Low Back Strain

with Rehab

A strain is an injury in which a tendon or muscle is torn. The muscles and tendons of the lower back are vulnerable to strains. However, these muscles and tendons are very strong and require a great force to be injured. Strains are classified into three categories. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although the function may be decreased. Grade 3 strains involve a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Pain in the lower back.

  • Pain that affects one side more than the other.

  • Pain that gets worse with movement and may be felt in the hip, buttocks, or back of the thigh.

  • Muscle spasms of the muscles in the back.

  • Swelling along the muscles of the back.

  • Loss of strength of the back muscles.

  • Crackling sound (crepitation) when the muscles are touched.

CAUSES

Lower back strains occur when a force is placed on the muscles or tendons that is greater than they can handle. Common causes of injury include:

  • Prolonged overuse of the muscle-tendon units in the lower back, usually from incorrect posture.

  • A single violent injury or force applied to the back.

RISK INCREASES WITH:

  • Sports that involve twisting forces on the spine or a lot of bending at the waist (football, rugby, weightlifting, bowling, golf, tennis, speed skating, racquetball, swimming, running, gymnastics, diving).

  • Poor strength and flexibility.

  • Failure to warm up properly before activity.

  • Family history of lower back pain or disk disorders.

  • Previous back injury or surgery (especially fusion).

  • Poor posture with lifting, especially heavy objects.

  • Prolonged sitting, especially with poor posture.

PREVENTION

  • Learn and use proper posture when sitting or lifting (maintain proper posture when sitting, lift using the knees and legs, not at the waist).

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

PROGNOSIS

If treated properly, lower back strains usually heal within 6 weeks.

RELATED COMPLICATIONS

  • Recurring symptoms, resulting in a chronic problem.

  • Chronic inflammation, scarring, and partial muscle-tendon tear.

  • Delayed healing or resolution of symptoms.

  • Prolonged disability.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Severe injuries may require referral to a therapist for further evaluation and treatment, such as ultrasound. Your caregiver may advise that you wear a back brace or corset, to help reduce pain and discomfort. Often, prolonged bed rest results in greater harm then benefit. Corticosteroid injections may be recommended. However, these should be reserved for the most serious cases. It is important to avoid using your back when lifting objects. At night, sleep on your back on a firm mattress with a pillow placed under your knees. If non-surgical treatment is unsuccessful, surgery may be needed.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • You develop numbness, weakness, or loss of bowel or bladder function.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Low Back Strain

Most people with lower back pain will find that their symptoms get worse with excessive bending forward (flexion) or arching at the lower back (extension). The exercises which will help resolve your symptoms will focus on the opposite motion.

Your physician, physical therapist or athletic trainer will help you determine which exercises will be most helpful to resolve your lower back pain. Do not complete any exercises without first consulting with your caregiver. Discontinue any exercises which make your symptoms worse until you speak to your caregiver.

If you have pain, numbness or tingling which travels down into your buttocks, leg or foot, the goal of the therapy is for these symptoms to move closer to your back and eventually resolve. Sometimes, these leg symptoms will get better, but your lower back pain may worsen. This is typically an indication of progress in your rehabilitation. Be very alert to any changes in your symptoms and the activities in which you participated in the 24 hours prior to the change. Sharing this information with your caregiver will allow him/her to most efficiently treat your condition.

  • These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

FLEXION RANGE OF MOTION AND STRETCHING EXERCISES:

STRETCH – Flexion, Single Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest. Hold your leg in place by either grabbing behind your thigh or at your knee.

  • Pull until you feel a gentle stretch in your lower back. Hold __________ seconds.

  • Slowly release your grasp and repeat the exercise with the opposite side.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Flexion, Double Knee to Chest

  • Lie on a firm bed or floor with both legs extended in front of you.

  • Keeping one leg in contact with the floor, bring your opposite knee to your chest.

  • Tense your stomach muscles to support your back and then lift your other knee to your chest. Hold your legs in place by either grabbing behind your thighs or at your knees.

  • Pull both knees toward your chest until you feel a gentle stretch in your lower back. Hold __________ seconds.

  • Tense your stomach muscles and slowly return one leg at a time to the floor.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Low Trunk Rotation

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Extend your arms out to the side. This will stabilize your upper body by keeping your shoulders in contact with the floor.

  • Gently and slowly drop both knees together to one side until you feel a gentle stretch in your lower back. Hold for __________ seconds.

  • Tense your stomach muscles to support your lower back as you bring your knees back to the starting position. Repeat the exercise to the other side.

Repeat __________ times. Complete this exercise __________ times per day

EXTENSION RANGE OF MOTION AND FLEXIBILITY EXERCISES:

STRETCH – Extension, Prone on Elbows

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Place your elbows under your shoulders. If this is too painful, stack pillows under your chest.

  • Allow your body to relax so that your hips drop lower and make contact more completely with the floor.

  • Hold this position for __________ seconds.

  • Slowly return to lying flat on the floor.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION – Extension, Prone Press Ups

  • Lie on your stomach on the floor, a bed will be too soft. Place your palms about shoulder width apart and at the height of your head.

  • Keeping your back as relaxed as possible, slowly straighten your elbows while keeping your hips on the floor. You may adjust the placement of your hands to maximize your comfort. As you gain motion, your hands will come more underneath your shoulders.

  • Hold this position __________ seconds.

  • Slowly return to lying flat on the floor.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION- Quadruped, Neutral Spine

  • Assume a hands and knees position on a firm surface. Keep your hands under your shoulders and your knees under your hips. You may place padding under your knees for comfort.

  • Drop your head and point your tail bone toward the ground below you. This will round out your lower back like an angry cat. Hold this position for __________ seconds.

  • Slowly lift your head and release your tail bone so that your back sags into a large arch, like an old horse.

  • Hold this position for __________ seconds.

  • Repeat this until you feel limber in your lower back.

  • Now, find your "sweet spot." This will be the most comfortable position somewhere between the two previous positions. This is your neutral spine. Once you have found this position, tense your stomach muscles to support your lower back.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Low Back Strain

These exercises may help you when beginning to rehabilitate your injury. These exercises should be done near your "sweet spot." This is the neutral, low-back arch, somewhere between fully rounded and fully arched, that is your least painful position. When performed in this safe range of motion, these exercises can be used for people who have either a flexion or extension based injury. These exercises may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTHENING – Deep Abdominals, Pelvic Tilt

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Tense your lower abdominal muscles to press your lower back into the floor. This motion will rotate your pelvis so that your tail bone is scooping upwards rather than pointing at your feet or into the floor.

  • With a gentle tension and even breathing, hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Abdominals, Crunches

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor. Cross your arms over your chest.

  • Slightly tip your chin down without bending your neck.

  • Tense your abdominals and slowly lift your trunk high enough to just clear your shoulder blades. Lifting higher can put excessive stress on the lower back and does not further strengthen your abdominal muscles.

  • Control your return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Quadruped, Opposite UE/LE Lift

  • Assume a hands and knees position on a firm surface. Keep your hands under your shoulders and your knees under your hips. You may place padding under your knees for comfort.

  • Find your neutral spine and gently tense your abdominal muscles so that you can maintain this position. Your shoulders and hips should form a rectangle that is parallel with the floor and is not twisted.

  • Keeping your trunk steady, lift your right hand no higher than your shoulder and then your left leg no higher than your hip. Make sure you are not holding your breath. Hold this position __________ seconds.

  • Continuing to keep your abdominal muscles tense and your back steady, slowly return to your starting position. Repeat with the opposite arm and leg.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING – Lower Abdominals, Double Knee Lift

  • Lie on a firm bed or floor. Keeping your legs in front of you, bend your knees so they are both pointed toward the ceiling and your feet are flat on the floor.

  • Tense your abdominal muscles to brace your lower back and slowly lift both of your knees until they come over your hips. Be certain not to hold your breath.

  • Hold __________ seconds. Using your abdominal muscles, return to the starting position in a slow and controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

POSTURE AND BODY MECHANICS CONSIDERATIONS - Low Back Strain

Keeping correct posture when sitting, standing or completing your activities will reduce the stress put on different body tissues, allowing injured tissues a chance to heal and limiting painful experiences. The following are general guidelines for improved posture. Your physician or physical therapist will provide you with any instructions specific to your needs. While reading these guidelines, remember:

  • The exercises prescribed by your provider will help you have the flexibility and strength to maintain correct postures.

  • The correct posture provides the best environment for your joints to work. All of your joints have less wear and tear when properly supported by a spine with good posture. This means you will experience a healthier, less painful body.

  • Correct posture must be practiced with all of your activities, especially prolonged sitting and standing. Correct posture is as important when doing repetitive low-stress activities (typing) as it is when doing a single heavy-load activity (lifting).

RESTING POSITIONS

Consider which positions are most painful for you when choosing a resting position. If you have pain with flexion-based activities (sitting, bending, stooping, squatting), choose a position that allows you to rest in a less flexed posture. You would want to avoid curling into a fetal position on your side. If your pain worsens with extension-based activities (prolonged standing, working overhead), avoid resting in an extended position such as sleeping on your stomach. Most people will find more comfort when they rest with their spine in a more neutral position, neither too rounded nor too arched. Lying on a non-sagging bed on your side with a pillow between your knees, or on your back with a pillow under your knees will often provide some relief. Keep in mind, being in any one position for a prolonged period of time, no matter how correct your posture, can still lead to stiffness.

PROPER SITTING POSTURE

In order to minimize stress and discomfort on your spine, you must sit with correct posture. Sitting with good posture should be effortless for a healthy body. Returning to good posture is a gradual process. Many people can work toward this most comfortably by using various supports until they have the flexibility and strength to maintain this posture on their own.

When sitting with proper posture, your ears will fall over your shoulders and your shoulders will fall over your hips. You should use the back of the chair to support your upper back. Your lower back will be in a neutral position, just slightly arched. You may place a small pillow or folded towel at the base of your lower back for support.

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles tire, which leads to excessive strain on joints and other tissues. Keep these recommendations in mind:

CHAIR:

  • A chair should be able to slide under your desk when your back makes contact with the back of the chair. This allows you to work closely.

  • The chair's height should allow your eyes to be level with the upper part of your monitor and your hands to be slightly lower than your elbows.

BODY POSITION

  • Your feet should make contact with the floor. If this is not possible, use a foot rest.

  • Keep your ears over your shoulders. This will reduce stress on your neck and lower back.

INCORRECT SITTING POSTURES

If you are feeling tired and unable to assume a healthy sitting posture, do not slouch or slump. This puts excessive strain on your back tissues, causing more damage and pain. Healthier options include:

  • Using more support, like a lumbar pillow.

  • Switching tasks to something that requires you to be upright or walking.

  • Talking a brief walk.

  • Lying down to rest in a neutral-spine position.

PROLONGED STANDING WHILE SLIGHTLY LEANING FORWARD

When completing a task that requires you to lean forward while standing in one place for a long time, place either foot up on a stationary 2-4 inch high object to help maintain the best posture. When both feet are on the ground, the lower back tends to lose its slight inward curve. If this curve flattens (or becomes too large), then the back and your other joints will experience too much stress, tire more quickly, and can cause pain.

CORRECT STANDING POSTURES

Proper standing posture should be assumed with all daily activities, even if they only take a few moments, like when brushing your teeth. As in sitting, your ears should fall over your shoulders and your shoulders should fall over your hips. You should keep a slight tension in your abdominal muscles to brace your spine. Your tailbone should point down to the ground, not behind your body, resulting in an over-extended swayback posture.

INCORRECT STANDING POSTURES

Common incorrect standing postures include a forward head, locked knees and/or an excessive swayback.

WALKING

Walk with an upright posture. Your ears, shoulders and hips should all line-up.

PROLONGED ACTIVITY IN A FLEXED POSITION

When completing a task that requires you to bend forward at your waist or lean over a low surface, try to find a way to stabilize 3 out of 4 of your limbs. You can place a hand or elbow on your thigh or rest a knee on the surface you are reaching across. This will provide you more stability so that your muscles do not fatigue as quickly. By keeping your knees relaxed, or slightly bent, you will also reduce stress across your lower back.

CORRECT LIFTING TECHNIQUES

DO :

  • Assume a wide stance. This will provide you more stability and the opportunity to get as close as possible to the object which you are lifting.

  • Tense your abdominals to brace your spine. Bend at the knees and hips. Keeping your back locked in a neutral-spine position, lift using your leg muscles. Lift with your legs, keeping your back straight.

  • Test the weight of unknown objects before attempting to lift them.

  • Try to keep your elbows locked down at your sides in order get the best strength from your shoulders when carrying an object.

  • Always ask for help when lifting heavy or awkward objects.

INCORRECT LIFTING TECHNIQUES

DO NOT:

  • Lock your knees when lifting, even if it is a small object.

  • Bend and twist. Pivot at your feet or move your feet when needing to change directions.

  • Assume that you can safely pick up even a paper clip without proper posture.