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EPISODE 44: Low Back Pain - Understanding Sprains & Strains

Chances are if you are reading this you are currently or have previously experienced Low Back Pain. Did you know 80% of people will suffer low back pain in their lifetime? 10% of these adults with low back pain will develop chronic pain. Low Back Pain is always a hot topic because it impacts so many of us on a daily basis. KNOWLEDGE IS POWER. If we can understand how the spine works, its likes and dislikes, then we can do a lot to help ourselves heal or prevent future occurrences. Our goal today is to teach you about a very common reason for Low Back Pain- the Sprain/Strain of the Lumbar Spine.

The spine is a fascinating structure that really drives so many of our body's functions both physically and systemically.The Spine is a column of vertebrae vertically stacked. It is split into 3 sections: cervical (neck), thoracic (ribcage), lumbar (low back). The shape of the vertebrae is unique as they allow space to house the spinal cord as it comes down from the brain. As each vertebrae interact the ones above and below, small holes are formed that allow each nerve to branch off from the spinal cord and leave the spine proceeding to feed either muscles or organs throughout the entire body. In addition, as each spine segment comes together, they form a facet joint on either side, discs between each vertebrae provide space and shock absorption, and ligaments connect each vertebral bone.

There are some key muscles and structures to be familiar with when learning about the lumbar spine:

(try to identify these on the accompanying images)

lower back muscles

Common Muscles Strained:

1. Extensors:

-Erector spinae: longissimus thoracis and iliocostalis lumborum.


-Latissumus Dorsi

2. Side muscles/Rotators:

-External obliques, Internal obiques

Common Ligaments Strained:

-Supraspinous and Interspinous ligaments between L4 and L5 and between L5 and S1

-Iliolumbar ligament.

Picking up a box, lower spine
lumbar spine region

A Lumbar Sprain/Strain, is an injury of the muscles and ligaments of the lumbar spine. Lumbar Sprains are injuries to ligaments in the Lumbar Spine region and and Lumbar Strains are injuries to the muscles or tendons in the Lumbar Spine region. Both sprains and strains typically have a MOI (Mechanism of Injury). The MOI is typically due to a change of activity/load or trauma. Some examples of movements that may cause lumbar injury include moving heavy furniture of awkward size, long periods of gardening/digging, falling onto your back, suffering a car accident, or strenuous pushing/pulling/rotating. Whether the injury is caused by trauma or prolonged positioning, typically there is an excessive stretch to the Lumbar muscles, tendons or ligaments resulting in injury.

Some people will describe that they feel the injury as soon as it happens. Others may not feel pain or discomfort it until they the next day or a few days after.

Common symptoms include:

  • Intense pain localized at the spine or radiating into the pelvis, buttocks or waistband

  • Range of Motion restrictions restricted with loss of ability to fully bend, extended or rotate

  • Stiffness in the morning or after prolonged sitting

  • Deficits likely correlate w/ the MOI. Ex: If someone injured themselves lifting something too heavy, they may be unable to fully straighten up or stand erect when they get out of bed in the morning or after prolonged sitting.

**Be aware of RED/YELLOW FLAGS: if you are experiencing pain radiating down the leg past the knee, numbness/tingling, severe weakness like drop foot or your leg giving way, balance issues, loss of sensation in the saddle region, or urinary incontinence, you need to see a medical professional immediately.

When suffering an Lumbar Strain/Strain it is important to listen to your body. Depending on the severity of the condition you may be able to reduce activity levels for a week then slowly ramp back up to normal. In more severe cases it will be important to be checked by your physician and start physical therapy to fully recover. The #1 most important thing to know is THE SPINE LIKES TO MOVE. So, when we advise you to "take it easy and reduce your intensity" that does not mean become sedentary and live in a recliner to get pressure off of your back. It is important to figure out the types of things your back likes and keep doing those things in small doses and often.

So HOW does the healing process begin from a Lumbar Sprain or Strain?

  1. Avoid the aggravating activity & stop reproducing the pain.

  2. Modify as necessary: shorten your range of motion or reduce loads to keep participating as much as possible in your routines/training.

  3. Avoid staying in one position for too long, switch positions frequently throughout the day.

  4. Go on gentle walks, swinging the arms, this helps to lubricate the joints of the spine and engage the supportive musculature.

  5. Participate in exercise to stabilize the spine: activate the core muscles (core muscles include any muscle that touches the spine!) work on a neutral lumbar spine while emphasizing isolated thoracic and hip motion.

  6. Discover your BACK CLASSIFICATION* and provide exercise snacks hourly to keep your symptoms down.

  7. Use modalities: ice/heat, analgesics, Nsaids (discuss medication with your physician if necessary). It is important to keep pain levels low so the supportive core muscles are not deactivated.

**Back Classification refers to grouping spine injuries according to what movements they respond to: extension, flexion, stabilization, centralization. A common classification is extension. Some Lumbar injuries can greatly benefit from repeating extension movements. Your classification would be best determined by a physical therapist.

If you have worked through the above recommendations and you are not making progress towards healing, it is time to seek help. You can start your journey in several places which may include a medical doctor specializing in orthopedics or the spine, your physical therapist, or a chiropractor. Your medical doctor will be able to take images and prescribe necessary medication for healing. They will refer you to a physical therapist to start treatment. A chiropractor may also be able to take images (depending on the office) and can help with some flexibility deficits and pain relief but are limited in the ability to prescribe the appropriate exercise to get you back to your goals. No matter what your path is, the best way to fully heal and return back to all your activities safely is to participate in physical therapy.

Physical Therapy for a lumbar sprain/strain will start with an Evaluation. This initial appointment will include a history of the injury and your health, establishing your goals, examination of your quality of movement and the injured structures. After the examination treatment will begin to help pain, range of motion, and activation of the spinal stabilizer muscles, and most importantly, individualized guidance on what you should do between sessions to facilitate a healing environment for your spine.

Treatment for Lumbar Sprain/Strain progresses in 3 phases:

The initial phase is aimed at reducing pain and gaining mobility.

The middle phase goal is to restore full flexibility and strength.

The last phase targets fully reaching your goals/returning to sport through guidance on correcting poor movement patterns and pushing for speed, power, agility, and plyometrics.

The biggest piece of advice we can give all patients is to complete your full course of therapy, the last phase is the most important and without it you are left with a higher chance of re-injury. If you have not been to physical therapy before it is a great learning experience, you will learn so much about your body, what is needed to take care of your body, fill in the holes in your training, and come out stronger than ever :)

Don't let low back pain hold you back, if you are stuck get help, you will be so happy that you did. Rehabilitation is an important part of the healing process, and we are prepared to walk you through it to help you successfully reach your goals. Whether you reach out to us for help, or get it elsewhere, we wish you so much luck and are sending healing vibes for a full recovery.

To learn more about the other types/causes of low back pain, Follow and LIKE our Blog and subscribe to our email list. This is the first installment of our Spine Series and we have several more blogs coming on Low Back Pain.

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Your PTSP team,

Dr. Brown, Dr. Bay, Dr. Yana

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