Muscle sprains and strains are frequent sources of back pain. Sprains involve stretching or tearing of ligaments, the tough, fibrous tissue that connects one bone to another. Strains involve a stretching or tearing of a Muscle and are commonly referred to as muscle “pulls.”
Sprains and strains can result from a variety of activities, including improperly lifting heavy objects, twisting sharply or merely standing for long periods of time. The vast majority of back sprains and strains are acuteinjuries that heal within four weeks, with most improving within a few days. However, in other cases back pain can become a chronic problem.
Although sprains and strains are common injuries, they also are largely preventable. Exercise that stretches and strengthens the back and abdominal muscles can help them endure abnormal amounts of force. Practicing good posture and ergonomics while maintaining a healthy body weight can also help reduce the risk of back sprains or strains.
About back sprain or strain
Muscle sprains and strains are among the most common causes of back pain. A number of factors can cause these, including injury, improperly lifting heavy objects, twisting sharply or merely standing for long periods of time.
A person’s back is composed of the bones, muscles and other tissues that form the posterior part of the trunk, which runs from the neck to the pelvis. The back is held upright by muscles and ligaments that are attached to the bones of the back. These bones, called vertebrae, are stacked on top of one another. Together, these bones are known as the spine, spinal column or vertebral column.
The back is vulnerable to injury because it supports most of the body’s weight. Nearly four in five people suffer from back pain at some point in their lives, according to the National Institutes of Health. In some cases, back pain is the result of a herniated disc or other damage to the intervertebral discs that cushion and separate the individual vertebrae that make up the spine.
However, in many cases, back pain is the result of a sprain or strain. A sprain is a stretching or tearing of ligaments, the tough, fibrous tissue that connects one bone to another. A strain is a stretching or tearing of a muscle, which can occur if a muscle suddenly contracts or is stretched too far. Strains are commonly referred to as “pulled muscles.”
Commonly injured muscles of the back include:
Erector spinae. Firm, prominent muscles in the lower back on either side of the midline. They can become painful when they are tensed or cramped up in spasms.
Psoas minor. A muscle of the abdomen that flexes the trunk. Strain on this muscle creates tremendous force on the lumbar spine of the lower part of the back, which can be very painful.
Most people who suffer a back sprain or strain have a good prognosis, only occasionally accompanied by minor scar tissue.
Risk factors and causes of back sprain or strain
The source of back pain can often be difficult to determine. However, it is assumed that a high percentage of back pain is due to sprains or strains. Factors that may cause sprains and strains include:
Injury. Various injuries can sprain, strain or cause spasms in muscles or ligaments of the abdomen and back. Sources of such trauma pain include sports mishaps, extremes in activity, or sudden movements or accidents. Repeated injuries can result in the formation of scar tissue that is not as strong or flexible as the tissue it replaced. This can leave the back vulnerable to additional injuries in the future.
Poor posture. Failure to sit or stand properly shifts the body out of balance, forcing just a few muscles and joints to support the entire body. This increases the vulnerability of these muscles to the types of stresses that cause back pain.
Poor body mechanics. Bending the back rather than the knees when lifting objects is a common source of back sprains and strains. For more information, see Posture & Ergonomics.
Emotional stress. People who are under stress experience a tightening of the back muscles that can worsen back problems.
Excessive weight, obesity and pregnancy. Too much weight, especially around the abdomen, places strain on the back and stomach muscles, causing them to weaken and stretch.
Poor muscle tone in the back and abdomen. Weakened muscles cannot properly support the back, leaving the back vulnerable to stresses and injuries.
Age. As people age, bone strength and muscle elasticity and tone tend to decrease. As a result, back injuries are more likely after age 30.
Use of heavy bags. Back pain is typically uncommon in children. However, backpacks overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue, resulting in injuries to the back. Oversize purses, heavy briefcases or luggage can strain adults’ backs.
Diseases of muscles. Conditions such as fibromyalgia can cause muscle spasms in the back.
Signs and symptoms of back sprain or strain
A sprain or muscle strain causes low back pain in a broad area of the back. In some cases, patients may feel a pop or tear as the injury takes place, but this is not always the case. Pain associated with sprains or strains may appear on either side of the back and may get worse with muscle spasms that occur during activity or during sleep.
Patients often find that the pain restricts their range of motion. They may find it difficult to straighten up and maintain normal posture, or to perform everyday activities such as sitting, standing, walking or driving.
Symptoms usually occur for a period no longer than five to 10 days. Pain normally does not radiate into or cause weakness in the legs. These symptoms may indicate pressure on the nerves in the spinal cord or the presence of a neurological problem, and require examination by a physician.
Diagnosis methods for back sprain or strain
To diagnose a back sprain or strain, a physician will review the patient’s medical history and perform a physical examination. In most cases, back sprains or strains can be diagnosed based on symptoms without the need for further diagnostic testing.
However, if a patient’s pain remains constant and does not improve after several weeks, an imaging procedure such as x-ray or MRI (magnetic resonance imaging) may be performed to rule out underlying injury to the spine or intervertebral discs, or disease. Other pain assessment tests could include electromyography or nerve conduction studies.
Treatment options for back sprain or strain
Initially, treatment for back sprains and strains may involve rest and refraining from activity. This can help reduce inflammation and calm symptoms. However, prolonged bed rest – more than one or two days – should be avoided. Instead, patients should engage in light activity, which can speed up healing and recovery. Patients should immediately stop any activity that aggravates the muscles. An individual's physician can suggest appropriate exercises, which may include stretching, swimming or walking.
In addition, treatment often involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs). In many cases, these drugs can be purchased by the patient in over-the-counter formulations. In cases of more significant pain, prescription medications may be necessary. Patients should consult their physician before using any medication, as even over-the-counter medications present health risks and side effects when taken in certain dosages.
Patients can also apply cold (cryotherapy) and heat (thermotherapy) to reduce back pain associated with sprains or strains. Cold treatment should be used first before moving on to hot treatment. This technique can soothe sore and inflamed muscles. Upon injuring the back, ice should be applied several times a day for up to 20 minutes at a time. Ice should not be applied to the back directly – there should always be at least a thin barrier between the ice and the skin. Cold compresses may also be used. Cold treatment should be used as long as spasms persist.
Once acute pain has subsided – or after two or three days – heat from a heating pad or heat lamp should be used to loosen tight muscles. Again, applications should last no longer than 20 minutes. Patients may also benefit from hot compresses or baths (hydrotherapy). Although not scientifically proven to resolve back pain, these treatments do appear to reduce pain and inflammation and increase mobility for some patients.
Following a back sprain or strain, patients generally are advised to avoid heavy lifting or twisting of the back for about six weeks. The vast majority of back sprains and strains heal within four weeks, with most improving within a few days. However, in other cases, back pain can become a potentially chronic problem requiring further treatment. Treatments recommended by a physician may include:
Professional therapies such as physical therapy or manipulation therapy.
Instruction in posture and ergonomics.
Modalities (physical agents) such as electrical therapy or ultrasound therapy.
Complementary and alternative treatments such as acupuncture, acupressure, yoga or biofeedback. “Dry needling” of the muscles can also help to decrease muscle spasms.
Prevention methods for back sprain or strain
Back sprains and strains are largely preventable. People who exercise daily to stretch and strengthen the lumbar spine (lower back) muscles sharply reduce their chance of suffering sprains and strains. Proper weight training can strengthen abdominal and back muscles, allowing them to serve as a natural brace for the back. This helps the back to remain uninjured when it is subjected to abnormal amounts of force. Patients should consult a physician before beginning any exercise program.
Other steps that can help reduce the risk of injury include:
Maintaining proper posture. When standing, maintain the pelvis in neutral position. People who stand for long periods of time should alternate placing each foot on a footstool. This can take some of the pressure off of the back. When sitting, choose a seat with good lower back support, arm rests and a swivel base. A rolled-up towel or pillow in the small of the back (lumbar area) can help maintain its normal curve. Individuals should also try to keep their knees and hips level.
Using proper lifting techniques. It is always best to bend the knees while lifting, not the back. When lifting heavy objects, keep the back straight and the load close to the body. Do not twist the back while lifting. Bending from the waist to pick up even lightweight objects from the floor can strain the back. If an object is heavy or awkward, do not lift it without a partner’s help.
Maintaining proper body weight. Healthy body weight reduces the pressure on the spine. Belly fat that hangs over a person’s belt line can cause chronic muscle spasms in the lower back.
Sleeping on a medium-firm mattress. Recent studies indicate that sleeping on such a mattress is better for the back than sleeping on a firm mattress. Pillows can offer good support, but only if they do not force the neck up at a severe angle.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about back sprains or strains:
What is the difference between a back sprain and a back strain? Which do I have?
Do I need to undergo any diagnostic tests? If so, what do they involve?
How can I tell if I can treat my back sprain or strain at home or if I need medical attention?
What signs or symptoms of back sprain or strain might I see?
Can I tell if my back pain may instead be due to another condition, such as a herniated disc or sciatica?
What are my options for treating back sprains and strains? What over-the-counter medications do you recommend for me?
When is it appropriate for me to use heat therapy or cold therapy at home?
If over-the-counter drugs and heat and cold treatments don’t help, what prescription medications would you recommend for me?
Would I benefit from physical therapy, massage therapy, chiropractic or other such treatments?
What puts me at most risk of back sprains and strains?
