Back pain is one of the most common medical complaints. Although spinal stenosis, a herniated disc, or other more serious condition may cause low back pain, sprain or strain is the most common diagnosis.
Sprains and strains often result from excessive physical demands on the spine, such as lifting a heavy object or falling awkwardly. Although the pain can be severe and even temporarily disabling, the good news is that most lumbar sprains and strains are easily treated and do not require spine surgery.
The purpose of this article is to explain (1) the mechanics of sprains and strains, (2) symptoms and diagnostic considerations and, (3) treatment and prevention.
The Mechanics of Lumbar Strains and Sprains
The lumbar spine is the chief weight-bearing structure of the human skeleton. With its large vertebral bodies, and its lordotic curve, the lumbar spine is uniquely designed to carry and distribute the loads from movement. With proper body mechanics the forces imposed on the spine from bending, lifting, sitting and other activities are handled without spinal injury or pain.
Sprains and strains are soft tissue injuries. Soft tissues in the lumbar spine include muscles, tendons and ligaments. Sprains are limited to ligaments, whereas strains affect muscles and tendons. Injury is sustained when these tissues are stretched beyond their normal limits due to excessive flexion (bending forward) or extension (stretching out), or when excessive forces are applied to these structures.
Symptoms and Diagnostic Considerations
The symptoms of lumbar sprains and strains include sharp pain, pain and difficulty when moving, swelling, and stiffness. The initial pain may be so severe that the patient fears something has "broken." At this point, many patients seek the advice of their doctor.
Prior to a physical and neurological examination, the doctor will take a detailed patient history. He will want to know such information as when the pain started what event preceded the pain what makes the pain worse and other questions that help the doctor determine the next step to take to make a proper diagnosis.
The physical and neurological examination will include palpation, during which the doctor feels the patient's spine to detect muscle spasm and areas of inflammation. Range of motion movements helps the doctor to measure the degree of injury. For example, can the patient touch their toes, bend side to side comfortably or bend backward without pain? The neurological segment of the exam tests the patient's reflexes and sensory responses. For example, are there areas of tingling or numbness in the legs or low back?
In addition, the doctor may order an x-ray to rule out fracture. Seldom is further diagnostic testing required.
Treatment and Prevention
Treatment is usually two-fold, including medications to relieve pain and muscle spasm and participation in a physical therapy program. Medications may include an anti-inflammatory, a muscle relaxant, and either narcotic or non-narcotic drugs for pain. A narcotic is only prescribed when pain is acute or when a non-narcotic medication does not relieve pain.
Physical therapy incorporates therapeutic exercises and "hands-on therapies" such as ultrasound, massage, heat or ice packs, and electrical stimulation. Therapeutic exercise programs begin slowly to acclimate the patient to stretching and strengthening routines. The patient is usually provided with a home exercise program to continue on a regular basis. A strong and agile spine is one step toward preventing future injury. "Hands-on" therapies work to decrease inflammation, muscle spasm, and pain. In addition, manual therapies of this type increase circulation to the site of injury and facilitate healing. Such therapies as chiropractic, ultrasound, massage, acupuncture and TENS are appropriate options.
Prevention in the form of proper posture and good body mechanics is essential. During physical therapy, patients learn how to move with good posture to protect the low back. Physical therapists teach patients how to develop ergonomically correct body mechanics in their everyday activities. This can be a great experience with life long rewards.
Lumbar sprains and strains are common, and the doctors at CCSI can help you to recover from these painful conditions. CCSI's medical team is also committed to educating patients about how to avoid future injuries. Thus each patient will receive instruction on such preventive "tools" as good posture, healthy body mechanics, and nutrition and weight control. Together, we can help your back stay healthy!
It is also important to remember that you should not assume every case of low back pain is simply a sprain or strain. If your symptoms persist, with severe pain, bowel or bladder dysfunction, or extremity weakness or numbness, seek medical attention at CCSI promptly.