In this blog, 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 is 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 deconditioning. Why deconditioning? Because when we lose our core stability (due to lack of exercise), we are not able compensate for the loads we place on our bodies. Hence, we get injured.
You Are NOT Dying!
When you have just been injured, you may feel as if you are dying. The good news is that you are probably not. There are actually some great red flags we can use to determine whether or not something more serious is occurring.Red Flag
Red Flags are what we look for when we ask our patients a series of questions. 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 complete lack of bladder and bowel control.
Have you experienced “severe numbness around your pelvis”? This is known as Saddle Anaesthesia – which is a complete loss of sensation in the area of the buttocks and perineum (the area between the anus and scrotum in males, and between the anus and vulva in females). This numbness can be a symptom 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. THIS IS A VERY RARE CONDITION.
Do you have “pain shooting down your leg from your low back to your foot when coughing, sneezing, or bearing down on stool”? If yes, this could be an indication of a disc issue, or if after a fall or trauma, an indication of a possible spinal fracture.
Again most sprain/strain injuries do NOT exhibit these symptoms.
If they are present, you may be required to undergo further diagnostic procedures (X-rays, in-depth neurological examination, and so on) that can provide more information to your practitioner.
If you actually do have some of these problems, then please go directly to the hospital. The GOOD NEW is, most patients with Sprain-Strain injuries will answer NO to these questions. In other words, YES, you may be experiencing major pain, but it is NOT an emergency situation.
Let’s Define 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 grading 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 functional activities.
Grade-Three Sprain (Severe): Involves a complete tear of the ligament, with severe pain, bruising, swelling, and loss of function. Grade-Three Sprains often 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 (such as Motion Specific Release–MSR) 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 grading in the following manner:
Grade-One Strain (Minor): Involves minimal stretching and tearing of muscle fibres. These tears usually heal within a few weeks.
Grade-Two Strain (Moderate): Involves more damage to muscle fibres, but does not include complete rupture of the muscle. Healing occurs 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, tissues, and bones of your body.
Every injury has a physical consequence, often in the form of biomechanical compensations, muscle imbalances, and inappropriate tissue remodeling.
In basic physiology, there is one 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)
So, if you don’t take the time to properly address your acute injuries, then you are basically setting yourself up for future chronic problems (ones which could show up years later).
Don’t kid yourself into thinking you are fine when your not. Trust me… I know what I am talking about. As a marathon runner and triathlete for over 30 years, I overlooked or ignored multiple injuries in my youth, thinking there would never be consequences. There always was, I just didn’t see it at the time.
If you strain your back, get it looked at as soon as possible by an experienced and trained MSK Practitioner. Techniques such Motion Specific Release, Chiropractic Manipulation, Registered Massage Therapy, and Acupuncture can make a huge difference, not only in healing from an acute injury, but also in the prevention of future chronic problems. So stop delaying your treatments if you are injured—see your Chiropractor or MSK practitioner — you will thank your practitioner further down the road.
Chou R, Quaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.
Andersson GB. Epidemiological features of chronic low-back pain. 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.
Ellenbecker, Todd, "Effective Functional Progressions in Sport Rehabilitation", Human Kinetics 2009
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 in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publications which will be available later this year.
Dr. Abelson is the owner of Kinetic Health, a partner in BKAT Motion Specific Release, and a partner in Rowan Tree Books.