Dealing with Lower Back Pain: Common Lumbar Strain Symptoms
What is a Lumbar Strain?
The lumbar (low back) spine is subject to tremendous loads. Excessive stress placed on the supporting soft tissues can lead to ligamentous “sprains” and muscular “strains.” These injuries frequently co-exist as a result of a single insult and are referred to commonly as “musculoligamentous injuries.” The L4-5 and L5-S1 segments are subject to the greatest ranges of motion with the highest loads and not surprisingly, are then the most often injured. The severity of the lumbar injury is dependent upon the magnitude, direction, and persistence of the applied external forces.
Ligaments serve as the primary “static” stabilizers and act to limit end range motion of a joint. Forces causing movements beyond the normal range of motion can damage spinal ligaments. The ligaments on the back side of the body are most prone to injury.
Different than ligaments, muscles act as “dynamic” stabilizers, which provide stability to the lumbar spine throughout its normal range of motion. Strains often result from a strong muscular contraction in response to an excessive or unexpected external force or load that can cause lumbar injury. Stressors that cause sustained or violent muscular contraction can lead to lumbar strain symptoms, causing damage to any of the spinal muscles, particularly those that span several joints along the back side of the body. Differentiating sprains from strains is difficult but inconsequential, as lumbar strain treatment is similar for both. Chiropractic solutions can be effective in treating these conditions by
providing specialized care to alleviate pain and promote healing.
Sprain/strain injuries may result from a single traumatic event or from cumulative mechanical overloading. Acute sprain/ strain injuries are often caused by sudden, excessively forceful movements like a fall, twist, lift, push, pull, direct blow, or abrupt straightening from a prolonged seated or crouched position. Acute strains are responsible for 60% of athletic injuries involving the lumbar spine and occur most often during practice. Participants in football and gymnastics have the highest rates of lumbar injury. Acute injuries are most likely to occur during combined motions, i.e. bending/twisting.
Stressors applied over an extended period of time can lead to muscle fatigue, inflammation, and micro-tearing. Sources of cumulative lumbar spine soft tissue injury include prolonged static postures, poor workstations, repetitive movements, improper lifting, sedentary lifestyles, poor conditioning, pregnancy, and obesity. Prolonged sitting places the lumbar spine at significant risk, particularly when slumping forward or backward. This can lead to a variety of lumbar strain symptoms, including lower back pain, stiffness, and limited range of motion. Sustained flexion lasting over three minutes generates a period of residual ligamentous laxity (creep) that may last over 30 minutes, wherein the ligaments and discs are more susceptible to lumbar injury from sudden or unexpected forces i.e. bending over to put on socks. Patients are typically more susceptible to ligamentous injury in the morning.
Muscular weakness, or imbalance, including weakness in the muscles that span the length of the spine or the hips, as well as tightness in the hip flexors or hamstrings are predisposing factors to lumbar injury. Additional risk factors for the development of low back pain include, smoking, a history of surgery, or pre-existing structural deformities, including scoliosis, spondylolysis, or spondylolisthesis.
Most people will experience acute low back pain at some point in their lifetime, and 70% of those patients can attribute their symptoms to sprain/strain injuries. Females are affected more frequently than males. Back pain is a common among all age groups. Underdeveloped strength, balance, and coordination combined with poor posture, heavy book bags, and rapid growth are thought to contribute to this mounting problem.
What Will a Lumbar Strain Look and Feel Like?
Symptoms of lumbar sprain/strain injuries may range from mild to surprisingly debilitating lumbar injury. Pain may begin abruptly, but more commonly develops gradually in the hours or days following an insult. Complaints often include poorly localized, constant dull lower back pain that intensifies or becomes sharp with movement. Patients may awaken with pain or note increased symptoms when flexing, bending, twisting, or lifting. Rest may relieve acute symptoms but often leads to inactivity-stiffness, compounding the issue. Physical therapy services can be crucial in managing these symptoms and improving mobility. Pain is generally limited to the low back and buttock region but may sometimes refer to the thigh, rarely below the knee. Additional symptoms may be generated from concurrent muscular spasm or myofascial involvement.
The clinical presentation of a lumbar injury, such as sprain/strain generally includes swelling and loss of range of motion in the low back. Pain during passive motion testing by the provider suggests ligamentous involvement, while pain on resisted muscle testing suggests a muscular contribution, a strain. There will likely be associated point tenderness and tightness or spasm in the muscles surrounding the spine.
How Do We Treat a Lumbar Strain?
The initial goals of treatment for lumbar strain symptoms include reducing pain, improving function and limiting lost workdays. Ice, heat, electrical stimulation, and NSAIDs are commonly employed modalities in the acute phase of lumbar injury. Ice may be more appropriate for the first 48-72 hours following an acute injury; thereafter, ice and heat have similar pain relieving effects for lower back pain. Gentle range of motion exercises and introductory stabilizing strengthening exercises can be implemented to tolerance in the acute phase of healing.
Spinal manipulation is a valuable tool for the restoration of normal joint mechanics in sprain/strain injuries and has been shown to reduce pain and disability in low back pain patients. Spinal manipulation has been shown to be more effective than other interventions for lower back pain, particularly in cases of lumbar injury and offers a “significant advantage for decreasing pain and improving physical functioning.” Additionally, myofascial release and stretching exercises may be needed for the muscles around the low back and gluteal areas as well as specific nerve mobilization techniques to restore normal dynamics of the nerves.
Chronic overloading and dysfunction can lead to spinal instability, which in turn can trigger lumbar strain symptoms. Instability then becomes a self-perpetuating cycle of dysfunction, stiffness, and abnormal movement patterns as evidenced by the ongoing and recurrent nature of the problem. Almost 1/3 of acute low back pain episodes, commonly known as lumbar injury, will persist at six months and recurrent episodes affect between 25 and 50% of that population. Those patients who forgo lumbar strain treatment often develop chronic low back. A well-directed home exercise program can reduce the recurrence rate of lower back pain. Home programs will focus on improving faulty postures/biomechanics through education, stretching, and stabilization and strengthening of the spine and pelvis.
Initially in the acute phase, patients should avoid repetitive bending, twisting, and lifting, but immobilization and bed rest are not suggested. Patients with lumbar injury are encouraged to remain active and return to normal activities of daily living as symptoms allow as well as taking frequent breaks from workstations to reduce prolonged postures. Ergonomic and postural training may include a discussion of workstation ergonomics, posture, sleep, proper lifting mechanics, and modifications of activities of daily living to promote healing and prevent recurrence of lumbar strain symptoms. The use of a lumbar support cushion while sitting will help maintain a healthy low back position and neutral spine posture. Patients should avoid heavy lifting or prolonged flexion early in the morning or after sitting or stooping for any prolonged period of time to reduce strain on vulnerable tissues.
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