Mississauga Chiropractor Presents: Lumbar Sprain/Strain

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Here’s another blog from a Mississauga Chiropractor…

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A Lumbar Sprain/Strain is due to soft tissue damage (stretch or rupture) to the ligaments & muscles surrounding the lumbar spine, sacrum & pelvis

 

Sprain/Strain Grading Severity Table:

Grade

Clinical Findings

Healing Time

1

  •   Simple strain/sprain – minimal fibre   disruption
  •   Minimal pain
  •   Trigger points and loss of range of motion
  •   Decreased joint play in spine

7 days to 4 weeks

2

  •   Moderate strain/sprain
  •   Partial tearing of ligaments/muscles
  •   Haemorrhage & marked pain
  •   Athletic injury, lifting, trauma

2 weeks to 1 year

3

  •   Severe strain/sprain
  •   May have complete laceration
  •   Palpate the torn muscle & edema
  •   Referral for surgical evaluation

8 weeks to > 1 year

 

Differential Diagnosis of Sprain vs Strain:

 

Action

Strain (muscle)

Sprain (ligament)

Passive Range of Motion

Mild to no pain except at end range (muscle stretch)

Painful due to the stretch of the ligaments

Active Range of Motion

Painful – decreased range of motion due to pain

Painful – decreased range of motion due to pain

Resisted Contraction

Painful

Mild or no Pain

 

History:

  1. Direct trauma – falls, motor vehicle accident, sports injury

 

  1. Overuse, fatigue, repetitive microtrauma (heavy lifting & bending) – over hours or days of the same motion

 

  1. Postural – may be either an intrinsic postural problem (e.g. hyperlordosis or anatomically short leg) or an extrinsic postural problem (e.g. prolonged stressful positions, student posture)

 

  1. Sudden unguarded movement – in particular being flexed & rotated while lifting something leaves the patient at a biomechanical disadvantage – this usually represents a single episode of trauma, however mild it might be at the time.  This may be secondary to having a poor proprioception of the trunk and lower extremity.

 

  1. Additional factors may include
  • Muscle imbalances, prior injuries
  • Inappropriate increase in training regime (doing too much, too soon)
  • Muscle deconditioning (weak core), abdominal obesity

 

Presentation:

  1. Pain in the lumbosacral region
  • Patient may experience immediate pain or pain shortly after the injury
  • Minor injuries may have delayed onset muscle soreness (24-48 hours after)
  • Pain may radiate into the lower thoracic spine, buttock or posterior thigh

2.   Decreased mobility, stiffness & muscle spasm

3.  Gait may be slow & guarded (limp is possible)

  • Guarded, slow trunk movements (bending, sitting)

 

  1. Range of motion will be limited in most motions
  • If there is pain in multiple directions it suggests joint capsule damage,  pain in a single direction indicates muscle or tendon damage

 

Treatment:

  1. Soft Tissue Therapy (active release technique) and/or massage therapy to the affected tissues
  2. Spinal Manipulative Therapy/Mobilization to the restricted joints in the lumbar spine
  3. Electrotherapy:  TENS, IFC
  4. Acupuncture
  5. Avoid prolonged bed rest; however the best resting position is sleeping on the back with knees bent
  6. Core strength & proprioceptive exercises; Aerobic and endurance exercises

 

Prognosis:

  1. Prognosis is good for complete recovery in first time cases
  2. Possible complications with joint instability, significant trauma or prolonged immobilizations

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