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Low Back Sprain and Strain: A Case for Cause and Effect
In today's society, low back pain is a remarkably prevalent condition. Probably everyone who reads this article will either have suffered with low back pain, or will know someone who has suffered with the condition. Although spinal stenosis, a herniated disc, or other more serious conditions may cause low back pain, the most common diagnosis is a sprain or strain.
Sprains and strains often result from excessive physical demands on the spine, such as lifting a heavy object or falling awkwardly. Although the pain can be severe and even temporarily disabling, the good news is that most lumbar strains and sprains are easily treated and do not require spine surgery.
The Mechanics of Lumbar Strains and Sprains
The lumbar spine is the chief weight-bearing structure of the human skeleton. With its large vertebral bodies, and its lordotic curve (an "inward" curve of the spine), the lumbar spine is uniquely designed to carry and distribute the loads from movement. With proper body mechanics, the forces imposed on the spine from bending, lifting, sitting and other activities are normally handled without spinal injury or pain.
Sprains and strains are soft tissue injuries. Soft tissues in the lumbar spine include muscles, tendons and ligaments. Sprains are limited to tendons and ligaments, whereas strains affect muscles. Injury is sustained when these tissues are stretched beyond their normal limits due to excessive flexion (bending forward) or extension (bending backwards), or when excessive forces are applied to these structures.
The symptoms of lumbar sprains and strains include sharp pain, pain and difficulty when moving, swelling, and stiffness. The initial pain may be so severe that the patient fears something has "broken." At this point, many patients seek the advice of their physician.
Prior to a physical and neurological examination, the physician will take a detailed patient history. He will want to know such information as when the pain started - what event preceded the pain - what makes the pain worse - and other questions that help the physician determine the next step to take to make a proper diagnosis.
The physical and neurological examination will include palpation, during which the physician feels the patient's spine to detect muscle spasm and areas of inflammation. Range of motion movements help the physician to measure the degree of injury. For example, can the patient touch their toes, bend side to side comfortably or bend backward without pain? The neurological segment of the exam tests the patient's reflexes and sensory responses. For example, are there areas of tingling or numbness in the legs or low back?
In addition, the physician may order an x-ray to rule out fracture. Seldom is further diagnostic testing required.
Treatment and Prevention
Treatment is usually two-fold, including medications to relieve pain and muscle spasm and participation in a physical therapy program.
Medications may include an anti-inflammatory, a muscle relaxant, and either narcotic or non-narcotic drugs for pain. A narcotic is only prescribed when pain is acute or when a non-narcotic medication does not relieve pain.
Physical therapy incorporates therapeutic exercises, and "hands on therapies" such as ultrasound, massage, heat or ice packs, and electrical stimulation. At the San Diego Center for Spinal Disorders (SDCSD) we are affiliated with an expert team of physical therapists and rehabilitation specialists. Therapeutic exercise programs begin slowly to acclimate the patient to stretching and strengthening routines. The patient is usually provided with a home exercise program to continue on a regular basis. A strong and agile spine is one step toward preventing future injury.
"Hands-on" therapies work to decrease inflammation, muscle spasm and pain. In addition, manual therapies of this type increase circulation to the site of injury and facilitate healing. Such therapies as chiropractic, ultrasound, massage and TENS are appropriate options.
Prevention in the form of proper posture and good body mechanics is also essential. During physical therapy, patients learn how to move with good posture to protect the low back. Physical therapists teach patients how to develop ergonomically correct body mechanics in their everyday activities. This can be a great experience with life long rewards.
Lumbar strains and sprains are common, and our doctors are trained to help you to recover from these painful conditions. Our medical team is also committed to educating patients about how to avoid future injuries. Thus each patient will receive instruction on such preventative 'tools" as good posture, healthy body mechanics, and nutrition and weight control. Together, we can help your back stay healthy!
It is also important to remember that you should not assume every case of low back pain is simply a strain or sprain. If your symptoms persist, with severe pain, bowel or bladder dysfunction, or extremity weakness or numbness, seek medical attention promptly.