Lumbar Sprain/Strain

Synonyms

Definitions

Strain

An overstretching or tearing of a muscle or tendon.

Sprain

An overstretching or tearing of ligamentous tissue.

A condition involving non-radicular low back pain that may extend into the buttocks and occurs either suddenly or following a trauma that may be either instantaneous or repetitive. Episode may result in incomplete annular tear that may allow substances to leak that cause irritation to lower lumbar roots.

Patient History

Lumbar sprain/strain is the most common cause for lost work time and disability in patients age 45 and younger.

Patient history may include

Patient Data

Specific Considerations

Red Flag

Possible Consequence or Cause

Severe Trauma

Fracture

Onset following minor fall or heavy lifting or osteopathic patient

Fracture

Direct blow to the back

Fracture

Global or progressive motor weakness in the lower extremities

Cauda Equina Syndrome

Saddle anesthesia

Cauda Equina Syndrome

Severe or progressive neurologic complaints

Cauda Equina Syndrome

Recent onset of bowel dysfunction or acute onset of bladder dysfunction  in association with low back pain

Cauda Equina Syndrome

Unexplained weight loss

Malignancy

Prior history of cancer

Malignancy

Pain that is worse with recumbency or worse at night

Malignancy

Fever or recent bacterial infection

Infection

Intravenous drug abuse or immunosuppression

Infection

Prolonged steroid use

Osteoporosis

Presentation

Strain

Overexertion of the back in some static or dynamic activity; overstretching; or contusion. Back pain is worse with initial activity and rest typically relieves the pain. Trauma may precipitate the condition.

Sprain

Chronic manifestations typically involve prolonged periods of postural abuse. Acute onset typically involves a sudden motion or poor body mechanics while performing an activity. Trauma may precipitate the condition.

Subjective Findings

Strain

Pain and stiffness in a muscle/tendon group of the lumbar region.

Sprain

Pain and stiffness in the lumbar area.

General

Low back pain that may radiate into the buttocks; need to frequently shift position; may have difficulty standing upright.

Objective Findings

Objective Findings may include

Scope of Examination

Examine the musculoskeletal system for possible causes, or contributing factors to the complaint.

Specific Examination Considerations

The following standardized tests may be used to assess functional limitation such as lifting, walking, sitting, standing, sleeping, social life and vocation.

 Results if Lumbar Sprain/Strain

Differential Diagnoses

Physical/Occupational Therapy Management

Therapy must show measurable functional progress.

Requirements for Physical/Occupational Therapy Visits

Two or more of the following findings must be present to establish medical necessity. At least one of the findings must address functional limitation.  Degree of abnormality should be specified at initiation of therapy, and periodically, to establish an objective response to therapy:

  1. Significant Functional Limitations (i.e. social, recreational, vocational activities) - Practitioners are strongly encouraged to utilize peer reviewed, standardized tools to quantify Functional Limitations.

  2. Strength: <4/good (5 = normal; 4 = good; 3 = fair; 2 = poor; 1 = trace)

  3. ROM: limited >30% (norms: flexion = 60; extension = 30; lateral flexion = 30; rotation = 30)

  4. Pain: limiting function and at least 3/10

  5. Neurological signs: altered reflexes and/or sensations

Treatment frequency and duration must be based on:

Treatment Methods

Discharge Criteria

Referral Guidelines

Refer patient to their primary care provider to explore alternative treatment options if:

Appropriate Procedures/Modalities

Use of modalities and/or passive treatments should be limited. The goal is to transition the patient as quickly as possible to active, self-management and functional independence.

The following table lists the procedures for Early Phase presentation:

Expected Outcome

Procedures/Modalities Such As

Decrease pain/muscle spasm

  • Electrical modalities, Cryotherapy

  • Soft Tissue mobilization

  • Manual or mechanical traction

Improve lumbar flexibility

  • Segmental mobilization-Grade I and II

  • Flexibility exercises (hamstring stretch, Hip flexors stretch, back muscle stretch, Quadriceps stretch, pelvic mobilization)

Improve strength and power of back

  • Isometric exercises to trunk muscles

  • Progress to isotonic exercises

Patient education, self management, and  initiation of home exercise program

  • Weight reduction

  • Early return to activities

  • Teach self-management of symptoms

  • Teach home exercise program

  • Determine causative factors, modify activities and postures

The following table lists the procedures for Mid and Final Phase presentation:

Expected Outcome

Procedures/Modalities Such As

Restore flexibility of lumbar spine

  • Segmental joint mobilization-Grade III/IV

  • Flexibility exercises (hamstring stretch, Hip flexors stretch, back muscle stretch, Quadriceps stretch, pelvic mobilization)

Enhance neuromuscular performance

  • Progressive resistive exercises

  • Stabilization exercises

  • Work hardening

  • Functional Restoration

  • Physical Reconditioning program

Improvement in body mechanics and postural stabilization

  • Body mechanics training

  • Postural stabilization activities

  • Postural Control

  • Endurance exercises

Ability to perform physical actions, tasks or activities related to self-care, home management, work, community and leisure

  • Gradual resumption of activities relating to work, community and leisure

  • Self-management of symptoms

  • Teach home exercise program

 

Note

Not all of the above modalities are appropriate for each individual case; they require the skill and judgment of persons properly trained and licensed for safe use. Use of diathermies, including microwave, shortwave, and ultrasound, is controversial and may be contraindicated in the presence of metals, and prior to neurological, and/or orthopedic maturity. Landmark recommends following all manufacturer and educational guidelines in the use of electrotherapeutic modalities.

Home and Self-Care Techniques

The patient can be taught to use medical equipment and administer self care at his residence.

Home Medical Equipment

Self-Care Techniques

Alternatives/Adjuncts to Physical/Occupational Therapy Management

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