Lumbago - Living With Lower Back Pain

Lumbago is the generic term used to describe pain the lumbar region of the back, it can range from mild to severe and affecting both younger and older adults. Depending on the severity, it can seriously hinder quality of life making simply daily routine tasks difficult and painful to perform, as any tasks involving bending forwards or backwards may cause painful symptoms felt either locally in the lower back itself or it may radiate to other parts of the body.

lumbago and living with lower back painThe spine is one of the strongest structures in the whole body, formed of 33 vertebrae stacked upon one another. Between the vertebrae are intervertebral discs, these serve as padding to separate the vertebrae and as shock absorbers.  Strong muscles, flexible tendons and ligaments are also key components to the structure and along with the bones, discs and nerves, contribute to a healthy spine.

The spine not only fulfils a weight bearing function but also encases the delicate spinal cord which travels from the brain to the first of the lumbar vertebrae, from there it branches out to form a bundle of nerves known as the cauda equina, due to its horse tail like appearance, which stretch from the lumbar to the sacrum.

 The five unfused vertebrae L1 – L5 in the lumbar region are amongst the largest and strongest of all the vertebrae, they bear most of the weight of the upper body whilst providing flexibility and movement. The lumbar connects with the sacrum at the lumbrosacral joint L5 – S1, allowing the body to rotate.

Lumbago is a common disorder affecting most people at some point during their lives, and although in many cases symptoms are relatively mild, as with any spinal disorder lumbago can cause significant pain, discomfort and even disability.

Symptoms of Lumbago

Pain may vary in intensity from patient to patient, ranging from mild discomfort to severe shooting or stabbing pains, symptoms will also vary depending on the root cause of the pain.

Typical symptoms include the following:

  • Pain in the lower back
  • Difficulty bending forwards or backwards
  • Pain radiating to the legs and buttocks
  • Tingling sensations in the lower back, legs or buttocks
  • Numbness in the buttocks, legs or even feet
  • Difficulty sleeping due to pain felt when lying down

Pain may vary in intensity from patient to patient, ranging from mild discomfort to severe shooting or stabbing pains.

Causes of Lumbago

In the majority of cases, lower back pain is caused by mechanical soft tissue problems, however for some patients other medical conditions are the root cause.

Soft Tissue Disturbances

Small tears or strains in the muscles and ligaments surrounding the vertebrae in the lower back can provoke painful symptoms. These types of injuries are often caused by lifting heavy objects, repetitive movement or prolonged sitting. It is often difficult for physicians to pin point the exact location of a strain or tear, but with the use of physio therapy, targeted exercises and pain medication, these types of disturbances usually resolve themselves with time.

Intervertebral Disc Issues

The intervertebral discs are made up of tough fibrous cartilage with a gel like centre, these act as shock absorbers soaking up any knocks and jolts from movements. Any problems within the intervertebral discs can cause painful symptoms.

Herniated Disc

Also referred to as a slipped or bulging disc, when a crack or a tear occurs in the exterior of the disc’s fibrous ring, it can cause the gel like substance of the nucleus to seep through the tear, bulge out and compress any nearby nerve roots, resulting in painful symptoms felt either at the source or radiating to another area of the body.  Wear and tear, injury and trauma can all cause disc herniation or disc protrusion.

Sciatica is often associated with herniated or protruding discs, as the disc’s material compresses the sciatic nerve in the lower back causing extremely painful symptoms.

Degenerative Disc Disease

The effects of ageing, the wear and tear process or sustained poor posture can all contribute to disc dehydration – as the discs dry out, lose height and elasticity, they also become more prone to damage. In severely degenerated discs, the disc collapses allowing the vertebrae to come into contact and grind against each other. This can lead to swelling and painful symptoms and may also encourage the formation of bony spurs (osteophytes).

Sciatica

The sciatic nerve is the largest single nerve in the whole body, its roots are located in the lower lumbar region and extend all the way to the lower limb where it branches off just above the knee innervating other major nerves in the lower leg, such as the tibial nerve and the common peroneal nerve. Any compression of the nerves in the lower back is generally referred to as sciatica and may provoke severe discomfort in the lower back itself, as well as radiating to the buttocks and lower legs. Sciatica is a painful form of lumbago and is most commonly caused by a herniated or protruding disc, there are however other possible causes such as spondylolisthesis, spinal stenosis, pregnancy or a tumour.

Osteoarthritis

Arthritis of the facet joints in the lower back are usually a result of the body’s natural ageing process. Wear and tear causes the cartilage covering the facet joint to become worn and rougher, movement is not as smooth as in a healthy joint and friction can occur during movement provoking local swelling, pain, inflammation and in some cases trigger the formation of bone spurs.

Spondylolisthesis

This occurs when one of the vertebrae slips out of place, pressing on nerves exiting the spinal column and evoking painful symptoms.

Spinal Stenosis

This refers to the abnormal narrowing of the bony channel of the spine, this can give rise to symptoms of compression of the spinal nerves and can occur as result of the degeneration of facet joints and intervertebral discs, resulting in neuralgia.

Foraminal Stenosis

This describes the narrowing of the exit of the foramen, the nerves that exit through this canal are impinged causing neuralgia.

Red Flags

In some rare cases, lumbago may indicative of a more serious health condition such as a tumour or infection.

Diagnosis

A detailed medical examination with history as well as investigative testing methods such as an MRI scan to look at the structure itself, and possibly a SPECT CT scan to investigate inflammation.

Treatment

This depends on the cause, conservative methods are usually the first port of call such as physiotherapy, pain medication, lifestyle changes such as a review of posture, habits, routine etc.

Other possible treatments may include steroid injections, radio frequency denervation, if these methods are not helpful then surgery may be an option.

The pain management clinic works with a multidisciplinary team of expert professionals including pain management consultants, surgeons, psychologists, nurses, physiotherapists and other specialists all working together to provide a comprehensive and individualised treatment plan.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment