Lower Back Pain (Lumbago)

Also known as: Low back pain, LBP (low back pain), Lumbago, Lumbar pain, Mechanical low back pain, Lumbar spine pain

Last updated: December 18, 2024

Lower back pain (lumbago) describes pain, stiffness, or discomfort from the lumbar spine and nearby tissues. It may be acute for days to weeks or become chronic with recurrent flares. Pain can be linked to mechanical strain, degenerative changes, inflammation, or less commonly systemic disease, with or without nerve root involvement. Symptoms include aching or sharp pain and stiffness that may worsen with bending or prolonged sitting. Acute mechanical cases often improve over days to weeks.

Key Facts

•Lower back pain (lumbago) describe pain, stiffness, or discomfort arising from structures in the lumbar spine and adjacent tissues
•Localized aching or sharp pain in the lumbar region that worsens with bending, lifting, twisting, or prolonged sitting
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Lower back pain (lumbago) may describe pain, stiffness, or discomfort arising from structures in the lumbar spine and adjacent tissues. Symptoms can range from acute episodes that span days to weeks to chronic patterns that last longer and may involve recurrent flares. Pain may relate to mechanical strain, degenerative changes, inflammation, or less commonly systemic disease, and it can occur with or without nerve root involvement. When nerve structures are irritated or compressed, pain may radiate into the buttock or leg and can be accompanied by sensory or strength changes.

Affected Anatomy

This condition affects several structures in and around the joint:

•Lumbar vertebral bodies (typically L1–L5) and posterior elements (laminae, pedicles, spinous processes)
•Intervertebral discs (annulus fibrosus and nucleus pulposus), including disc bulge or herniation regions
•Facet (zygapophyseal) joints and their articular cartilage/capsules
•Paraspinal muscles (erector spinae, multifidus) and thoracolumbar fascia
•Lumbar spinal nerve roots and dorsal root ganglia (commonly L4, L5, S1 in radicular patterns)
•Sacroiliac joints and supporting ligaments
•Ligamentous structures (anterior/posterior longitudinal ligaments, ligamentum flavum, interspinous ligaments)
•Spinal canal and neural foramina (sites of stenosis or foraminal narrowing)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Localized aching or sharp pain in the lumbar region that may worsen with bending, lifting, twisting, or prolonged sitting
•Stiffness and reduced range of motion, often more noticeable after inactivity or on waking
•Muscle spasm or a sensation of “tightness” in the paraspinal region that can limit movement
•Pain that may radiate to the buttock, thigh, or below the knee when nerve roots are irritated (sciatica-like distribution)
•Numbness, tingling, or burning sensations in the leg or foot that can accompany radicular pain
•Weakness in specific muscle groups (for example, ankle dorsiflexion or plantarflexion) that may suggest nerve root involvement
•Pain that can occur at rest and may disrupt sleep, particularly during inflammatory or severe mechanical episodes
•Functional limitation, such as difficulty standing from a seated position, walking tolerance reduction, or reduced ability to perform usual activities

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Mechanical strain or sprain involving lumbar muscles, tendons, or ligaments, often related to sudden loading, repetitive motion, or deconditioning
•Degenerative spine changes, including lumbar spondylosis, facet arthropathy, and disc degeneration that can contribute to chronic or recurrent pain
•Intervertebral disc herniation or disc bulge that may irritate adjacent nerve roots and produce radicular symptoms
•Lumbar spinal stenosis or foraminal narrowing, typically related to degenerative changes, that can compress neural structures and cause back and leg symptoms
•Vertebral compression fracture, which can occur after trauma or in the setting of low bone density and may cause acute focal pain
•Inflammatory, infectious, or systemic causes (for example, inflammatory spondyloarthritis, spinal infection, or malignancy) that can present with back pain and systemic features

Risk Factors

•Older age, which can be associated with higher prevalence of degenerative disc and facet joint changes
•Occupational or recreational activities involving heavy lifting, repetitive bending/twisting, vibration exposure, or prolonged sitting
•Low physical conditioning, reduced core endurance, or limited hip mobility that can increase mechanical stress on the lumbar spine
•Overweight or obesity, which may increase spinal loading and can correlate with persistent symptoms in some populations
•Smoking, which can be associated with disc degeneration and impaired tissue healing
•History of prior episodes of back pain, which can correlate with recurrence
•Psychosocial factors (for example, high stress, depression, anxiety, or job dissatisfaction) that can influence pain perception and recovery patterns
•Osteoporosis or other conditions affecting bone strength, which can increase risk of vertebral compression fracture

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history focusing on onset, duration, location, radiation, functional impact, prior episodes, and features that may suggest systemic disease (often described as “red flags”)
•Physical examination including posture and gait assessment, lumbar range of motion, palpation for tenderness/spasm, and evaluation of hip and sacroiliac contributions
•Neurologic examination assessing strength, reflexes, and sensation to evaluate for radiculopathy or other neurologic involvement
•Provocative maneuvers such as straight-leg raise or slump testing that can support suspicion of nerve root irritation when correlated with symptoms
•Imaging when clinically indicated, which may include plain radiographs for suspected fracture or structural change and MRI for suspected disc, nerve, infection, or malignancy-related causes
•CT imaging in selected situations (for example, detailed bony assessment or when MRI is not feasible), sometimes with CT myelography for specific neural compression questions
•Laboratory testing in selected presentations (for example, inflammatory markers or infection-related tests) when inflammatory, infectious, or systemic etiologies are suspected

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest strategies that can span short periods, with gradual return to usual activities as tolerated
•Prescription medications in selected cases (for example, short-term muscle relaxants or neuropathic pain agents) that can be considered when symptoms are significant and aligned with clinician assessment
•Manual therapy options (for example, spinal manipulation or mobilization) that may provide short-term relief for some mechanical low back pain presentations

Physical Therapy and Exercise

•Physical therapy approaches that may include graded exercise, core stabilization, flexibility work, and education on movement patterns and ergonomics
•Heat or cold modalities that can be used for symptom relief in acute or subacute phases
•Multidisciplinary rehabilitation approaches that can integrate physical reconditioning with behavioral and psychosocial support for persistent pain

Medications

•Nonprescription pain-relieving medications (for example, acetaminophen) and anti-inflammatory medications (NSAIDs) that may reduce pain and inflammation for some individuals, depending on clinical context

Injections and Office-Based Procedures

•Interventional procedures such as epidural steroid injections or facet-related injections that can be used in selected radicular or facet-mediated pain patterns

Surgery

•Surgical options in selected cases (for example, discectomy for persistent symptomatic disc herniation with correlating findings, or decompression for stenosis) when conservative measures have not provided sufficient improvement or when neurologic compromise is present

Prognosis and Recovery

The course of this condition varies between individuals:

•Acute mechanical low back pain often improves over days to weeks, although symptom intensity and recovery pace can vary across individuals
•Recurrence can be common, particularly in people with prior episodes, ongoing mechanical exposures, or persistent deconditioning
•Radicular symptoms from disc herniation may improve with time in many cases, though some individuals can experience prolonged pain or functional limitation
•Degenerative conditions such as spinal stenosis or facet arthropathy can follow a fluctuating course with periods of relative stability and intermittent exacerbations
•Outcomes can be influenced by psychosocial factors, sleep quality, physical conditioning, and workplace demands, which may affect persistence and disability more than imaging findings alone

Physical Therapy (Physiotherapy)(Procedure)
Epidural Steroid Injection(Procedure)
Sciatica(Condition)
Lumbar Disc Herniation(Condition)

Frequently Asked Questions

Common symptoms include: Localized aching or sharp pain in the lumbar region that may worsen with bending, lifting, twisting, or prolonged sitting; Stiffness and reduced range of motion, often more noticeable after inactivity or on waking; Muscle spasm or a sensation of “tightness” in the paraspinal region that can limit movement; Pain that may radiate to the buttock, thigh, or below the knee when nerve roots are irritated (sciatica-like distribution); Numbness, tingling, or burning sensations in the leg or foot that can accompany radicular pain.

Diagnosis typically involves: Clinical history focusing on onset, duration, location, radiation, functional impact, prior episodes, and features that may suggest systemic disease (often described as “red flags”); Physical examination including posture and gait assessment, lumbar range of motion, palpation for tenderness/spasm, and evaluation of hip and sacroiliac contributions; Neurologic examination assessing strength, reflexes, and sensation to evaluate for radiculopathy or other neurologic involvement; Provocative maneuvers such as straight-leg raise or slump testing that can support suspicion of nerve root irritation when correlated with symptoms.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest strategies that can span short periods, with gradual return to usual activities as tolerated; Physical therapy approaches that may include graded exercise, core stabilization, flexibility work, and education on movement patterns and ergonomics; Heat or cold modalities that can be used for symptom relief in acute or subacute phases; Nonprescription pain-relieving medications (for example, acetaminophen) and anti-inflammatory medications (NSAIDs) that may reduce pain and inflammation for some individuals, depending on clinical context; Prescription medications in selected cases (for example, short-term muscle relaxants or neuropathic pain agents) that can be considered when symptoms are significant and aligned with clinician assessment.