Back Strain: Symptoms, Causes and Treatment Strategies

Musculoskeletal Health with Dr D. 

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.

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Symptoms

A 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.

Causes

When 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 Symptoms

Sudden onset

Localized pain  & stiffness

Limited range of motion

Difficulties maintaining straight posture

Muscle cramp in the area of the lower back

Causes

Sudden 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

by Dr. Michal Domeny DNP, L.Ac, CD/N

Trigger Points: The Shocking Culprits Behind Your Pain

Complementary Medicine

What are Trigger Points ?

In the mid-1960s doctor Travel introduced the term myofascial pain.  Over the years, many publications and clinical experience have shown that nearly 80% of local muscular pain can be attributed to myofascial pain. The term myofascial pain has been associated with muscle tenderness that arises from hyperirritable areas in the muscles called trigger points. Muscular pain caused by trigger points has been known to mimic symptoms of a very long list of common maladies. Pain resembling sciatica, herniated discs, joint problems, kidney stones, and even headaches can be caused by the presence of trigger points in the associated muscle groups. Dismissing the concept of trigger points when evaluating common daily pains and aches, can result in incorrect diagnosis and failure to formulate an effective treatment plan to resolve the painful condition.

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What is a Trigger Point?

A trigger point is usually defined in textbooks as a painful point that can be felt as a hard nodule in the muscle. Clinically, however, a trigger point is more of an area of the muscle, not necessarily a precise point. There may be a palpable nodule, but that is not always the case. A better definition of a trigger point is an area of muscle that feels tight and ropy and usually is tender on palpation. Not every tender area within a muscle, however, is a trigger point. Several other characteristics have to be present for a tender area of the muscle to meet the criteria for the definition of a trigger point. Trigger points are therefore usually defined as areas that are tender on palpation, but also display twitch response when strumming the tight muscle band in a perpendicular direction.  Compression of the trigger point also needs to reproduce the patient’s familiar pain. In some cases, when pressure is applied to the trigger point, the pain can be felt in a distant area of the body. This phenomenon is known as referred pain. The typical example of referred pain secondary to trigger points is pain at the base of the spine or the buttock, caused by trigger points in the mid-back muscles, at the area of the lowest ribs. A new definition of trigger points, however, suggests that referral of the pain to the distal area of the body does not need to be present in order to make the diagnosis of a trigger point.

Formation of Trigger Points

When a muscle or a group of muscles is subject to repetitive overuse or sudden strain, a contraction will form in a small number of muscle fibers within the affected muscle. We refer to these small contractions as trigger points. The presence of trigger points in the muscle, shortens the length of the muscle, much like making series of knots on a piece of a string. The more knots on the string, the shorter and tighter the string becomes. This analogy can be applied to muscles that become tight due to the presence of trigger points. The shorter the muscle becomes, the more distinct ropy feeling can be appreciated when strumming perpendicularly across the affected muscle.  When a muscle becomes shorter because of the trigger points, it will start to generate greater pull on the tendons and ligaments that attach the muscle to the joints and other structures. In the case of the knee joint for example, if trigger points are present in the quad muscles, they will shorten the quad muscles. The quad muscles attach below the knee through a tendon that runs over the kneecap (patella). The shortness in the quad muscles will therefore cause the kneecap (patella) to be compressed over the underlying cartilage whenever the knee is flexed. Greater friction between the patella and the underlying cartilage will over time result in faster loss of the underlying cartilage or formation of inflammation. This condition is called a chondromalacia patella and is experienced by the individual as a deep achy pain underneath the kneecap.

What causes trigger points?

In general, trigger points tend to form in the muscle that is subject to a higher load than the muscle can tolerate. There are a variety of factors that have been noted as potential causes for the development of trigger points. The most significant of these include acute or chronic muscle overload due to poor posture or over-exercising. Direct trauma to the muscle, as well as trauma due to a car accident which leads to a whiplash, are another common cause for developing trigger points. Additionally, psychological distress, homeostatic imbalances, and certain lifestyle habits such as smoking, have been identified as important contributors to the formation of trigger points. When an area of muscle is constantly overloaded, the resulting muscle tightness in that area will compress the surrounding blood vessels. This leads to poor local blood circulation with subsequent accumulation of various metabolic by-products and chemicals which sensitize the surrounding nerve endings. The impaired metabolism and blood circulation in the muscle further impair the muscle’s ability to fully relax. Eventually, the muscle develops sustained contraction leading to the development of palpable tight and ropy areas of the muscle defined as trigger points.

Consequences of Trigger points

There are many implications of having trigger points in the skeletal muscles. The most well-known include pain, stiffness, and decreased range of motion of the affected muscles. Decreased athletic performance and pain radiation to other parts of the body are two less known facts about trigger points. Understanding how trigger points affect athletic performance is particularly important for anybody interested in maximizing the benefits of their workout routines. Many top athletes pay large sums of money to experts in myofascial release to keep their muscles free from trigger points.

 

Decreased athletic performance   

When muscles develop trigger points, their overall capacity to do their job is impaired.  Physiologically, the basic function of the muscle is to expand and contract. The presence of the trigger points causes the muscle to assume a constant shortened and contracted state, hindering the muscle’s ability to fully flex and contract. This will manifest as overall muscle weakness, decreased range of motion, feeling of stiffness, earlier fatigue, and intolerance to high-intensity workload. Muscles that have trigger points also recover much slower. The combination of all these factors interferes with athletic performance and leads to suboptimal results despite adequate training and preparation.

Pain radiation to other parts of the body

The characteristic feature of trigger points is their ability to refer pain to distal areas of the body, which makes the correct diagnosis of the true origin of the pain challenge.  Detailed pain referral pathways have been described for individual muscles and their trigger points. These referral pathways sometimes overlap, therefore a detailed search of all muscles which can refer pain to a particular area, should be conducted, to identify all the sources of the pain. An example of referred pain to the same area from a different muscle is a pain in a pinky and along the inner aspect of the hand. This referral pattern is typical for trigger points in the Latissimus dorsi. In some cases, however, the pain in the pinky and along the inner aspect of the hand can result also from the presence of trigger points in the Infraspinatus muscle.

 

Several non invasive treatment options are available to address and treat trigger points. Some of the most popular include acupuncture, dry needling and acupressure modalities. Follow these links to learn more about each one of the them.

 

To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health

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.”

by Dr. Michal Domeny DNP, L.Ac, CD/N