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Lumbalgia of the lumbar spine: diagnosis, how to treat
Last reviewed: 12.07.2025
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From the point of view of medical terminology, the last three words in the definition - lumbago of the lumbar spine - are clearly unnecessary, and now it will become clear to you why and what it is?
Doctors talk about lumbago when a person feels pain (Greek - algos) specifically in the lumbar spine or simply in the lower back (Latin - lumbus). Therefore, as you understand, lumbago of the thoracic or cervical spine is nonsense.
Back pain is called dorsalgia (Latin dorsum - back, back side). In ICD-10, lumbago has the code M54.4-M54.5 in the class of diseases of the musculoskeletal system. However, this term denotes a locally manifested clinical symptom that can be caused by any disease or dorsopathy of the lumbar spine.
The following definitions are used interchangeably: lower back pain, lumbar pain. But lumbago of the lumbar spine or simply lumbago is called a sudden "shooting" sharp pain.
Epidemiology
The international Global Burden of Disease Study, conducted among patients in 47 countries in 2012, confirmed the fact that low back pain is the leading cause of disability worldwide: it affects almost 600 million people (twice as many as 25 years ago).
As clinical statistics show, almost 20% of people suffering from acute and subacute pain may develop chronic lumbago of the lumbar region within a year.
According to the European Spine Journal, the frequency of visits for a first episode of acute low back pain, diagnosed as lumbago or lumbosciatica of the lumbar spine, in adult Europeans ranges from 6.3 to 15.4% per year. And the frequency of relapses during the year is observed on average in 36% of the population.
According to the National Institute of Neurological Sciences (USA), lumbago most often affects people aged 40 to 60. The prevalence of lower back pain is somewhat higher in women.
In the United States alone, degenerative disc disease affects approximately 12 million people aged 20 to 65 years (3.8% of the adult population), of whom 52% experience low back pain of varying severity.
Causes lumbalgia of the lumbar spine
The lumbar spine (vertebrae LI-LV) and the entire lower back provide support for most of the body and the functioning of the musculoskeletal system. In addition, this work is controlled by the spinal nerves that pass through here.
So, no matter what the name of the pain in the lumbar region, the main identifiable causes of lumbago of the lumbar spine are associated with all structures of the spine: the vertebrae (Latin - vertebra) and intervertebral discs (Latin - disci intervertebrales), muscles, ligaments, fascial structures, nerve roots, as well as the visceral organs of the abdominal cavity.
Lumbago has a biomechanical etiology in skeletal defects, including scoliosis, lordosis, diffuse idiopathic skeletal hyperostosis, ligamentous apparatus anomalies (for example, in Ehlers-Danlos syndrome).
Lumbago of the lumbar region during pregnancy is of a mechanical nature, and its etiology lies in the change in the normal curvature of the spine in the lumbar region due to an increase in weight load with a simultaneous (necessary for the upcoming birth) weakening of the ligaments of the pubic symphysis and the lumbosacral joint under the influence of the hormone relaxin.
Lower back pain of varying intensity is observed with excessive stretching of the anterior longitudinal ligament of the spine and muscle tendons (for example, when lifting weights), with injuries that may result in damage to the lumbar intervertebral discs, including displacement of the lumbar vertebrae. These injuries, in turn, lead to compression of the nerve endings and the development of cauda equina syndrome, in which pain - in addition to the lower back - affects the areas of the ischial tuberosities, coccyx, groin and thighs.
In many cases, lumbago is associated with lumbar spondylosis (bone growths that cover the intervertebral discs) or spondyloarthrosis (when the intervertebral facet joints become calcified with age). Then spondylogenic lumbago of the lumbar spine is defined.
Chronic lumbago of the lumbar region appears when the cushioning properties of the intervertebral discs are reduced due to degenerative changes in their cartilaginous tissue - when osteochondrosis of the lumbar spine is diagnosed, as well as with a herniated intervertebral disc, pathological changes in the intervertebral facet joints or the formation of osteophytes.
Risk factors
With many conditions that provoke the appearance of lower back pain, specific risk factors for the development of lumbago are seen in the natural processes of aging, that is, age-related changes in both the vertebral joints and intervertebral discs, as well as in the negative consequences of professional impacts on the lumbar region (arising from constant standing or sedentary work).
Significantly increases the likelihood of pain in the lower back muscles, defined as muscle tension syndrome or myofascial syndrome, if a person moves little and remains in one position for a long time.
Lower back pain is a problem for most people with excess weight (obesity) – due to increased load on the lumbar vertebrae. And with alcohol abuse, the substances contained in it quickly destroy the cartilaginous tissue of the intervertebral discs and impede their diffuse nutrition.
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Pathogenesis
The pathogenesis of lumbago may be associated with inflammatory processes in patients with Bechterew's disease, osteomyelitis of the spine, bone tuberculosis (Pott's disease), intervertebral discitis, sacroilitis (inflammation of the sacroiliac joint).
Due to damage to the roots of the lumbosacral region of the spinal cord, a very painful inflammation of the sciatic nerve develops - sciatica or lumbosacral radiculitis, in which lumbago of the lumbosacral region or lumbosciatica is observed: the pain affects the lower back and gluteal region, as well as the back of the thigh up to the knee joint.
A condition caused by compression, inflammation and/or damage to a spinal nerve root is called radiculopathy, which causes symptoms of lumbago in the lumbar spine, often with decreased sensitivity in the lower extremities. Radiculopathy can occur due to narrowing or stenosis of the spinal canal. For details, see - Radicular Syndromes and Back Pain
In addition, lumbago is a symptom of myositis of the back and focal compactions in the large or small lumbar muscles (associated with their constant tension and deterioration of tissue trophism).
Pain syndrome, which manifests itself as periodic lumbago of the lumbosacral region, is observed in diseases of the abdominal organs and pelvic organs: nephrolithiasis, pyelonephritis and granulomatous enteritis; endometriosis, polycystic ovary disease and uterine prolapse; with aneurysm of the abdominal aorta, as well as with spinal neoplasia (myeloma and sarcoma) and the spread of metastases of malignant tumors of any localization to it.
Useful information is also in the material - Causes of lower back pain
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Symptoms lumbalgia of the lumbar spine
Lumbago is usually characterized by a combination of the following symptoms:
- a feeling of tension (stiffness) in the back after sleep (due to muscle contracture);
- an increase in dull aching pain with any movement (change of position) or after a long period of sitting;
- limitation of movement (bending forward, backward or sideways);
- unilateral irradiation of pain into the buttocks, groin, down the back of the thigh;
- decreased sensitivity and “tingling” (paresthesia) in the lower back, buttocks and legs;
- spasms of the lumbar muscles;
- forced change in posture (associated with attempts to reduce pain).
- numbness and muscle weakness.
Forms
Depending on the duration, there are such types of lumbago as acute, subacute and chronic. Acute pain in the lower back lasts less than 6 weeks; subacute – from 6 to 12 weeks, and chronic lumbago of the lumbar region persists for more than three months (with periodic weakening and strengthening).
If the pathogenesis of lumbar pain is rooted in damage to the structures of the spine, it is considered vertebrogenic lumbago. Pathogenesis issues are discussed in detail in the publication - Symptoms of lower back pain
When the lumbar muscles hurt (with myositis), lumbago is called neuromuscular (muscle-tonic), and compression of the nerve roots is classified as neurogenic or neurodystrophic lumbago.
Western vertebrologists distinguish mechanical (or axial) pain in the lumbar region (due to muscle tension), reflexive lumbago and radiculopathy (radicular pain)
Reflexive lumbar pain is perceived in a location other than the location of its source. For example, degenerative changes in the lumbar vertebrae may cause pain in the sacrum or hips; such pain occurs when activation of nociceptors in the internal organs leads to the perception of pain in the lumbar spine).
Burning radicular pain is the result of compression or inflammation of a spinal nerve root, which causes irritation of the sensory root or dorsal root ganglion of the spinal nerve.
Complications and consequences
What are the risks of lumbago in the lumbar spine? Problems with lower back pain are recognized by specialists of the North American Spine Society as one of the most common reasons for visiting doctors and the most common cause of disability among people under 45 years of age.
So the consequences and complications of lumbago are quite serious, including: numbness of the legs, difficulty moving - neurogenic claudication (due to spinal stenosis); loss of control of the bladder (enuresis) or intestines (encopresis) - with cauda equina syndrome or in cases of protrusion of the intervertebral disc into the spinal canal.
As experts note, recurring episodes of lumbago not only limit patients in their daily lives, but also reduce stress resistance, often leading to emotional instability and depression.
Diagnostics lumbalgia of the lumbar spine
It is impossible to diagnose lumbago without a complete medical history and physical examination of the patient. But, as doctors themselves admit, the cause of chronic lower back pain is often difficult to determine even after a thorough examination, for which, first of all, instrumental diagnostics are used: radiography, CT/myelogram, MRI, discography, electromyography and electroneurography.
Blood tests usually include a general clinical examination, erythrocyte sedimentation rate, and C-reactive protein (to detect inflammatory processes). Blood tests can also detect the leukocyte antigen HLA-B27, a genetic marker of susceptibility to Bechterew's disease and other inflammatory diseases of joint connective tissues (spondyloarthropathies).
Of course, differential diagnostics is necessary, since the innervation of most anatomical structures of the lumbar spine is interconnected, which often does not allow the central nervous system to distinguish damage to one structure from another. For example, the sensations of lumbago due to a herniated disc and damage to the lumbar muscle ligaments are identical.
Also read – Back Pain Diagnosis
Who to contact?
Treatment lumbalgia of the lumbar spine
Treatment methods for lumbar pain may vary depending on the manifestations of this symptom in patients with various lumbar spine dorsopathies.
Is it possible to quickly treat lumbago of the lumbar spine? And how to treat such pain?
To quickly relieve severe pain, injections are given: corticosteroids are administered epidurally in combination with anesthetics - in the form of a novocaine blockade.
The most commonly used medications are non-steroidal anti-inflammatory drugs (NSAIDs) - Diclofenac, Ibuprofen, Ketoprofen, Naproxen, etc., taken orally. For more information on dosage, contraindications and side effects, see - Pills for lower back pain, as well as Treatment of lower back pain.
It is useful to take vitamins C, E, B1, B6, B12.
Various external remedies are widely used; see the article Ointments for lower back pain.
Home treatment with hot or cold compresses can significantly relieve pain and reduce inflammation in acute, subacute or chronic lumbago. Doctors recommend using cold compresses (applying cold for 20 minutes several times a day) during the first two days after the onset of pain.
When lower back pain is associated with myalgia, you need to alternate between hot and cold compresses (20-30 minutes each) for two to three days. But if you feel a pulsation when exposed to heat, or the pain intensifies, you need to stop using heat and do only cold compresses, and try warming procedures again after a couple of days.
Traditional treatment involves rubbing the sore spot with a mixture of vodka and turpentine, heated badger fat, alcohol tincture of red pepper; compresses of grated horseradish, mustard powder dissolved in water, and bischofite.
Complex therapy includes physiotherapeutic treatment using: electro- and phonophoresis, diadynamic currents, paraffin and peloid applications, therapeutic baths, massage, acupuncture, etc.
An integral part of the treatment program is exercises and exercise therapy for lumbago of the lumbar region, which in most cases give a positive result. What exercises exactly need to be done, in detail in the material - Exercises for the lower back
Surgical treatment
Surgical treatment may be recommended in the case of complete lack of effect from conservative therapy conducted for at least three to four months; in case of damage to nerve fibers and serious changes in bone structures, for which corrective surgical or minimally invasive percutaneous procedures have been developed.
Surgical intervention is not always successful: discectomy or microdiscectomy (removal of the intervertebral disc when it is herniated) provides pain relief in 85-90% of patients. So there are risks associated with surgical treatment of lumbago of the lumbar region, and patients should be aware of them.
Treatment options include vertebroplasty and kyphoplasty (repair of vertebral compression fractures caused by osteoporosis), spinal laminectomy (decompression of the spine due to spinal stenosis), foraminotomy (widening the opening through which the nerve root exits the spinal canal), and pulsed radiofrequency (used for moderate lumbar disc herniations).
Prevention
Regular physical activity is the most important method of preventing lumbago and the only effective way to maintain the range of motion and flexibility of the spine. Walking at a moderate pace, swimming or cycling (half an hour a day) improves muscle strength. Yoga can also help stretch and strengthen muscles and improve posture.
Try to do specially designed lower back exercises at least two to three times a week (ideally daily) to help prevent lower back pain.
You should avoid the “couch” method of rest, lose excess weight, wear comfortable shoes with low heels, sleep on your side with your knees bent (the position of the fetus in the womb reduces pressure on the lumbar vertebrae) and not lift heavy objects.
Forecast
The prognosis of a locally manifested clinical symptom, such as lumbago of the lumbar spine, depends on the disease that causes it.
For example, one of the most famous US presidents, John F. Kennedy, suffered from back pain after a lumbosacral spine injury sustained while playing football in his student years (in 1937). He underwent four surgeries (laminotomy and discectomy) and wore a special corset to support his spine. And the president's lumbago was alleviated by analgesic injections, physical therapy, swimming and massage.
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