Lumbago: Severe acute back pain in the lumbar spine
Back pain refers to discomfort along the spine - from the neck through the chest to the tailbone. Pain most commonly occurs in the lower back, in the lumbar region; this is also referred to as lumbago.
Back pain is and will continue to be a global health problem. In 2020, the worldwide prevalence of lower back pain amounted to 619 million cases, and an increase to 843 million cases worldwide is projected for 2025.1 These problems can be caused, for example, by poor posture, overuse or illness.
You can find more information on the anatomy of the spine here.
The most common causes of nonspecific back pain
Back pain is often caused by functional disorders, muscle tension, or improper strain in everyday life. It frequently occurs as a result of prolonged sitting, poor posture while using a computer, heavy lifting and carrying, or prolonged bending, such as during gardening. Being overweight and having weak core muscles also significantly increase the risk. Additionally, the condition of the core muscles can deteriorate due to a lack of exercise, which can lead to acute back pain.
Lumbago usually occurs suddenly after sudden movements such as lifting, bending, or twisting—most often caused by muscle strains or functional issues like vertebral blockages. The pain is very intense; patients can barely move at first and adopt a protective posture due to the pain-induced restriction of movement.
Diagnosis: How is back pain diagnosed?
The diagnosis of back pain typically begins with a detailed medical history, that is, a consultation during which the duration of symptoms, the location of the pain, and the patient’s daily activities are assessed. In cases of nonspecific back pain, there are no sensory or motor deficits.
This is followed by a clinical physical examination. Doctors assess mobility, posture, and muscle tension along the spine. If there are signs of nerve involvement—such as tingling, numbness, or loss of strength in the legs—additional neurological tests are performed, such as muscle strength and reflex tests.
International guidelines on low back pain (Diagnosis and Treatment of Low Back Pain)2,3 recommend against ordering further diagnostic tests during the initial consultation if the medical history and physical examination do not indicate a dangerous course of the condition or a serious underlying disease. Imaging such as X-rays, MRI, or CT scans is therefore not automatically necessary for back pain. Further diagnostic testing is recommended only in cases of increasing, persistent, or worsening symptoms, as well as in the presence of neurological abnormalities.
Differential diagnoses to distinguish from nonspecific back pain
To distinguish this condition from nonspecific back pain, the following conditions must be evaluated or ruled out:
- Inflammatory rheumatic diseases
- Fractures, such as those caused by osteoporosis
- Infections
- Tumors and metastases
- Radiculopathies: irritation or damage to nerve roots in the spinal region Neuropathies: disorders of the peripheral nervous system (outside the brain and spinal cord) in which nerves are damaged or impaired
Can back pain be prevented?
Regular exercise is the most important protective factor. It is recommended to prevent or shorten episodes of lower back pain and work-related disability. In contrast, prolonged rest is not advisable. An ergonomic workstation, frequent changes in posture, proper lifting techniques, and weight management also contribute to prevention. In addition, educating those affected about healthy lifestyle choices is beneficial.
Symptoms and signs of back pain
The pain is very intense; patients may initially be barely able to move and adopt a protective posture due to pain-related limitations in movement. The back pain may also radiate. When pain radiates into the lower extremities, it is referred to as sciatica or lumbar sciatica.
Back pain can be dull, aching, or stabbing and may worsen with movement. Typical symptoms include muscle tension, limited mobility, and pain when standing up straight.
Note: Numbness, tingling, or weakness in the legs should be evaluated by a doctor!
How is back pain treated?
Treatment depends on the cause, duration, and intensity of the symptoms.
Regular physical activity always forms the basis of treatment for nonspecific back pain.
In the short term, heat and rest can provide relief; in the long term, regular exercise is crucial for recovery. Symptomatic, medication-based pain management can be used as a supportive measure but, due to the potential for side effects, should be used for as short a time as possible. In addition to specific therapeutic measures, counseling and informing patients are very important.
In most cases, conservative treatments are sufficient:
- Back exercises and physical therapy
- Manual manipulation by an orthopedist or physical therapist
- Topical pain relievers (such as diclofenac)
- Injections of local anesthetics or anti-inflammatory agents
- Analgesics or muscle relaxants as needed
Which doctors treat back pain?
The first point of contact is your primary care physician’s office. Depending on the findings, you may be referred to an orthopedic, trauma surgery, or neurology practice.
Why regular exercise is so important
Targeted exercises for the back and abdominal muscles strengthen the stabilizing muscles, improve mobility, and reduce the risk of recurring symptoms. Regular exercise helps correct poor posture and promotes active, back-healthy habits in everyday life.
What medical devices can help?
Medical aids such as back braces can stabilize the lower back, relieve pain, and promote good posture. Heat therapy products improve blood circulation and relax the muscles. They are a useful supplement to therapy—but they are no substitute for exercise.
Highlights
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Explore the body's central support and movement system: the spine and pelvis.
Sources:
1 Ferreira M et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology 2023; 5(6):e316-e329.
2 Macedo F et al. Diagnosis and Treatment of Low Back Pain: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. American Journal of Physical Medicine & Rehabilitation2024; 103(4):350-355.
3 National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s. Published: 27 July 2017.
