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.
Lumbar Back Sprains and Strains
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.
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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.
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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.
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