The lumbar spine is subject to tremendous loads. (1) Sprains refer to a force causing movement beyond the normal range of of motion of ligaments in the spine. Strains refer to the muscles surrounding the spine, which act as stabilizers, providing stability of the lumbar spine throughout its normal range of motion (2). The severity of lumbar sprain/strain injuries is dependent upon the magnitude, direction, and persistence of the applied forces. Differentiating sprains from strains is difficult but inconsequential, as treatment is similar for both.
What causes strain/sprains?
Sprain/strain injuries may result from a single event or from cumulative overloading. Acute sprain/ strain injuries are often caused by sudden, excessively forceful movements like a fall, twist, lift, push, pull, direct blow, or abrupt straightening from a prolonged seated or crouched position (1). Other cumulative causes include prolonged poor posture, poor workstations, repetitive movements, improper lifting, sedentary lifestyles, poor conditioning, pregnancy, and obesity (25,59). Prolonged sitting places the lumbar spine at significant risk, particularly when slumping forward or backward. (5-9,21).
Symptoms of sprain/strain injuries may range from mild to surprisingly debilitating. Pain may begin abruptly, but more commonly develops gradually in the hours or days following an insult. Complaints often include non-specific constant dull lower back pain that becomes sharp with movement. Patients may awaken with pain or note increased symptoms when flexing, bending, twisting, or lifting. Rest may relieve acute symptoms but often leads to inactivity-stiffness. Pain is generally limited to the low back and buttock region but may sometimes refer to the thigh (17). Additional symptoms may be generated from muscular spasms or other myofascial involvement.
- Patients are more susceptible to ligamentous injury in the morning, where flexion-induced forces to the disc are increased by 300% and ligamentous stressors by 80%. (11)
- Muscular weakness or imbalance, including weakness in the lumbar muscles or hip muscles, and tightness in the hip flexors or hamstrings (lower crossed syndrome) are predisposing factors to injury.
- History of surgery
- Structural abnormalities
Strain/sprains in sports:
Acute strains are responsible for 60% of athletic injuries involving the lumbar spine and occur most often during practice. (3) Participants in football and gymnastics have the highest rates of lumbar injury. (3) Acute injuries are most likely to occur during combined motions such as lateral bending with flexion, extension, or rotation.
Special Consideration to Teens and Adolescents:
A high prevalence of low back pain has been reported in adolescence. (14-16) Underdeveloped strength, balance, and coordination combined with poor posture, heavy book bags, and rapid growth are thought to contribute to this mounting problem. (8,9)
Do I need an X-ray or an MRI?
Plain film imaging is not necessary and does not improve clinical outcomes for the majority of acute lower back pain patients. (17-20) Plain film imaging is warranted to rule out fracture in the presence of a dangerous mechanism of injury (i.e. car accident), or for presentations suggesting significant degeneration.
Goals of treatment:
The initial goals of treatment include reducing pain, improving function and limiting lost workdays. (22)
Recommended Treatment options:
- Spinal manipulation is a valuable tool for the restoration of normal joint mechanics in sprain/strain injuries
- Shown to reduce pain and disability in low back pain patients. (27-34,66,67)
- Spinal manipulation has been shown to be more effective than other interventions for lower back pain.
- The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) advocates a “typical initial therapeutic trial” consisting of 6-12 visits over a 2-4 week period. (65)
- Soft tissue therapy addressing muscle tension and/or spasms
- Clinicians may choose to implement modalities in the initial phase of care as part of a passive-to-active multimodal approach. (65)
- Ice, heat, electrical stimulation, ultrasound, and NSAIDs are commonly employed modalities in the early phases of treatment. (23-25)
- Ice may be more appropriate for the first 48-72 hours following an acute injury; thereafter, ice and heat have similar analgesic effects for lower back pain. (23)
- Gentle range of motion exercises and isometric strengthening should be implemented to tolerance in the acute phase of healing.
- Ergonomic and postural training may include a discussion of workstation ergonomics, posture, sleep, proper lifting mechanics, and modifications of activities of daily living to promote healing and prevent recurrence of symptoms.
- The short-term use of a lumbar support belt may be helpful. (56)
Treatments that are not effective:
Immobilization and bed rest are not recommended and typically worsen the issue. (24,25,58,60)
How can I help this issue on my own?
- Home programs should focus on improving faulty postures/ biomechanics, including lower crossed syndrome, through stretching and stabilization of the spine and pelvis.
- Initially, patients should avoid repetitive bending, twisting, and lifting.
- Patients should be encouraged to take “micro breaks” from workstations for ten seconds every 20 minutes.
- The use of a lumbar support cushion while sitting will help maintain a healthy arch in your lower back, called a lordosis.
- Patients should avoid heavy lifting or prolonged flexion early in the morning or after sitting or stooping for any prolonged period of time (57)
- Following prolonged flexed postures, patients may benefit by performing 2-3 repetitions of spinal extension prior to lifting or bending.
At Creekside Performance Center, we are highly trained to treat each of these conditions. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves.
Evidence Based-Patient Centered-Outcome Focused
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