Lower Back Pain : Lumbago – Symptoms, Causes, and Treatment
Lower back pain can happen to anyone, most of the time it can result from strenuous activities like carrying heavy objects or by simply sitting in the office all day. Surprisingly, several researchers have discovered that there isn’t any correlation between lower back pain in runners due to higher training mileage. In fact, symptoms of lumbago (low back pain) are more of a common problem for the general population as compared to athletes.
Apparently, this may sound comforting to runners who do not have any issues with low back pain, but few athletes do struggle with the achy issue. Most especially when the pain travels down to the legs and causes other symptoms such as “sciatica.”
Running with discomfort can be bothersome, or much worse, can cause severe injury over the long term. It is best for runners to educate themselves about the risks of lower back pain and how to prevent it from happening over the course of this article.
Prevention can often be the best cure and according to Irish novelist Samuel Lover, “It is better to be safe than sorry!”
What is Lower Back Pain?
Low back pain or LBP is a common disorder that involves the muscles, nerves, and the bones of the back. Levels of pain can vary from a dull constant ache to a sudden prickly feeling. Duration often classifies lower back pain and is divided into three types:
- Acute, pain lasting less than six weeks
- Sub-chronic, pain lasts six to 12 weeks
- Chronic, more than 12 weeks
The underlying cause of this condition may further classify the infirmity as either mechanical, non-mechanical or referred pain. In most cases, its particular cause is not identified or even looked for, in many instances, runners often assume that mechanical problems like muscle or joint strain cause the pain. Apparently, there is more than meets the eye when it comes to low back pain.
Lumbago or lower back pain has a broad range of symptoms, it can be mild and slightly annoying, or it could be severe and debilitating for many runners. It could start suddenly after a morning jog or could begin slowly, gradually getting worse over time.
To break it down, these are the most common symptoms of low back pain to watch.
- Pain that is dull or achy to parts of the lower back
- Stinging, burning pain that moves along the back of the thighs, lower leg or feet.
- Numbness or tingling of the lower legs, more commonly known as sciatica
- Muscle spasms and tightness in the lower back, pelvis, and hips
- Emergence of pain from prolonged sitting or standing
- Difficulty standing up straight, walking, or going from a standing to a sitting position
Classifying of Low Back Pain
Lower back pain can come from many different reasons. To fully understand the physiology of lumbago or low back pain, runners must figure out what causes its symptoms. Presumably, the pain can arise from three different reasons.
- Mechanical pain
- Radicular pain
- Referred pain
Mechanical pain is the most common cause of low back pain. The discomfort primarily originates from muscle groups, ligaments, joints (facet joints and sacroiliac joints), or bones in and around the lumbar vertebrae. Moreover, the pain tends to occur on the lower back, buttocks and in some instances, at the top of the legs. Its cause usually occurs by loading the spine and may feel different based on forwarding, backward and twisting motions. Various physical activities including sports can influence mechanical pain. Also, sitting and standing in a wrong posture can advance its symptoms.
Radicular pain can occur if a spinal nerve root becomes interrupted or inflamed. It may follow a nerve root pattern or in many cases a dermatome down into the buttocks or leg that can cause a sharp and electric-like pain associated with sciatica or weakness of the legs. It often happens on one side of the body.
Referred pain has many variations, most often low back pain is caused by the onset of other conditions including claudication that comes from stenosis and other circumstances like myelopathic pain, neuropathic pain, deformity, tumors, and infections. Furthermore, lumbago can also stem from inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis. Other reasons include pain that originates from other parts of the body like kidney stones and ulcerative colitis.
Symptoms That Indicate A Serious Medical Issue
In rare cases, low back pain can signal a serious underlying medical problem. People who encounter any of the following symptoms are advised to seek immediate medical attention:
- Loss of bowel and bladder control
- Sudden weight loss that is not due to lifestyle changes such as diet and exercise
- Frequent Fever, chills and severe pain in the abdomen
Additionally, individuals that experience the symptoms after a major trauma are advised to see a doctor. More importantly, if lumbago interferes with sleeping, mobility and other daily activities, immediate medical attention is recommended.
Causes of Lower Back Pain
The most common causes of lumbago or low back pain are mechanical issues and soft-tissue injuries that induce the condition. These can often range from damages in intervertebral discs, compression of nerve roots, and abnormal movement of spinal joints. However, the single most common cause of lower back pain is a torn or pulled muscle and ligament.
A low back muscle strain and ligament sprain can suddenly happen or develop over time from repeated movements. Strains result when a muscle is stretched too far and tears, damaging the tissue. Meanwhile, sprains occur when overstretching and tearing affects ligaments that connect the bones together. In the medical field, doctors often treat muscle and ligament damage the same way due to the similarities of their symptoms and for practical purposes.
Common causes of muscle strain and ligament sprain include:
- Raising a heavy object or twisting the spine while lifting
- Sudden movements that put too much stress on the low back such as falling and slipping down to a hard a surface
- Poor sitting and standing posture over time
- Sports related injuries that involve twisting the spine like basketball or large forces of impact often characterized by elements of American Football
Causes of Chronic Lower Back Pain
Medical experts consider lumbago chronic if it lasts for more than three months and beats our body’s natural healing process. More often, chronic pain in the low back includes and underlying disc, joint, and an irritated nerve root problem. Common causes include the following:
- Lumbar herniated disc
- Degenerative disc disease
- Facet joint dysfunction
- Sacroiliac joint dysfunction
- Spinal stenosis
- Compression fracture
Lumbar herniated discs occur when the jelly-like center of a lumbar disc can break through its tough outer layer and irritate nearby nerve roots. The herniated portion of the disc is full of proteins that cause inflammation upon reaching a nerve root. These instances can cause swelling and nerve compression that can lead to severe nerve root pain. Also, the richly supplied nerve fibers can tear the wall and induce severe discomfort.
Degenerative disc disease happens when intervertebral discs lose hydration and wear down as people age over time. At birth, the discs are full of water, and at their healthiest state. As we age, the discs lose hydration and force the disc wall to weaken. In a period, the weakened wall may develop tears that can lead to herniation. Also, other cases may result in the wall’s collapse and cause stenosis.
Facet joint dysfunction can occur when the two facet joints behind each disc at each motion segment found in a human body’s lumbar vertebrae develop some issues. These joints have cartilage in between the bones that are enclosed by a capsular ligament. The nerves richly innervate these joints and at most times can be painful by themselves or in a combination of disc pain.
The sacroiliac joint attaches the sacrum at the base of the spine to each side of the pelvis. It is an active low-motion joint that absorbs shock and tension between the upper and the lower body. A sacroiliac joint dysfunction occurs when the joint becomes irritated and inflamed or if there is too copious or too diminutive movement of the joint.
Spinal stenosis can often emerge from the narrowing of the spinal canal where the nerve roots are. The restriction can be central, forminal, or both. It can often occur at a single level with instances of happening at multiple areas in the lower back.
Spondylolisthesis is an ailment that occurs when one vertebra slips over an adjacent one. In the medical world, there are five types of this malady, but the most communal are secondary to a defect or break of the parts between the facet joints. It can also happen through mechanical instability of the facet joints that causes pain due to the compression of nerves.
Osteoarthritis is a degenerative state that results from the wear and tear of the disc and facet joints. It causes many symptoms including pain, inflammation, weakness, and stenosis to a fitful degree. It can occur at a single level or multiple levels of the lower spine. Often, spinal osteoarthritis correlates with aging and is slowly happening. Its other names include spondylosis and degenerative joint disease.
The curve of the spine including conditions like scoliosis or kyphosis can increase the risk of individuals developing symptoms of low back pain; the deformity is often associated with lumbago if it leads to the decline of the discs, facet joints, and sacroiliac joints. Most of the time these symptoms lead to stenosis.
Trauma often occurs when acute fractures or dislocations of the spine can lead to pain or discomfort. Lumbago often develops after a shock injury such as a vehicular accident or a fall. The best-case scenario is to go to a medical specialist to evaluate the extent of the injuries and prevent the scope of further damage.
A compression fracture occurs in the cylindrical vertebra in which the bone typically caves in on itself. Its occurrence can cause sudden pain. Moreover, this fracture is most common to weak bones such individuals with osteoporosis and older people.
Less Common Causes of Lower Back Pain
Sometimes low back pain is caused by considerably less common reasons such as:
- Autoimmune Diseases
Infection or osteomyelitis is a rare spinal disease that can cause severe pain and is life threatening if untreated. Surgical procedures often trigger its cause and can spread through the bloodstream via injections. Patients with a jeopardized immune system are more sensitive to developing an infection in the spine.
Most spinal tumors start in a different part of the body and can metastasize to the spine. Common tumors that spread to the spine originate from cancer found in the various regions of the body. Breast, prostate, kidney, thyroid and lung cancer have links to the occurrence of spinal tumors. Individuals that have a history of cancer are advised for evaluation as soon as possible if they have developed symptoms of low back pain for a possible spinal contagion.
Back pain is also a possible symptom associated with autoimmune diseases like ankylosing spondylitis, rheumatoid arthritis, lupus, Crohn’s disease, and fibromyalgia. There are also other autoimmune conditions associated with lumbago and finding a correct clinical diagnosis is vital for individuals that suffer from these maladies.
There apparently factors that put the general population and runners of developing a greater risk for low back pain:
- Age is one of the most common reasons why individuals develop lower back pain. The symptoms of lumbago become more prevalent as we age. It usually begins to occur to people aged 30 and above.
- Exercise does not only prevent low back pain but can also give our bodies a healthy boost. Lack of physical activity can often lead to weak back muscles that cause back pain.
- Being overweight is often caused by poor diet, and lack of exercise. Carrying excess weight puts extra stress on an individual’s back that causes lower back pain.
- Some diseases like arthritis and cancer can contribute to the occurrence of back pain.
- Improper lifting is a grave risk factor for low back pain, using your back instead of your legs can lead to severe back injuries
- Psychological conditions also give individuals a higher risk for low back pain. Studies have shown that people that are prone to depression and anxiety have a greater chance of acquiring lumbago.
- Smoking can also cause the condition by keeping your body from delivering vital nutrients to the disks in your back.
Diagnosing Lower Back Pain
Obtaining an accurate diagnosis is critical in identifying the cause of low back pain. In many cases, a chosen treatment cannot fully correlate to the symptoms of lumbago, that is why an accurate prognosis is important in guiding the treatment.
Often, the diagnostic process for athletes and the general population is the same. The first significant step of diagnosing the condition is for a patient to provide a detailed description of symptoms and a complete medical history. Doctors will be given a general idea of the source of the patient’s low back pain and may proceed to further tests.
Before starting any tests, the patient will be asked to provide information regarding underlying symptoms and medical history. Inquiries typically include:
- Information about current symptoms
- Activity level
- Sleep habits
Accurate answers to these questions provide the physician with detailed information that can indicate possibilities for low back pain. A medical history is often the most precise medium for finding the right diagnosis. Consequently, non-disclosure of past conditions may make it difficult for physicians to come up with the correct prognosis.
The purpose of a physical exam is to pinpoint possible causes of low back pain. Typically, the test includes a combination of the following steps:
Palpation is a method where a physician will feel by hand possible areas of tightness or tenderness along the lower back to locate muscle spasms and joint abnormalities.
Neurologic examinations involve motor movements from the hip, knee, and big toe extension. It also includes flexion or forward and backward movement of the ankles. Often involved in these tests are sensory exams that test the patient’s reaction to light touch, pinprick, or other senses in the lower trunk, buttocks, and legs.
The range of motion test is also done to look for positions that worsen or cause pain and see if discomfort limits certain movements.
A reflex test analysis tests the patient’s reflexes in the legs to see weakened parts that have decreased muscle strength. If the reflexes are declining, a nerve root might not be as responsive as it should be.
In a leg raise test, a patient is asked to lay flat on his back and raise one leg from bottom to top and as straight as possible. If the leg raise recreates low back pain, it is possible that a herniated disc might be causing the issue.
Diagnostic Imaging Tests
Sometimes more tests are needed to gain more information if the physical exam and patient history do not pinpoint the exact cause of the condition. An imaging test can further point a situation that aggravates a patient’s severe low back pain. Standard imaging tests include:
- CT scan or Myelogram
- Magnetic Resonance Imaging scan or MRI
- Injection studies
X-rays are commonly used to view the bones of the spine. They can show abnormalities such arthritis, fractures, bone spurs and presence of various tumors.
A CT scan and Myelogram provides a more accurate cross-section image of the vertebrae. In the scan, an x-ray passes through the spine which a computer picks up and reformats into a 3D image. The detailed picture allows doctors to take a better look at the backbone at different angles. In rare cases, a myelogram performs in tandem with a CT scan in which dye is injected around the nerve roots to highlight spinal structures that give the image more clarity.
Injection studies are fluoroscopic-directed shots of local anesthetic and steroid medication in particular anatomic structures. Furthermore, the procedure is effective in confirming low back pain, they are often used in diagnosis, rehabilitation and are considered predictive of surgical results.
In many cases, doctors can predict the cause of the pain but not exactly where it is occurring. Imaging tests are very efficient in locating the primary source of the pain.
Basing on an individual’s diagnosis some treatments may work better than others or may work thoroughly with a combination of treatment methods. In some cases, self-care for low back pain is as effective in treating the condition as expensive remedies. Athletes (including runners) employ self-care practices that prevent the symptoms of lumbago.
Self-Care for Low Back Pain
Applying basic treatment techniques at home for treating mild and acute pain can be very effective. In some instances it can reduce the effects of chronic and severe pain, practicing self-care can easily be adjustable depending on the individual, these include:
Episodes of low back pain can lessen in occurrence by briefly avoiding strenuous physical activity that put stress on the lower back. Having a short rest period is highly advised, but too much inactivity can often make healing more difficult. Medical experts suggest that relaxing for a few days (depending on the severity of the pain) is better than resting for longer a period.
One technique allows patients to stay active but avoids strenuous physical activities. Activity modification allows patients to do their daily routine but with less action that aggravates low back pain. For example, if standing for a prolonged period intensifies the pain, doctors advise patients to sit in intervals to allow a favorable healing environment. Avoiding activities and positions that worsen the pain will help reduce lumbago in the long run.
Heat and ice therapy is a traditional method that is used by athletes to provide relief to low back pain. Heat generated by a warm bath, hot water bottle or heat wraps can relax the tense muscle and improve the circulation of blood. Increased blood flow allows nutrients and oxygen to heal the sore muscle. In the case of pain due to inflammation, ice or cold packs are effective in reducing swelling; most importantly, protecting the skin while applying heat and ice is important to prevent tissue damage.
Over The Counter Medication
Over the counter medication or OTC is one of the most convenient ways of relieving low back pain. Prescriptions such as aspirin, ibuprofen, and naproxen are proven anti-inflammatory drugs that reduce swelling and discomfort. Acetaminophen is also a popular OTC drug that works by interfering with the pain signal that the brain receives.
Although self-care treatments do not need guidance from a physician, discretion is still important because any medication carries possible risks and side effects. If a patient still suffers low back pain despite the self-care methods, talking to a physician might be the course of action.
Exercises to Help Relieve Low Back Pain
Physical therapy is an effective way of managing low back pain, types of exercises used to rehabilitate the spine include:
- Strengthening exercises
Stretching is an essential exercise that targets muscles in the low back, buttocks, hips, and legs. These muscles are vital in supporting the weight of the upper body, and the more flexible these muscle groups are, the chances of lower back pain tend to occur less.
Strengthening exercises add strength to the abdominal, hip, and gluteus muscles that support the spine. Stronger core muscles can help relieve low back pain; two favorite techniques that are used to strengthen the muscle groups are:
- The Mckenzie Method
- Dynamic Lumbar Stabilization
The McKenzie method stretches the spine through building core muscle strength. This exercise reduces the pain that is caused by compressed spinal structures like a herniated disc due to a compressed disc space. The Dynamic Lumbar Stabilization Exercise strengthens the back muscles to maintain a “neutral spine” or posture that prevents the occurrence of lumbago.
Other methods include low-impact aerobic exercises that increase the flow of blood that supports healing from an injury without jerking the spine. These activities can range from stationary bikes, elliptical or step machines, walking, and water therapy. Athletes and common folk who regularly do aerobic exercises reportedly have a lower risk of recurring low back pain.
Overall, any exercise that elevates the heart rate for a sustained time benefits the body. Consequently, regular physical activity is vital for keeping the range of motion and elasticity of a healthy spine. Lack of exercise often contributes to a stiff spine that causes discomfort and the emergence of low back pain.
Medical Treatments for Low Back Pain
Use of medical procedures reduces symptoms of lumbago but does not necessarily affect the underlying source of the condition. A doctor will usually prescribe medicine along with a physical therapy program or regimen, these include:
- Muscle relaxants
- Narcotic pain medications
- Back braces
- Epidural steroid injections
Muscle relaxants act as a depressant of the central nervous system and increase the fluidity of tense muscles; this relieves pain from a muscle tightness. Most of the time these prescriptions have no role in managing chronic pain.
Narcotic pain medications or painkillers alter a patient’s acumen of pain by weakening signals that the brain receives. A physician uses narcotic drugs for treating severe short-term pain after an operation. Its use is rare in the treatment of long-term chronic pain because they have adverse side effects and can easily become addictive.
Back braces also provide comfort and reduce pain by supporting the weakened back muscles. Researchers have found out that the use of a corset-style brace in combination with physical therapy can speed up the healing of low back pain.
Epidural steroid injections are administered directly into the outer part of the dural sac that surrounds the spine. It temporarily relieves pain by reducing inflammation around a compressed nerve root.
If these methods do not work, a doctor may recommend surgery. Also, it is always the patient’s decision to undergo surgical proceedings. In rare situations, a physician may decide to do the operation if a patient is involved in an accident that requires immediate action.
A decompression surgery removes anything that is pressing on a nerve root from the vertebrae that might include a herniated part of a disc or a bone spur. Minimally invasive techniques that use relatively small incisions that cause minimal discomfort is common among the procedures. Usually, most of these surgical procedures take less than a day to perform.
There are two types of decompression methods for low back pain:
Microdiscectomy is a minimally invasive procedure for individuals that suffer from a lumbar herniated disc that is causing sciatica.
Laminectomy is a procedure that removes a layer of the bone or soft tissue that is constricting a nerve or multiple nerve roots. This surgical operation also works with individuals that suffer from spinal stenosis.
Lumbar Spinal Fusion
Lumbar fusion surgery is a process that removes soft tissues between two or more adjacent vertebral bones. The operation usually replaces the removed tissues with bone or metal that enables a 6 to 12-month recovery after fusing into one long bone to stabilize and eliminate the movement of the spinal segments.
Surgical fusion procedures often use a posterior, anterior, or a lateral approach to join the parts of the bone. Newer techniques have made the operation more predictable with a faster recovery.
Lumbar spinal fusion is useful in treating conditions like spondylolisthesis, fracture, instability, and the onset of spinal deformity. It is also effective in treating degenerative disc disease, and stenosis. Lumbago that is caused by a sacroiliac joint dysfunction is also a candidate for fusion surgery, in rare cases, the same method is used to treat tumors and infections.
Alternative or non-medical treatments have also become popular among athletes and the general population. While the term alternative does not mean that it is inferior to medical therapies, the term instead provides traditional methods to treat lumbago. Furthermore, many individuals have reported relief by undergoing these processes, standard options include:
- Manual manipulation
- Massage Therapy
Manual manipulation by a chiropractor or a physical therapist helps alleviate the pain by making physical adjustments to the spine. The goal is to improve mobility that reduces stiffness and discomfort. Moreover, applying hand thrusts of varying speed and intensity adjusts spinal structures that often impede nerve roots.
Acupuncture is a traditional Chinese practice that stimulates the points of the body by placing needles on the skin for periods of time. Practitioners of this method believe that it corrects the body’s “qi” or life force. Researchers have shown that method provides significant pain relief for some people.
A Massage to the low back relieves muscle spasms that usually contribute to lumbago. The method increases blood that speeds up healing by bringing nutrients and oxygen to damaged muscle groups.
Meditation is another traditional way of relieving back pain. Moreover, it helps by reducing the perception of pain via mind over matter. It can also reduce depression, anxiety and sleep problems that commonly occur with prolonged low back pain. Meditative techniques include deep breathing exercises and yoga.
Preventing low back pain can be possible with proper exercise and diet. Also, correct posture is vital in limiting the symptoms associated with Lumbago. Consequently, related symptoms of lumbago are more prevalent in individuals that have bad posture. Whether you are an athlete or not, having regular check-ups can help people lessen the risks of having lower back pain. If the problem persists, it is best that you consult a physician and ask for a treatment that would suit your needs.
The references in this article are listed below and have been written by medical professionals for established medical websites and publications. Moreover, this article aims to educate individuals on the cause of low back pain and its related symptoms. Consequently, information within the article does not count as medical advice. It’s best that you go to a physician to diagnose low back pain and its associated symptoms.
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