Low Back Pain (Lumbago)

What low back pain is

The lumbar spine has five large vertebrae, the discs between them, facet joints, the sacroiliac joints and strong muscles and ligaments. In nonspecific low back pain, these structures are sensitive and painful but no specific injury or disease can be reliably identified. Scans often show disc bulges or wear (spondylosis), but these are equally common in people without pain, so they do not explain the pain.

Modern pain science shows that low back pain is shaped by tissue sensitivity, muscle guarding, sleep, stress, mood and beliefs about pain. This is why the most effective treatments combine movement, education and attention to psychological factors, rather than focusing on the spine alone.

Classification

By duration, low back pain is acute (under 6 weeks), subacute (6 to 12 weeks) or chronic (over 12 weeks). See chronic low back pain for long-term management.

Symptoms

• Aching, stiffness or sharp pain in the lower back
• Muscle spasm and difficulty standing straight
• Pain that changes with movement, sitting, standing or bending
• Pain spreading into the buttocks or thighs
• Leg pain, numbness or tingling in sciatica

For causes by side and associated symptoms, see lower back pain causes.

Risk factors

• Previous episodes (the strongest predictor)
• Heavy lifting, twisting, vibration or prolonged sitting at work
• Low physical activity and poor fitness
• Smoking and obesity
• Depression, anxiety and high stress
• Risk factors for chronic pain: fear that movement will cause harm, catastrophic thinking, low expectations of recovery, job dissatisfaction and pending compensation claims

Diagnosis

Assessment

A clinician takes a history covering the onset, pattern and location of pain, leg symptoms and red flags, and examines movement, tenderness, the straight leg raise and nerve function in the legs. Many use a risk tool such as the STarT Back questionnaire to identify people at higher risk of chronic pain, who benefit from more intensive support early.

Imaging and tests

NICE and the American College of Physicians advise not to image nonspecific low back pain routinely. MRI is used when serious pathology is suspected, for severe or progressive neurological deficits, or when surgery or injections are being considered. Blood tests such as ESR, CRP and a blood count help when infection, inflammation or cancer is suspected. HLA-B27 testing and pelvic MRI are used for suspected axial spondyloarthritis.

Treatment

Self-management (everyone)

• Reassurance and education: low back pain is common, rarely serious and usually improves.
• Stay active and return to usual activities, including work, as early as possible.
• Heat wraps for short-term relief.

Physical treatments

• Exercise therapy: recommended for all stages. Group exercise, Pilates, yoga, tai chi, strengthening and aerobic exercise all help; choose what you enjoy.
• Manual therapy (spinal manipulation, mobilization, massage) as part of a package including exercise.
• Acupuncture may give modest benefit.
• Not recommended: belts and corsets, foot orthotics, traction, TENS and ultrasound therapy.

Psychological approaches

Cognitive behavioral therapy and combined physical and psychological programs are recommended for people with persistent pain or high risk of chronic pain. They reduce pain, disability and fear of movement.

Medicines

• NSAIDs (ibuprofen, naproxen) at the lowest effective dose for the shortest time, considering stomach, kidney and heart risks.
• Weak opioids only for acute pain when NSAIDs are unsuitable, and for short periods.
• Not recommended for nonspecific low back pain: acetaminophen (paracetamol) alone, long-term opioids, gabapentinoids and most antidepressants.
• Muscle relaxants have small short-term benefits with drowsiness.

Procedures and surgery

• Radiofrequency denervation for selected chronic pain from facet joints confirmed by a diagnostic block.
• Epidural steroid injections for acute, severe sciatica, not for back pain alone.
• Spinal decompression for sciatica from a herniated disc or spinal stenosis not improving with non-surgical care.
• Spinal fusion is not recommended for nonspecific low back pain outside clinical trials.

Recovery timeline

• First 1 to 2 weeks: pain often eases considerably.
• By 6 weeks: most people are much better and back to normal activities.
• 6 to 12 weeks: a minority have ongoing pain; this is the time to step up physical and psychological treatments.
• After 12 weeks: chronic low back pain, which affects roughly 1 in 10 people after an acute episode.

Prevention

Regular exercise is the best evidence-based way to prevent recurrence, with education about back pain also helping. Keeping a healthy weight, not smoking, varying posture and lifting with good technique are sensible measures.

Frequently asked questions

What is lumbago?

Lumbago is an older, everyday term for low back pain, especially sudden pain and stiffness after a strain. It is not a specific diagnosis. Doctors now usually call it nonspecific or mechanical low back pain when no specific cause is found.

What is nonspecific low back pain?

It is low back pain where no specific cause, such as a fracture, infection, tumor or nerve compression, can be identified. It accounts for about 90% of cases. It is real pain, influenced by tissues, muscles, sleep, stress and beliefs, and it usually responds to activity and exercise.

How long does low back pain take to heal?

Most acute low back pain improves substantially within 2 weeks and largely settles by 6 weeks. Some people have pain for longer, and recurrences are common. Staying active, exercising and addressing worries about pain improve recovery.

Should I get an X-ray or MRI for low back pain?

Not usually. Guidelines advise against early imaging for low back pain without red flags, because it does not improve outcomes and often finds harmless age-related changes. Imaging is needed if a serious cause is suspected or if surgery or injections are being considered.

What exercises are best for low back pain?

No single exercise is clearly best. Walking, core strengthening, Pilates, yoga, tai chi and general fitness all help. The best program is one you will keep doing regularly. A physical therapist can tailor exercises if pain is severe or persistent.