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Lumbar Back Sprains and Strains

Peer Reviewed

Most people will experience back pain during their lifetime. Some patients fear the worst, especially when pain is severe. Although back pain can be caused by fracture, disc disorder, or tumor, the most common cause is sprain or strain.

Sprains and strains often result from excessive physical demands on the back. Lifting something too heavy, a sudden fall, car crash, or sports injury can cause soft tissues (ligaments, muscles, tendons) to stretch too much.

Sprains · Strains
The spine includes vertebrae (bones), discs (cartilaginous pads or shock absorbers), the spinal cord and nerve roots (neurological wiring system), and blood vessels (nourishment). Ligaments link bones together, and tendons connect muscles to bones and discs. The ligaments, muscles, and tendons work together to handle the external forces the spine encounters during movement, such as bending forward and lifting.

spinal segment, labeled

Sprains and strains are similar disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations.

Ligaments are strong flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some freedom of movement. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury.

To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.

sprain, strain

Local tissues 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.
 

Updated on: 12/12/12
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 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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A lumbar sprain or strain causes local tissues to swell causing pain, tenderness and stiffness. The pain and other symtpoms may mimic other disorders affecting the back.
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