Back Strains and Sprains
We all ask a lot from our backs. We bend, we lift, we slouch -- it's enough to make a back complain. These injuries are painful, but they can also be temporary. “Ninety percent of low back pain resolves within one year,” says Dr. Anthony Romero, a Cottage Center for Orthopedics affiliated surgeon. "With proper care, most people can look forward to a quick recovery."
What are sprains and strains?
Healthy backs are strong and flexible, thanks in large part to the muscles that support the spine and the tough, fibrous ligaments that hold the vertebrae together. Unfortunately, these tissues can't always handle the pressure of everyday life. Excess stress on your back can stretch or tear the ligaments. This is called a sprain. A strain is a stretching or tearing of muscle or tendon.
It doesn't really matter whether you have a strain or a sprain. If your back hurts, it hurts. Your doctor may not even be able to tell the difference between the two. Fortunately, strategies for relief and prevention are equally successful for each type of injury.
Who is at risk for back sprains and strains?
Repetitive, forceful movements can easily injure the back. People who do a lot of bending, lifting and twisting are usually no strangers to back pain. At the other end of the spectrum, people who rarely exercise are also prone to sprains and strains. Muscles and ligaments can become weak if they aren't used. When an inactive person suddenly gets a notion to move a couch or shovel the sidewalk, an injury should hardly be surprising.
What are the symptoms of sprains and strains?
Sprains and strains usually cause a broad, aching pain across the lower back. The pain may be limited to one side or the other. You may have trouble bending your back or standing up completely straight. You may also have an occasional muscle spasm, especially when moving around or while sleeping. Spasms can turn the muscles in your back into a hard, painful knot.
What can I do to relieve the pain?
Given time, most injuries to the ligaments and muscles will heal on their own within six weeks. The key to recovery is staying active, within limits. Most people who try to return to their normal lives as soon as possible find that their ache gradually fades. Of course, some common sense is in order: If your job requires heavy lifting or other strenuous activities, you may have to limit these activities to give your back a chance to heal. Bed rest should be avoided if possible. Too much time in bed can weaken your muscles and slow your recovery.
While waiting for your back to recover, you can ease the pain with over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen (such as Motrin or Advil). However, follow the dosage recommendations carefully and don't take them any longer than necessary. Talk to your doctor if you need to take pain relievers more than several days.
A combination of cold and heat can also help ease back pain. Try putting a cold pack (a bag of ice wrapped in a cloth) on the sore spot soon after the pain first arises. Use the cold pack several times a day, 20 minutes at a time. When the pain starts to fade, 20 minutes with a heating pad can help loosen muscles and speed relief.
A recent review by the Cochrane Collaboration, which promotes evidence-based medicine, found that massage might be beneficial for patients with subacute back pain (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) low-back pain that is not attributed to a specific disease or condition. The review found massage appeared especially beneficial when combined with exercises and education.
When should I see the doctor?
Most people with sprains or strains can safely wait four to six weeks before calling the doctor. The pain will probably disappear long before six weeks, the earliest time most orthopedists would recommend an x-ray. Some cases call for quicker action. If you’ve had a serious injury, have a fever, have a known cancer history or develop incontinence call a doctor promptly for advice.
You should also call your doctor for back pain if you're experiencing back pain for the first time after age 50, don’t notice any improvement at all after three days, or if you've experienced unexplained weight loss. Constant, intense pain or pain that spreads down a leg or causes weakness or numbness in a leg is also a reason to call your doctor. These are all warning signs that you may have something more than a simple back strain or sprain.
What treatments can a doctor provide?
First of all, your doctor will try to understand the source of your pain. Sprains and strains won't show up on x-rays or any other test, but your symptoms can paint a fairly clear picture. If your pain has lasted for several weeks without a hint of improvement, your doctor may order an x-ray or a high-tech imaging test to check for herniated disks or other injuries. Such tests can also detect or rule out spinal infections and cancer.
Your doctor may prescribe stronger NSAIDs to help control your pain. Muscle relaxants help some patients, but they generally don't work any better than NSAIDs and often cause drowsiness.
Physical therapy can be important to quicken your recovery and prevent recurrence. Core strengthening and pelvic stabilization exercises are particularly helpful. A therapist can also instruct you on proper lifting techniques.
Surgery is generally not indicated for chronic low back pain. According to a report in the New England Journal of Medicine, surgery has never been shown to ease low back pain caused by sprains or strains, and may make it worse. One key point to remember is that surgery is more likely to be beneficial if a back injury causes chronic pain radiating into the legs. Be sure to get a second opinion if necessary.
How can I prevent back sprains and strains?
Once you've had an episode of back pain, the pain is likely to come back. Your job is to make sure the attacks are as brief and as far apart as possible. A strengthening and stretching program (Pilates or yoga) will help keep the muscles used for lifting in good shape and less vulnerable to strain. For extra protection, keep a straight posture when standing or sitting. If you lift heavy objects, let your legs, not your back, do the work.
In short, don't let that strain in your back become a strain on your life.