Lumbar Strain & Lumbar Sprain
- Soft tissue damage (stretch or rupture) to the ligaments & muscles surrounding the lumbar spine, sacrum & pelvis. Lumbar strain is ligamentous tissue damage, while lumbar sprain is muscular damage.
Lumbar Strain & Sprain Grading
|Clinical Findings||Healing Time|
||1 to 4 weeks|
||2 weeks to 1 year|
||8 weeks to 1 year|
Lumbar Strain vs Lumbar Sprain
|Action||Lumbar Strain (Muscle)||Lumbar Sprain (Ligament)|
|Passive Range of Movement||Mild to no pain except at end range (muscle stretched)||Pain Ligament are stretched|
|Active Range of Movement||Painful, decreased ROM due to pain||Painful, decreased ROM due to pain|
|Isometric Contraction||Pain||Mild or no pain|
- Direct Trauma – falls, road traffic accidents, sport injuries
- Overuse – fatigue, repetitive microtrauma: over hours, days, months of same motion.
- Postural – may be either an intrinsic postural problem (e.g hyperlordosis or anatomically short leg) or an extrinsic postural problem (e.g. prolonged stressful positions, student posture)
- Sudden Unguarded Movement – in particular being flexed & rotated while lifting something leaves the patient at a biomechanics disadvantage – this usually represents a single episode of trauma, however mild it might be at the time.
- Additional Factors may include:
- Muscle imbalance, prior injuries, leg length discrepancy.
- Sudden increase or uptake of training regime.
History, Signs & Symptoms
- Patient may experience immediate pain or pain shortly after injury
- Minor injuries may have delayed onset muscle soreness (24-48 hours after) – possibly due to disruption of muscle proteins and resulting inflammation.
- pain may radiate into lower thoracic spine or into buttocks
- Decreased Mobility, stiffness & muscle Spasm.
- Gait may be slow & guarded, with a potential limp.
- Range of Motion – will be limited in most motions
- If there is pain in multiple directions it suggests joint capsule damage, pain in a single direction indicates muscle or tendon damage – most patients will present with a combination of the two.
- Local swelling, erythema, possible ecchymosis
- Palpation may reveal local tenderness & multiple joint restrictions
- Neurologic Testing is usually normal
- Orthopaedics – (+) any test that challenges the injured joint tissue
- Always rule out:
- Hemarthrosis (vascular damage) or hematoma
- Fractures: stress or avulsion fractions
- Ice and rest
- Consider lumbar brace in early stages, but eliminate as quickly as possible
- NSAIDs, anti-inflammatories
- Electrotherapy: TENS, IFC
- Early Rehabilitation
- Helps to prevent chronic pain & disability (3+ days post injury)
- Pain free ROM exercises & activity as tolerated, osseous manipulation
- Massage Therapy
- Myofascial Release
- Late Rehabilitation
- (10+ days) – patient education & prevention
- Osseous manipulation as needed, also consider lumbar traction
- Stabilisation exercises; ergonomic & biomechanic training, aerobic & endurance exercises
- Continued massage therapy, myofascial release, hydrotherapy as needed
- Consider therapeutic ultrasound to break adhesions & promote more rapid healing
Prognosis is good for complete recovery in first time casesPossible complications – joint instability, arthritis, myofibrosis / periarticular fibrosis
- Periarticular fibrosis – post injury fibrous repair of myofascial soft tissue
- Often the result of significant trauma or prolonged immobilisation
- Palpable nodule causing reduced elasticity of tissue may sometime develop, predisposing to recurrent injury