Lumbago, which is a problem among young adults and older patients alike, is an acute contraction of the lumbar paraspinal muscles. It has nothing to do with nerve root pressure but can occur when someone is tense, frightened, or has to sit for long periods of time under tension. It is a muscular problem, not to be confused with sciatica, which is a nerve problem. For example, someone who reports pain in the low back and hip probably has sciatica, but if the pain is only in the low back, it is more likely to be lumbago.
Patients with lumbago have lost the natural curve in the lower back; the lower spine will appear completely straight on an x-ray. Lumbago causes a dull (rather than sharp) pain, but in severe cases, people feel like they can't move. The pain is usually worse when sitting.
In this month's column, I'll describe some exercises to relieve the pain of acute lumbago. (See illustrations and instructions below that you can photocopy for your patients.)
Lumbago is a diagnosis of exclusion. Although x-rays and MRI scans may be positive, they are not likely to be helpful for identifying the cause of the pain. The condition is as likely to occur in someone with a desk job, such as working on a computer, as in someone with a manual labor job, such as working on an assembly line.
A medical history may reveal the underlying cause of the lumbago. A slipped or herniated disc could be the source of the pain. Conditions such as osteoarthritis and osteoporosis also can contribute to the onset of lumbago.
The first thing to do, however, is to ease the patient's pain with ice. Application of ice to the low back for 20–30 minutes will temporarily eliminate the ability of sensory nerves to conduct a pain stimulus. Once the acute pain has resolved somewhat, advise the patient to gently perform low back exercises. Although some Web sites and literature recommend the use of heat, I advise patients with lumbago to avoid heating pads; heat will only increase the blood circulation and will not provide much relief.
I recommend that patients apply ice to the injured area for 20 minutes, perform the series of exercises, and then apply the ice for another 20 minutes.
Patients who have difficulty doing the buttocks squeeze should place one hand on each buttock and gently squeeze them together, holding for a few seconds, and then releasing. Eventually, patients will be able to do the exercise without using their hands.
Next month: Exercises to relieve pain caused by whiplash.
Exercises for Acute Lumbago
Buttocks squeeze Lie on your stomach with a pillow under your abdomen. Gently squeeze your buttocks together and release. Repeat 8–10 times.
Side-lying knee-to-chest Placing a pillow under your head, lie on your right side, with knees slightly bent. Slide your left knee up toward your chest, and gently drop it to the floor. Then, gently straighten the leg so both the hip and knee are straight and slightly above right leg. Lower the leg to the floor. Return to starting position. Repeat 6–8 times, then turn over and repeat with your right leg.
Back-lying knee-to-chest Lie on your back with knees bent and feet flat on the floor. Raise your right knee and bring it as close to your chest as possible without straining or using your hands, then return to starting position. Slide the right heel out along the floor until the leg is straight, and gently roll the extended leg from side to side. Return to starting position. Repeat 6–8 times with each leg.
Abdominal strengthening Lie on your back on the floor with arms at your sides and a pillow under your knees. Exhale slowly while lifting your head. Lift only far enough so your shoulder blades are off the floor, then inhale as you lower your head to the floor. Roll it gently from side to side. Repeat 8–10 times.