Back Strains and Sprains

The back is a complex structure of bone and muscle, supported by cartilage, tendons and ligaments, and fed by a network of blood vessels and nerves. The back—especially the lumbar, or lower back—bears much of the body’s weight during walking, running, lifting and other activities. It makes sense, then, that injuries to the lower back—such as strains and sprains—are common.

What is a strain?

A strain is an injury to either a muscle or tendon. Tendons are the tough, fibrous bands of tissue that connect muscle to bone. With a back strain, the muscles and tendons that support the spine are twisted, pulled or torn.

What is a sprain?

A sprain is the stretching or tearing of a ligament. Ligaments are the fibrous bands of tissue that connect two or more bones at a joint and prevent excessive movement of the joint.

How common are back strains and sprains?

Strains and sprains are very common injuries. Next to headaches, back problems are the most common complaint to healthcare professionals.

What causes a back strain or sprain?

Twisting or pulling a muscle or tendon can result in a strain. It can also be caused by a single instance of improper lifting or by overstressing the back muscles. A chronic (long-term) strain usually results from overuse after prolonged, repetitive movement of the muscles and tendons.

A sprain often occurs after a fall or sudden twist, or a blow to the body that forces a joint out of its normal position. All of these conditions stretch one or more ligaments beyond their normal range of movement, causing injury.

In addition, several factors can put a person at greater risk for a back strain or sprain, including:

• Curving the lower back excessively
• Having overweight
• Having weak back or abdominal muscles, and/or tight hamstrings (muscles in the back of the thighs).

Playing sports that involve pushing and pulling—such as weightlifting and football—also increases the risk of a low back injury.

What are the symptoms of a back strain or sprain?

Symptoms of a strain or sprain include:

• Pain that gets worse when you move
• Muscle cramping or spasms (sudden uncontrollable muscle contractions)
• Decreased function and/or range of motion of the joint (difficulty walking, bending forward or sideways, or standing straight)

In some cases, the person may feel a pop or tear at the time of the injury.

How are back sprains and strains diagnosed?

Mild strains and sprains can usually be diagnosed based on a medical history—including a review of the symptoms and how the injury occurred—and a physical examination by a healthcare provider. In cases of more severe strains and sprains, especially when there is weakness or loss of function, an X-ray may be taken to rule out a fractured (broken) or herniated (bulging) disk as the cause of the back pain.

How are back strains and sprains treated?

The treatment for strains and sprains is similar, and often takes place in two phases.

The goal of the first phase is to reduce the pain and spasm. This may involve rest, and the use of ice packs and compression (pressure), especially for the first 24 to 48 hours after the injury. An over-the-counter nonsteroidal anti-inflammatory drug, such as ibuprofen (Motrin®), may be recommended to help reduce pain and swelling.

After the first 24 to 48 hours, returning to normal activities, as tolerated, is advisable. Extended bed rest or immobility (nonmovement) simply prolongs symptoms and delays recovery.

Most people with lumbar strain/sprain symptoms improve in about 2 weeks. If symptoms continue for more than 2 weeks, additional treatment may be required.

What complications are associated with back strains and sprains?

The most common complication of a back strain or sprain is a reduction in activity, which can lead to weight gain, loss of bone density, and loss of muscle strength and flexibility in other areas of the body.

How can back sprains and strains be prevented?

It is not possible to prevent all back injuries, but you can take some steps to help lower the risk of a sprain or strain:

• Eat a healthy, well-balanced diet to keep your bones and muscles strong.
• Maintain a healthy weight. Excess weight puts added stress on the structures of the lower back.
• Exercise regularly, including stretching, to keep your joints flexible and your muscles in good condition.
• Practice safety measures to help prevent falls, such as wearing shoes that fit properly, and keeping stairs and walkways free of clutter.
• Use good body mechanics when sitting, standing and lifting. For example, try to keep your back straight and your shoulders back. When sitting, keep your knees bent and your feet flat on the floor. Don’t over-reach, and avoid twisting movements. When lifting, bend your knees and use your strong leg muscles to help balance the load.
• Stop smoking. Nicotine interferes with blood flow to the muscles.

What is the prognosis (outlook) for people with back strains and sprains?

Most people with back strains and sprains have a full recovery with treatment within 2 weeks.

When should I contact my healthcare provider about a back strain or sprain?

Call your healthcare provider if:

• You have severe pain and cannot walk more than a few steps.
• You have numbness in the area of injury or down your leg.
• You have injured your lower back several times before.
• You have a lump or area with an unusual shape.
• You have pain that interferes with sleep.
• You have obvious weakness in an extremity (hands or feet) after an injury.