Sprains - Strains - Soft Tissue Injuries
Part 1: Common Spinal Disorders
There are many types of back and neck disorders that affect the majority of the population in the United States. Injury, aging, general health, and lifestyle may influence the development of some conditions. Most spinal disorders are known to result from soft tissue injury, structural injury, and degenerative, or congenital conditions.
Soft Tissue Injuries
Soft tissues include the muscles, tendons (ten-duns), ligaments (lig-ah-ments), and nerves. Injury to these tissues can be caused by unnecessary stress to the spine. To give you an idea of how stress affects the spine, consider the following information. Keep in mind the numbers are relatively accurate when proper posture and body mechanics are used.
Lying flat on the back, very little pressure is exerted on the spine. As a person stands upright the pressure climbs three times and while sitting four times. Forces affecting the lower back can rise five times as a medium weight box is lifted. But what happens when poor posture is combined with faulty body mechanics? Those numbers would escalate as the following example demonstrates:
Poor Body Mechanics: Bending at the waist instead of at the knees to pick something lightweight up off the floor. This movement may cause as much as 10 times the amount of unnecessary stress to the spine. Micro-trauma or mini-injuries to soft tissue may result from improper movement especially when repetitive. It is not surprising why so many people suffer from back and neck pain.
Sprains and Strains affect soft tissue. By definition both conditions mean something has stretched beyond normal. Consider Dave who has not shoveled snow since last winter and has decided to take care of his driveway after the first big storm. More than likely Dave's back and neck muscles will become strained causing pain, tenderness, and stiffness. Why? Dave forced his muscles to perform beyond what he does on a routine basis.
Muscle tissue may become strained when forced to exceed its ability to work. Regular exercise helps to strengthen muscles, allowing them to work harder longer. Muscles are the spine's workhorses. Besides muscle tissue, sprains and strains can affect a ligament or tendon. Ligaments attach bone to bone and tendons attach muscle to bone. A sprained ankle is an example of a sprained ligament.
The bulk of the back is muscle. Extreme force may injure muscle. During a motor vehicle accident the body may be suddenly thrown forward, backward, and sideways. These movements can cause hyperextension (excessive forward movement) and hyperflexion (excessive backward movement), which can cause muscles, ligaments, and tendons to tear.
The symptoms of sprain and strain include sudden, sharp, and persistent pain at the injury site followed by swelling. The patient may think a bone has broken. If medical attention is sought, the physician will ask several questions about the injury during the physical examination. When indicated, an x-ray is performed to rule out abnormality (e.g. broken bone). The physician may prescribe medication to treat pain, inflammation, and spasm during the healing phase.
Following injury, the soft tissues switch into high gear to begin the healing process. Circulating blood quickly carries nutrition to the injury and carries away waste. Sprains and strains are usually self-healing within a two to three week time period.
Treatment may include physical therapy accompanied by a stretching program to help prevent the formation of scar tissue, which can be debilitating. Scar tissue is not normal tissue but is the result of healing. Consider scars that develop on the skin after a severe burn. In most cases the scars are with the patient for life, unless surgically removed. In the case of muscles, ligaments, and tendons a physical therapist may be able to train the scar tissue to mimic the function of the tissue prior to injury. Where a ligament has torn scar tissue can be used to aid in providing some limited strength.
Muscle Spasms are common. Muscles that have not been conditioned may not be able to handle added demands. When a muscle is overworked or overstretched its response is to go into spasm. The pain produced by muscle spasm can be so severe the patient is fearful that something serious is wrong. The intensity of the pain can be disabling and affect posture (e.g. bent to one side).
Whiplash is a hyperextension and hyperflexion injury that may cause micro-trauma to the soft tissues in the neck and upper back. The forces to the spine incurred during a car accident may cause the head and neck to suddenly and rapidly move forward, backward, and sideways. Muscles, ligaments, and tendons in the spine may become stretched beyond normal limits causing micro-trauma or small tears in the muscles, ligaments, and tendons. Symptoms may include pain, burning.
Treatment for whiplash may include a soft cervical collar to help lift some of the skull's weight off tender neck, shoulder and back tissues. The collar helps to immobilize and protect the cervical area during the initial healing stage. In most cases, whiplash is self-limiting. It heals over a four to six week time period. Sometimes whiplash may cause long lasting (chronic) problems of a nonsurgical nature. Rarely does whiplash create a severe disorder requiring surgery.
This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.