BACK STRAIN, LUMBAR-SPINE REGION |
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General Information
DEFINITION--Injury to muscles or tendons that attach to the vertebral column at the lumbar (lower midportion) spine. Muscles, tendons and vertebrae comprise units. The units stabilize the spine and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles of the lower midspine.
One or more vertebral bones or bones of the pelvis.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain with motion or stretching of the lower back.
Muscle spasm in the lower back.
Swelling along muscles of the back.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or tendon (visible with X-rays).
CAUSES
Prolonged overuse of muscle-tendon units in the lower back.
Single violent injury or force applied to the lower back.
RISK INCREASES WITH
Contact sports, especially football or hockey.
Gymnastics or diving.
Improper lifting of heavy objects.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous back injury, especially if it resulted in loss of back mobility.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport. Include exercises to promote back flexibility.
Warm up before practice or competition.
Use proper lifting techniques. Don't bend over to lift. Squat to lift, and rise using leg muscles.
Wear proper protective devices, such as a back brace or taping, to prevent a recurrence after you recover.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's diagnosis.
Application of a cast (rare), brace or corset (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the lumbar spine to rule out fractures or dislocations.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated lumbar-spine injury.
Unstable or arthritic vertebrae following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Recurrence is likely without adequate healing time. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Rest the injured area at the first sign of severe symptoms. Rest in bed until pain decreases. Use a firm mattress.
Use ice to help stop internal bleeding. Prepare an ice pack of ice cubes or chips wrapped in plastic or in a container. Place a towel over the injured area to prevent skin damage. Apply ice for 20 minutes, then rest 10 minutes. Repeat applications for 24 to 48 hours after injury.
CONTINUING CARE
When bed rest is discontinued, you may need a cast or brace to allow the strain to heal completely. Later, a special corset may be used.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After 24 to 48 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Oral dose or injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYRest in bed until pain subsides. If activities are resumed too early, recurrence is likely.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive devices are no longer needed. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have persistent back pain.
Pain or swelling worsens despite treatment.
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