Lumbar Back Sprains: Treatment and Prevention
Non-Surgical Treatment for Lumbar Sprains/Strains
During the first 24 to 48 hours cold therapy helps to reduce swelling, muscle spasm, and pain by reducing blood flow to the injured area. Never apply cold or ice directly to skin; instead wrap the ice pack or cold product in a towel and apply for no longer than 15 minutes.
If the low back sprain or strain is serious, the doctor may recommend a day or two of rest, cold and/or heat therapy, and medications. Medications may include an anti-inflammatory to reduce swelling, a muscle relaxant to calm spasm, and a pain-killer (narcotic) to alleviate intense but short-lived pain (acute pain). Most sprains and strains heal within a few weeks.
Mild to moderate pain may be treated with non-steroidal anti-inflammatory drugs (NSAIDs). These work by relieving both swelling and pain. Many NSAIDs are available over-the-counter. Discuss NSAID use with your physician first.
The chiropractic approach to treating sprains and strains includes specific, gentle adjustments (also called spinal manipulations) to help restore spinal function.
Usually, after the first 48 hours, heat therapy is used to warm sore tissues. Never apply heat directly to skin; instead, wrap the heat source in a thick towel. Heat increases blood flow warming and relaxing soft tissues. Heat therapy is often used in physical therapy to prepare patients for gentle stretching and exercise to increase flexibility. When combined with stretching, the benefits of heat therapy are greater than heat alone.
Spine Surgery ?
The pain from sprains and strains can be so severe the patient may feel surgery is a certainty! Thankfully, most sprains and strains can be managed using the treatments listed above.
Rarely is Surgery a Consideration
Typically disorders that may warrant surgery include spinal cord impingement and structural deformity. In fact, the majority of patients with back pain are successfully treated non-surgically. Less than 5% of all back problems require surgery!
If surgery is recommended, always ask the purpose of the operation and what results you can expect. Never be afraid to obtain a second opinion.
It would be foolhardy to believe that all spine problems can be prevented! However, by thinking ahead and a little maintenance, most people can enjoy the benefits a healthy spine offers.
- Proper posture lessens stress to the back.
- A healthy body needs regular exercise! Strong abdominal muscles help support the spine.
- Stop smoking! Nicotine restricts blood flow needed to deliver oxygen and nourishment to the spine.
- Healthy eating habits help keep body weight moderate to reduce excessive stress to the spine.
- Common sense rules! Learn how to safely lift and carry items, apply ergonomic principles by selecting spine-friendly chairs, always wear a seat belt when traveling, and wear protective equipment during sports so fun can be safe and injury free.
Take time to learn, adjust, and adopt habits that will help preserve your spine for the future.
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 towards 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.—David S. Bradford, MD
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