Sprains and strains often result from excessive physical demands on the back. Lifting something too heavy, a sudden fall, car crash, or sports injury can cause soft tissues (ligaments, muscles, tendons) to stretch too much.
Sprains · Strains
The spine includes vertebrae (bones), discs (cartilaginous pads or shock absorbers), the spinal cord and nerve roots (neurological wiring system), and blood vessels (nourishment). Ligaments link bones together, and tendons connect muscles to bones and discs. The ligaments, muscles, and tendons work together to handle the external forces the spine encounters during movement, such as bending forward and lifting.
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Sprains and strains are similar disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations.
Ligaments are strong flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some freedom of movement. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury.
To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.
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author : Jean-Jacques Abitbol, MD, FRCSC, Edgar G. Dawson, M.D., Regis W. Haid, Jr., MD
a. Symptom and Diagnosis Back Pain
What is acute low/mechanical back pain?
Acute low/mechanical back pain is a common medical problem. Acute pain is pain that has been present less than 4 to 6 weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome.
What causes low/mechanical back pain?
A precise cause of low/mechanical back pain can be identified 20 percent of the time. Sometimes, a specific trauma or strenuous activity may cause the pain. However, 80 percent of the time, the specific source of pain is not found.
It implies the source of pain is in the spine and/or its supporting structure. The surrounding muscles and ligaments may become inflamed and irritated.
Less than one percent of people who develop acute low back pain have a serious cause, such as cancer or infection, to explain their pain.
What are the symptoms of low/mechanical back pain?
Most people experience pain primarily in the lower back. The pain may spread (radiate) to the buttocks, thighs or knees. Many people may also experience spasms with mechanical back pain. The symptoms of low/mechanical back pain are generally more noticeable with flexion of the back and when lifting heavy objects.
Back pain is usually more severe than leg pain (sciatica). Sciatica is usually the result of a pinched nerve, when a protruding disc is putting pressure on a spinal nerve. With sciatica, the pain frequently extends below the level of the knee.
How is back pain diagnosed?
A careful evaluation of your medical history and a physical examination will help your health care providers determine if you have mechanical back pain. Then, they will work with you to create an appropriate treatment plan.
If your health care provider has determined your back pain is mechanical, additional testing is not usually necessary. If your symptoms or examination suggest the possibility of infection, malignancy or a pinched nerve, additional tests may be necessary. Additional testing may include blood tests, X-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or nerve conduction studies.
b. Exercise For Back Pain
1. What is Physical Therapy?
Physical Therapy (PT) is considered a conservative treatment method addressing the treatment, healing and prevention of injuries and disabilities. PT focuses primarily, but not solely, on pain relief, promoting healing, and restoring function and movement associated with injury. Other areas within physical therapy are ergonomic (body mechanic) training, fitness/ wellness, and especially education and prevention.
2. What can a Physical Therapy program do for me that I cannot do on my own?
Many patients may think that they know how to properly exercise, manage their pain and rehabilitate themselves. I have commonly been given explanations from patients for why they do not need therapy - for example, "I have had this before and I know what works for me" or "I know what is causing this, because my neighbor had the same thing so I will just do what she did" and attempt to manage themselves. A Physical Therapist is a specialist skilled and educated specifically in proper rehabilitation. We are continually educated as to management for different dysfunctions, differentiation of one dysfunction/injury from another and work closely with the referring physician in the development of a rehabilitation program specifically designed for each individual. The other important aspect to remember with physical therapy is that each individual is different. We all have different types of bodies, different patterns of movement, alignments and habits. A physical therapist, along with their trained staff, monitors each individual and attempts to correct improper movements, alignments and habits.
Most importantly with therapy comes education. Because of healthcare guidelines and reimbursement changes, your physician may not have the time needed to explain exactly what your injury/dysfunction/disability is and why/how it occurred. Your therapist is specialized in this and many times is the person who will educate you about the specifics of your problem and what the course of action will be to correct it and hopefully prevent it from reoccurring. PT focuses on education, correction and prevention.
3. How long is it going to take?
This is such a popular question. It seems that everyone has to have timelines, which is understandable because we all have lives to lead. Your physical therapist is aware that rehabilitation can be an imposition. I explain that because each person is different, rates of healing are different. I can usually get an idea of your progress within two weeks. I explain to my patients that even though they have other things to do, rehab is important. Although rehab takes time, it also took time for the injury to progress to the point of causing pain or contirbuting to injury.
Physical therapists want their patients to understand that although we are here to teach and rehabilitation them, their Home Program it is their responsibility. The Home Program is a major contributing factor to how quickly the patient recovers.
4. Who benefits from physical therapy?
Many and all can benefit from physical therapy. As an active therapist, I work out and always observe others. I very rarely come across individuals with perfect body mechanics, training techniques or movement patterns. This is where wellness comes into play. Typically, the most appropriate patients are those who have been in accidents (work, auto, or falls), athletes with overstress injuries, patients with arthritis, pre- and post-operative patients, and people with general deconditioning or strains.
5. What will I have to do in physical therapy?
PT generally encompasses pain relief, strength and flexibility training, proper postural alignment, regaining movement or range of motion, improving and correcting posture, endurance training, relaxation and stress relieving techniques, balance and coordination training, proper walking, education, safety awareness and development/implementation of a home exercise program.
Remember that each individual is different, so each rehab/physical therapy experience and program is different. Be patient with yourself, your physician and your physical therapy staff. Healing takes time, diligence and compliance. If you think you may be a candidate for physical therapy, speak to your physician or to a therapist. We never will say "no" to questions.
author : Dana L Davis MPT
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