Lumbago

Synonyms in the wider sense

Lumbago, acute lumbago, sudden back pain, blockage

Definition

The term lumbago is not a medical diagnosis in a strict sense. It describes however an illness condition. Under the term lumbago, one understands a sudden, severe back pain of the lumbar vertebrae that leads to an inability to move.

Abstract concept

The term lumbago deals with a concept that is widely used by people to indicate sudden back pain. The medical terminology for rheumatism of the muscles of the loin is lumbago or acute lumbago. Both terms describe pain in the region of the lumbar vertebrae. While the term acute lumbago still emphasizes sudden pain, the term lumbago can represent simple, perhaps chronic and persistent back pain. But both terms do not represent a true diagnosis, because they do not specify anything about the cause of the malady.

With sudden, painful and immobilizing incidents in the region of the neck and cervical vertebrae, one speaks in a similar manner from a stiff neck or an acute cervicalgia (cervicobrachialgia) or an acute neck spasm (torticollis).

A differentiation in terminology should be made for the acute complaint exacerbation of Chronic Back Pain, which usually has a less severe character.

Complaints

Different causes of illness can be the basis of lumbago. Usually patients mention an trivial movement, which caused a sudden back pain in a situation where complete freedom of movement previously existed, e.g. standing upright again from a bending position, raising an object in a bent position, or twisting the torso in an unusual body position. A nearly complete immobility arises in the lumbar vertebral region either immediately or shortly after the causative event. Even the smallest movement results in very severe back pain and causes the back muscles to contract in a cramp-like manner. Usually the pains are limited to the lower lumbar vertebral region. If the complaint persists somewhat longer, pain may arise in the buttocks, the groin or the upper thigh. Hardly ever do the pains reach the foot nor are they ever linked with disorders of skin sensitivity.

Causes

For patients with lumbago, it is Interesting to observe that the majority assume that lumbar sciatica must be the cause of their complaint. It is a fact that lumbar sciatica is regarded to be the most severe and the most painful cause of sudden back pains; accordingly, upon the occurrence of such an event it is also expected. However, lumbar sciatica is actually very seldom responsible for sudden back pain. In that case, leg pain plays a more prominent role, which is caused by pressure of the lumbar sciatica on the spinal nerve roots.

MRI of the lumbar vertebral column

vertebral column Nerves Position of the dorsal ligaments slipped disc Body of the verterbal column

The cause of the malady for lumbago can differ. Different theories exist about which modifications in the spinal column can cause such a sudden painful clinical picture:

1. Segmental articular dysfunction („blockage“) of a vertebra
2. Capsular strain of a vertebra
3. Vertebral disk prolaps
4. Lumbar sciatica
5. Pulled muscle

1. With a blockage, one assumes that an adverse body movement has led to hooking of small vertebrae during the movement; thereby the natural articular movement is reduced. According to the position that was adhered to when this hooking, occured the vertebrae can in this case either no longer be properly opened or closed upon movement. Through the „false“ vertebral positioning, the capsule of the spinal column with many pain-transmitting nerve fibers is put under tension, whereby a sudden pain arises.
   
2. With the vertebral strain, the origin of the pain is the same; only it does not lead to hooking of the vertebra, but rather the vertebra is strained by an adverse movement.
   
3. A sudden vertebral disk prolaps, e.g. on the basis of an increased inner vertebral disk pressure when bending over, can press against the posterior, longitudinal ligament (restriction ligament for the spinal column) and stretch this momentarily. The posterior longitudinal ligament is a structure of the spinal column, which is also interspersed with many pain-transmitting nerve fibers. The dilation irritation leads to an activation of these nerve structures.
   
4. With lumbar sciatica, the same mechanism can be active. If the pressure on the posterior, longitudinal ligament is greater than that on the spinal cord nerve root, back pains can be felt more strongly than leg pains. Otherwise, a characteristic of lumbar sciatica is that leg pains predominate over back pains.
   
5. An additional assumption about the origin of pain in lumbago is related to the proprietary (indigenous/ autochthon) back muscles of the spinal column. Through a sudden strain of the muscles that span the vertebrae, a sudden back pain can be caused.

However, often the cause of sudden lumbago remains inexplicable, because the malady has a benign character and the complaints are remedied rather quickly under symptomatic (palliative-oriented) therapy.

Diagnosis

Patients with lumbago are usually dependent on outside assistance, in order to reach a doctor.

The diagnosis of lumbago is rapidly made on the basis of the case history (anamnesis) as well as the clinical picture. Patients with lumbago report about the above-mentioned trivial movements, how they actually perform them daily and about the sudden pain event that subsequently occurred. Each movement leads to very strong back pain. Often compulsive postures are undertaken, because only then is a somewhat endurable bodily positioning achieved. For example, one can mention the often observed appearance of a patient, who comes to the doctor in a bowed posture and reports that an upright position is no longer possible.

For the doctor it is of primary importance to determine, whether a serious illness is evident, which requires rapid treatment; otherwise, permanent damage could remain. This could be the case in the event of an acute herniated vertebral disk. By means of a thorough, medical examination, including an endurance test, tactile sensitivity and muscle reflexes as well as inquiring about urinary and straight intestinal control (cauda equina syndrome), an acutely hazardous illness can be excluded with the greatest degree of certainty. Hereby, the strength of the back pain is not decisive.

Since the terminology lumbago does not represent a proper diagnosis, the doctor should attempt to discover the reason for this sudden back pain. Hereby the physical examination is decisive. By means of manual-therapeutic examination techniques, blockages of the minor vertebrae can be recognized, while the mobility of each individual vertebral pair can be investigated, segment by segment. The temporary vertebral blockage is probably the most frequent cause of lumbago. Otherwise, modifications are less characteristic. Nearly always, one can find an elevated, pain-related strain of the (paravertrebral) muscles that accompany the lumbar spinal column. In most instances, the focal point of pain can lie somewhat to the side of the spinal column, in the region of the vertebrae or directly in the middle between two spinous processes, in the region of the vertebral disks (vertebrae).

If an intensive examination should not be possible on the basis of intense pain, it must not be forced, if serious illnesses can otherwise be excluded with certainty. A symptomatic pain therapy has priority above all.

Exactly for younger patients who are experiencing their first instance of lumbago, an X-ray (roentgenography) is not absolutely necessary, in spite of the acute incidence of pain. Blockages of the spinal column, lumbar sciatica or pulled muscles cannot be recognized in an X-ray. The case differs, if chronic back pain existed previously, an accident has occurred (e.g. a fall) or older patients have become ill. Exactly with older patients who are experiencing a previously unrecognized reduction of the bone mass (osteoporosis), even a trivial movement can lead to a fractured vertebra. In this instance, in order not to omit an optimal therapy (vertebroplasty / kyphoplasty), it is worthwhile to prepare an X-ray image. The same applies in the event of falling down and chronic back pain. In these cases, an X-ray should also be prepared.

The performance of a magnetic resonance imaging (MRI) should be made with pain that radiates until the lower calf or foot, or if a muscle paralysis (paresis) is evident, which represents a well-founded suspicion of lumbar sciatica.

Therapie

Above all, the cause of the malady should always be sought to be resolved. In the case of a blockage of the spinal column, a de-blocking or as it is widely referred to a straightening can occur via particular treatment techniques or via manual therapy. Hereby the goal is to restore the normal (physiological) vertebral movement of the vertebrae.

If the origin of the complaint cannot be determined with certainty, or if the resolution of the cause is not possible without further ado, then the pain therapy stands in the foreground of the treatment. Suitable medical treatments for lumbago are:

• Bed rest: A temporary bed rest relaxes the back.
• Warm therapy (Warm bottle, warm pillows, warm packs etc.): The effect of the warm therapy is primarily muscle relaxation. The share of pain, which is caused by muscle strain, can be well treated hereby.
• Pain medicines in pill form (analgesics, NSAR): They function purely symptomatically by reducing the pain.
• Pain infusion: Stronger form of the medical pain therapy with more rapid onset of effectiveness.
• Muscle relaxing medicines: The share of pain that is caused by muscle strain can be well treated hereby.
• Infiltrations into the region of pain: Pain injections with a local anesthetic in the skin, the muscle or along the vertebrae are very effective. In the hands of family doctors, pain injections in the muscles of the buttocks are commonly administered.
• Physiotherapy: Physiotherapeutic exercise treatments, such as extension and traction (tensile treatment) cause a reduction in pain. Movement inhibited sectors of the spinal column are treated with mobilization techniques (part of the manual therapy).
• Massage: Massages serve to relax tissue and muscles.

Prognosis

The disease history of lumbago is usually not of long duration under the above-mentioned therapeutic efforts. In this respect, the prognosis for a relative rapid recovery is good. If the seldom case should arise, that lumbar sciatica is the cause of lumbago, the recovery can last longer and under certain circumstances a surgical therapy can also be required.

In order to prevent additional events of this type (prevention), the principles of the back training school should be learned and taken seriously. Well-trained back muscles also protect the vertebral column, but against lumbago, one can never be 100% protected.