Low-Back Strain

Low-Back Strain



Description


Low-back strain is an injury to the muscles and tendons of the lower back. These muscles require great force to be able to stand upright, and the forces are tremendously increased when bending at the waist, such as to pick things up from the ground.



Common signs and symptoms



• Pain in the back that usually affects one side, is worse with movement, and may be felt in the hip, buttocks, or back of the thigh

• Muscle spasms of the muscles in the back

• Swelling along the muscles of the back

• Loss of strength of the back muscles

• Crepitation (a crackling sound) when the muscles are touched


Causes



• Prolonged overuse of the muscle–tendon units in the lower back, usually from incorrect back mechanics

• Possibly, a single violent injury or force applied to the back


Factors that increase risk



• Any sport that causes twisting force on the spine or excessive bending at the waist; also, contact sports, such as football, weightlifting, bowling, golf, tennis, speed skating, racquetball, swimming, running, gymnastics, or diving

• Poor physical conditioning (strength, flexibility)

• Inadequate warm-up before practice or play

• Family history of low-back pain or disk disorders

• Previous back injury or surgery, especially fusion

• Poor mechanics with lifting, especially heavy objects

• Prolonged sitting, especially with poor mechanics


Preventive measures



• Use proper mechanics when sitting or lifting, and maintain proper posture with sitting; lift using the knees and legs, do not bend at the waist.

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes maintaining an ideal body weight, cardiovascular fitness, hamstring and back flexibility, and muscle strength and endurance training.


Expected outcome


With appropriate conservative treatment, low-back strain is usually curable within 6 weeks.



Possible complications



• Frequent recurrence of symptoms may result in a chronic problem; appropriately addressing the problem the first time decreases the frequency of recurrence.

• Chronic inflammation, scarring, and partial muscle-tendon tears may occur.

• Healing may be delayed, or symptoms may be slow to resolve.

• Prolonged disability may result.


General treatment considerations


The injury to the back results in pain and inflammation. The pain and inflammation result in muscle spasms of the back muscles, which in turn result in more pain. Thus the initial treatment consists of rest, medications, and ice to relieve pain, inflammation, and muscle spasms. As pain and spasms subside, exercises to improve strength and flexibility and education regarding proper back mechanics are started. Referral to a physical therapist or athletic trainer may be recommended for these exercises, education regarding back mechanics, and possibly other treatments, such as transcutaneous electronic nerve stimulation (TENS) or ultrasound. A corset or back brace (low back) may be recommended. Biofeedback and psychotherapy may also be prescribed. Prolonged bed rest is felt to do more harm than good, but proper body mechanics should be encouraged. Bending at the knees to pick things up off the ground, as opposed to bending at the waist, sleeping flat on your back on a firm mattress with a pillow under your knees, and using good posture when sitting are helpful. Occasionally an injection of cortisone, with or without local anesthetics, may be administered to help relieve the pain and spasms.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Topical analgesic ointments may be of benefit.

• Pain relievers and muscle relaxers may be prescribed as necessary. Use these medications only as directed, and take only as much as you need. Do not operate any heavy machinery or drive a car while on these medications.

• Oral corticosteroids may be given for pain, or injections of corticosteroids may be administered into the spot where most muscle spasms occur.


Heat and cold



• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. It should be applied for 10 to 15 minutes every 2 to 3 hours as needed and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


When to call your doctor



• Symptoms get worse or do not improve in 2 to 4 weeks despite treatment.

• You develop numbness, weakness, or loss of bowel or bladder function.

• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

image

Figure 1


From Jenkins DB: Hollinshead’s functional anatomy of the limbs and back, ed 6, Philadelphia, 1991, W.B. Saunders, p 193.



Range of Motion and Stretching Exercises


Low-Back Strain


The exact range of motion and stretching exercises appropriate for you should be determined on an individual basis. Some individuals respond better to flexion, such as pulling your knees to your chest, whereas others respond better to extension, such as arching your back. The key point to remember is that if any exercise—range of motion, stretching, or strengthening—causes pain to radiate away from your back and toward your buttocks or legs, stop immediately. The purpose of these exercises is to begin to decrease the intensity and the size of the area of your pain.


These are some of the initial exercises you may use to start your rehabilitation program, until you see your physician, physical therapist, or athletic trainer again, or until your symptoms resolve. Flexion and extension exercises are presented. The specific exercises that are appropriate for you must be specified by your physician, physical therapist, or athletic trainer before you start. Please remember:


• Flexible tissue is more tolerant of the stresses placed on it.

• A gentle stretching sensation should be felt.

• If pain or other symptoms radiate away from the back toward the buttocks or legs, stop the exercises immediately.

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Jul 19, 2016 | Posted by in SPORT MEDICINE | Comments Off on Low-Back Strain

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