Lumbar Back Sprain: One of Our Most Common Back Pain Problems

Lumbar Back Strain:  Understanding and Managing a Common, Painful Injury

I want to provide you with the important information you need to understand these common spine problems, the ones that patients most often ask me about.  While specific medical advice about your problem should come directly from your healthcare professional, here is the next big concern in our list of ten spine problems that patients often ask about:

LUMBAR SPRAIN AND STRAIN:
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Lumbar strain or sprain refers to an injury affecting the muscles, ligaments, or tendons in the lower back region, specifically the lumbar spine. These injuries are common and often result from overuse, improper lifting, sudden twisting, or traumatic events. Here's information on diagnosis and treatment:
 
There are many potential causes of a lower back or lumbar strain:

Lumbar back strain is often caused by overuse or injury to the muscles, ligaments, and tendons in the lower back. Common causes include:

1. Muscle Overuse: Repetitive activities or movements that strain the muscles in the lower back can lead to overuse injuries. This is common in activities such as lifting heavy objects, especially when done with improper body mechanics.

1. Poor Body Mechanics: Incorrect posture or body mechanics while lifting, bending, or performing other activities can place excessive stress on the lower back muscles and ligaments, leading to strain.
2. Sudden Twisting or Turning: Abrupt and forceful twisting or turning motions, especially when lifting or carrying objects, can strain the muscles and ligaments in the lumbar region.
3. Heavy Lifting: Lifting heavy objects without proper technique or attempting to lift objects that are too heavy for the individual's strength can result in lumbar strain.
4. Sports Injuries: Participation in sports that involve repetitive or forceful movements, such as weightlifting, golf, or tennis, may contribute to lumbar strain.
5. Accidents or Trauma: Traumatic events, such as falls, car accidents, or blows to the lower back, can cause immediate strain on the muscles and other structures in the lumbar region.
6. Prolonged Sitting: Maintaining a seated position for extended periods, especially with poor ergonomics, can strain the lower back muscles and contribute to stiffness.
7. Sedentary Lifestyle: Lack of regular physical activity and weak core muscles can make the lower back more susceptible to strain.
8. Obesity: Excess body weight can increase the load on the spine and contribute to lumbar strain.
9. Age-Related Changes: With aging, the spine undergoes natural degenerative changes, such as disc wear and tear, which can make the lower back more prone to strain.
10. Deconditioning: Lack of regular exercise and physical conditioning can lead to weakened muscles and reduced flexibility, making the lower back more vulnerable to strain.
11. Inadequate Warm-up: Engaging in physical activities without proper warm-up can increase the risk of muscle strain.

Individual factors, such as genetics, overall fitness and health, and pre-existing conditions, can influence susceptibility to lumbar strain.  Additionally, a combination of factors may contribute to the risk of lower back injury. Understanding and practicing good body mechanics, maintaining a healthy lifestyle and body weight, and incorporating exercises to strengthen the core muscles can help reduce the risk of lumbar strain.  Also, there are just some activities that carry a high risk of back injury and lumbar strain.  Whether it's at home or on the job, activities that involve repetitive bending, lifting, and twisting, particularly with heavy weights, will eventually cause a lumbar strain.

So, What causes the pain??

The pain experienced after a lumbar strain is primarily attributed to the inflammation and damage to the soft tissues, including muscles, ligaments, and tendons, in the lower back. Several factors contribute to the development of pain in lumbar strain:
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• Muscle Injury: Lumbar strains typically involve acute damage to the muscles that support and control the lower back. When they are overused, stretched, or torn, muscles can cause serious pain.  Microscopic tears in muscle fibers can cause inflammation and trigger pain signals in nerves in the muscle and in tissues near the muscle, leading to spasm and stiffness.

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• Ligament or Tendon Damage: In addition to muscles, the ligaments, which connect bone to bone, and tendons, which connect muscle to bone, can be stretched or torn. Overstretching or tearing of these structures can result in severe immediate pain and persistent discomfort for weeks afterwards.


• Inflammation: These soft tissue injuries trigger an inflammatory response, causing pain, swelling, and redness.  In the case of lumbar strain, inflammation contributes to the sensation of pain directly and makes all of the affected tissues more sensitive to pain for some time afterwards.


• Nerve Irritation: In some cases, lumbar strain can lead to irritation of nerves in the spine. This can cause burning pain, radiating down the leg, or numbness tingling tingling that may extend into the legs or feet. Nerve irritation can result from direct pressure on the nerve, or inflammation in the affected area irritating the nerve.​

• Spasm of Muscles: The body's response to injury often includes muscle spasms. These involuntary contractions can lead to increased pain and contribute to stiffness in the lower back.


• Reduced Range of Motion: Pain and inflammation can limit the normal range of motion in the lower back. Reduced flexibility contributes to discomfort and difficulty with movement.


• Psychosocial Factors: Emotional and psychological factors, such as stress or anxiety, can influence the perception of pain.  Fear of pain is normal, but can sometimes make it hard for patients to push forward in their rehab.  All that is true, but be aware: SOME DOCTORS ARE WAY TOO INVESTED IN THIS ISSUE and will routinely dismiss their back injury patients as having "psychological problems".  Chronic pain conditions may be influenced by a complex interplay of physical and psychological factors, but this is rarely the big issue in a new, acute injury.  A good doctor will acknowledge those issues while treating your back problem, and offer support.  If your doctor doesn't recognize the need for treatment of the back injury, though, seek another opinion.

It's important to note that the severity of pain can vary based on the extent and location of the injury, individual pain thresholds, and the presence of any underlying conditions such as arthritis.  Proper treatment and management, including rest, physical therapy, and pain medications, can aid in the recovery process and alleviate discomfort.  

A common component of any lumbar strain is the muscle spasm that follows the muscle injury - that can be intense and disabling, and can last alot longer than you'd expect.  None the less, that aspect will get better over time.  If pain persists or worsens, there may be a more extensive injury or damage to other tissues, and it's time to seek additional medical advice for further evaluation and intervention.

Diagnosis:

1. Medical History and Physical Examination:

• Symptoms Assessment: Inquiring about the nature, duration, and intensity of pain, as well as any other associated symptoms like numbness or tingling.
• Circumstances of Injury: Understanding how the injury occurred provides insight into potential causes and helps in formulating a treatment plan.
• Past medical history: If you've had problems with your back before, it's important to be up-front about those injuries and previous treatment.  If you've had previous imaging studies, comparison of the old to any new studies can provide important clues as to the nature of your injury and what to expect in recovery.

1. Imaging Tests:

• X-rays: While they are not always necessary, X-rays can reveal fractures, boney abnormalities, or alignment issues in the spine.
• MRI (Magnetic Resonance Imaging): This imaging technique is more detailed and helps identify soft tissue injuries, such as disc herniations, as well as muscle or ligament strains.
• CT (Computed Tomography) Scan: Useful for assessing bony structures and detecting fractures with greater precision.

Treatment:
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Lumbar spine strains can typically be managed through conservative, non-surgical treatments. These treatments focus on reducing pain, inflammation, and promoting the natural healing of the injured tissues.  Return to full activity, work, and recreation is the norm, but takes time and usually requires a course of active physical rehabilitation and exercise.  Common non-surgical approaches include:

1. Rest and Activity Modification: Giving the injured muscles and ligaments time to heal, while carefully avoiding activities that aggravate the injury and worsen the pain, such as heavy lifting, repetitive bending or twisting, or prolonged sitting.
2. ​Pain Management: Over-the-counter pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce inflammation and help reduce pain. Topical treatments like ice or heat packs may also be helpful.
3. Preventive Measures:​  Providing information on proper lifting techniques and body mechanics to reduce the risk of recurrent injuries.
4. Physical Therapy: A structured, progressive, physical therapy program can be designed to improve strength, flexibility, and promote proper posture. Therapeutic exercises are typically tailored to the individual's condition.  Aggressive exercise may aggravate symptoms if started too soon, so start with a very gentle stretching program and work with your health care provider as you get better.  Incorporating exercises that target the core abdominal and lumbar muscles is always a goal, as a strong core provides stability to the spine.

• Muscle Relaxants: In cases of severe muscle spasms, healthcare providers may prescribe muscle relaxants to alleviate tension in the first days after the injury.  Prolonged use is not helpful, can be harmful, and should be avoided.
• Supportive Measures: Braces or lumbar supports may provide additional stability and aid in the healing process if a fracture or instability is recognized, but will not take the place of exercise and physical therapy.
• Gradual Return to Normal Activities: As the condition improves, a gradual return to normal activities is usually recommended under the guidance of healthcare professionals.  Activity and job modifications are often needed to allow return to normal without reinjuring the back muscles.

Surgery is rarely required for lumbar strains, and surgical treatment is generally considered only when conservative treatments fail, and the patient demonstrates evidence of a more severe associated or underlying injury such as a fracture or severe disc injury.  These conditions may cause severe pain, neurological symptoms (such as persistent numbness or weakness), or show evidence of a structural instability that requires surgical correction.

Surgical options may include procedures such as discectomy (removal of part of a herniated disc), spinal fusion, or decompression surgery. However, surgery comes with its own risks and recovery periods, and it is usually considered a last resort when conservative measures are not effective.

It's important for individuals experiencing lumbar strain to consult with a healthcare professional for a thorough evaluation and to determine the most appropriate course of treatment based on their specific condition. In the majority of cases, non-surgical approaches prove effective in relieving pain and promoting recovery.

Healthcare Professionals:
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There are several kinds of healthcare professionals who can provide appropriate care and guidance after a lumbar soft-tissue injury.  The choice of healthcare provider may depend on the severity of your symptoms and the specialists available in your area, but should also take into account your own personal feelings about which kind of care you want to start with. Here are some professionals you may consider consulting:

• Primary Care Physician (PCP):
• Your primary care doctor can assess your symptoms, provide an initial diagnosis and earliest supportive care, and can recommend appropriate follow-up treatment or specialist care if you need it.

• Orthopedic Surgeon:
• If your symptoms are severe or persistent, or if there is a suspicion of a structural issue like a fracture or instability, your primary care doctor may refer you to an orthopedic surgeon. Orthopedic surgeons may provide both non-surgical and surgical treatment options, and can reassure you that - despite your significant pain - this is a soft tissue injury that will improve with time and without surgery.
• Physiatrist (Physical Medicine and Rehabilitation Doctor):
• Physiatrists are medical doctors who focus on physical medicine and rehabilitation. They can assess and treat many musculoskeletal conditions, provide rehabilitation plans, and may offer interventional procedures for pain relief.  They are also trained to recognize conditions that are more serious and may require interventional care or surgery.
• Physical Therapist:
• Physical therapists are trained in rehabilitative exercises and therapies. They can design a personalized exercise program to improve strength, flexibility, and reduce pain. Physical therapy is often a key component of lumbar strain treatment.
• Chiropractor:
• Chiropractors specialize in diagnosis and treatment of injuries to the musculoskeletal system, particularly the spine. Most use manual adjustments to relieve pain and improve spinal function, but many also provide modalities such muscle stimulation, physical therapy, and ultrasound to calm muscle pain. A chiropractor with appropriate credentials and experience will obtain appropriate x-rays and imaging before starting treatment, and avoid aggressive manipulation in the earliest phases of treatment.  Most chiropractors that I have worked with are very good at spotting more serious problems and referring patients when interventional therapy or surgery need to be considered.
• Pain Management Specialist:
• A pain management specialist may be consulted if the pain is persistent. They can offer a variety of interventions, including medications, injections, or other minimally invasive procedures to manage pain.  Nerve root blocks or epidural steroid injections are commonly offered in care of ongoing back problems, but have little benefit when muscle injuries cause severe back pain. Injections into the muscles or injured joints can be helpful.
• Sports Medicine Specialist:
• If the lumbar strain is related to sports or physical activity, a sports medicine specialist can provide specialized care and guidance on rehabilitation.
• Occupational Therapist:
• Occupational therapists can assist in optimizing daily activities, recommending ergonomic adjustments, and providing strategies to prevent further strain.  Patients who have been injured at work will often be directed to an occupational therapy specialist.

It's crucial to communicate openly with your healthcare provider, providing details about your symptoms, medical history, and any relevant activities or events leading to the lumbar strain. Based on the evaluation, the healthcare provider will guide you through an appropriate treatment plan, which may include a combination of therapies or referrals to specialists.
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Conclusion:
It can take quite a while for a lumbar strain or sprain to completely heal, and the pain can be intense and disabling.  Because these injuries primarily involve muscles and soft tissues that can heal and repair, you have a great chance of getting back to normal, with enough time.  Getting back to activity and health is always the goal, but it can take some time and alot of effort to get there.  

​Because these injuries often occur at work or as the result of an accident, there is often a secondary issue of who's at fault, and who will pay, and that intensifies everything about the healing process.  So, be patient, remember that your health care providers are on your side, and don't get depressed when it takes longer than you expected to get back to your old self!