Mechanical Back Pain - Sprains/Strains
Updated: Oct 9
In this article, I want to talk about one of the most common causes of Low Back Pain (LBP). In fact, this problem accounts for about 60% of all low back injuries – the sprain/strain injury of the lumbar spine (1,2).
The lower lumbar region (L4/L5 and L5/S1) is particularly susceptible to injury, since the majority of load-bearing forces in the human body are concentrated at the base of the spine. That being said, sprain/strain injuries can occur anywhere along the length of the spine from the neck down to the tail-bone.
Typically, sprain/strain injuries are due to over exertion (snow shoveling, lifting, etc.), accidents (slips, falls, sports, weekend warrior syndrome) and de-conditioning. Why de-conditioning? When we lose our core stability (due to lack of exercise), we are not able to compensate for the loads we place on our bodies. Hence, we get injured. The good news is there is a lot you can do to take control of this situation. But first let lets talk about "Red Flags"!
HOW DO YOU KNOW YOUR NOT DYING?
When you have just been injured, you may feel as if you are dying. The good news is that your probably not. How do we know this? Its because of the Red Flags. Red Flags are signs and symptoms that something more serious is occurring.
Every time we ask you questions about your condition we are always looking for Red Flags. Some of these questions would include (3):
Have you experienced a “recent onset of bowel or bladder incontinence”? We are not asking about minor changes in bowel movement, but are instead investigating a significant and recent lack of bladder and bowel control. This would be an indication that something more serious is going on, and that your condition may NOT be mechanical in nature.
Have you experienced “severe numbness around your pelvis”? This is known as Saddle Anesthesia – which is a complete loss of sensation in the area of the buttocks and perineumcer (the area between the anus and scrotum in males, and between the anus and vulva in females). We would also ask you if you are experiencing significant lower extremity weakness, in both legs or numbness. These symptoms can be an indication of Cauda Equina Syndrome – a neurosurgical emergency – caused by compression of the nerve roots below the level of the spinal cord, and sometimes as a result of a prolapsed disc. Cauda Equina Syndrome is A VERY RARE CONDITION.
Have you had a recent trauma? In these cases we are looking to rule out fractures, or significant soft tissue damage.
Do you have a history of cancer? Have you experienced unexplained weight loss? Do you have a persistent fever, suffer from extreme fatigue, do you have sores that don't heal, and many other questions. Though not on the top of our list, cancer and tumors are in our list of differentials.
Have you had a persistent fever (over 100.4)? Recent spinal surgery history within the last year? We may ask you questions about being immuno-compromised. In these cases we are looking for indications of possible infection.
We would also ask you questions about any progressive neurological deficits, such as major muscle weakness, major sensory weakness, and indications of significant muscle atrophy.
Fortunately, most sprain/strain injuries DO NOT exhibit these symptoms.
WHAT ARE SPRAINS AND STRAINS?
Sprains and Strain are actually two different types of injuries. Though sprains and strains often occur together, they involve different parts of your body, and have distinctive and dissimilar impacts on your body.
Sprains are injuries to the ligaments (tough, fibrous tissues that connect bone-to-bone, and act to limit excessive movement within a joint). Ligaments provide stability through all ranges-of-motion.
Sprains in the spinal column occur when a spinal ligament is stretched or torn from its attachment site. Sprains are graded in the following manner:
Grade-One Sprain (Minor): Involves minor tearing of the ligaments, with no resulting joint instability, and minimal bruising.
Grade-Two Sprain (Moderate): Involves partial tearing of the ligaments, with bruising, pain, swelling, and some loss of your functional ability.
Grade-Three Sprain (Severe): Involves a complete tear of the ligament, with severe pain, bruising, swelling, and loss of function. Grade-Three Sprains may require surgical intervention for a full resolution.
By far the majority of sprains are Grade-One and Grade-Two, which can be treated quite effectively by using a combination of manual therapy and appropriate rehabilitative exercises.
Strains describe injuries to muscles and tendons. Strains typically occur when muscle or tendon fibres are over-stretched or torn. Strains are graded in the following manner:
Grade-One Strain (Minor): Involves minimal stretching and tearing of muscle fibers. These tears usually heal within a few weeks.
Grade-Two Strain (Moderate): Involves more damage to muscle fibers, but does not include complete rupture of the muscle. Healing most often occurs within three to six weeks.
Grade-Three Strain (Severe): Involves a complete rupture of a muscle. This type of injury often requires surgical intervention, with post-surgery healing taking up to three or more months.
WE ALL CARRY OUR HISTORY
I am being quite literal when I say that “we are all walking around, with a recorded history of every injury that we have ever suffered”. This history is stored in the muscles, connective tissues, and bones of your body.
Every injury has a physical consequence, often in the form of bio-mechanical compensations, muscle imbalances, and inappropriate tissue remodeling.
In physiology, there is a law of cellular remodeling that you just can’t get around. This is known as Davis’s Law which describes how soft tissue (muscle, tendons, ligaments, and fascia) remodels itself in accordance to the demands placed upon it. This law describes how, based on the stresses placed upon it, soft tissue thickens, become less elastic, and loses its ability to store and release energy. (4)
Therefore, if you don’t take the time to rehabilitate your injuries, you are basically setting yourself up for future problems (ones which could show up years later).
I know what I am talking about. All my life I have been involved in contact sports, marathons, and triathlons, many times I foolishly overlooked or ignored injuries in my youth. There was always a consequence to these injuries, sometimes not for many years. For example, just three years ago I had a hip replacement due to osteoarthritic changes in my hip. The osteoarthritis that started in my hip was the result of a cycling injury that happened in my late twenties that was never looked at.
GET ASSESSED - GET TREATED - RESOLVE THE ISSUE!
Sometimes a minor injury is just that. In these cases all that is needed is some good advice and the right set of exercises. In other cases when you are suffering from acute pain a proper assessment is definitely what is needed. In these cases see a qualified practitioner ASAP! Rule out the Red Flags, let the practitioner examine you using orthopedic and neurological tests, then get treated so that you can resolve your pain, and reduce the probability of a chronic problem developing. The right treatment in the early stages of an injury can put you back in control of your life much faster than trying to ignore an injury.
Sprain/Strain injuries of the low back (or any where in the back) usually involve both soft tissue and joint dysfunction. For the best result, a combination of procedures must be used to address both problems.
Below are some links to videos demonstrating manual therapy procedures that we often have used successfully in treating sprain-strain injuries. These videos include both soft tissue and joint mobilization procedures.
Note: This is only a small sample of possible procedures. These videos are for demonstration purposes only, and should only be performed by a qualified practitioner.
The Deep Para-Spinal Release: The Deep Para-Spinal (transversospinalis) muscles often atrophy in cases of chronic low back pain. Trigger points are often found in two of those muscles (multifidus and rotatores). These trigger points can feel like small nodules. Release of these nodules, before mobilization/manipulation of the spine, will greatly help improve treatment outcomes. (The video will be available to the public May 14/2020)
The Gluteus Maximus Release - Motion Specific Release (MSR): In this video Dr. Abelson demonstrates how to use Motion Specific Release (MSR) to release restrictions in the Gluteus Maximus muscle. Strong, flexible, engaged gluteal muscles are critical to optimum performance and injury prevention.
Thoracolumbar Fascial Release - Motion Specific Release: The thoracolumbar fascia (TLF) plays a critical role in both stabilization of the spine and in load transfer from the core. In this video Dr. Brian Abelson DC. demonstrates an extremely effective way of releasing the TFL. MSR videos are for demonstration purposes only. If you have a medical condition, please see your medical practitioner.
Lumbar Spine Joint Mobilization - MSR: Our capacity to produce an unlimited variety of movements requires good joint integrity. No joint ever works in isolation. An injury in one joint often results in bio-mechanical compensations occurring in both adjacent and distant joints.
Research has shown that spinal mobilization/manipulation is an effective component of an overall treatment strategy for relieving pain (local and radiating pain) in patients who suffer from back pain and sciatica. (The video will be available to the public July 2/2020)
EXERCISE CAN NOT BE IGNORED
Exercise is always a critical factor in reaching a full recovery. Recovery is a partnership between the patient and the practitioner. It is the practitioners responsibility to provide the best possible treatment, and it is the patients responsibility to do daily exercises to reach a full recovery. A full recovery is not achieved just by a lack of pain. A full recovery is only achieved when the patients body has reached a level of stability, where a future injury of the same type is unlikely.
Exercise programs in general should start with recommendations for the acute stage. Then focus on mobility and flexibility, progressing to strengthening, and then into functional exercises which focus more on balance and proprioception.
The follow videos are exercises that we may prescribe to our patients. Please note that each exercise recommendation should be specific to the individual. The first video is on how to avoid aggravating a back strain it covers: sleeping positions, bracing your core, lifting, and many other common activities that make back pain worse.
Back Pain and Activities of Daily Living: In this video we give you key information on Back Pain and your Activities of Daily Living. Performing everyday actions in the right way can make all the difference.
Cat Camel Stretch - First stretch of the day: This is the first stretch you should perform in the morning, even before you get out of bed. This is a great spinal mobilization exercise. If you are suffering from back pain avoid intense exercises that involve stretching or bending first thing in the morning. Give your body time to warm up. It takes about an hour for the extra fluid in your spinal discs to be squeezed out through normal motion.
Myofascial Release with a Foam Roller - The Back Muscles: In this video we show you how to release myofascial restrictions in glutes, lumbar and thoracic spine.
Pelvic Raises - Beginner to Advanced: Pelvic raises are a great way to activate the muscles of your hips and pelvic floor. This exercise tones and strengthens the muscles of your lower back, abdominals, glutes, and hamstring. This video demonstrates three versions: Beginner, Intermediate, and Advanced. Do NOT attempt the advanced version until you can successfully perform the beginner and intermediate versions with good form.
4-Point Kneeling Exercise - The Bird Dog: This is a great exercise for grooving your nervous system. An important exercise if you have low back pain, and can even be performed shorlty after an injury. Four-point kneeling teaches your body to transfer energy from your lower extremity through your core to the upper extremity. Best of all, it acts to increase the stability and motor control of your whole body.
Core Exercise - Front Plank - Kinetic Health: In this video, we show you how to perform both the Beginner and the Standard plank. Both are great core exercises that work to stabilize the shoulder and strengthen the muscles of your core. Ensure that you only do this exercise within your pain-free zone.
Though common, a strain of the low back can be extremely painful. With the right strategy this problem is often resolved within a relatively short period of time. Take control of the situation and address this problem in the right way:
Get examined by a professional.
Get the treatment you need.
Remember that exercise is essential not optional.
An acute episode of low back pain does not have to become a chronic problem, DO NOT make it one! Life is too short to waste your time dealing with injuries, when you could be out there enjoying your life! Take control of your Back Pain!
DR. BRIAN ABELSON DC.
Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.
Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.
Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Chou R, Quaseem A, Snow V, et al. Intern Med. 2007;147(7):478-491.
Epidemiological features of chronic low-back pain. Andersson GB. Lancet. 1999;354(9178):581-585.
Bigos SJ. United States Agency for Health Care Policy and Research. Acute low back problems in adults. Clinical practice guideline. Rockville, Md: US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. viii, 1994:160.
Effective Functional Progressions in Sport Rehabilitation, Ellenbecker, Todd, Human Kinetics 2009
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