Lumbar Strain & Lumbar Sprain

Definition
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
Grade 1

  • Simple lumbar strain / lumbar sprain – minimal disruption of adjacent fibers
  • Estimated 1%-10% fiber damage
  • Minimal pain, splinting, minimal palpatory pain
  • Trigger points, some loss of range of motion
  • Fixation & decreased joint motion in spine
1 to 4 weeks
Grade 2

  • Moderate lumbar strain / lumbar sprain – partial tearing of ligaments or muscle, hemorrhage, marked pain & splinting
  • Estimated 11%-50% fiber damage/li>
  • Minimal pain, splinting, minimal palpatory pain
  • Athletic injury, lifting or trauma
  • Same clinical picture as above but more severe
2 weeks to 1 year
Grade 3

  • Severe lumbar strain / lumbar sprain – may be complete laceration
  • Estimated 51%-100% fiber damage/li>
  • Marked dysfunction, palpate torn muscle & edema
  • Athletic injury, lifting or trauma
  • Consider referral for surgical evaluation
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

Aetiology

  1. Direct Trauma – falls, road traffic accidents, sport injuries
  2. Overuse – fatigue, repetitive microtrauma: over hours, days, months of same motion.
  3. 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)
  4. 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.
  5. Additional Factors may include:

History, Signs & Symptoms

  1. Pain
    • 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
  2. Decreased Mobility, stiffness & muscle Spasm.
  3. Gait may be slow & guarded, with a potential limp.
  4. 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.
  5. Local swelling, erythema, possible ecchymosis
  6. Palpation may reveal local tenderness & multiple joint restrictions
  7. Neurologic Testing is usually normal
  8. Orthopaedics – (+) any test that challenges the injured joint tissue
  9. Always rule out:
    • Hemarthrosis (vascular damage) or hematoma
    • Fractures: stress or avulsion fractions
    • Dislocations

Management

Pain Control

  1. Ice and rest
  2. Consider lumbar brace in early stages, but eliminate as quickly as possible
  3. NSAIDs, anti-inflammatories
  4. Electrotherapy: TENS, IFC

Rehabilitation

Early Rehabilitation
Helps to prevent chronic pain & disability (3+ days post injury)
  1. Pain free ROM exercises & activity as tolerated, osseous manipulation
  2. Massage Therapy
  3. Myofascial Release
  4. Hydrotherapy
Late Rehabilitation
(10+ days) – patient education & prevention
  1. Osseous manipulation as needed, also consider lumbar traction
  2. Stabilisation exercises; ergonomic & biomechanic training, aerobic & endurance exercises
  3. Continued massage therapy, myofascial release, hydrotherapy as needed
  4. Consider therapeutic ultrasound to break adhesions & promote more rapid healing

Prognosis

Prognosis is good for complete recovery in first time casesPossible complications – joint instability, arthritis, myofibrosis / periarticular fibrosis

  1. Periarticular fibrosis – post injury fibrous repair of myofascial soft tissue
  2. Often the result of significant trauma or prolonged immobilisation
  3. Palpable nodule causing reduced elasticity of tissue may sometime develop, predisposing to recurrent injury