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.