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Lumbago

Lumbago is a term which is not used much nowadays and refers to moderate severe and disabling low back pain, usually of acute or recent onset and often secondary to disc problems in the back. It can be chronic if it persists for three months or longer.

The causes of lower back pain or lumbago are often not clear, with a definite cause identified only rarely. Much back pain is thought to be related to disc problems but pain can be caused from the joints, muscles, ligaments or nerves. A minority of cases are caused by serious underlying conditions such as tumours or infections.

Lumbago symptoms typically include pain the the back which can refer to the buttocks, backs of thighs or round to the groin. Spinal movements are limited, particularly bending forwards which increases the pressures in the spine. The back muscles may be over contracted in muscle spasm and may force an abnormal posture to one side.

Further useful information about lumbago is available at Wikipedia's Low Back Pain page and Netdoctor.

 

Sciatica

Sciatica symptoms are different, with severe pain in the buttock, leg and foot which is very clearly defined by the patient. Sciatica treatment by a physiotherapist can be helpful although a sciatica cure may have to wait until nature settles the nerve down and the pain subsides. Sciatica stretches are often recommended and may be unhelpful due to stretching the already inflamed nerve. Sciatica – pregnancy may also be a problem along with the sacroiliac and low back pains typically suffered. Further information is available at sciatica Emedicine.

 

Important issues with low back pain are the symptoms and signs which warn of a serious medical condition, known as red flags. Your doctor or physiotherapist will question you about these at your first attendance to screen you for underlying illnesses or conditions. Indications that all is not right include loss of weight, disturbance of bladder or bowel function, loss of feeling around the groin and genitals and numbness or loss of power in the legs. If you have any of these symptoms you should consult your doctor or other medical authority immediately.

 

Back Pain Relief for Acute Back Pain

Acute back pain is worrying if the pain is very severe but this does not reflect the seriousness of the underlying problem - most back pain is caused by a strain or sprain to one of the spinal structures. The back pain will settle down with time and you should return to normal activity.


  1. Don't panic, it's not serious and you will get better with time.

  2. Reduce your activity within the limits of pain, do not rest greatly unless you pain makes you do so.

  3. Cold or warmth applied to the back may help but be careful about the condition of your skin in the area.

  4. Take painkillers as advised and discuss with your doctor if you need to. Take them regularly as prescribed as don't leave them out because you are feeling a bit better.

  5. Avoid stressful activities such as sitting in low chairs, bending over, lifting objects and repetitive work.

  6. Pace your return to activity by doing things in small timed amounts you know you can manage without the pain becoming too much worse.

  7. Go back to work as soon as you can and don't expect to be pain free before you do.


Back Pain Relief for Chronic Back Pain

Chronic back pain is longer lasting, for example over three months and perhaps for much longer, and is rarely cured completely. It can be managed well or it can take over someone's life and make everything much more difficult for them.

  1. Your back pain is not a punishment nor an enemy to be defeated, it is something you can manage well or manage badly, with more or less pain and disability resulting.

  2. Manipulation from a physiotherapist or chiropractor or osteopath may be helpful, though often for short to medium periods.

  3. A pain management programme may be useful which combines fitness, education and cognitive behavioural techniques to improve the function of people with long term back pain.

  4. If you feel you are getting nowhere, ask your doctor to refer you to the nearest pain management clinic, most of which have therapy teams attached to them.


Diagnosing Low Back Pain

This is a difficult matter and many people with back pain will never get a moderately clear diagnosis as to why they have their pain. X-rays are not routinely helpful in identifying causative problems in the spinal anatomy.

Spinal surgeons diagnose back pain by thinking of three categories:

  • Serious underlying conditions which can also cause back pain, such as infection, trauma, tumours and arthritic diseases.

  • Specific back syndromes which are well recognised such as spinal stenosis and nerve root compressions (e.g. sciatica in the leg).

  • Non-specific low back pain, the vast majority of sufferers, who have a problem but for which the cause is not clearly defined.

Physiotherapists, osteopaths and chiropractors make detailed examinations to form therapeutic diagnoses so that they can plan treatments. There appears to be no scientific evidence however to back up the usefulness of these examination tests in terms of outcome.


The Treatment of Lumbago

Research work has shown that for acute back pain the following treatments are:

  • Beneficial – advice to stay active (small benefit only), anti-inflammatory medications (short term symptom relief), individual patient education

  • Possibly beneficial – spinal manipulation (similar to other treatments), painkillers

  • Needs to be judged if harmful or helpful – muscle relaxants e.g Valium

  • Unknown effectiveness – back exercises, facet joint injections, epidurals, back schools, TENS and corsets

  • Likely ineffective or harmful – traction, bed rest


While for chronic back pain the following treatments are:

  • Beneficial – multidisciplinary management, back exercises

  • Possibly beneficial – spinal manipulation (similar to other treatments), drugs, back schools

  • Effectiveness not known – epidurals, steroid injections, muscle relaxants, lumbar corsets, advice to stay active

  • Not likely to be helpful – bed rest

  • Harmful or ineffective – traction, facet joint injections


 

References from the Cochrane Library

van Duijvenbode I, Jellema P, van Poppel M, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001823. DOI: 10.1002/14651858.CD001823.pub3.

Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2

Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.pub2.

Engers AJ, Jellema P, Wensing M, van der Windt DAWM, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004057. DOI: 10.1002/14651858.CD004057.pub3.

Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD002014. DOI: 10.1002/14651858.CD002014.pub3.

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007612. DOI: 10.1002/14651858.CD007612.pub2.

Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low-back pain.. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD000261. DOI: 10.1002/14651858.CD000261.pub2.

Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-back pain. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000447. DOI: 10.1002/14651858.CD000447.pub2.


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