Muscle strains and ligament sprains are two of the most common diagnoses made for lower back pain, a condition that affects 4 out of 5 people in their lifetime. Sprains and strains of the lumbar spine can result from heavy lifting, excessive exercise, or unusual movement during a fall or a motor vehicle accident. Low back injuries are seen most often in industrial workers and athletes.
The lumbar spine consists of five bony vertebrae cushioned by intervertebral discs made of cartilage. The lumbosacral region of the spine bears tremendous loads and is responsible for mobility of the trunk; its muscles are essential for demanding weight-bearing activities such as walking, bending, turning, or lifting.
Sprains and strains imply stretching or tearing of the tissue involved, either muscles (strain) or ligaments (sprain). Sprains are ligamentous injuries typically caused by sudden, strong contraction, torsion, a direct blow, or a sudden, forceful straightening from a crouched position. Strains are either partial or complete tears of muscle-tendon units, usually as a result of strong muscular contraction sustained in forceful stretching. Stretching or tearing of the deep muscles of the lumbar spine will generally present with pain and spasm of the paraspinous muscles. Temporary or permanent damage of lumbosacral structure can result.
Sprains and strains of the lumbar spine and low back pain are more likely to be experienced by individuals whose physical conditioning is poor and whose abdominal and lower back muscles are weak. Poor posture, improper lifting, obesity, and fatigue can also contribute to these conditions. Pre-existing structural deformities such as spondylolysis, scoliosis, or previous spine surgery may predispose individuals to injury, as can any pre-existing injuries to the lower back. Among athletes, an inadequate warm-up period, excessive training, or failure to allow proper healing of a previous injury can result in muscle strain in the lumbar spine. In the workplace, back injuries like sprains and strains are decreasing in frequency, perhaps because of increased awareness of the problem and improved instruction in preventive measures such as proper lifting techniques.
Although muscle strains usually require only rest and application of heat or cold treatments to aid recovery, avoidance of further injury during the recovery period is beneficial. Pain and swelling may be relieved through the application of ice during the first 48 to 72 hours following injury and by heat, massage, or therapeutic ultrasound thereafter. Nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for relief of pain and inflammation. In cases of severe pain, a mild narcotic or muscle relaxant may be prescribed for a short period. Intramuscular injections of muscle relaxants or NSAIDs may be used at pain points to help control muscle spasm.
Too little activity, as well as too much, can aggravate injury. For this reason, bed rest exceeding 1 to 2 days is normally not recommended. The individual’s subsequent activity level should be adjusted according to what can be tolerated and should only be increased gradually. Any activity, such as lifting, bending, or twisting, that causes pain to return or worsen should be avoided.
In addition to modification of activity and the use of other modalities, sprains and strains may be treated with physical therapy, short-term immobilization with a brace (corset), and trigger point injections. Transcutaneous electrical nerve stimulation (TENS) may be recommended to manage pain in some cases. Although muscle tissues will heal following severe injury, physical therapy with an emphasis on therapeutic exercise may be helpful for regaining or improving function. Surgery is not indicated for a sprain or strain injury of the lumbar spine.
Return to Work
Individuals with severe sprains or strains whose normal work duties require extensive lifting or bending may require temporary reassignment to lighter or sedentary duties. Duration depends on the severity of original injury and can range from 1 to 91 days.
Find Out More
To learn more about lumbar sprains and strains, including treatment, rehabilitation, complicating factors, recovery times and return-to-work durations, go to www.mdguidelines.com.
Today we read with great interest a news story about Broadspire, a leading third party administrator for workers’ compensation claims, liability claims and medical management services, which introduced a new strategy called BOLD.
BOLD is a custom PPO network strategy that includes targeted selection of medical networks on a state-by-state basis.
Their new state-stratified, multi-tiered approach will allow them to partner with the best networks by region, industry and even company. Such customization has lots of potential to produce cost savings and better outcomes.
In a post today, healthcare blogger Joe Paduda says: “(Broadspire President Ken Martino) sees the BOLD network as a differentiator for Broadspire, a unique solution that is clearly different from those offered by the company’s competitors. Martino also noted that the extensive analysis conducted by Broadspire confirmed their belief that “greater savings could be obtained using multiple partners than relying primarily on one network.”
“I’ve seen the analysis,” Paduda continues, “and the numbers support the company’s assertion. When examining network penetration and net savings percentage, the new strategy provides better results in all but three states, and in those the difference is minimal.”
Read more about Broadspire’s BOLD.
Read Joe Paduda’s Managed Care Matters post.
This week we issued version 6.1 of our MDGuidelines.com online platform of return-to-work guidelines. The new release includes:
- Updated Content based on changing medical trends.
- Text-Only Version for use with mobile devices and by the visually impaired.
- Colorado State Guidelines.
MDGuidelines 6.1 has updated content in 179 monographs as well as updated RBRVS (Medicare fee data) and HCUP (hospital length of stay and cost) data . It also offers nine new topics and new tables to reflect treatment advances and responses to user requests.
For example, our return-to-work durations have been shortened for Anterior Cruciate Ligament Reconstruction to reflect current medical trends.
James B. Talmage, M.D., chair of our Reed Group Medical Advisory Board, explains why patients recover more quickly from this injury: “Over the past five years, open reconstruction has been basically abandoned, and essentially, all isolated ACL reconstructions are now done arthroscopically. Also, there is more use of motion control bracing which helps to protect the new ligament.”
Trends such as these dramatically change the expectations that employees and employers should share, so that the employee can return more quickly to productivity. Without this kind of updated information, users would be attempting to navigate changed terrain with out-of-date maps, so we constantly strive to provide the most up-to-date, medically accurate information available.
Another feature of MDGuidelines version 6.1 is EasyAccess, which provides the same information as the fully graphic MDGuidelines, but primarily in text for faster loading with mobile devices (e.g. iPhones, Blackberrys) and devices used by the visually challenged.
We’ve also added to MDGuidelines version 6.1 the State of Colorado Treatment Guidelines, which are well-established evidence-based guidelines utilized in workers’ compensation injuries. Content from the Colorado Guidelines has increasingly been considered for adoption by other states legislating the use of guidelines for reimbursement of treatments in workers’ compensation cases.
Also, stay tuned for these coming enhancements:
- MDGuidelines, Spanish – the MDA in Spanish, available on the MDGuidelines web site
- Washington State Guidelines – a data driven, searchable version, indexed to medical codes
- New York State Guidelines – a data driven, searchable version, indexed to medical codes
- Online Tutorials – written by medical professionals to guide you through MDGuidelines and disability management.