Low back pain is said to be the most common cause of lost work days, after colds. Most everyone has experienced an episode of lower back pain at some point in their life; millions suffer from chronic lower back pain.
The low back, or lumbar spine, is comprised of the last five (5) vertebrae in the spine. These vertebrae are the largest as they support most of the body’s torso weight.
Low back pain can originate in one of several structures in the lower back:
- the discs (strong ligaments that hold vertebrae together
- the facet joints (the “rear” joints of a vertebra, opposite the vertebral
- the surrounding muscles
- the surrounding fascia (muscle covering)
- the nerve roots inside the spinal canal
- the vertebrae itself
Today we’ll address lower back pain due to muscle and fascia strain. I’ll refer to this a low back or lumbar strain. This is a common cause of lower back pain and is more manageable than pain due to deeper spinal structures.
In the many cases of lower back strain that I’ve treated over the years, the patient describes a sudden onset of pain after bending at the waist reaching for something. In other cases, the pain starts a day after doing something like weight lifting, running or rock climbing.
Medically speaking, a muscle strain occurs when muscle fibers tear during contraction and subsequently release inflammation.
The convention is such that “strain” refers to injury to a muscle and tendon; “sprain” refers to injury to ligaments, which connect bone to bone. Since muscles, ligaments and tendons typically get injured together as a group, doctors refer to these types of injuries as “sprain/strain” injuries.
Sprain/strain severity is described as Grade I, Grade II and Grade III, with Grade III being the most severe and refers to complete rupture of a tendon or ligament. Most lumbar strains are Grade I and II.
Inflammation is meant to contain/ quarantine an injury and is actually an important process in the healing phase (tissue regeneration). The problem is that it releases chemicals that irritate nerves and surrounding tissues, and stiffens adjacent muscles and joints. The inflammatory response can “overshoot” causing the patient to needlessly suffer.
If you go to your doctor complaining of lower back strain, and tests do not indicate damage to deeper structures (discs, facet joints, nerve roots, bone) then you will most likely be prescribed pain blockers (usually NSAIDs- non-steroidal anti-inflammatories), rest, and ice. Your doctor will likely put you on “temporary disability” which means no heavy lifting, bending at the waist, and other activities that put stress on the lower back. Sometimes muscle relaxants are prescribed, if there are complaints of spasm and stiffness. You will be told that it should resolve on its own, and most cases do.
At first onset of straining your back, apply ice for 20 minutes every two hours of the waking day. Get a large 12″ x 12″ gel icepack from your local drugstore; freeze it. Place the frozen gel pack on the floor. Put 3 kitchen towlettes over it to prevent iceburn. Get a feel for the coldness after 10 minutes, and remove one or two towlettes so that you can tolerate the maximum coldness without getting ice burn.
Lie down so that your exposed (no clothing) lower back is directly on top of the ice. Bend your knees or put a pillow under them for comfort. This flattens the lower back and allows it to make good contact with the icepack. (Optional: put a neck roll under your neck for comfort). Be prepared to do this for the next three days.
On the second day, you can introduce gentle stretches while you ice. After your 20 minutes of icing, try lifting your knees to your chest, pulling them gently towards you with your hands. Hold for 5 seconds; repeat five times. Then, keeping your feet together (you are still lying on your back), knees bent, let the knees fall to the right side, gently twisting the lower back; reverse sides. Do five times to each side.
On day four, use a hotpack on your lower back. Get a hot water bottle and fill with water heated on your stove to 150 degrees (don’t guess; use a thermometer), and a moist hand towel. Use the right amount of layered towels to get a deep heating effect without burning the skin. Wet the towels with warm water for better conduction. Dry heat, like an electric pad is not as effective. Heat for 10-12 minutes, every 3-4 hours. It’s OK to ice also from day 4-7; keep icing if your strain still feels acutely strong after day three.
After a week, your lower back strain should be 60-90% better. If it is not, see a doctor or experienced chiropractor. Spinal adjustments may help improve the situation by increasing vertebral movement in the lower back.
Last thought: I believe that if someone strains his lower back by simply bending forward, it indicates that the back muscles, and probably core/abdominal muscles need better conditioning. It’s not all about strength, it’s also muscle coordination in response to varying loads; for example, picking up a piece of heavy luggage. Those with excellent muscle coordination (there are five major muscle groups that have to work together to move the lower back) are less likely to injure their backs like this. Interestingly, research shows that osteoarthritis, or degenerative joint disease in the lumbar spine, is related to poor lower back muscle coordination.
So, the best strategy is to prevent getting lower back strain by strengthening AND conditioning (improve coordination of) your lower back muscles by doing functional exercises.