| 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. The tissues are deep, and therefore it is difficult to categorize these injuries as first-, second-, or third-degree sprains and strains, as in the knee or ankle. Temporary or permanent damage of lumbosacral structure can result.
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 (Beers). 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.
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.Risk: The risk for lumbar spine strain or sprain is highest among athletes, such as football players and gymnasts, and industrial workers. Individuals compromised by previous back injury or back surgery, obesity, or structural deformity (e.g., scoliosis, spondylolysis) are also at greater risk. Incidence and Prevalence: Among the general population, lumbar sprains and strains contribute to many cases of lower back pain, which is the leading cause of disability for people 19 to 45 years of age and the second most common cause of missed work days, after the common cold (Beers).
Among intercollegiate athletes, 7% to 13% of all sports injuries are lower back injuries, among which muscle strains account for 60% (Radebold). Football players and gymnasts have the highest rates of low back injury—80% and 11%, respectively (Radebold). |
Source: Medical Disability Advisor
| History: The individual may report a known injury, such as an accident or a fall, but sometimes the mechanism of injury is a subtle event, and symptoms may not be immediate at onset. Strains commonly result from overexertion of a muscle, either in movement or sustained positioning, and the individual may report unusual amounts of exercise or other unaccustomed activity. In a sprain, injury results from sudden force or movement exerted upon ligaments; in that case, the individual may report unusual, sudden turning or twisting. The individual may complain of pain and loss of function, such as an inability to turn, twist, or bend normally. The pain of a lower lumbar sprain or strain is generally located along the lower back and upper buttocks. It may originate from a particular location but radiate into surrounding tissue. The pain associated with a strain or sprain is often activity-related and may be persistent or experienced only when the individual moves in a particular way. The individual may report painful muscle spasms that worsen with activity or at night during sleep. A history of prior back injury or surgery is obtained, as well as a general health history. Physical exam: The individual may be observed while standing for posture, spinal alignment, and deformities. The individual may be unable to straighten up into a normal posture while standing. A range of particular activities, including sitting, standing, walking, or driving, may be severely limited or impossible. While the individual lies in a prone position, palpation of the muscles in the lower lumbar area may reveal local tenderness and muscle spasm. A neurologic exam of the lower extremities, including reflex testing at the knees and ankles, may reveal changes in sensation or motor function and may indicate other associated injuries or nerve involvement. Raising a straight leg from a supine position may reproduce sciatica, requiring further evaluation. Tests: Most cases of lower lumbar strains and sprains do not require diagnostic tests, but if an individual has persistent symptoms that fail to respond to the usual interventions, additional laboratory studies (white blood cell count, erythrocyte sedimentation rate, and human leukocyte antigen assay for HLA-B27) may be appropriate to assess for underlying rheumatic disease. Plain x-rays may be used to look for fractures related to the muscle pulling away from bone (avulsion fracture), but those are uncommon. MRI may be needed to rule out other potential causes of back pain, such as soft tissue injury, infection, tumor, and involvement of spinal nerve roots. In a lumbar sprain or strain injury, MRI findings will frequently be unremarkable. |
Source: Medical Disability Advisor
| 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. |
Source: Medical Disability Advisor
| With proper care and treatment, the pain of less severe lumbar sprains and strains typically lasts about 5 to 10 days. Most lumbosacral injuries (90%) resolve within 6 weeks regardless of type of treatment (Radebold). If proper rehabilitation is provided, sprains and strains should heal without any residual change in function. Some individuals may experience a degree of functional limitations or chronic pain that is inconsistent with the initially diagnosed injury. A more serious underlying condition may be considered if the individual does not respond to conservative treatment. |
Source: Medical Disability Advisor
| Complications of severe sprains or strains include accompanying fractures, dislocations, and avulsion injuries that result when muscle is torn away from bone. A severe sprain or strain may be accompanied by other injuries; based on the clinical presentation, those injuries should be evaluated. Bleeding into a muscle as a result of strain or tearing can produce severe pain in the affected area. |
Source: Medical Disability Advisor
| Individuals with severe sprains or strains whose normal work duties require extensive lifting or bending may require temporary reassignment to lighter or sedentary duties. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Have diagnostic tools, such as x-rays and/or MRI, been used to rule out herniated discs and/or fractured vertebrae?
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Has individual experienced any complications such as dislocations, avulsion injuries, or bleeding into a muscle?
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Were any signs of nerve involvement noted?
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Have other conditions, such as internal organ disease, bone disease, tumor, muscle disease, or psychological stress, been ruled out?
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Does individual have a history of back injury or surgery? Is any other spinal condition or deformity present (spondylolysis, scoliosis)?
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Does individual suffer from depression?
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Is there another underlying condition that may affect recovery?
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Does individual have continued pain and disability following an adequate course of treatment?
Regarding treatment:
- Has individual followed recommendations for activity restrictions and limited bed rest?
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Has individual avoided lifting, bending, twisting, or other activity that produces or worsens pain?
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Did individual take medications, such as nonsteroidal anti-inflammatory drugs or muscle relaxants, as prescribed?
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Did individual ask for more pain relievers or muscle relaxants than the injury warranted?
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Did individual undergo comprehensive physical rehabilitation?
Regarding prognosis:
- Was accommodation in the workplace made to allow injury to heal completely?
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Does individual have persistent or chronic low back pain?
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Has individual responded to conservative therapy?
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What additional treatment options are available?
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If individual is obese, would weight reduction counseling be appropriate?
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Has individual been evaluated for rheumatologic disease or other possible underlying disorders?
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Has a psychological evaluation been done to rule out hypochondriasis, somatization, malingering, and seeking of secondary gain?
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Would individual benefit from counseling?
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Source: Medical Disability Advisor
| Beers, Mark H., et al., eds. "Low Back Pain." Merck Manual of Medical Information. 2nd Home Online ed. New York: Pocket Books, 1997. Merck. Merck & Co., Inc. 6 Jan. 2005 <http//www.merck.com/mmhe/sec06/ch094/ch094a.html>.Radebold, Andrea. "Lumbosacral Spine Sprain/Strain Injuries." eMedicine. Eds. Andrew D. Perron, et al. 21 Nov. 2007. Medscape. 6 Jan. 2005 <http://emedicine.medscape.com/article/95444-overview>. |
Source: Medical Disability Advisor
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