Mid-Back Strain

with Rehab

A strain is an injury in which a tendon or muscle is torn. The muscles and tendons of the mid-back are vulnverable to strains. However, these muscles and tendons are very strong and require a great force to be injured. The muscles of the mid-back are responsible for stabilizing the spinal column, as well as spinal twisting (rotation). 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 middle of the back.

  • Pain that may affect only one side, and is worse with movement.

  • Muscle spasms, and often swelling in the back.

  • Loss of strength of the back muscles.

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

CAUSES

Mid-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:

  • Ongoing overuse of the muscle-tendon units in the middle back, usually from incorrect body 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 low back pain or disk disorders.

  • Previous back injury or surgery (especially fusion).

PREVENTION

  • Learn and use proper sports technique.

  • 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, mid-back strains usually heal within 6 weeks.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, resulting in a chronic problem. Properly treating the problem the first time decreases frequency of recurrence.

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

  • Delayed healing or resolution of symptoms, especially if activity is resumed too soon.

  • Prolonged disability.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. As the pain begins to subside, you may begin strengthening and stretching exercises to improve body posture and sport technique. 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. Corticosteroid injections may be given to help reduce inflammation. Biofeedback (watching monitors of your body processes) and psychotherapy may also be prescribed. Prolonged bed rest is felt to do more harm than good. Massage may help break the muscle spasms. Sometimes, an injection of cortisone, with or without local anesthetics, may be given to help relieve the pain and spasms.

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 IMMEDIATE 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 - Mid-Back Strain

These exercises may help you when beginning to rehabilitate your injury. In order to successfully resolve your symptoms, you must improve your posture. These exercises are designed to help reduce the forward-head and rounded-shoulder posture which contributes to this condition. 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.

STRETECH - Axial Extension

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, stomach muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Slowly retract your chin, so your head slides back and your chin slightly lowers. Continue to look straight ahead.

  • You should feel a gentle stretch in the back of your head. Be certain not to feel an aggressive stretch since this can cause headaches later.

  • Hold for __________ seconds.

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

RANGE OF MOTION- Upper Thoracic Extension

  • Sit on a firm chair with a high back. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, and feet hip width apart. Place a small pillow or folded towel in the curve of your lower back, if you are having difficulty maintaining good posture.

  • Gently brace your neck with your hands, allowing your arms to rest on your chest.

  • Continue to support your neck and slowly extend your back over the chair. You will feel a stretch across your upper back.

  • Hold __________ seconds. Slowly return to the starting position.

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

RANGE OF MOTION- Mid-Thoracic Extension

  • Roll a towel so that it is about 4 inches in diameter.

  • Position the towel lengthwise. Lay on the towel so that your spine, but not your shoulder blades, are supported.

  • You should feel your mid-back arching toward the floor. To increase the stretch, extend your arms away from your body.

  • Hold for __________ seconds.

Repeat exercise __________ times, __________ times per day.

STRENGTHENING EXERCISES - Mid-Back Strain

These exercises may help you when beginning to rehabilitate your injury. They 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 by your caregiver.

  • 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 – 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.

STRENGTH - Shoulder Extensors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a thumbs-up grip, grasp an end of the band in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band, until it becomes tense.

  • Squeezing your shoulder blades together, pull your hands down to the sides of your thighs. Do not allow your hands to go behind you.

  • Hold for __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

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

STRENGTH - Horizontal Abductors

Choose one of the two positions to complete this exercise.

Prone: lying on stomach:

  • Lie on your stomach on a firm surface so that your right / left arm overhangs the edge. Rest your forehead on your opposite forearm. With your palm facing the floor and your elbow straight, hold a __________ weight in your hand.

  • Squeeze your right / left shoulder blade to your mid-back spine and then slowly raise your arm to the height of the bed.

  • Hold for __________ seconds. Slowly reverse the directions and return to the starting position, controlling the weight as you lower your arm.

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

Standing:

  • Secure a rubber exercise band or tubing, so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • Grasp an end of the band in each hand and have your palms face each other. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band, until it becomes tense.

  • Squeeze your shoulder blades together. Keeping your elbows locked and your hands at shoulder height, spread your arms apart, forming a "T" shape with your body. Hold __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

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

STRENGTH - Scapular Retractors and External Rotators, Rowing

  • Secure a rubber exercise band or tubing, so that it is at the height of your shoulders when you are either standing, or sitting on a firm armless chair.

  • With a palm-down grip, grasp an end of the band in each hand. Straighten your elbows and lift your hands straight in front of you at shoulder height. Step back away from the secured end of band, until it becomes tense.

  • Step 1: Squeeze your shoulder blades together. Bending your elbows, draw your hands to your chest as if you are rowing a boat. At the end of this motion, your hands and elbow should be at shoulder height and your elbows should be out to your sides.

  • Step 2: Rotate your shoulder to raise your hands above your head. Your forearms should be vertical and your upper arms should be horizontal.

  • Hold for __________ seconds. Slowly ease the tension on the band, as you reverse the directions and return to the starting position.

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

POSTURE AND BODY MECHANICS CONSIDERATIONS – Mid-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).

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 low back for

support.

When working at a desk, create an environment that supports good, upright posture. Without extra support, muscles fatigue and lead 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.

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 an excessive swayback.

WALKING

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

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 paperclip without proper posture.