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| Patient Education -- Lumbar Sprain
/ Strain |
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Lumbar Sprain / Strain
Lumbar, low back sprain/strain occurs with a sudden stressful
injury to the low back region, causing stretching or tearing
of the muscle/tendons/ligaments of the low back region.
The muscles are large in this area and when a strain occurs,
severe low back pain is the result. However, a sprain
or strain my be misdiagnoses when an underlying disc injury
has not yet made itself evident.
The erector spinae muscles are the firm prominent muscles
that you can feel in the lower part of your back, on either
side of the midline. These muscles can be painful when
they get tensed and cramped up in spasms. When strains
are imposed on the psoas muscle, tremendous forces are
exerted on the lumbar spine. These forces can be very
irritating to the low back.
Typical Pain and Findings
The low back pain from a sprain or muscle strain is in
a broad area of the back and may be on either side, with
consequent painful muscle spasms occuring with activity,
or at night during sleep. The pain is worsened by activities
and bed rest is an absolute necessity for a short period
of time - one to three days.
The pain is typically limited to five to ten days and
does not involve either leg. There is no weakness in the
legs. There is marked restriction and painful limitation
in range of motion.
Patients are typically bent over and unable to straighten
up or maintain a normal posture. Any particular activity
is impossible, including sitting, standing, walking, driving,
etc.
What Diagnostic Tests are Used for Evaluations
No diagnostic testing is indicated, except in a case of
unremitting sprain or strain which has been present for
several weeks and is not improving as expected. At this
point, x-rays of the lumbar spine will be needed to rule
out underlying spinal injury or disease. If symptoms persit,
an MRI is indicated to diagnoses underlying disc injury
such as ruptured or degenerated disc, not evident or suspected
at the initial examination.
Treatment
Treatment initially should involve nosteroidal anti-inflammatory
medications such as Nuprin, Motrin, Voltaren, Naprosyn,
Tolectin, Lodine, Dolobid, Clinoril, or Feldene. A rehabilitation
program involving physical therapy is prescribed. Physical
Therapy with ultra-sound, heat and ice applied to the
low back region allows the muscle spasms to relax. Exercises
to strecth out painfully contracted muscles which are
in spasm, followed by muscle strengthening exercises to
build up the muscles to prevent further sprain and strain
injuries completes a physical therapy program.
Prognosis
The prognosis is excellent for a complete recovery of
a lumbar sprain or strain injury. The muscle typically
recovers nearly 100% with some minimal scar tissue, if
there was tearing of the muscle. Recurrent episodes of
sprain and strain injury to the lumbar spine may be prevented
by a conscientious daily exercise program to stretch and
strengthen the lumbar spine muscles. This will avoid muscles
that are weak and chronically underused or in a state
of "chronic deconditioning."
Recommendations
An active strengthening and stretching porgram for the
lumbar spine. This program should be done daily to build
up strength and muscle mass, as well as maintain their
normal length by simultaneous stretching program. This
will definitely decrease the frequency and severity of
episodes of sprain and strain injuries when the back is
subjected to an abnormal force.
If overweight, get down to your ideal body weight. Reducing
one's weight decreases force on the spine. Weight which
hangs out in front on the spine causes chronic spasms
in the low back region. When the back muscles contract
to hold the belly up, abnormal forces on the spine result
in disc degneration and arthritis in the spine.
Heat and ice treatment are indicated on an "as needed"
basis at home to treat sudden flare-ups of low back pain,
along with anti-inflammatory medications, as stated above.
The cornerstone of treatment, however, is prevention,
which is accomplished through an active exercise program.
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