Back Strain: Symptoms, Causes and Treatment Strategies
Back Strain: Symptoms, Causes and Treatment Strategies
Back strain is probably the most common form of acute back pain. It affects the muscles and their tendons which attach them to various structures in the back. In general, muscle strain refers to a small tear in the muscle or its tendon. Most muscle strains tend to develop in the lower back area where the muscle changes into the tendon, but they can develop anywhere.
SymptomsA strain of the back muscles mostly causes localized pain in the area of the muscle/tendon injury accompanied by stiffness, limited range of motion and difficulties maintaining straight posture. Timing is very important when it comes to muscle strain.
Most muscle strains usually happen while lifting something very heavy or doing a sudden movement. Many individuals experiencing back pain due to muscle strain may feel a popping sensation at the moment of the injury which usually prompts them to seek medical attention.
They may have difficulties straightening their back up after the onset of the pain and usually maintain a semi bent position to avoid severe pain. That is not to say that muscle strain cannot come gradually. Even in this case, however, the individual can usually remember the moment when he felt sudden uncomfortable pain in the back which became progressively worse with activities.
Most individuals will also complain of muscle cramps in the area of their lower back. Additionally, coughing and sneezing usually brings on bouts of severe pain during acute back strain. The back muscles which tend to be the most affected by muscle strain are those right next to the spine.
Frequently, however, the pain can also be felt around the base of the spine and in the buttock area. Occasionally, pain may radiate into the buttocks. Under normal circumstances, pain due to back strain does not radiate down to the legs.
Pain radiating down to the legs is usually associated with nerve compression, but it is also frequently seen as a result of trigger points in the gluteal (buttock) muscles. Back strain is not a serious condition and most individuals with acute back strain recover spontaneously within 1 to 2 weeks.
CausesWhen muscle strain is caused by a sudden movement, it is generally a result of preexisting tightness in the back muscles which has developed over a period of time. Tight muscles are less flexible. Decreased flexibility results in limited ability to respond to sudden demands for muscle extension beyond the normal daily activity.
Therefore when the muscle is required to suddenly extend beyond its limits, such as when catching a falling object or catching ourselves from falling down, a strain can develop in the muscle or the tendon. To prevent further injury, the body triggers protective mechanism which manifests as muscle spasm.
The final outcome is stiffness and significantly limited range of motion with great amount of pain when trying to move in any direction.
Back strain can, however, develop also due to muscle overuse. In this case, the muscles and/or their tendons become strained due to repetitive movements in absence of sufficient time for recovery and repair.
Activities involving excessive forward bending of the spine constitute one of the most common misuses of the back leading to increased vulnerability to a variety of injuries. The forward bend position stretches the muscles and tendons of the back to a point where very little control can be exercised over the spine’s position.
Therefore lifting objects in forward bend positions can easily strain these muscles and their tendons. Additionally, forward bend position creates an uneven pressure on the spinal discs making them significantly more prone to injury.
Poor posture
Poor posture is one of the main underlying causes for the development of back strain. It generally refers to either too large or too small curvature in the area of the lower back. Over a period of time, poor posture leads to muscle imbalance and strain of the muscles/tendons in the back.
Spending extensive period of time in uneven position such as being twisted sideways or bent forward, also puts great stress on the spinal discs predisposing them to injury.
Poor physical fitness
poor physical fitness, excessive weight, sedentary lifestyle and lack of flexibility are also among the leading factors predisposing individuals to back strain. The result is poorly conditioned back muscles that lack sufficient strength and endurance to respond to increased physical demand when called upon.
This is why sudden unexpected movement, or performance of new repetitive task requiring the use of back muscles, easily result in back strain.
More information is available on this page.
Summary
Main SymptomsSudden onset
Localized pain & stiffness
Limited range of motion
Difficulties maintaining straight posture
Muscle cramp in the area of the lower back
CausesSudden movement
Tight muscles and lack of flexibility
Muscle overuse
Activities involving excessive forward bending of the spine
Lifting objects in forward bend position
Poor posture
Working in uneven position - twisted sideways or bent forward
Poor physical fitness,
Excessive weight
Sedentary lifestyle
Sciatica, Symptoms, Causes and Treatment strategies
Sciatica
Sciatica is a type of back pain that affects the sciatic nerve. The sciatic nerve is a large nerve that exits from the spine in the area of the low back, travels down to the buttock and continues down along the back of the thighs into the feet. It is an important nerve that branches in several places in the legs and provides nerve innervation to the legs and feet. A disc in the spine can herniate and compress the sciatic nerve causing symptoms of sciatica.
SymptomsPatients with sciatica usually experience the familiar electric jolt like sensation propagating along the back of the thighs sometimes all the way to the feet. The sensation of pins and needles or ants crawling under the skin of the legs is also frequently described by patients experiencing sciatica. The intensity of the pain varies among the patients. Some individuals experience excruciating debilitating pain that causes them to become bedridden for a couple of days, while others have only mild pain in their back and legs. While the sciatic pain usually starts in the low back and continues down the leg along the path of the sciatic nerve, the pain is usually more intense in the legs than in the back. Sciatica generally affects only one leg at a time. It is rare to see the involvement of both legs at the same time. If this is the case, it is important to seek medical evaluation to rule out other causes for these symptoms.
Most patients complain of more significant pain when they sit down. Standing for extended periods of time is also very painful and most people prefer to lay down or slowly walk around to ease their pain. Numbness and weakness in the leg are also frequently associated with sciatica. If the sciatic nerve becomes compressed in the buttock by a muscle called piriformis, it is called piriformis syndrome. The main differentiating symptoms between sciatica and the piriformis syndrome is that painful sensation caused by piriformis syndrome propagates down the leg along the back of the thighs and only up to the knees and not past the knees. The quality of the pain is also different. Pain radiating down the legs due to the Piriformis Syndrome generally feels like a dull, achy sensation unlike the electric-like, burning sensation caused by a pinched nerve in the spine causing sciatica.
CausesThere are many reasons why someone may develop sciatica. The risk factors are similar to developing any back pain. The excessive weight which creates too much pressure on the spine, sedentary occupation with lack of movement or carrying heavy objects are some of the most important causes. Aging is an independent factor that compounds any of the above risk factors because most people become more sedentary as they get older, gain weight and become less flexible. Sciatica is however not exclusive of young healthy individuals. Many individuals in the 30s present to their health care provider’s office with symptoms of sciatica after sustaining injury from doing exercises at the gym. This is usually related to lifting heavy weights, not stretching before and after exercising, as well as not getting enough rest to allow body fully recover and regenerate. To prevent flare-ups of sciatica it is, therefore, crucial to maintaining healthy weight and stay mobile.
Treatment GuidelinesWhile sciatica can be rarely caused by a bone spur or a tumor, in most cases of sudden onset of sciatica, it is related to a disc herniation. The treatment for sciatica is therefore essentially the same as for disc herniation since both share the same underlying cause. Treatment guidelines for disc herniation can be found here.
Summary
SymptomsElectric jolt like sensation in the back & back of the leg
“Pins and needles” sensation
Numbness and weakness in the leg
Burning sensation
Affects usually only one leg
More pain with sitting or standing
Pain is better when laying down or walking slowly
CausesExcessive weight
Sedentary occupation & lack of movement
Carrying heavy objects
Advanced age
Lifting heavy weights
Spinal Stenosis: Causes, Symptoms and Treatment
Spinal Stenosis
Chronic back pain can be a result of spinal stenosis. Spinal stenosis is usually seen in individuals over the age of 50 who developed significant degenerative changes in their spine from wear and tear. The medical word for these degenerative changes is osteoarthritis. Spinal stenosis is a result of the narrowing of the spaces within the spine where the spinal nerve roots are located. When the spaces get too narrow, excessive pressure on the nerves in the area develops.
SymptomsPeople affected by spinal stenosis may experience a variety of symptoms. Some individuals may have no symptoms at all, especially in the initial stages, while others may experience significant amount of pain. It is not known why some people experience more or less pain. Spinal stenosis is a degenerative disease and therefore develops slowly over period of time with gradually worsening symptoms. Most individuals experience tingling and numbness in their buttocks, legs, and calves, especially after prolonged walking. Walking up the hill or up the stairs is particularly painful, but even walking down the stairs can lead to significant amount of pain. In more advanced cases, weakness of the legs, pain, and cramping in one or both legs and feet can present with prolonged standing or walking. In severe cases, an individual may not be able to walk more than few blocks before severe pain develops.
Urination and bowel movement can also be occasionally affected as a result of the pressure on the spinal nerves that control these two essential physiologic functions, and the individual may develop urinary urgency and incontinence. In general, the back pain from spinal stenosis gets better with sitting down for a few minutes. Sitting flexes the spine and this relieves some of the pressure on the nerves. Many individuals with severe spinal stenosis, therefore, walk stoop forward and keeping their torso slightly flexed to lessen the pain while walking.
CausesThere are several reasons why spinal stenosis may develop. The most common causes include osteoarthritis and bone spurs. Osteoarthritis is one of the forms of arthritis. It is a result of wear and tear that affect the protective cartilage on the ends of the bones. When osteoarthritis is present in the spine, it can cause over time narrowing of the spinal canal, which eventually results in spinal stenosis. When bone spurs develop as a result of long term wear and tear, the spurs may grow inside of the spinal canal and cause pressure on the spinal nerves. Less frequent causes of spinal stenosis include a spinal tumor and a car accident. In both of these cases, there are usually several other prominent symptoms that point out to that diagnosis.
Treatment guidelinesIn mild cases of spinal stenosis, a conservative treatment approach is recommended. This may consist of physical therapy and strength training, stretching, short term course of acupuncture, daily stretching, swimming, Tai Chi or Yoga exercises. The goal is to keep the back muscle flexible and relaxed as much as possible. Building core strength is also important to properly distribute the weight and decrease the load on the spine. Losing excessive weight is crucial for the successful management of back pain. Carrying less weight translates to less pressure on the lumbar area of the spine from the excessive forward pull of the abdomen.
In more severe cases when the benefits of conservative treatment have been maximized, but pain continues to significantly affect the quality of life, surgery may be necessary. This should be however the last resort since there are inherent risks to any surgical procedure. It has been recommended, that only when all other treatment options have been exhausted, and the individual’s quality of life as it is now is poor, surgery should be considered as a possibility to improve current quality of life.
For more information about spinal stenosis you can visit the Mayo Clinic Spinal Stenosis page
Facet Joint Syndrome: A Silent Cause of Chronic Pain
Facet Joint Syndrome
Back pain can be caused by degenerative changes and inflammation in the facet joints which is commonly referred to as a Facet Joint Syndrome. The spine is made up of individual vertebral bodies which are stacked one on top of another. On each side of the vertebral bodies are tiny joints called facet joints. Their primary role is to allow the spine to move and make twisting and bending movements. They also keep the individual vertebras from moving too far forward or twisting without limits. Most facet joint-related pain is seen among individuals over the age of 60 secondary to osteoarthritis. It is, however, not uncommon for younger very active individuals to experience the same pain after engaging for several years in exercises that put lots of stress on the facet joints.
SymptomsWhen the facet joints become inflamed because of injury or arthritis, they will generate pain. Acute presentation of facet joint pain may resemble those caused by a herniated disc and at this stage it may be difficult to differentiate between these two. In most case the individual can pinpoint the area of pain indicating involved facet joint. At time, however, the person may experience diffused poorly localized pain in the lower back, hips, and buttocks on both sides. Most patients presenting with pain due to facet joint inflammation have difficulty bending backward which may help to establish the diagnosis. In some cases, the facet joint pain may project pain down to the legs and mimic the sciatic pain. Unlike sciatica, where the pain may project all the way down to the feet, facet joint pain usually terminates at the level of the knees. Only in rare cases the pain may project all the way down to the feet. This is usually seen when osteophyte is causing pressure on the nerve root.
CausesThe major cause for the development of facet joint syndrome appears to be osteoarthritis of the facet joints. Osteoarthritis is generally a consequence of wear and tear. It is characterized by narrowing of joint spaces, loss of joint cartilage and local joint inflammation. This process is similar to the more familiar knee osteoarthritis which is a well-known cause of knee pain among the elderly population. It has been shown that younger individuals suffering from facet joint syndrome tend to have history of strenuous jobs prior to the age of 20 which puts them at high risk for early osteoarthritis of the facet joints.
Diagnosis & Treatment guidelinesInflammation of the facet joints is generally not well diagnosed by MRI or X-Rays. There is also a poor correlation between the findings on the images, physical exam by the provider and the symptoms that the patient experiences. In most cases injection of an anesthetic medication into the vicinity of the painful facet joint can help to make the diagnosis. If the patient experiences immediate pain relief after the injection, the condition can be diagnosed as facet joint syndrome and steroid injections can then be administered to decrease the local inflammation. The steroid injections are usually administered by pain specialists under fluoroscopy which helps to guide the needle placement. The patient may receive these injections every 3-6 months based on the duration of symptoms relief.
Acupuncture treatment can also be beneficial since needling the musculature in the affected area can improve local blood circulation and decrease the inflammation and muscle tension. Referral to physical therapy to learn appropriate core strengthening and stretching exercise is important in long term management and prevention of further exacerbation.
Avoiding activities that put undue stress on the spine is as important, if not the most important aspect of any long term management of facet joint syndrome. No treatment will be effective if these perpetuating factors are not effectively addressed and appropriate modifications incorporated into daily lifestyle.
Chronic Back Pain: Treatment Options for Chronic Back Pain
Chronic back pain continues to be one of the most common musculoskeletal complains seen in primary care. It is estimated that the incidents of chronic back pain will continue to rise given our increasingly more sedentary lifestyle. While research in the areas of pain management and safer surgical procedures continues, both should be viewed as the last resort.
Self-AcupressureSelf-acupressure can be applied to the specific trigger points in the affected musculature by the patient at home on daily bases. It can be used as a sole treatment for the management of mild to moderate back pain. Self-acupressure can be also used along with any other modality to reinforce the treatment effect and promote faster recovery. More information about acupressure can be found by clicking on the tab on the left-hand side of this page.
Physical Therapy
Physical therapy is frequently used as a part of an overall treatment protocol to treat acute or chronic back pain. The goal of physical therapy is to relieve pain, help the body in the healing process, and restore normal functional pain-free movement. A physical therapist can prescribe specific rehabilitation exercises alone or in combination with dry needling, TENS, heat application, soft tissue release or gentle manipulations. Physical therapy is generally initiated if the injury is not spontaneously recovering with conservative treatments within 2-6 weeks. In case of severe acute back pain, however, a referral to physical therapy can be initiated right away. For more information click on the tab on the left-hand side.
Acupuncture and Dry NeedlingAcupuncture and dry needling are both very safe therapeutic modalities. Dry needling is mostly available to the patients through the department of physical therapy. The carefully selected patients which may benefit from dry needling usually receive a series of dry needling sessions as part of their physical therapy treatment plan. There are some primary care providers who have been trained in dry needling. They may offer this treatment modality to their patients on limited bases given their busy schedule. Acupuncture is available to patients only from licensed acupuncturists or physicians with training in medical acupuncture. For more information about Acupuncture and Dry Needling please click on the tabs on the left-hand side of this page.
Pharmacologic management
Pain medications play an important role in the management of chronic back pain for many patients. Some patients rely on a daily dose of pain medication to control their pain and there is a definite role for pain medication in the management of chronic pain. It is important to point out, however, that the medication should not be relied on as the sole long term strategy to keep chronic pain under control. This passive approach generally leads to further deconditioning, the need for increasing the dosages of medication and inherently to more side effects associated with their daily use. Appropriate use of pain medication can be, however, an integral part of a comprehensive treatment plan when used under the guidance of a qualified health care provider. In general, the pain medication should be used at the minimal effective dose and for the shortest amount of time, unless directed otherwise by the health care provider.
Surgical procedureNo surgical procedure is risks free. Formation of scar tissue and the need for subsequent surgery are known complications. Surgery should be therefore reserved only for rare cases. These generally include instances where all other treatment options have been exhausted. In these cases either the pain cannot be successfully controlled by any other intervention or there is a significant functional deficit that can be improved by the surgical procedure.
The information provided on these pages is not intended to treat or diagnose any condition and should be viewed solely for the purpose of education. By no means is this information replacing evaluation by a qualified health care provider. For detailed Terms and Conditions, as well the use of cookies by this website, please see the sections “Terms and Conditions” and “Privacy.”
For more information on Acupuncture and other complementary therapies visit Alternative, Complementary & Integrative Therapies: Acupuncture/Acupressure
Back Pain and Physical Therapy
Physical therapy is frequently used as a part of an overall treatment protocol to treat acute or chronic back pain. The goal of physical therapy is to relieve pain, help the body in the healing process, and restore normal functional pain-free movement. A physical therapist can prescribe specific rehabilitation exercises alone or in combination with dry needling, TENS, heat application, soft tissue release or gentle manipulations. Physical therapy is generally initiated if an injury is not spontaneously recovering with conservative treatments within 2-6 weeks. In case of severe acute back pain, however, a referral to physical therapy can be initiated right away.
Individualized treatment and workout plansPhysical therapists can review with patients their daily routine and help them identify the major aggravating factors that continue to flare up their back pain or prevent the maximal recovery. They will thoroughly asses the patient’s condition and create an individual exercise treatment plan. Physical therapists can help the patient tailor a specific work out routine that will help them achieve their personal fitness goals without aggravating their back pain. Additionally, physical therapists are the top authority to teach patients the correct execution of individual exercises to prevent future injuries. Incorrectly performed exercises continue to be the leading cause of many exercise-related injuries. Incorrectly performed exercises can lead to permanent joint or back injury.
Summary
Physical therapy is an integral part of any comprehensive treatment approach to chronic back pain. In some cases, physical therapy can be, however, beneficial also in acute cases of back pain. Physical therapists often incorporate variety of techniques and tools when designing their individual treatment plan. Imaging is usually not needed in most cases of uncomplicated chronic and acute back pain but imaging studies can be ordered by the physical therapist if it is indicated. Physical therapists are top experts in designing individual workout routines that will help patients achieve their fitness goals without risking further injuries. Lastly, physical therapy only works if patients become active participants.
