Low Back Pain

What is a low back strain or lumbar sprain?
Muscle strains and lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscle fibers are abnormally stretched or torn. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms. Many doctors refer to both injuries as a category called "musculoligamentous injuries" of the lumbar spine. In general, it doesn't matter what you call the problem because the treatment and prognosis for both back strains and sprains is the same.
Nearly everyone will experience low back pain at some point in their life--it is the second most common cause of missed days of work in the United States! (Only a common cold causes more missed work). Almost all of these low back injuries are due to injuries of the muscle or ligament. If you don't know the cause of your back pain, you should have it evaluated by a doctor. Some warning signs of a serious injury to the spine include:

Loss of control of bladder or bowels
Progressive lower extremity weakness
Severe, constant pain
As said earlier, most back pain is caused by a muscle strain or ligament sprain. However, there are serious conditions that require more immediate treatment. If you are unsure of the cause of your symptoms, you should be evaluated by a physician.

Why are sprains and strains of the low back so common?
The spine is supported by large muscles called the paraspinal muscles. These muscles both support the spinal column as well as the weight of the upper body. The five lumbar vertebrae are connected by tough ligaments that help to maintain the position of the spinal column.

These muscles, ligaments, and bones all work together to provide control and strength for nearly all activities. The lumbar spine and its muscles are needed for most all movements and activities. For this reason, the lumbar spine is prone to injury, and when an injury has been sustained, we are prevented from performing many activities.

What are the symptoms of a low back injury?
Most lumbar muscle strains and sprains cause symptoms isolated to the low back, usually they do not cause problems in the legs like some other spine conditions. The most common symptoms of a lumbar strain or sprain are:

Pain around the low back and upper buttocks
Low back muscle spasm
Pain associated with activities, and generally relieved with rest
What causes these symptoms of low back pain and spasm?
When the lumbar spine is strained or sprained, inflammation of the soft-tissues results. This inflammation causes pain and can cause muscle spasm. People are often surprised at how painful and debilitating a lumbar strain or sprain can be--these are not small injuries. They often force patients to remain in bed for a day or two, and can cause intermittent symptoms for weeks. That said, over 90% of patients are completely recovered from an episode of lumbar muscle strain or sprain within one month.

Why do some patients tend to have low back strains and sprains more often?
Good question! We do know some factors that tend to influence the development of this type of problem, but often these symptoms strike in unexpected situations. Most commonly, patients who develop a lumbar strain or sprain are doing an activity that places their back at risk. This may be a sudden forceful movement, lifting a heavy object, or twisting the back in an unusual manner. Knowing how to properly lift can help to prevent many back injuries.

Some well known factors that contribute to low back pain include:

Poor conditioning
Obesity
Smoking
Improper use/lifting technique
If you have persistent problems with your lumbar spine, consider these issues. If you smoke, are overweight, or do not perform regular back strengthening exercises, then you have steps that you can take to help control your symptoms.

Treatment of a lumbar muscle strain is important to understand. Once you know the cause of your symptoms, you can proceed with treatment. It is important that if you are not sure of the cause of low back pain, that you are evaluated by a physician. There are low back conditions that require immediate treatment.
Step 1: Rest
The first step in the treatment of a lumbar muscle strain is to rest the back. This will allow the inflammation to subside and control the symptoms of muscle spasm. Bed rest should begin soon after injury, but should not continue beyond about 48 hours. While it is important to rest the injured muscles, it is just as important to not allow the muscle to become weak and stiff. Once the acute inflammation has subsided, some simple stretches an exercises should begin (see below).
Step 2: Medications
Two groups of medications are especially helpful in treating the acute symptoms of a lumbar back strain. The first of these are anti-inflammatory medications. These medications help control the inflammation caused by the injury, and also help to reduce pain. There are many anti-inflammatory options, talk to your doctor about what medication is appropriate for you.
The second group of medications commonly prescribed for the treatment of lumbar strains are muscle relaxing medications. Again, there are several options that you may discuss with your doctor. These medications are often sedating, so they need to be used with care. For patients who have back spasm symptoms, these muscle relaxing mediations can be a very useful aspect of treatment.

Step 3: Physical Therapy/Exercises
Proper conditioning is important to both avoid this type of problem and recover from this injury. By stretching and strengthening the back muscles, you will help control the inflammation and better condition the lumbar back muscles. The exercises should not be painful. Without some simple exercises, the low back muscles can become "deconditioned," or weak. When the low back muscles are deconditioned, it is very difficult to fully recover from low back injuries.
It is also important to understand that even if you are "in good shape," you may have weak low back muscles. When you have a low back muscle injury, you should perform specific exercises that stretch and strengthen the muscles of the low back, hips and abdomen. These exercises are relatively simple, do not require special equipment, and can be performed at home.

Step 4: Further Evaluation
If your symptoms continue to persist despite treatment, it is appropriate to return to your doctor for further evaluation. Other causes of back pain should be considered, and perhaps x-rays or other studies (MRI, CT scan, bone scan, laboratory studies) may be needed to make an accurate diagnosis.