Lower Back

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Lumbar Sprain/Strains

The lumbar spine is comprised of 5 vertebral bones sandwiched below the thoracic spine and connect with the sacrum. These bones are surrounded by large muscles that support the low back. A few muscles including the spinal erectors, quadratus lumborum (QL), multifidus, Latissimus Dorsi span beyond the region of just the lumbar spine. The primary movement seen in the lumbar spine is predicated by the alignment or configuration of the facet joints. (add picture of the facets). This architecture of the lumbar vertebrae allows for spinal flexion and extension as its primary motion, with rotation and lateral flexion being a secondary movement.

A sprain or strain indicates that there is either a ligament or muscular component to the injury. A general presentation of lumbar (lower back) sprain/strains is poorly defined borders of dull ache like symptoms. The rating of these symptoms can be low to mid-range. Sprain/strains can be a single event trauma or a cumulative injury from repetitive insult to the tissue. It is possible and not uncommon for sprain/strains to be seen concurrently with other conditions or diagnosis.

Presentation: A musculoligamentous injury will present as symptomatic with both passive and active range of motion tests. Movements that created the trauma will recreate the symptoms.
Culprits or causes of lumbar sprain strains can include: prolonged postures, poor workstation ergonomics, repetitive movements, obesity, pregnancy, improper lifting mechanics, and/or sedentary lifestyle. Movements that have been reported to cause acute low back pain include: twisting, bending, lifting or flexing. Each of these have the capability to over exceed the tissues capacity and can lead to an injury.

Additional risk factors of poor diet, smoking, previous surgeries, spondylosis and lower cross syndrome are seen as comorbidities for lumbar sprains/strains.

At your initial assessment with the complaint of generalized low back pain you will be asked to fill out two questionnaires. One is the Fear Avoidance Behavior Questionnaire and the Oswestry Back Disability Index to help find baselines. Movement assessments including active and passive range of motion and motion palpation for joint restrictions. Certain orthopedic tests or assessments testing both hip and local neurology may be normal.

Treatment of sprains/strains may include a short term approach of ice dependent on the time of the onset and severity. Movement to help induce blood flow, such as isometric contractions is useful as well. Joint manipulation of restricted segments is beneficial to improve poor movement patterns. Myofascial release can be useful to decrease tension in muscle groups or regions causing lower cross syndrome, i.e. hip flexors, quadriceps, paraspinal muscles, hamstrings and hip adductors. The use of kinesiology tape to help restrict painful ranges of motion can help to prevent further repetition of the current injury.

Management continues by improving workstation setup. A lumbar support pillow is helpful at providing better lumbar lordosis while in sitting postures. It is also important to take breaks from prolonged sitting and stand and move. We suggest finding a simple routine that involves either walking, stretching or small banded exercises to provide muscular tissue a stimulus to provide increased blood flow.

In the long term approach, fight having predisposing risk factors such as sedentary lifestyles, poor diets and change to work ergonomics to improve your movement quality through weekly strength or fitness training.

For help with dietary habits we suggest following the Deflame Diet by Dr. David Seaman. For exercise programs or personal training we offer those services in house. Treatment of lumbar sprain/strains begins with an assessment. Schedule your appointment today.

Citation:

  1. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-50. PMID: 22335313.
  2. Schneider S, Mohnen SM, Schiltenwolf M, Rau C. Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany. Eur J Pain. 2007 May;11(4):387-97. doi: 10.1016/j.ejpain.2006.05.005. Epub 2006 Jun 21. PMID: 16793296.

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