Dynamics and Treatment of Back Strain

DEFINITION

Back Strain is defined as an injury to the muscles and tendonous tissues of the back. By definition, it excludes injury to ligaments and joints that is more correctly denoted as a “sprain”.

The term Back Strain is the most common diagnosis utilized for back pain of acute origin when a more finely tuned diagnosis can not be derived from the presenting history, symptoms and clinical signs. Physicians are quick to lump the majority of patients into this category of diagnosis. Ironically, they won’t really be wrong because almost all back injuries will have “back strain” as at least one component of the injuries. However, a prudent examination should be utilized to rule out more severe and complicated injuries like Sacro-iliac Sprain, Facet Syndrome or Lumbar Disc Herniation. With inadequate care or repetitive use, even a very mild acute back strain can turn chronic.

ACUTE BACK STRAIN CAN LEAD TO CHRONIC BACK STRAIN

• An acute back strain is one that is of recent origin and often has never occurred before. It is most often brought on by an incident. Pain is often sharp, burning, stabbing, pulling and/or intense. It has a probable prognosis of being finite or coming to an end. Application of an ice pack or cryotherapy is one of the treatments of choice.
• A chronic back strain is one that persists with some level of discomfort over a long period of time. A chronic strain can at times become an acute episode, sometimes for no apparent reason. Pain level is usually, but not necessarily less intense than an acute episode and is often described as stiffness, limited mobility, arthritis or fatigue. Application of moist heat packs is one of the treatments of choice.

PULLED MUSCLE OR MUSCLE SPASM?

The term Back Strain is often associated and used interchangeably with the term pulled muscles. It may be interesting to know that a pulled muscle rarely occurs with the onset of back pain. The Erector Spinae and Quadratus Lumborum muscles of the low back are so strong, that it takes incredible forces to actually pull, strain or tear the muscle fibers. On the other hand, muscles spasm in response to the shock of injury. This occurs because an unexpected or jerky shock to the body may either elicit inflammation or irritate sensitive nerves adjacent to the joint capsule. This often causes the body to respond with a muscle spasm as a result of an overload of stimulating nerve impulses. Consistent spasm leads to a vicious cycle of pain, persistent inflammation, vertebral subluxation (misalignment) and a repeating barrage of nerve impulses offering feedback to the brain and spinal cord that something is wrong. Spasm is the body’s protective mechanism, acting to splint the area to prevent movement, not unlike putting a brace or back support on.

GOALS AND PROTOCOL OF TREATMENT

Unfortunately, a rather minor back strain can become chronic and produce a battery of systematic sequelae that lead to future generative changes. Such changes in adjacent joints manifest in the form of arthritis of the posterior facet joints or degenerative changes in the spinal disks. Salter’s work on joint degeneration with immobility proved this point. Dr. Salter provided extreme examples by reporting what happened when he restricted the movement of a joint in dogs to virtually zero. These immobile joints would completely degenerate and become fused within a relatively short period of time. As a more minor example, this is why old sports injuries come back later to haunt us or the reason an old injury becomes a good weather forecaster someday.

Two factors responsible for converting an acute strain to a chronic strain with degeneration:

• Lack of movement and inflexibility of the spinal joints. Movement is restricted by muscle spasms and later the infiltration of scar tissue and/or joint capsule adhesions. Inflammation and low oxygen concentration are impetuses for scar tissue formation.
• Lack of oxygen (O2), water (H20) and nutrients for healing. With lack of movement comes lack of all 3 of these. Beyond the age of 25 years, our spines are very dependent on individual joint flexibility for the flow of nutrients, O2 and H20 into our joint cartilage and surrounding structures.

The two ultimate goals of treatment for back strain are (1) to increase (maintain) flexibility and (2) to reduce inflammation.

Treatment Protocol

• ICE IS NICE - 15-20 minutes of ice packs or ice massage twice per day to control inflammation is always a good initial therapy because it helps break the cycle of pain and lessens scar formation by reducing swelling and inflammation.

• REST – Initial rest for the back is necessary to give the body a chance to begin healing. However, it is important to begin a program of movement exercises beginning no more than 4-7 days after the initial injury.

• SPINAL MOBILITY THERAPY – should be specific hands on mobilization by a trained physical therapist, chiropractor or medical professional. This is often referred to as spinal manipulation or an “adjustment”.

• EXERCISE ROUTINE - These may begin with simple isometric contraction and relaxation of core muscle groups, depending on the severity of injury. The important thing is that this routine be progressive whereby the number of reps, intensity and complexity of exercise increases with the tolerance of the patient. The overall program should strengthen and stretch all core muscles of abdomen, lower back, gluteal, hip and even thigh muscles. Regimen should at least begin under the guidance of a trained rehabilitative exercise specialist to guarantee proper form in the performance of such.

• NUTRIENT CONSIDERATIONS – To properly heal and maintain the integrity of the spinal joints and soft tissues, we need an abundant supply of oxygen, clean water, amino acid proteins and other micro-nutrients necessary for building strong joints and producing copious amounts of joint lubricants. If you learn nothing else from this article, start drinking at least ½ once of water per pound of body weight per day. This should be either purified, distilled or a spring water, preferably with a PH of 6 or greater (more alkaline is better). Your joints will degenerate without it, not to mention the rest of your body. Other nutrient considerations are numerous and probably beyond the scope of this initial article. Let it suffice to say, that you eat a well balanced diet with lots of good protein, omega 3 fatty acids, olive oil and take a good natural multi-vitamin-mineral supplement. Additional supplements of Glucosamine and MSM have proven benefits for joint healing and maintenance.

• LIFESTYLE CONSIDERATIONS – let’s just put this in very simple terms and say: “what you walk in, what you sit in, what you sleep on and what you think about are all extremely important.” So, consider things like having an orthopedic foam mattress and an ergonomic chair if you spend lots of time sitting. These are simply necessary tools for healthy living.

• HEAT PACK THERAPY – note that I put this last. I did this on purpose because it is the first thing most people think of (including physicians) when someone strains their back and really a bad idea in initial or acute stages. It is however great for chronic strains or to alternate with ice treatments once the pain has become dull and the condition is healing.