Lumbar (lower back) muscle strains and sprains are the most common causes of low back pain.
The back is prone to this strain because of its weight-bearing function and involvement in moving, twisting and bending. Lumbar muscle strain is caused when muscle fibers are abnormally stretched or torn. Lumbar sprain is caused when ligaments, the tough bands of tissue that hold bones together, are torn from their attachments. Both of these can result from a sudden injury or from gradual overuse.
When the lumbar spine is strained or sprained, the soft tissues become inflamed. This inflammation causes pain and may cause muscle spasms. Lumbar strain or sprain can be very debilitating.
Three types of muscles support the spine:
• Extensors (back muscles and gluteal muscles)
• Flexors (abdominal muscles and iliopsoas muscles)
• Obliques or rotators (side muscles)
• Low back pain that may radiate into the buttocks, but does not affect the legs
• Stiffness in the low back area, restricting range of motion
• Inability to maintain normal posture due to stiffness and/or pain
• Muscle spasms either with activity or at rest
• Pain that persists for a maximum of 10-14 days
Diagnostic testing is usually not necessary, unless pain has been present for more than two weeks and has not improved as expected. It is important to rule out underlying causes such as an undetected disc injury. If symptoms are persistent, we may order the following diagnostic imaging.
• Digital X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e. tumors, infections, fractures, etc.
• Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
Rest for a short period of time, usually from one to three days. This should be as brief as possible, as prolonged rest can lead to a loss of muscle strength and may increase muscle stiffness, adding to pain and discomfort. Conventionally sprain and strain is commonly treated with non-steroidal anti-inflammatory medication if the pain is mild to moderate but we find that low intensity laser works better without the side effects of drugs.
We may also recommend physical therapy. Our therapist will perform an in-depth evaluation, which combined with the Dr. Moona’s diagnosis, will dictate a treatment specifically designed for each individual patient with low back pain. Therapy may include traction, gentle massage, ice and heat therapy, Laser therapy, electrical muscle stimulation, custom orthotics and stretching exercises.
The prognosis is excellent for a complete recovery from a lumbar strain or sprain injury. More than 90 percent of patients completely recover from an episode of lumbar muscle strain or sprain within one month. Heat and ice treatment are indicated on an "as needed" basis at home to treat sudden flare-ups of low back pain. However, low back strain may develop into a chronic condition unless efforts are made to change habits that contribute to the problem. At Advanced Pain Relief Clinic, we are happy to provide suggestions on lifestyle change and exercises to prevent future flare-ups.
Herniated/Bulging/Degenerative Lumbar Discs/sciatica/stenosis
Normally, there are five gel-like cervical discs (one between each of the lumbar spines’ vertebrae) that absorb shock and prevent vertebral bones from rubbing against each other while the neck moves. Each disc is comprised of a tough but flexible outer layer of woven cartilage strands, called the annulus fibrosus. Sealed inside the annulus fibrosus is a soft interior filled with a mucoprotein gel called the nucleus pulposus. The nucleus gives the disc its shock absorption property.
In children, the discs are about 85% water. The discs begin to naturally lose hydration during the aging process. Some estimates have the disc’s water content typically falling to 70% by age 70, but in some people the disc can lose hydration much more quickly. As the disc loses hydration, it offers less cushioning and becomes more prone to cracks and tears. The disc is not able to easily repair itself because it does not have a direct blood supply (instead getting nutrients through diffusion caused by healthy movement with adjacent structures). As such, a tear in the disc either will not heal or will develop weaker scar tissue that has potential to break again. We also know that nerves run between the vertebrae and when disc degenerates we can sometimes see a pinching of these nerves leading to symptoms include pain radiating from the buttocks down the leg. When the inner part of the disc, the Nucleus Pulposis squishes out the side of the disc, this is referred to as a disc herniation. Depending on the size and location of the disc herniation it may put pressure on a nearby nerve and cause pain or numbness/tingling/pain in the hips, buttocks and legs commonly referred to as sciatica. Sciatica is pain along the sciatic nerve. It usually results from compression of nerve roots in the lower back. Other common causes include intervertebral disk herniation, osteophytes, and narrowing of the spinal canal (spinal stenosis). Severe cases may result in Cauda Equina Syndrome causing bladder and bowel symptoms.
At Advanced Pain Relief Clinic we use treatments to boost the bodies ability to repair and produce healthier, better hydrated tissues through laser and shockwave therapy and create unloading/restorative pressures on the discs and introduce better movement Spinal Decompression Therapy and occasionally/optionally Chiropractic adjustments for on-going relief.
Lumbar Facet Syndrome
Each level of your spine functions as a three-joint complex. There are two facet joints in the back and a large disc in front that comprise each intervertebral segment. This tripod creates great stability, supports all your weight above each level and provides support for you to move in all directions. The posterior facet joints are synovial joints, similar to other joints in the human body. They experience constant, repetitive motion, and can become worn or torn. They also can become restricted in movement or develop too much movement resulting in pain. The facet joints are shaped and angled differently in the cervical, thoracic and lumbar spine. This allows for all of the available motion within the spine.
Pain stemming from the facet joints is termed “facet syndrome.” The facet joints become inflamed and may cause pain, soreness and stiffness. Patients often report increased pain with extension or prolonged periods of inactivity like sitting or standing too long. Changing positions often improves pain. Facet syndrome pain may feel worse in the morning and improve after moving around as the day progresses. However, for those who work sitting all day with poor posture, they may experience pain throughout the day. The lumbar spine has considerable motion and high compressive forces. Facet pain from these joints is quite common. Pain is usually felt directly over the affected joints, but may also be felt in the buttocks, hips, groin, and back of the thighs depending on which facet joint is injured.
Facet syndrome can be caused by trauma. Abnormal postures can overload spinal tissues, including the facet joints, and cause inflammation and pain in these joints. More commonly, degenerative changes in the lumbar spine can lead to abnormal stress and strain. This results in increased loads on the facet joints.
Most conservative treatments for facet syndrome involve postural correction, soft tissue massage and manipulation of the affected areas. This includes physical therapy, Chiropractic care and specialized treatments such as laser therapy, shockwave therapy and spinal decompression.
Lower Back Conditions – Spinal Stenosis
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the legs especially with activity. Many of our patients with this condition report symptoms that develop with walking are reduced when bending forward or pushing a shopping cart. There are many potential causes of stenosis that we are equipped to recognize and in many cases improvement is possible within a few visits.