Lumbar Back Sprains: Diagnostic Steps
A lumbar back sprain or strain causes local tissues to swell when ligaments, muscles, tendons, or combinations become overstretched, overused, or torn. Swelling causes pain, tenderness, and stiffness; swelling serves to protect the injured back by restricting movement - similar to a splint on a broken leg.
Locating the Cause of Pain
General practitioners, primary care physicians, and spine specialists routinely treat patients who suffer from low back sprain and strain. After reviewing the patient's medical history, current symptoms, and treatments or medications the patient has tried, the doctor performs a physical and neurological examination. This exam may include testing the patient's range of motion by observing their ability to bend forward, backward, and from side to side. Nerve deficit in the legs may be tested by traditional ankle and knee jerk tests. Straight leg raises, when the doctor raises each leg while the patient lies on their back, help determine if there is nerve root irritation.
Sprains and strains can be very painful and the patient's complaints may be similar to other disorders affecting the back. Therefore, to accurately diagnose the problem, the doctor may order an x-ray, CT or MRI Scan.
Of course, if the doctor determines back pain is not due to sprain or strain, he will look further, which may include seeking the opinion of a another specialist.
Commentary by David S. Bradford, MD
The authors present a well-organized review of one of the most common causes of acute back pain. Diagnosing a specific pain generator in cases of acute back pain is a difficult challenge, and often guided more accurately by an accurate history and examination than any imaging studies.
The case of ligamentous strain or muscle sprain is a good example of a condition that will not be specifically represented by MRI or other imaging modalities. Therefore, in the absence of neurologic findings (eg, leg weakness) or pain persistent longer than one month, radiographic evaluation is rarely useful.
The authors offer appropriate emphasis to prevention. Since >90% of muscle sprains and ligament strains will improve spontaneously within four weeks, the goal of therapy is prevention of recurrence. Posture, ergonomic principles, and smoking cessation are fundamental to prevention.
I would add that cardiovascular fitness is an independent factor that predicts spinal health, and work toward improving cardiovascular fitness is an important therapeutic intervention. There is not a reliable intervention for the management of back pain related to ligamentous strain or muscle sprain.
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