The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. The spine contains three segments: cervical, thoracic and lumbar.
Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine, disks are similar but smaller in size.
Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.
Muscles, tendons and ligaments are fibrous cords of tissue that connect the vertebrae and allow motion, while providing support and stability for the spine and upper body.
While a lumbar strain may not sound like a serious injury, it can be the source of surprisingly severe pain. Lumbar strains are among the most common causes of lower back pain, and the reason for many emergency room visits each year. A lumbar strain can occur at any age, but it is most common in those in their forties.
A lumbar strain is an injury to the tendons and/or muscles of the lower back, ranging from simple stretching injuries to partial or complete tears in the muscle/tendon combination. When the tissues are stretched too far, or torn, microscopic tears of varying degrees can occur. These tears cause inflammation in the surrounding area, resulting in painful back spasms and difficulty moving. A lumber strain that has been present for days or weeks is referred to as acute. If it has persisted for longer than 3 months, it is considered chronic.
Symptoms of a lumbar strain or sprain include mild to extreme discomfort or pain in the lower back area, particularly after an event or injury that mechanically stresses the lumbar tissues. Depending on the injury and severity, other symptoms that may be experienced include: weakness or noticeable loss of strength, instability, difficulty with movement, complete loss of muscle function; swelling, tenderness and bruising. Severity of symptoms typically corresponds with the severity of the injury.
Seek immediate medical treatment if you experience sudden or severe pain, loss of mobility, complete muscle weakness, or if the potential for a fracture or other serious injury exists. Be sure to see your physician or other medical professional if you experience back pain that does not go away after a short period of rest, application of ice, and anti-inflammatory medication.
People with a pulled lower back muscle may experience one or more of the following:
The injury causing a lumbar strain may be the result of overuse, improper use, or trauma that can occur during athletic participation as well as everyday activities.
Your physician will perform a physical exam that may include placing pressure on or near the suspected injury to identify swelling, tenderness of pain. You may be asked to perform certain movements which will help determine your range of motion limitations and what increases or decreases your pain. You may also be asked to describe your symptoms and the activity or injury that caused them.
X-rays or magnetic resonance imaging (MRI) may be requested to rule out fractures, bone abnormalities or other potential sources of pain, or to determine if damage to spinal discs has occurred. If prescribed treatment does not provide relief from symptoms, additional diagnostic testing, such as electromyography (EMG) or nerve conduction studies, may be needed.
During your diagnosis, your physician may apply a grading scale to classify your injury as mild, moderate or severe.
Treatment for a lumbar strain typically involves: limiting the activity that caused the injury (heavy lifting, twisting, bending or other actions); applying ice for the first 48 hours, and applying heat, thereafter; anti-inflammatory medications (NSAIDS) and medications to relieve muscle spasms. Although an initial course of rest may be required, prolonged periods of inactivity or bedrest are not recommended and may actually slow recovery. Physical therapy and exercises to strengthen back muscles may also be prescribed. Surgical treatment is only indicated in rare circumstances when a complete tear of the ligaments or muscles has occurred.
Other nonsurgical treatment recommendations may include electrical stimulation, moist heat therapy and trigger point injections. For patients with no signs of nerve irritation, spinal manipulation for up to one month has been found helpful. Use back protection techniques and support devices as needed to avoid future injury.
Back muscle strains typically heal with time, many within a few days, and most within 3 to 4 weeks. Most patients with mild or moderate lumbar strains make a full recovery and are free of symptoms within days, weeks, or possibly months. However, it is important to remember that resuming activity levels too quickly may cause re-injury, which can be more severe than the original injury and may result in recurring or chronic pain.
Although some low back muscles receive adequate exercise during daily activities, many do not. These tend to weaken with age unless specifically targeted. Generally, those who exercise regularly and stretch back muscles are less likely to suffer from low back pain due to strains, sprains, tears or spasms.
To prevent or lessen the impact of any problems, it is important to exercise regularly and combine walking, swimming or other activities with a spine conditioning program, low back exercises, or specific exercises to stretch and strengthen back and abdominal muscles. A complete exercise regimen for the low back may include: stretching for back pain relief, back strengthening exercises, and low-impact aerobic exercise. Regular stretching of the hamstring (the muscle running through the back of the thigh) will also help reduce and prevent back muscle tightness and injury. Tightness in the hamstring limits motion in the pelvis, which can strain the lower back. By gradually lengthening these muscles, regular hamstring stretching can reduce stress in the lower back.