylolisthesis and spinal osteoarthritis
  • Osteoporosis
  • Ankylosing spondylitis
  • Spinal canal stenosis

Common lumbago symptoms

While lumbago can present in many ways, this is a typical clinical picture of lumbago:

  • Pain across the lower part of the back often radiating into the area of tailbone
  • Pain worse on movement or while weight bearing, especially when first standing
  • Reduced movement of the spine, especially forward and backward bending
  • Tense muscle spasm and palpable rigidity in the area of pain near the spine
  • Inability to assume a normal posture, with an unnatural tilt or leaning of the spine in any direction, usually to either side or forward
  • Pain that is occasionally accompanied by a tingling or pins and needles sensation, or numbness, radiating from the back into the buttocks or leg, and sometimes going as far as the great toe

Lumbago treatment

Correct treatment of lumbago and back pain relief is completely dependent on determining the cause of the problem, which has been described as diverse and multiple possibilities.

As a general rule, lumbago will probably respond to a limited or major degree to the same basic conservative measures that most skeletal pain conditions respond:

  • Bed rest if severe or limited activity based on the degree of pain.  A very comforting and helpful posture to rest the low back is to lie on the back on a firm surface with the knees bent and legs elevated slightly (as when placing two stacked couch cushions below the lower legs) so the low back can rest in a slightly flattened posture.
  • Cold/heat therapy to the back.  To use this correctly, see  How to use a cold pack for lumbago 
  • Stretching the low back muscles and other soft tissue structures  Lumbago exercises and lower back stretches: Basic Four
  • Avoid all activities and postures that aggravate the lumbago
  • Return to light modified activity as soon as acute symptoms are under control
  • Acupuncture or acupressure can be extremely effective.
  • Light dose of non-prescription drugs to reduce inflammation and reduce pain
  • Apply whatever structural or postural correction or improvement is indicated (spinal manipulation if misalignment is noted, improvement of work or sport environment to reduce low back stress, massage of spastic muscle tissue, start appropriate exercises to increase muscle tone, etc.)

Many times lumbago is caused by or contributed to when the muscles, discs, ligaments and tendons do not fully support the low back spinal vertebra, causing  the nerves to become pressed upon, or compressed, resulting in what some people would call a pinched nerve.   There are simple and effective treatment measures a person with a pinched nerve can do that can be very helpful in many cases.   Review some of these ideas for pinched nerve lumbago treatment to learn how to help yourself and reduce  or eliminate lumbago.

Danger signs of lumbago  

Most often the cause and the course of lumbago are unremarkable, with about 75% cases of routine low back pain never receiving a specific diagnosis to explain the origin and nature of the problem.  In these cases the cause remains unknown and is assumed to be a low grade soft tissue problem involving the structural elements of lumbar spine and pelvis.  Even so, sudden worsening and new superimposed  problems can develop in these cases resulting in an sudden emergency situation.

If during an episode of lumbago the nature of the problem worsens or develops a different set of symptoms and complaints, it suggests the need for immediate emergency care:

  • Sudden intensification of pain for no apparent reason
  • Loss of bladder or bowel control
  • Loss of feeling in the lower back, pelvis or legs
  • Inability to control leg movement
  • Notice a recent loss of muscle strength of one leg compared to the other, or a difference in size of one leg compared to the other

Lumbago prevention

Following a faithful exercise routine of low back stretching and strengthening exercises will go a long way toward eliminating or at least reducing the majority of lumbago cases.  Exercise is not the best course of action to take while in the acute and painful stages of lumbago, however.   At this time rest, ice and NSAIDs are most commonly effective.  Once in the non-acute state a well planned program of low back conditioning will often help considerably.

Lifting Do’s and Don’ts to avoid lumbago

Additional benefit will be gained in most cases by stopping cigarette smoking, losing excess body weight and correction of any ergonomic problems known to exist in the home, workplace, automobile and anywhere else much time is spent.

Chronic low back pain and frequent episode of lumbago do not have to be a way of life.

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