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Lumbar Strains, Low Back Strains

While back pain is common in the general populations, lumbosacral strains and sprains do occur in specific activities and sports, with sprains of the musculo-ligamentous complexes the most common cause of pain. Perhaps around 10 percent of injuries in young sports people could be back related, with muscle sprains heading the list, followed by disc injury. The ligament sprains may be the result of sudden muscle contractions pulling on a joint, sudden twisting or straightening up powerfully from a bent position.

There are a great number of ligaments in the spinal column, all of which can be injured, but the most vulnerable to injury are the more posterior ligaments, which are both not as strong as some of the others and more typically stretched in the flexion postures we often adopt in activity. If the muscle or the muscle-tendon areas are torn this is typically due to the muscle contracting forcefully whilst it is also being stretched at the same time, leading to too much force through the system and a strain of varying severity. Pain is typically to the sides of the spine close to where the injury lies and there may be spasm of the local spinal muscles, with no negative factors such as severe generalised back pain or leg symptoms.

During activity the loads put through the lumbar spine are very high as the body weight is multiplied by muscular contraction and often by momentum. The loads are very high in specific combined movements such as bending sideways and rotating together, and in these positions the majority of strains and sprains occur. These injuries may impair core stability of the spine and affect joint position sense, making the spine more vulnerable to further injury.

Physiotherapists will encourage patients to use rest, ice and gentle activity during the acute period, and take regular prescribed analgesia. Stress to the area should be minimised and the physio can teach the patient the easiest ways of managing day to day activities without unnecessary loads being applied. Keeping a general level of activity is encouraged unless the pain is very severe and limits the patient severely. The physio will progress the exercises gradually and introduce core stability work and stretching over time. It is important to steadily increase the level of stress through the spine by gradated increases in activity until normal function is restored as too long a process can run the risk of the pain and reduced function becoming chronic.

Author: Jonathan Blood-Smyth