Back Strain

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Overview
What is a back strain?

Most athletes will have a minor back problem at one time or another. Muscle strains are the most common causes of low back pain. A low back strain occurs when the muscle fibers are abnormally stretched or torn. For example, back muscle strains can occur during sports, recreational activities and after sudden movements. They can also occur while lifting heavy objects and even normal household items.

Why are back muscles subject to strain?

The muscles that move the spine are not large muscles grouped together, but rather a large contingency of very small, individual muscles layered and aligned to produce contractions of varying intensities. Because they are small, they are more at risk for injury.

Who gets a back strain?

A back strain is common in athletes and the general population with a great deal of research being spent on how to better understand the mechanics of lifting for the purpose of preventing these injuries.

The back muscles are placed at risk for strain when an individual starts in any combined positions of flexion, lateral flexion, and rotation and then extends and rotates the spine back into a neutral position. Sports that involve repetitive hyperextension, jumping (compressive loading from the landing), and twisting can place athletes at risk for back strain. These sports include gymnastics, basketball, wrestling, tennis, golf and rowing.

Symptoms
What are the classifications of muscle strains?

Classifications of muscle strains are divided into three categories including minor (first degree), moderate (second degree), and severe (third degree).

First degree muscle strains are the most common and involve either overstretching or minor tearing of one or more muscle fibers. Because the injury is mild, the individual is typically functional (can move the spine) but with some discomfort. Increased movement exacerbates the pain and may lead to localized muscle spasm. There may also be some weakness in the muscle that has been strained.

Second degree muscle strains involve a partial tear of one or more muscles. Because the tear is greater in a second degree, the symptoms of the injury are more pronounced. The individual may be guarded in all back movements due to muscle spasm. All movements are affected and may be limited in all directions. The pain is significantly greater both because of the torn tissue and the associated muscle spasms.

With a back strain, the individual may have significant difficulty standing, sitting, and lying down. Because the muscles responsible for spine extension are used any time the body is in movement, all movements may be guarded and painful.

A third degree muscle strain involves a complete tear of one or more muscles. The tear may either be in the muscle or at the musculotendinous junction (common location for a rupture). Significant muscle tears may have a palpable indentation or gap. Swelling and discoloration maybe present. As in the second degree strain, muscle spasm will be present and may cause increased pain during any attempted movement.

How is a back strain diagnosed?

The best and most common tool for diagnosing a back strain is a comprehensive medical history with specific attention to the mechanism and signs and symptoms of injury. The sports medicine professional will initially rule out more serious injuries that may involve the spine, nerve roots, intervertebral discs, and/or ligaments.

The location of the pain (either to the right or left of the spine), absence of neurological symptoms (numbness, tingling, radiating pain down the legs), functional movement, and manual muscle tests can all be used to diagnose a muscle strain.

If a second or third degree strain is suspected, an MRI may be ordered. The MRI can clearly distinguish a tear in soft tissue injury.

Causes
What causes back strain?

Individuals whose back muscles are tight and weak are at risk for muscle strains. Muscles that are flexible can be stretched farther (during a quick movement) before tearing as compared to muscles that are rigid and tight.

Weak back extensor muscles are also at risk for injury. Weak muscles tend to atrophy and become smaller and less able to handle the demands placed on them.

A common mechanism for a back strain is a quick, unanticipated movement (extension or rotation) or a sustained muscle contraction that places the muscles in a position of risk (extension, rotation).

Prevention
What can I do to prevent a back strain?

The focus on preventing a back strain needs to be on stretching and strengthening the muscles in and around the spinal column as well as an awareness of good body mechanics for lifting.

Flexibility - Keeping the muscles of the back flexible is one way to prevent a back strain. Static stretching performed over time will gradually elongate muscles allowing them to be stretched farther before an injury to the muscle occurs.

Static stretching – Static stretching is a type of stretch that is done actively by the individual. The individual gradually stretches the muscle to be stretched to a point of discomfort and then backs off slightly. This position is then held for 30 seconds and repeated two more times. The individual should not move into a position of pain as pain is an indicator of injury to the body.

Strengthening – Strengthening the muscles in and around the spine will also reduce the risk of injury. Exercises that strengthen the core muscles of the trunk (rectus abdominis, internal and external obliques, and erector spinae) should be the focus. This can be achieved through a variety of exercises that focus on sustaining either an isometric or concentric contraction for the muscles most involved in flexion, extension, and rotation of the spine.

Exercises can be accomplished through using the individual’s own body weight as resistance, using external weights, or by using a piece of exercise equipment such as a therapy ball.

Utilize Large Muscles - One of the most important ways to prevent a back strain is utilizing the large muscles of the lower extremity to lift heavy objects rather than bending and using the small erector spinae muscles of the spine.

The key is to carry the heavy object close to the spine, keep the spine straight throughout the lift, and lift with the legs. By keeping the spine straight and bending at the hips and knees, the small muscles of the spine are protected while the large muscles of the pelvis and thigh are actively engaged in the lift.

Treatment
Click the following link to see information about treatment. This includes initial treatment, early exercises, intermediate exercises, and advanced exercises.
http://www.sportsmd.com/Articles/id/20.aspx

Also, be sure to check out SportsMD at www.sportsmd.com for all your sports related injuries.SportsMD is the most trusted resource for sports health and fitness information for people engaged in sports everywhere. We have assembled the sports industry’s leading Doctors and health experts – each sharing valuable, practical advice to keep you playing injury-free.

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To summarize the treatments:

Days 1-3 (Initial treatment - Inflammatory Phase)
- Rest
- Ice pack, for 20 minutes at a time
- limit movement

Days 3-7 (Early Exercises)
- you can add heat at this phase for 10-15 mins at a time
- gentle exercises such as figure four, sit and reach, and cat stretch. (But don't stretch too far or into pain)

Days 7-14 (Intermediate Exercises)
Once isometric contractions can be sustained pain free
- begin trunk rotation exercises
- Exercises, lumbar rock, spinal twist, knees-to-chest, and lateral trunk stretch
- core strengthening exerciese


Advanced exercises add power