What is lumbago, and how is it different from sciatica?

What is lumbago?

Lumbago is a general medical term that describes low back pain. It normally affects the area below the rib cage and sometimes into the buttock. I see this on a regular basis at YB Osteopathy in Soho, where I treat office-based professionals and executives.

I see a lot of patients in my clinic who come in with low back pain. I would say maybe 15 to 20 percent of those patients would use the term lumbago to describe the pain that they’re experiencing.

Low back pain or lumbago can be very painful and it can be very debilitating. If it’s the first time you’ve experienced those kinds of symptoms, it can be very worrying.

Sciatica is different. It involves the sciatic nerve and usually runs below the knee.

Why did my back give way when I stood up?

Your back can give way on a small movement because postural strain has been building up on it for days, weeks or months.

I had a patient come into my clinic recently with exactly that. This particular patient had had a busy week at work. In fact they had a busy month at work. So they’d been sitting for longer hours at their desk than they would like. They were doing less exercise than they would normally do.

They stood up from their desk and they felt their back give way. They felt their back go. There was a sudden onset of pain, quite sharp pain, quite debilitating. And they asked me, why did just standing up from my desk cause this pain?

This is a question I get asked a lot. Why did doing something quite simple or low energy cause the low back to give way? It might be standing up from a chair, putting a sock on or some shoes on, or a gentle stretch.

The answer is that it’s not the standing up from your desk or the putting your shoes on that’s caused the back to go.

It’s the build up of pressure on your back over the preceding few days, weeks, months even, where you’ve been not looking after your back. You’ve been putting postural strain on it. It can absorb that postural strain up to a point until it can’t absorb it anymore, and then it goes.

If that sounds like your working week, my article on osteopathy for desk workers covers the desk side in more detail.

Do you need an X-ray or MRI scan for low back pain?

Once I have assessed you, an X-ray or MRI scan in most cases won’t be very helpful for low back pain. Some of my patients will insist on getting one. And that’s understandable, given how painful and worrying back pain can be.

After I assess them and reach a clear diagnosis, I tell them a scan in most cases won’t be very helpful. Guidance from NICE, which sets standards for NHS care, advises against routine scans for low back pain outside specialist care.

I reassure those patients that we can relieve their symptoms. Treatment starts with osteopathy. Then I talk them through and support them through a rehab programme of gentle stretches, exercises and lifestyle changes. In most cases that will get patients better.

It’s only in the very small minority of cases where I think something else might be going on that I would recommend an X-ray or an MRI scan.

Should you lie down and rest with a bad back?

Lying down and not moving for days is one of the worst things you can do for a bad back. A common myth that patients who come to me have is that they need to rest. They need to just lie down and not move for a period of days until things get better.

What I say to those patients is that it will most likely delay your recovery and possibly even make the symptoms worse. The NHS back pain advice agrees. It says to stay active and not to stay in bed for long periods of time.

Instead, I encourage patients, carefully and safely, to be gently active. I want them walking, moving and stretching at regular intervals. I want them to have the confidence that it’s going to help them get better. I talk them through that and support them through that.

How is lumbago different from sciatica?

Lumbago is pain in the low back, and sciatica is pain where the sciatic nerve is being involved.

	Sciatica	Back pain spreading into the leg
Where it goes	Below the knee, into the calf and often the foot	The buttock or thigh, above the knee
What it feels like	Shooting, burning or very sharp, often with pins and needles	A dull, achy pain

Classic sciatica tends to go from the back or the buttock right down the back of the leg. It runs through the back of the thigh, below the knee, into the calf and often into the foot. It tends to be a shooting, burning or very sharp pain, often with tingling or pins and needles.

Back pain that spreads into the leg tends to be a dull, achy pain. It often reaches the buttock or the thigh, and it doesn’t tend to go below the knee.

At your first appointment, a neurological examination helps me tell which one you have. I test your reflexes and muscle strength, and check for any change in feeling, such as numbness or tingling. My article on osteopathy for sciatica covers sciatica in more detail.

What does an osteopath do for low back pain?

An osteopath finds out what is behind your back pain with a full history and examination, then treats it. At YB Osteopathy, your first appointment starts with your history.

1. Your history. I start with the back pain itself. I ask where you feel it, when it comes on, and which positions or activities ease or worsen it. I also ask how long it has lasted and what you were doing as it started and just before.
2. Your medical background. I go through past illnesses and injuries too, so nothing gets missed.
3. A physical and neurological examination. I watch your posture and how you move and stretch, and note how each movement changes the pain. The neurological checks come next. I test your reflexes and muscle strength, and check for any change in feeling.
4. The osteopathic assessment. You lie on the treatment couch. I gently test how freely each joint in your spine moves, and whether it feels sore or stiff when I press. I also check how tight and tender the muscles beside your spine are.

But more importantly, I assess the whole body. So I won’t just be looking at the back. I’ll be looking at how the legs, the knees, the hips are functioning, how the shoulders and the upper back and the neck are functioning.

I’m looking for anything that might be an underlying factor as to why this back can no longer function effectively and is giving you pain. You can see how the appointment runs in your first osteopathy appointment, and read about my osteopathy consultation and treatment.

When does lumbago need a doctor?

I refer you on to a doctor if you need stronger medication or if your pain may have another cause. If the spinal cord or nerves are being pressed, that needs urgent hospital assessment, sometimes through A&E.

Fortunately, the vast majority of patients who come into my clinic with lumbago or low back pain recover fully and quickly. They get there through the osteopathic treatment and support that I give them.

There are, however, a very small minority of patients who will need to be referred on to a doctor, or possibly, in even fewer cases, A&E.

• Severe pain or spasm. Some people are in so much pain, or so much muscle spasm, that they need stronger medication, muscle relaxants or stronger painkillers.
• Pain from another cause. A few patients, following my examination, don’t appear to have mechanical low back pain, the kind that comes from the joints and muscles. They need to be investigated for another cause. It could be a tumour in the bone or a cardiovascular issue, meaning a heart or blood vessel problem.
• Pressure on the spinal cord or nerves. Occasionally I get patients who are suffering from some kind of spinal cord or spinal nerve compression. That needs urgent hospital assessment, sometimes through A&E, to take the pressure off.

But thankfully, those patients are very few and far between.

What the NHS says about urgent signs

The NHS also says to ask for an urgent GP appointment or get help from NHS 111 if severe pain starts suddenly, or your pain is getting worse quickly. The same applies if you feel hot, cold, shivery or generally unwell.

The NHS says you should phone 999 or go to A&E if you have back pain with any of the signs below.

• You have pain, tingling, weakness or numbness in both legs.
• You have lost feeling around your genitals or anus.
• You notice changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself.
• You have changes in how sex feels, or problems with erections or orgasm.
• You have chest pain.
• Your pain started after a serious accident, such as a car accident.

The NHS adds that you should not drive yourself to A&E. Ask someone to drive you, or call 999 and ask for an ambulance.

Is your pain in the back or down the leg?

Pain that sits in your low back, below the rib cage and sometimes into the buttock, is what people mean by lumbago. Pain that runs below the knee with burning or tingling may be sciatica, and the checks at your first appointment help tell them apart.

If the checks show signs of something else, I refer you to a doctor.

For more on how I treat back pain, see my low back pain page, or read more about me.

Frequently asked questions

What does lumbago mean?

Lumbago is a general medical term that describes low back pain. It normally affects the area below the rib cage and sometimes into the buttock. Yousif Barr at YB Osteopathy says around 15 to 20 percent of the patients who come in with low back pain use the word lumbago for it.

Why does my back give way on something as small as putting on a sock?

Yousif Barr explains that pressure has been building up on your back over the preceding days, weeks or months of postural strain. Your back can absorb that strain up to a point, until it can't absorb it anymore, and then it goes, even on a movement as small as putting on a sock.

Do I need an X-ray or MRI scan for low back pain?

In most cases, no. After a full assessment, Yousif Barr finds that an X-ray or MRI scan won't be very helpful. He recommends one only in the very small minority of cases where something else might be going on. NICE advises against routine scans for back pain outside specialist care.

Should I rest in bed with a bad back?

Yousif Barr tells patients that lying down and not moving for days is one of the worst things you can do. It will most likely delay your recovery. He encourages you to be gently active instead, such as walking, moving and stretching at regular intervals. The NHS also advises against long periods in bed.

Can I book YB Osteopathy for back pain with no GP referral?

Yes. You can book YB Osteopathy directly, with no GP referral. The initial consultation at UNTIL in Soho costs £125 and runs up to 60 minutes. It covers your history, a physical and neurological examination, the osteopathic assessment and treatment where it is right for you.