Lumbago: What It Means and How to Handle an Attack

What lumbago means

"Lumbago" comes from lumbus, the Latin for loin. It simply means pain in the lumbar region, between the bottom of the ribs and the crease of the buttocks. The word is still used in some countries and on sick notes, but most doctors today say low back pain. For the full medical picture of diagnosis and long-term treatment, see low back pain. This page focuses on the classic acute attack and what to do about it.

When lumbago spreads down a leg, especially below the knee, it is called lumbago with sciatica, because an irritated nerve root is involved. See sciatica.

What a lumbago attack feels like

• sudden, sharp or catching pain across the lower back, often after bending to pick something up, twisting, or simply getting out of bed
• muscle spasm that makes it hard to stand straight; you may lean to one side
• pain that is worse with movement, coughing or sneezing, and eases when lying still in a comfortable position
• stiffness, especially in the morning or after sitting
• an ache that can spread into the buttocks or upper thighs

Many people describe their back as having "gone" or "locked". In German, this is called Hexenschuss, the "witch's shot", because it strikes so suddenly.

What causes lumbago

In about 9 out of 10 people, no specific damaged structure can be identified. This is called nonspecific low back pain. Likely contributors are:

• muscle strain or ligament sprain from lifting, twisting or an awkward movement
• irritation of the small facet joints at the back of the spine
• a minor bulge or tear in the outer wall of a disc
• protective muscle spasm, which adds to the pain

Less common specific causes include a herniated disc pressing on a nerve, spinal stenosis in older adults, vertebral compression fractures in osteoporosis, and inflammatory back pain from ankylosing spondylitis. Rarely, back pain comes from infection, cancer, kidney stones or an aortic aneurysm.

Things that make lumbago more likely

• previous episodes (the strongest predictor)
• heavy lifting, especially with twisting, and long periods of sitting or driving
• low physical fitness and excess weight
• smoking
• stress, low mood and poor sleep, which increase pain sensitivity and slow recovery

What to do in the first 72 hours

1. Keep moving gently. Walk around the house every hour or so. Bed rest longer than a day or two makes recovery slower.
2. Find a position of relief. Many people are most comfortable lying on their back with pillows under the knees, or on their side with a pillow between the knees.
3. Use heat. A heat pack or warm bath relaxes muscle spasm. Some people prefer cold in the first day; use whichever feels better, wrapped in a cloth, for 15 to 20 minutes.
4. Take pain relief to let you move. An NSAID such as ibuprofen or naproxen helps most for acute back pain (follow the label dose; avoid if you have stomach ulcers, kidney disease, heart failure or take blood thinners). Acetaminophen (paracetamol) alone is not effective for back pain but can be combined.
5. Avoid heavy lifting and long sitting for a few days, but return to normal activity as soon as you can.
6. Stay at or return to work where possible, with temporary changes such as regular breaks.

Treatment if it does not settle

• Physical therapy: a tailored exercise program, manual therapy and advice on gradual return to activity.
• Exercise programs: walking, core strengthening, Pilates and yoga all have evidence for recurring back pain.
• Muscle relaxants: may be prescribed for a few days for severe spasm; they cause drowsiness.
• Psychological approaches: cognitive behavioral therapy helps when pain persists beyond 3 months.
• Not recommended for simple lumbago: routine X-rays or MRI, opioids beyond a short course, traction, back braces, and spinal injections.

Imaging is only needed if red flags are present, or if nerve symptoms are severe enough that surgery might be considered.

How long does lumbago last?

About half of people have another episode within a year. Recurrences are usually similar and also settle, but staying fit between episodes reduces them.

Preventing another attack

• Exercise regularly: walking, swimming and strengthening exercises for the back, hips and abdominal muscles.
• Lift with your legs, keep the load close, and avoid twisting while holding something heavy.
• Break up long periods of sitting every 30 to 45 minutes.
• Keep a healthy weight and stop smoking.
• Address sleep and stress.

Frequently asked questions

What is the difference between lumbago and sciatica?

Lumbago is pain in the lower back itself. Sciatica is pain from an irritated nerve root that travels down the leg, often below the knee, sometimes with tingling or numbness. They can occur together, which is called lumbago with sciatica.

Is lumbago serious?

Usually not. Most lumbago comes from muscles, ligaments and joints and settles within a few weeks. It is serious when it comes with numbness around the genitals, bladder or bowel changes, leg weakness, fever, a cancer history or a major injury. These need urgent medical care.

Should I rest in bed with lumbago?

No. Short periods of lying down for comfort are fine, but staying in bed for more than a day or two slows recovery and increases stiffness. Gentle walking and gradually returning to normal activity give better results.

How long does acute lumbago last?

Most acute lumbago improves noticeably within 1 to 2 weeks and settles within 6 weeks. Pain lasting longer than 12 weeks is considered chronic. Recurrences are common, but staying active and fit between episodes helps prevent them.

Is heat or ice better for lumbago?

Either can help; heat is often better for muscle spasm and stiffness. Use whichever feels more comfortable, for 15 to 20 minutes at a time, with a cloth between the pack and your skin. Neither should replace gentle movement.