Muscle strains and lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscles of the back are abnormally stretched too far. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will have similar symptoms. Many doctors refer to both injuries as a category called “musculoligamentous injuries” of the lumbar spine. In general, it doesn’t matter what you call the problem because the treatment and prognosis for both back strains and sprains are the same.
Nearly everyone will experience low back pain at some point in their life; it is the second most common cause of missed days of work in the United States–only a common cold causes more missed work. Almost all of these low back injuries are due to injuries of the muscle or ligament. If you don’t know the cause of your back pain, you should have it evaluated by a doctor. Some warning signs of a serious injury to the spine include:
- Loss of control of bladder or bowels
- Progressive lower extremity weakness
- Pain that wakes you from sleep
- Severe, constant pain
While most back pain is caused by a muscle strain or ligament sprain, there are serious conditions that require more immediate treatment. If you are unsure of the cause of your symptoms, you should be evaluated by a physician.
Low Back Pain – Muscle Strains
The spine is supported by large muscles called the paraspinal muscles. These muscles both support the spinal column as well as the weight of the upper body. The five lumbar vertebrae are connected by tough ligaments that help to maintain the position of the spinal column.
These muscles, ligaments, and bones all work together to provide control and strength for nearly all activities. The lumbar spine and its muscles are needed for almost all movements and activities. For this reason, the lumbar spine is prone to injury, and when an injury has been sustained, people have difficulty performing many activities.
Symptoms of a Low Back Pain / Strain
Most lumbar muscle strains and sprains cause symptoms isolated to the low back, usually, they do not cause problems in the legs like some other spine conditions. The most common symptoms of a lumbar strain or sprain are:
- Pain around the low back and upper buttocks
- Low back muscle spasm
- Pain associated with activities, and generally relieved with rest
When the lumbar spine is strained or sprained, inflammation of the soft-tissues results. This inflammation causes pain and can cause muscle spasms. People are often surprised at how painful and debilitating a lumbar strain or sprain can be–these are not minor injuries. They often cause severe symptoms for a few days and may not completely resolve for weeks or months. That said, over 90% of patients are completely recovered from an episode of lumbar muscle strain or sprain within one month.
We do know some factors that tend to influence the development of this type of problem, but often these symptoms strike in unexpected situations. Most commonly, patients who develop a lumbar strain or sprain are doing an activity that places their back at risk. This may be a sudden forceful movement, lifting a heavy object, or twisting the back in an unusual manner. Knowing how to properly lift can help to prevent many back injuries.
Some well-known factors that contribute to low back pain include:
- Poor conditioning
- Improper use/lifting technique
If you have persistent problems with your lumbar spine, consider these issues. If you smoke, are overweight, or do not perform regular back strengthening exercises, then you have steps that you can take to help control your symptoms.
Treatment of Lumbar Strains
Treatment of a lumbar strain can usually be accomplished with some simple steps. The most challenging aspect of treatment is that it often takes time to find relief and symptoms can last weeks or even months. However, there are some aspects of treatment that can help ensure future episodes of injury are less likely.
There is more data coming to our attention to supporting the notion that the best treatment for typical, muscular back pain is: time. Unfortunately, speeding the healing process has not been shown to be terribly effective with most standard treatments, and certainly, potentially harmful treatments should be avoided. In particular, medications, especially potentially addictive medications, should not be used for the treatment of back pain. The best recommendation, based on scientific data that has compared hundreds of treatments to find the most beneficial and safe treatment, is to encourage people to move gently. Whether this is with physical therapy or other activities, light, gentle movement is the best way to heal muscular back pain.
The back is a complex structure of bone and muscle, supported by cartilage, tendons, and ligaments, and fed by a network of blood vessels and nerves. The back—especially the lumbar, or lower back—bears much of the body’s weight during walking, running, lifting, and other activities. It makes sense, then, that injuries to the lower back—such as strains and sprains—are common.
What is a strain?
A strain is an injury to either a muscle or a tendon. Tendons are the tough, fibrous bands of tissue that connect muscle to bone. With a back strain, the muscles and tendons that support the spine are twisted, pulled, or torn.
What is a sprain?
A sprain is the stretching or tearing of a ligament. Ligaments are the fibrous bands of tissue that connect two or more bones at a joint and prevent excessive movement of the joint.
How common are back strains and sprains?
Strains and sprains are very common injuries. Next to headaches, back problems are the most common complaint to healthcare professionals.
What causes a back strain or sprain?
Twisting or pulling a muscle or tendon can result in a strain. It can also be caused by a single instance of improper lifting or by overstressing the back muscles. A chronic (long-term) strain usually results from overuse after the prolonged, repetitive movement of the muscles and tendons.
A sprain often occurs after a fall or sudden twist, or a blow to the body that forces a joint out of its normal position. All of these conditions stretch one or more ligaments beyond their normal range of movement, causing injury.
In addition, several factors can put a person at greater risk for a back strain or sprain, including:
- Curving the lower back excessively
- Being overweight
- Having weak back or abdominal muscles, and/or tight hamstrings (muscles in the back of the thighs).
Playing sports that involve pushing and pulling—such as weightlifting and football—also increases the risk of a low back injury.
What are the symptoms of a back strain or sprain?
Symptoms of a strain or sprain include:
- Pain that gets worse when you move
- Muscle cramping or spasms (sudden uncontrollable muscle contractions)
- Decreased function and/or range of motion of the joint (difficulty walking, bending forward or sideways, or standing straight)
In some cases, the person may feel a pop or tear at the time of the injury.
Lower Back Ache? Be Active and Wait It Out, New Guidelines Say
Dr. James Weinstein, a back pain specialist, and chief executive of Dartmouth-Hitchcock Health System, has some advice for most people with lower back pain: Take two aspirin and don’t call me in the morning.
On Monday, the American College of Physicians published updated guidelines that say much the same. In making the new recommendations for the treatment of most people with lower back pain, the group is bucking what many doctors do and changing its previous guidelines, which called for medication as first-line therapy.
Dr. Nitin Damle, president of the group’s board of regents and a practicing internist, said pills, even over-the-counter pain relievers, and anti-inflammatories, should not be the first choice. “We need to look at therapies that are nonpharmacological first,” he said. “That is a change.”
The recommendations come as the United States is struggling with an epidemic of opioid addiction that often begins with a simple prescription for ailments like back pain. In recent years, a number of states have enacted measures aimed at curbing prescription painkillers. The problem has also led many doctors around the country to reassess prescribing practices.
The group did not address surgery. Its focus was on noninvasive treatment.
The new guidelines said that doctors should avoid prescribing opioid painkillers for relief of back pain and suggested that before patients try anti-inflammatories or muscle relaxants, they should try alternative therapies like exercise, acupuncture, massage therapy or yoga. Doctors should reassure their patients that they will get better no matter what treatment they try, the group said. The guidelines also said that steroid injections were not helpful, and neither was acetaminophen, like Tylenol, although other over-the-counter pain relievers like aspirin, naproxen or ibuprofen could provide some relief.
Dr. Weinstein, who was not an author of the guidelines, said patients have to stay active and wait it out. “Back pain has a natural course that does not require intervention,” he said.
In fact, for most of the people with acute back pain — defined as a present for four weeks or less that does not radiate down the leg — there is no need to see a doctor at all, said Dr. Rick Deyo, a spine researcher, and professor at the Oregon Health and Science University in Portland, Ore., and an author of the new guidelines.
“For acute back pain, the analogy is to the common cold,” Dr. Deyo said. “It is very common and very annoying when it happens. But most of the time it will not result in anything major or serious. ”
Even those with chronic back pain — lasting at least 12 weeks — should start with nonpharmacological treatments, the guidelines say. If patients still want medication, they can try over-the-counter drugs like ibuprofen or aspirin.
Article from the New York Times, Feb. 13, 2017
SARAH was rushing to her seat at the ballet when she missed a step, lost her balance, and turned her ankle. Within moments the pain was severe enough for her to abandon all thoughts of seeing the performance. The house physician sent her to the emergency room of a nearby hospital where a bad sprain was diagnosed. Three weeks later, her ankle is still painful and swollen, forcing her to walk with a cane.
* Ed, a tennis buff who plays about four times a week, had never hurt himself on the court. But one day while carrying groceries from his car, he failed to step fully onto the curb and pulled the muscle in his calf. Ed hobbled about in mild discomfort for the rest of the day, but awoke the next morning in severe pain, barely able to walk. He spent the next two and a half weeks on crutches and it was six weeks before he could play tennis again.
* Recently, I tripped while ice skating and wrenched my right arm trying to break my fall. Though I slept on a heating pad for days, the pain severely limited my arm motion and carrying ability for weeks. A month later, I still have trouble opening and closing car doors with my right arm.
All of us might have been spared weeks of misery had we known what to do and had done it, immediately after our injuries. As common as such mishaps are, their care is shrouded in myths and outmoded old wives’ tales, some of which only serve to compound the injury and prolong recovery. Even less well-appreciated is that many movement-related injuries are preventable, especially once their causes are understood.
Injuries to muscles, tendons, and ligaments are hardly limited to athletes and amateur sports enthusiasts. Although athletic endeavors greatly increase the opportunities for such damage, sedentary individuals are at PERSONAL HEALTH greater risk of severe harm from a minor misstep because weak muscles offer little support for weight-bearing joints.
Though resting an injured part is usually a critical aspect of therapy, orthopedic experts now urge a return to activity, at a reduced level, as soon as discomfort allows so that muscles don’t become so weak that the injury recurs.
When an injury keeps you from pursuing your usual fitness-promoting activities, find temporary alternatives that do not use the injured part but will help to keep you in shape. When a back injury several years ago brought my jogging to a temporary halt, I took up swimming, which actually helped to strengthen the muscles that support my back.
Following is a description of common injuries and their causes, prevention, and treatment. Sprains and strains. Many people think that a sprain is simply a more serious version of a strain. In fact, however, these injuries involve different tissues and can be equally painful and incapacitating. Strains are stretches or tears of muscles or tendons, the connective tissues that attach muscles to bones. Sprains are similar injuries but affecting the ligaments, the connective tissues that attach one bone to another. Both strains and sprains may result in partial or complete tearing of the tissue. They produce varying degrees of swelling and tenderness. Both types of injuries are most likely to occur when muscles are tight and inflexible. Therefore, a major aspect of prevention involves warm-up exercises before athletic exertion and stretching exercises afterward.
Tendinitis, an inflammation of the tendon, causes pain that is usually worse in the morning and eases with use. It commonly afflicts the knees of football and basketball players as well as swimmers who use the frog kick. Tennis players are prone to tennis elbow, an inflammation of the tendons on the outer side of the forearm. Shinsplints, a pain felt along the tibia, or main calf bone is caused by an inflamed tendon that has become partly separated from the bone. It is a common malady among runners.
The treatment for tendonitis is to stop the strenuous exercise of the affected area and do stretching exercises to relieve muscle tightness. Steroid injections are generally not recommended; while they may hasten recovery, they also weaken the tendon and make it more susceptible to future injury.
Tendons can also rupture, making a popping noise as they separate completely from their muscle or bony moorings; they heal by growing new filaments to reattach themselves.
While Achilles tendinitis (in the tendon above the heel) is one of the most common tendon injuries, sprained ankle probably leads the pack of ligament injuries, even for non-athletes.
Sprained arches, which involve a ligament-like tissue called fascia, may afflict those who run or walk on hard surfaces without adequate support and cushioning for their feet.
Sprains may result in partial tearing or a complete rupture of ligaments. The affected joint must be immobilized to prevent further damage. The torn ligaments usually reattach themselves.
As for muscle strains (commonly called ”pulls”), hamstring pulls, involving the muscle at the back of the thigh, and pulls of the calf muscles, are the bane of both weekend and professional athletes. Muscle pulls can also result from a misstep on uneven terrain, a sudden stop, or a sudden burst of activity.
A muscle strain may cause immediate or delayed muscle soreness or, in more serious strains, tearing of muscle fibers. Muscle soreness (which may begin up to a day after exertion) can affect sometimes house painters and wallpaper hangers, as well as sports enthusiasts who overdo their activity. A long bicycle ride by someone not used to that level of activity will result in soreness of the quadriceps muscles on the front of the thighs. There is no treatment for muscle soreness except stretching exercises. Liniment, oil of wintergreen, or aspirin can relieve pain but do not promote healing.
Muscle tears produce sudden disabling pain. In a minor tear, only a few fibers may tear and the muscle sheath remains intact, but more severe tears involve tearing of many or all fibers and partial or complete tearing of the sheath, with internal bleeding and bruising. If you try to continue using a muscle that has been torn, you will cause further damage and delay healing.
According to Dr. Gabe Mirkin, a sports-medicine specialist and co-author of ”The Sportsmedicine Book,” causes of muscle pulls include insufficient warm-up, poor flexibility, overtraining, muscle imbalance (overdevelopment of one muscle in relation to its opposing muscle), trauma (such as stepping in a hole) and lack of an endurance program to strengthen tissues.
Muscle cramps and stitches. Muscle cramps, or spasms, occur when all the fibers in a muscle contract and don’t relax. Cramps, which may last for seconds or hours, can result from a deficiency of potassium, diminished blood supply to the muscle, and hyperventilating (fast, shallow breathing). If you exercise too soon after eating, you might get a muscle cramp because the blood needed by your muscles is temporarily shunted to your digestive tract.
Stitches are cramps in the diaphragm muscle. Common causes include excessive intestinal gas, sometimes caused by a food intolerance such as an inability to digest milk, and exercising too soon after eating, which can put undue pressure on the diaphragm muscle.
Fractures. These involve injuries to the bone and, like muscle strains, maybe partial cracks or complete breaks. Stress fractures, which have similar symptoms (swelling and tenderness) to shin splints, are hairline cracks in bones, usually the foot or leg. The crack may not show on an X-ray for several weeks. Runners and ballet dancers are often victims of stress fractures. Some female runners develop stress fractures of the pelvic bones. The rest of the injured part is the only treatment; casts do not promote healing.
Complete fractures are often the most painful of all movement injuries and usually take the longest to heal (one to six months). Most fractures require immobilization of the injured part after the bones have been set so that they knit properly.
About six to eight weeks after a leg fracture, it may be possible to have the plaster cast removed and switched to a lightweight, pneumatic brace, such as the Aircast Walking Brace. This helps to regain muscle strength and mobility while the fracture heals completely.
Bursitis. The bursa, a fluid-containing sac near certain joints, can become painfully inflamed as a result of abuse or a direct injury. Swimmers, players of racquet sports, and those who carry heavy shoulder bags may get bursitis of the shoulder; runners may develop it in the knees, and football players may get bursitis in the hip.
The following publications are especially helpful for sports enthusiasts. The Sportsmedicine Book, by Gabe Mirkin, M.D., and Marshall Hoffman. Boston: Little, Brown. $9.95. Sports Health: The Complete Book of Athletic Injuries, by William Southmayd, M.D., and Marshall Hoffman. New York: Quick Fox. $14.95.Sports Injuries: An Aid to Prevention and Treatment, a pamphlet financed by Bufferin for the United States Tennis Association. Available for $1 by writing to Bufferin Sports Injuries Booklet, P.O. Box 537, Coven- try, Conn. 06238.
THERE is a simple mnemonic device to help you remember what to do immediately after suffering an injury to a muscle, tendon, ligament, bone or joint: RICE. It stands for Rest, Ice, Compression, and Elevation.
The goal of this first aid therapy is to limit the extent of the injury, keep swelling to a minimum, relieve pain and promote healing. The sooner you start this regimen, preferably within the first few minutes, the better.
Rest. As soon as you feel pain, stop using the injured part. Continued use can make the injury worse. Rest for at least one day, and as soon as your pain and the doctor allow, begin a series of graded rehabilitation exercises to help remove the waste products of injury, such as dead cells and blood clots, and to maintain muscle strength.
Ice. Wrap ice in a towel or plastic bag (or use an ice pack) and put it on the injured part. Do not apply ice directly to your skin. Ice relieves pain and reduces swelling and bleeding from injured blood vessels, both of which prolong your recovery.
Compression. Wrap an elastic bandage firmly over the ice around the injured part, but not so tightly that you cut off circulation. The bandage is too tight if you begin to feel numbness or cramping in the area or develop further pain or swelling beyond the edge of the bandage. Compression limits swelling, which prolongs healing. Keep the bandage wrapped for 30 minutes, then release it for 15 minutes, temporarily removing the ice; then replace the ice and rewrap for another 30 minutes. Repeat this process for about three hours.
Elevation. Position the injured part so that it is above the level of your heart. If you have hurt your leg or ankle, this means reclining or lying down with your leg raised to about shoulder height. This posture enables gravity to work in your favor, helping to drain excess fluid from the injured area. Elevation should continue while you sleep.
If necessary, you can continue RICE for up to 24 hours. If you still have pain and swelling two days after the injury, that’s the time to apply heat.
See a doctor if: you have suffered a traumatic injury to any joint (such as smashing your knee on the dashboard); you are in severe pain; you can’t move the injured part; your pain lasts for more than two weeks; your injury hasn’t healed in three weeks.
Article from the New York Times, FEB. 9, 1983
How Massage Heals Sore Muscles
A massage after vigorous exercise unquestionably feels good, and it seems to reduce pain and help muscles recover. Many people — both athletes and health professionals – have long contended it eases inflammation, improves blood flow and reduces muscle tightness. But until now no one has understood why massage has this apparently beneficial effect.
Now researchers have found what happens to muscles when a masseur goes to work on them.
Their experiment required having people exercise to exhaustion and undergo five incisions in their legs in order to obtain muscle tissue for analysis. Despite the hurdles, the scientists still managed to find 11 brave young male volunteers. The study was published in the Feb. 1 issue of Science Translational Medicine.
On a first visit, they biopsied one leg of each subject at rest. At a second session, they had them vigorously exercise on a stationary bicycle for more than an hour until they could go no further. Then they massaged one thigh of each subject for 10 minutes, leaving the other to recover on its own. Immediately after the massage, they biopsied the thigh muscle in each leg again. After allowing another two-and-a-half-hour of rest, they did a third biopsy to track the process of muscle injury and repair.
Vigorous exercise causes tiny tears in muscle fibers, leading to an immune reaction — inflammation — as the body gets to work repairing the injured cells. So the researchers screened the tissue from the massaged and unmassaged legs to compare their repair processes and find out what difference massage would make.
They found that massage reduced the production of compounds called cytokines, which play a critical role in inflammation. Massage also stimulated mitochondria, the tiny powerhouses inside cells that convert glucose into the energy essential for cell function and repair. “The bottom line is that there appears to be a suppression of pathways in inflammation and an increase in mitochondrial biogenesis,” helping the muscle adapt to the demands of increased exercise, said the senior author, Dr. Mark A. Tarnopolsky.
Dr. Tarnopolsky, a professor of pediatrics and medicine at McMaster University in Hamilton, Ontario, said that massage works quite differently from Nsaids and other anti-inflammatory drugs, which reduce inflammation and pain but may actually retard healing. Many people, for instance, pop an aspirin or Aleve at the first sign of muscle soreness. “There’s some theoretical concern that there is a maladaptive response in the long run if you’re constantly suppressing inflammation with drugs,” he said. “With massage, you can have your cake and eat it too—massage can suppress inflammation and actually enhance cell recovery.”
“This is important research because it is the first to show that massage can reduce pro-inflammatory cytokines which may be involved in pain,” said Tiffany Field, director of the Touch Research Institute at the University of Miami Medical School. She was not involved in the study. “We have known from many studies that pain can be reduced by massage based on self-report, but this is the first demonstration that the pain-related pro-inflammatory cytokines can be reduced,” she said.
Getting a massage from a professional masseur is obviously more expensive than taking an aspirin. But, as Dr. Field points out, massage techniques can be taught. “People within families can learn to massage each other,” she said. “If you can teach parents to massage kids, couples to massage each other. This can be cost-effective.”
Dr. Tarnopolsky suggests that, in the long run, a professional massage may even be a better bargain than a pill. “If someone says “This is free and it might make you feel better, but it may slow down your recovery, do you still want it?” he asked. “Or would you rather spend the 50 bucks for a post-exercise massage that also might enhance your recovery?”
Article from the New York Times, FEBRUARY 6, 2012
Regimens: Massage Benefits Are More Than Skin Deep
Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.
All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.
To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, found that a single session of massage caused biological changes.
Volunteers who received Swedish massage experienced significant decreases in levels of the stress hormone cortisol in blood and saliva, and in arginine vasopressin, a hormone that can lead to increases in cortisol. They also had increases in the number of lymphocytes, white blood cells that are part of the immune system.
Volunteers who had the light massage experienced greater increases in oxytocin, a hormone associated with contentment, than the Swedish massage group, and bigger decreases in adrenal corticotropin hormone, which stimulates the adrenal glands to release cortisol.
The study was published online in The Journal of Alternative and Complementary Medicine.
Article from the New York Times, SEPT. 20, 2010
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