Back Strains and Sprains

We all ask a lot from our backs. We bend, we lift, we slouch -- it's enough to make a back complain. According to the Mayo Clinic, four out of five adults experience back pain at some point in their lives. Two times out of three, injuries to muscles and ligaments in the lower back are to blame. These injuries are painful, but they can also be temporary. With proper care, most people can look forward to a quick recovery.

What are sprains and strains?

Healthy backs are strong and flexible, thanks in large part to the muscles that support the spine and the tough, fibrous ligaments that hold the vertebrae together. Unfortunately, these tissues can't always handle the pressure of everyday life. Excess stress on your back can tear the muscles or ligaments. This is called back strain. Stretched ligaments can hurt even if they aren't actually torn. This type of injury is called a sprain.

It doesn't really matter whether you have a strain or a sprain. If your back hurts, it hurts. Your doctor may not even be able to tell the difference between the two. Fortunately, strategies for relief and prevention are equally successful for each type of injury.

Who is at risk for back sprains and strains?

Repetitive, forceful movements can easily injure the back. People who do a lot of bending, lifting, and twisting are usually no strangers to back pain. At the other end of the spectrum, people who rarely exercise are also prone to sprains and strains. Muscles and ligaments can become weak if they aren't used. When an inactive person suddenly gets a notion to move a couch or shovel the sidewalk, an injury should hardly be surprising.

What are the symptoms of sprains and strains?

Sprains and strains usually cause a broad, aching pain across the lower back. The pain may be limited to one side or the other. You may have trouble bending your back or standing up completely straight. You may also have an occasional muscle spasm, especially when moving around or while sleeping. Spasms can turn the muscles in your back into a hard, painful knot.

What can I do to relieve the pain?

Given time, most injuries to the ligaments and muscles will heal on their own within a couple of weeks. The key to recovery is staying active, within limits. Most people who try to return to their normal lives as soon as possible find that their ache gradually fades. Of course, some common sense is in order: If your job requires heavy lifting or other strenuous activities, you may have to take some time off to give your back a chance to heal.

If lying down feels good, you can try a day or two of bed rest. But too much time in bed can weaken your muscles and slow your recovery.

While waiting for your back to recover, you can ease the pain with over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen (such as Motrin or Advil). However, follow the dosage recommendations carefully and don't take them any longer than necessary. The U.S. Food and Drug Administration requires warning labels on the drugs to inform users of the risk of cardiovascular and gastrointestinal problems. Talk to your doctor if you need to take pain relievers more than several days.

A combination of cold and heat can also help ease back pain. The Mayo Clinic recommends putting a cold pack (a bag of ice wrapped in a cloth) on the sore spot soon after the pain first arises. Try the cold pack several times a day, 20 minutes at a time. When the pain starts to fade, 20 minutes with a heating pad can help loosen muscles and speed relief.

If these measures aren't enough, consider massage therapy. One study, published in the New England Journal of Medicine, followed patients between 20 and 70 years old and found that therapeutic massage may be more effective than back exercises for people with persistent low back pain.

A more recent review by the Cochrane Collaboration, which promotes evidence-based medicine, found that massage might be beneficial for patients with subacute back pain (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) low-back pain that is not attributed to a specific disease or condition. The review found massage appeared especially beneficial when combined with exercises and education.

Acupuncture has also proven effective in some studies.

What about using narcotics for back pain?

Research suggests narcotics are not effective against low back pain, according to Consumer Reports. In addition, the magazine warned, about 50 percent half of patients taking them have side effects such as difficulty breathing and symptoms such as constipation, reflux, heartburn, cramping, nausea, and vomiting. One in four people also develop problems with addiction or other substance abuse issues, so Consumer Reports recommends avoiding narcotics for low back pain.

When should I see the doctor?

According to the Mayo Clinic, most people with sprains or strains can safely wait four to six weeks before calling the doctor. The pain will probably disappear long before you have to make an appointment. Some cases call for quicker action. If you don't notice any improvement at all after three days, or if you have a fever, call a doctor for advice.

You should also call your doctor promptly for back pain if you're experiencing back pain for the first time after age 50, if you've had a serious injury, or if you've experienced unexplained weight loss. Constant, intense pain or pain that spreads down a leg or causes weakness or numbness in a leg is also a reason to call your doctor. These are all warning signs that you may have something more than a simple back strain or sprain.

What treatments can a doctor provide?

First of all, your doctor will try to understand the source of your pain. Sprains and strains won't show up on x-rays or any other test, but your symptoms can paint a fairly clear picture. If your pain has lasted for several weeks without a hint of improvement, your doctor may order an x-ray or a high-tech imaging test to check for herniated disks or other injuries. Such tests can also detect or rule out spinal infections and cancer.

Your doctor may prescribe stronger versions of NSAIDs to help control your pain. Muscle relaxants help some patients, but they generally don't work any better than NSAIDs and often cause drowsiness.

If your doctor recommends surgery, you need to know what it is for. Be sure to get a second opinion if necessary. According to a report in the New England Journal of Medicine, surgery has never been shown to ease the pain caused by back sprains or strains, so your doctor would be highly unlikely to recommend it if those are the only complication.

How can I prevent back sprains and strains?

Once you've had an episode of back pain, the pain is likely to come back. Your job is to make sure the attacks are as brief and as far apart as possible. If you lift heavy objects, let your legs, not your back, do the work.

Ask your doctor about exercises that can strengthen weak back muscles. A strengthening and stretching program will help keep the muscles used for lifting in good shape and less vulnerable to strain. For extra protection, keep a straight posture when standing or sitting.

In short, don't let that strain in your back become a strain on your life.

References

Mayo Clinic. Back pain.

Furlan AD, Imamura M, Dryden T, Irvin E. Massage for Low Back Pain. The Cochrane Database of Systematic Reviews, Issue 10. The Cochrane Collaboration.

Kinkade, Scott, M.D. Evaluation and treatment of acute low back pain. American Family Physician.

Be Wary of Narcotics for Low Back Pain. Consumer Reports. http://www.consumerreports.org/cro/2012/05/be-wary-of-narcotics-to-treat-back-pain/index.htm

American Association of Neurological Surgeons. Low Back Pain.

Cherkin, Daniel C. et al. Randomized Trial Comparing Traditional Chinese Medical Acupuncture, Therapeutic Massage, and Self-care Education for Chronic Low Back Pain, Archives of Internal Medicine Vol. 161 No. 8, pp. 1081-1088

University of California at Davis. What are the lifestyle risk factors for low back pain? Online fact sheet, undated.

FDA Public Health Advisory. FDA Announces Important Changes and Additional Warnings for COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). http://www.fda.gov/cder/drug/advisory/COX2.htm

Furlan, AD, Brosseau, L, Imamura, M and Irvin, E. Massage for lower back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 27(17): 1896-910.

Deyo, R.A. and J.N. Weinstein. Primary care: Low back pain. New England Journal of Medicine 344 (5) 363-370.

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