Last updated: June 13, 2019
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Lumbar strain

 

 

Low back pain can often be difficult to diagnose due to the complex nature of the symptoms and origins.  Add to this the complexity of the spine, muscles, ligaments, and tendons in the low back, and diagnosis becomes tricky.  Low back pain does not always begin in this region, but may begin in other areas of the body and increase in area to affect the structures in the low back. 1

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The origins for low back pain have been identified, and they include the following:

Nerves                                               Abdominal Aortic aneurysm

Circulatory disorders             Sacroiliac Joint dysfunction

Congenital disorders             Piniformis syndrome

Postneural difficulties                       Fibromyalgia

Trauma                                   Automobile accidents

Infections                              Pregnancy related back pain

Degenerative disorders          Rheumatoid Arthritis

Tumors                                   Osteoporosis

Hip osteoarthritis                   Ankylosing spondylitis 1,2

 

 

The origins for low back pain are categorized as different groups of disorders – these disorders being the “most common causes and diagnoses of low back pain.” 1  They include:  1) Mechanical Disorders; 2) Inflammatory and Infectious Disorders; 3) Developmental Disorders; 4) Tumors; and 5) Trauma. 1

It is imperative to mention that no matter what the disorder, emotional distress can greatly affect low back pain, whether the pain is of an acute or chronic cause.  People suffering from chronic back pain may be pain-free for a long period; then, with an emotionally-upsetting experience,  exacerbation of the on-going pain occurs. 1

Let’s examine the anatomy and physiology of the lower back to have a full understanding of all components that may be involved in any particular disorder.  The lumbar spine, commonly referred to as the low back, is between the thoracic and sacral divisions of the spinal column.  Back pain most commonly occurs in this region of the back, because “these vertebrae carry the most amount of body weight and are subject to the largest forces and stresses along the spine.” 1

 

 

The lumbar spine components are the vertebrae (designated L1-L5, respectively),

intervetebral discs, facet joints, ligamentum flavum, spinal nerves, spinal musculature, and the sacroiliac joint.  See Figs. 1-3. 1, 8  People who suffer from mechanical pain in the lumbar region do so because a spinal component in this area is damaged or injured.  Any of the above named component parts could be involved. 1

 

Mechanical Disorders

Mechanical disorders can include a myriad of problems, including degenerative disc disease, herniated discs, strains and sprains, facet arthropathy, stenosis, myelopathy, and spondylolysis.  Lumbar strain, Degenerative disc disease (DDD), herniated discs, facet arthropathy, Failed back syndrome(FBS) will be discussed in length below. 1

Lumbar Strain or sprain is defined as lower back pain that occurs after an injury, or results after a sudden movement or a very strenuous day at work.  The lumbar region accepts most of the stress or punishment of the twisting, lifting, and bending movements associated with handling or moving objects.

Strain or sprain occurs when improper body mechanics have been used; or, the object was too heavy for the individual manipulating it.  An object may also be too heavy for a particular individual not just solely due to weight, but also due to the person’s weak stomach muscles secondary to a sedentary lifestyle and/or obesity.

Strains or sprains are small tears in the muscles and ligaments surrounding the lumbar region of the spine.  The tears in the muscle result in accumulation of small amounts of blood within the injured muscle(s), which consequently results in muscle spasms and pain.  No further lifting or activity should be undertaken when this type of pain occurs, until you have sought medical help, followed the practitioner’s treatment protocol, and returned to normal functioning.  When first injured, massages, alternating hot and cold packs, and rest are the proven remedies to help the body heal itself.

Other treatments for lumbar strain and sprain include anti-inflammatory drugs and stretching and strengthening exercises.  These exercises should be used even after healing from the acute pain, in order to help prevent further injury in the future.  Shortly, these exercises will be outlined.

Though patients may feel they have suffered only a lumbar strain or sprain, if the following symptoms occur, medical attention is necessary.  More than a strain may be present:

·         Changes in your bowel and bladder habits, especially

incontinence; or, difficulty controlling bowel movements

·         Feelings of weakness in the legs or instability when

walking; or, “progressive decrease in the distance that

you can walk.” 1

·         Numbness and pain traveling down the legs, especially

if it is worse with coughing and sneezing or sitting.

·         Pain that is bad enough that it wakes you during the

night.

·          Pain that is worse when you are lying down. 1

 

 

Low Back Exercise Program

 

Lumbar strain and other lumbar disorders and diseases causing pain have been discussed.  Following are exercises that can be done to strengthen and lengthen the muscles of the lumbar spine.  These may be done as a rehabilitative practice; or, they may be done at home on your own as a preventative measure.  No exercises should be undertaken immediately following a lumbar injury without the precise direction of your physician or physical therapist. 6

People who are in good physical shape and are at their proper body weight for age and height can still have weak stomach, pelvic, and lumbar spine muscles.  Without proper exercise, the low back will be deconditioned and prone to injury.  Anyone can benefit from these exercises: 6

·         Knee to chest                         Pelvic Tilt

·         Hip rolling                             Pelvic Lift

·         Lower abdominal exercises   Curl ups

·         Cat and camel                                   Tail Wagging

·         Hip extension                        Hand-Knee Rocking

·         Lying prone in extension       Press up

·         Back extension                      Knee push up

 

 

 

 

 

 

·         Push up                                  Trunk rotation

·         Full back release                    Upper back stretch

·         Side bending                         Backward bending

·         Pectoralis stretch 5

 

*See the examples of a few exercises in Figs. 5-13.

 

 

Exercise done immediately following the injury, under the direction of a therapist, will not only stretch and strengthen the back muscles, but in doing so will also reduce the inflammation caused by the injury or condition.  These exercises should not cause pain.  Exercise is usually recommended for 10-30 minutes per day, according to your practitioner.2  Additionally, the physical therapist may employ the use of ultra-sound, heat and ice to the low back region to relieve painful muscle spasms. 3

 

Medication Usage

 

Mentioned throughout discussion of these low back conditions has been the use of non-steroidal anti-inflammatory drugs in conjunction with therapy and exercise.  These drugs include the use of Nuprin, Voltaren, Tolectin, Dolobid, Motrin, Naprosyn, Lodine, Clinoril, or Feldene. 3

 

Spinal Injection Treatments  Patients suffering from chronic pain may add yet another treatment regimen to their pain relief program.  Different types of spinal injections are given at different locations and in different fashions dependent upon the origin of the pain. 7

General contraindications to any spinal injection would be an on-going medical condition that would leave the patient in a debilitated state.  Additionally, any bleeding conditions or infections would also prevent a patient from seeking spinal injections for pain relief. 7

Commonly, a local anaesthetic such as Lidocaine, Xylocaine, or Marcaine will be used in conjunction with Cortisone, a strong anti-inflammatory that lasts for longer durations.  Sometimes, doctors will also include a narcotic medication with the other two for further pain relief.  Fentanyl and Morphine are commonly used. 7

 

The spinal injections differ in the site administered as well as for the purpose given.  The types of injections are as follows:

·         Epidural steroid injection (ESI)

·         Facet joint injections

·         Hardware injections

·         SI joint injections

·          Differential lower extremity injections  7

 

 

New Innovative Treatment

 

VAX-D is a relatively new treatment for people with chronic back pain, as well as leg pain and numbness associated with herniated or degenerated discs.  Patients with pain from posterior facet syndrome also benefit from this non-invasive procedure. 4

VAX-D, or rather Vertebral Axial Decompression, differs from traction in two important ways:  1) The patient is treated in the supine, not the prone position;  2) A pelvis harness is applied, versus a chest harness as in traction.  The pelvis harness is preferred in VAX-D because it does not limit breathing, and does not risk the chance of reduced blood flow back to the heart.

 

“VAX-D is the only medical device that delivers treatment

through its patented logarithmic decompression curve.

The treatment is designed to relieve pressure on structures

that may be causing back pain usually associated with bulging

or herniated discs and degenerative disc disease.  VAX-D is

safe and effective and does not involve the risks associated

with surgery or injections also used to treat chronic back pain.” 5

 

 

 

VAX-D treatment involves use of a table which can separate between the chest and pelvic regions.  Also, 20-24lbs. Of pressure  are applied at various areas along the lumbar spine, according to the physician’s directions and the origin of the problem.  A bar above the patient, allows the patient to hold his upper body while the maneuvers are being done.

 

Herbal Treatments for Back Pain

A recent review of 10 studies for the use of devil’s claw, white willow bark, and cayenne for acute, subacute, or chronic low back pain, was done by Joel Gagnier, ND of Canada’s Provincial Medical Centre in Windsor, Ontarior, Canada.  All studies combined followed the short-term(six week) progress of 1,567 people. 9

Gagnier’s group voiced some concern about conflicts of interest in 6 of the studies, and some concern about the quality of the studies.  Gagnier’s group agreed that long-term, high-quality studies must be conducted before final results may be calculated, but the preliminarily findings were:

·         Standardized doses of 50-100mg of devil’s claw, taken

orally, reduced back pain more than placebo.

·         60mg daily doses of devil’s claw also “appeared

to cut back pain as much as a 12.5mg daily dose of

Vioxx, a painkiller no longer…..”

·         White willow bark, administered at daily dosages

of 120-240 mg, was found to reduce back pain

more than placebo.

·         Cayenne, when applied to the skin as a plaster,

appeared to reduce the back pain more than placebo. 9

 

 

It is imperative to remember that over-the-counter herbs are not regulated as prescription drugs are.  History taking on any patient should include a direct inquiry about herbal medicines, because most people due not consider them medicines and will not mention them if not asked specifically. 9

With today’s popularity and increased use of home remedies from herbal medicine, important and sometimes life-threatening side-effects have found to result from the use of the herbs themselves, or the use of herbs in combination with prescribed drugs.

For instance, some herbs will lengthen the clotting time, therefore unexpectedly presenting bleeding problems in surgery without the physician’s foreknowledge of the patient’s use of herbs and their respective effects.

 

Chiropractic and Acupuncture:  “Chiropractic and acupuncture have the same role.  Their mechanism of actions are still not proven but only theorized.” 9  Though the methods of their actions remain undetermined, many patients experience relief from the perceived pain.  Therefore, since there are no scientifically-based reasons for improvement, the benefit is supported by observational reports only. 9

 

Massage Techniques for Lumbar Strain:   The importance of massage immediately after a lumbar injury is not just for comfort and relief of pain.  The most important reason for massage is to reduce soft-tissue damage that has occurred from the injury. 10

Scar tissue will occur where muscle fibers have been torn.  If “the area is not properly mobilized during the healing phase, scar tissue may inappropriately bind adjacent muscle fibers and prevent optimal function of the muscle.”  This mobilization is accomplished by a massage technique called deep transverse-friction. 10

No doubt the muscles involved in lumbar strain become taught.  The methods used to reduce the tension in the muscle are called deep longitudinal-stripping.  Another technique that can be used to reduce the hypertonicity of the affected muscles is static-compression, wherein the palm of the hand is used to apply a broad range of pressure. 10

If putting pressure on the affected muscles results in too much pain for the patient, the therapist can utilize stretching procedures solely, instead of massage.  These facilitated stretching techniques are also named “muscle-energy technique or Proprioceptive Neuromuscular Facilitation(PNF)”. 10

In summary, lumbar back pain can have a number of different causes, from injury and trauma, to degenerative changes and infection, to tumors.  Treatments involve physical therapy, medications, exercising, injections, VAX-D, and surgery when all conservative means have been exhausted.

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 1

 

 

 

 

 

 

Fig. 2.                                                 Fig. 3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
SAMPLE LOW BACK EXERCISES
 

Knee to Chest

 

 

Hip Rolling

Cat and Camel

 

 

 

Tail wagging                                                                         Hand knee rocking

 

 

SAMPLE LOW BACK EXERCISES
 

 

Press up                                                                                 Back extension

 

 

 

 

 

 

Knee push up

 

 

 

 

 

 

Trunk Rotation

 

 

 

 

 

 
BIBLIOGRAPHY
 

All About Back & Neck Pain:  Articles. 2005. Available at

www.back.com. Accessed November 2, 2006.

 

Miscellaneous Causes of Low Back Pain. 1999-2006. Available at

www.spine-health.com/topics/cd/overview/lumbar/misc/misc01.html.

Accessed November 2, 2006.

 

Lumbar Spine Anatomy and Biomechanics. 2003. Available at

www.athomeseminars.com/newweb/No_Flash/Lumbar1x.htm.

Accessed November 2, 2006.

 

Texas Spine Center:  Complete Solution for Neck & BackPain. 2005. Available at

www.texasspinecenter.com/en/cms/?5.

Accessed November 2, 2006.

 

About Orthopedics:  Lumbar Strain Treatment – Back Muscle Strain Treatment.
20/05/04. Available at
http://orthopedics.about.com/cs/sprainsstrains/a/lowback_2.htm.
Accessed November 2, 2006.

 

Nismat WEB SITE – Low Back Exercise Program:  Low Back Exercise Program. Available at

www.nismat.org/orthocor/programs/lowback.html.

Accessed November 2, 2006.

 

All About Back & Neck Pain   Your online resource for info about BACK and NECK pain!

Available at www.allaboutbackandneckpain.com/html/spinesub.asp?id=14.

Accessed November 2, 2006.

 

Low Back Anatomy  Low Back Pain – Anatomy. Available at
www.dcdoctor.com/pages/rightpages_healthconditions/lowbackpain/lbp_anatomy.html.
Accessed November 5, 2006.

 

Haronian, E MD. Disorders & Surgery of the Spine  Your Diagnosis:  Lumbar: Strain.

Available at www.espinedoctor.com/diagnosis_lum_strain.htm.

Accessed November 5, 2006.

 

Massage Magazine  Lumbar Muscle Strain Massage Techniques. Available at

www.massagemag.com/Magazine/2004/issue111/assess111.5php.

APPENDIX:  TITLE PAGE
 

 

 

 

 

 

 

 

 

LUMBAR STRAIN

 

 

 

 

 

 

 

2006