Backache

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 low back pain. 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 when 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.

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 department 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 painkillers. Special medicines for relaxation of muscles may sometimes be prescribed. Research shows that NSAIDs (nonsteroidal anti-inflammatory drugs eg ibuprofen) and muscle relaxants relieve pain better than placebo. 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 go away in a couple of days.

Chronic low back pain

• If your backache persists for a long period, you should consult your GP. Rarely does an X-ray benefit. Many people find that treatment by a physiotherapist, osteopath or chiropractor (including spinal manipulation) often provides some relief of symptoms, but may not be long-lasting.
• Low back pain benefits from back exercises, attention to posture and seating, 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, 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?

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 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.