Lumbago

The lower back is an anatomically complex area with multiple structures and tissues – this being one of the reasons that your lower back pain is commonly not caused by one specific structure. Let’s go through the main anatomy and identify some of the areas in the lumbar region which can contribute to lumbago.

Lumbar Discs

Lumbar discs are a cartilage like structure with a softer, firm jelly centre which allows the disc to be manoeuvrable in all directions allowing your lower back to move. When you move one way, pressure is placed through the disc in the opposite direction to perform the movement. Your discs sit between the vertebrae and act also as shock absorbers for the spine. They are extremely strong and durable – however if you place them under too much pressure from a poor lifestyle, repetitive job or a poor technique with heavy lifting it can result in a disc bulge which can cause pain for a long period of time and major loss of function. Disc injuries can range from irritation, to a bulge, which is a small herniation of the disc outside of its usual structure, to a prolapse which is the wrist injury you can have by the disc wall rupturing and the disc nucleus protruding from the centre – this injury is rare however. Disc injuries can lead to sciatica type symptoms as a bulged disc can press on to a nerve.

Vertebrae

These are the bones in the lower back and sit on top and below each disc. There are 5 lumbar vertebrae in the lumbar region and they increase in size and thickness from lumbar 1 to lumbar 5 and there is a small curve known as a lumbar lordosis which varies in amount from person to person. The curve in the back which goes from front to back (not side to side – this is known as scoliosis) helps the spine to bear weight properly and carry load. Each vertebrae connects with the next via facet joints which have small holes for the lumbar nerve roots to exit the spine.

Nerves

Nerve roots exit our facet joints of the lumbar spine and then form in to the main body of the nerve which runs off down the legs. Depending on the cause of your lumbago, you may have pain that extends down in to your legs – this can be commonly from nerve roots becoming aggravated at the lower back. Nerve pain can also contribute to what yu are feeling locally in the back region also.

Muscles

Your back has many muscles of different size which help your back to function and provide support for the spinal column. Put simply you have flexors, extensors and the oblique muscles which live in the lumbar region.

Flexors – sit towards the front aspect of the lower back and allow flexing, bending and lifting.

Extensors – sit on the back of the spine and posterior half of the body and include the erector spinae and glutes, they assist in standing up straight and lifting weight

Oblique’s – assist with posture, stabilising the spine and rotation of the body.

Tendons & Ligaments – There are multiple tendons and ligaments in this area.

Tendons – strong, fibrous connective tissue which attaches your muscles to the bones and help with the movement of bones and joints – when they become painful they can be inflamed and this can add to your lumbago.

Ligaments – elastic type connective tissue, strong in nature which attach bone to bone – during a trauma induced episode of lumbago you will find that ligaments can be sprained by being overstretched or placed under a force that your ligaments aren’t used (think about the moving furniture example).

Aches & Pain

The types of symptom every person will feel differ based on their perception of pain. Some may have a constant pain, others intermittent. Some may have a dull pain, others sharp. The areas where pain could extend could range from the lower back and when worse it can affect and radiate in to the upper back and the glutes. Depending on if there is involvement from the nerves there could be pain going down in to the legs.

Stiffness & Tightness

If you are lucky enough to have kept your full movement range in the lower back you may have a feeling of tightness and stiffness which makes your quality of movement significantly less than before.

Loss of movement

You may find the lower back becomes restricted in movement, especially in the bend. Difficulty with washing, dressing and general household tasks. Commonly lumbago can also give difficulty with gaining full extension and makes it difficult for you to stand up straight due to pain.

Red Flag Symptoms

These are extremely rare in lumbago however it is vital you are aware. The nerves tat supply your bladder, bowels and sexual organs live in your lower back – a very small percentage of back pain/injuries develop signs of cauda equine syndrome which can result in problems with bladder and bowel function and sexual function – and if not acted upon quickly – can lead to irreversible damage. If within 2 weeks of a lower back pain starting you experience a change in frequency of bladder and bowel movements, the inability to go to the toilet when needing to or pain during, loss of control of bladder or bowels (incontinence) or loss of sensation in the genitals or saddle region or loss of sexual function – you need to report to an A&E immediately for the right testing.

Treatment of the symptoms of lumbago from the early onset can vary depending on how bad your pain levels are and restriction of movement. If you have high pain levels and your symptoms are extremely irritable to the point you are having difficulty completing simple daily tasks and are finding walking and standing difficult then have a lie down for a short period, rest the injury and use heat packs and pain relief to help settle the pain in the short term.

The next stage for your recovery is to begin moving – now if your symptoms aren’t as high as mentioned previously – this will be your starting point. Avoid sitting for long periods of time, move frequently and perform gentle range of motion exercises in a lying down position. Things like hugging your knees in to your chest, rocking your knees from side to side and arching the lower back up off the floor – these movements take any load off the spine and help us to move all the affected tissues without placing them under too much load.

Rehabilitation of lower back pain and lumbago commences immediately from the onset – when pain levels reduce to a more manageable level you can start to perform more varied exercise. As a general rule – the only bad exercise for your lower back when it is painful – is exercise that aggravates it.

To provide some guidance – start with gentle exercises like walking and swimming. Early stage rehab can be based around Pilates and yoga which are great for restoring movement and modulating pain. The next stage is to commence some strengthening of the back – this can be done at home or in the gym with a varied range of exercises from weight lifting or floor based strength exercises for the core.

Basic mobility exercises to manage your lumbago:

Knee hugs: lying on your back, gently hug both knees in to your chest, hold for a few seconds and release then repeat.

Knee twists: lying on your back with your knees bent and feet on the floor/bed – gently rock your knees to each side and twist your lower back.

Supine Pelvic tilts: lying down – gently pick and arch the lower back up off the bed then flatten it down, repeat this action several times.

Once your back is more mobile and pain reduces, start to strengthen it by adding a bridge. This involves bending your knees, placing your fleet flat on the floor and lifting your hips and bum up off the bed as high as you can to strengthen you back and buttocks.

Conclusion

To summarise, Lumbago is normal and most people will experience it at some point in their lives. It will only last 4-8 weeks on average and the key to getting better is managing your pain levels, moving frequently and starting to exercise as soon as possible.