Understanding Lumbar Sprains: Causes, Symptoms, and Treatments

Lumbar sprains are a common condition that can affect anyone, from athletes to sedentary individuals. They manifest as pain in the lower back, often caused by tension or injury to the muscles or ligaments in the lumbar region. In this guide, we’ll explore in detail what a lumbar sprain is, its symptoms, diagnosis, recovery time, ways to relieve pain, and available treatments.

What is a Lumbar Sprain?

A lumbar sprain occurs when the muscles or ligaments in the lower back are stretched or torn due to a sudden movement, excessive or repeated effort, or the cumulative effect of poor posture. This injury can be caused by daily activities such as lifting a heavy object, falling, or moving incorrectly. The muscles and ligaments in the lumbar region play a crucial role in supporting the spine and trunk mobility, which explains why a sprain can be particularly debilitating.

Causes and Risk Factors for Lumbar Sprains

Lumbar sprains can be caused by several factors that increase the risk of injury.

Scientific literature has identified several risk factors. There are three groups of risk factors: Individual and Lifestyle, Physical and Biomechanical, and Psychosocial.

Individual and Lifestyle

• Previous back pain: This is the most significant predictive factor for future episodes of low back pain. (Dunn 2013, Taylor 2014, Kjaer 2017)
• Age (Parreira 2018): as we age, the chances of having a lumbar sprain increase.
• Smokers have a higher chance of experiencing lumbar sprains. (Shiri 2010, Cook 2014, Parreira 2018)
• Obesity increases the load on the muscles and ligaments of the spine and increases the risk of lumbar sprains. (Frilander 2015, Suri 2017, Peng, Green B 2018)
• A sedentary lifestyle means that the muscles supporting the spine are weaker and less flexible, which increases the chances of lumbar sprains. (Heneweer 2009)
• Excessive activity without giving the muscles and body time to recover increases the risk of lumbar sprains. (Heneweer 2009)

Physical and Biomechanical

• Frequently lifting or heavy loads, especially without good technique, increases the chances of lumbar sprains. Repetitive lifting fatigues the soft tissues that support the spine and makes it susceptible to injuries. The body is not designed to lift heavy loads, so having a good lifting technique to minimize the load on the spine is essential to avoid a lumbar sprain. (Coenen 2014, Cook 2014, Hurwitz 2018)
• Daily loading of the back in a forward-bending position (flexion) significantly increases the load on the back. (Bakker 2007). Imagine that bending straight forward without bending your knees is equivalent to having more than three people standing on your back.
• Having a working position in twisting/flexion puts constant stress on the soft tissues that stabilize your spine. (Miranda 2022, Hurwitz 2018)

This makes these structures tired at the end of the day and susceptible to a lumbar sprain with even a small abrupt movement.

• More than 2 hours of driving in a car (Taylor 2014)
• More than 2 hours of standing or walking (Parreira 2018)

Psychosocial

• Depression (Pinheiro 2015, Suri 2017, Green B 2018). Disorders such as depression and anxiety can worsen back pain and increase the risk of it becoming a long-term problem. Certain behaviors can also maintain pain: avoiding movements for fear of worsening the situation can lead to more stiffness and discomfort, while enduring intense pain without resting correctly can lead to additional tension. In addition, negative thought patterns, such as constantly worrying about pain (“catastrophizing”) or doubting one’s ability to cope with it (“lack of self-efficacy”), can make people feel even more disabled by their pain.
• Post-Traumatic Stress Disorder (Suri 2017). PTSD affects the body and mind in a way that makes back sprains more likely due to increased muscle tension, lack of movement, or reduced physical resilience.
• Psychosomatic factors (Parreira 2018). Psychosomatic factors create a cycle in which stress, tension, poor movement habits, and pain sensitivity contribute to increasing the risk of lumbar sprains.

What Are the Symptoms of a Lumbar Sprain?

The symptoms of a lumbar sprain vary depending on the severity of the injury, but the most common signs include:

• Localized pain in the lower back: The pain can be sharp or dull, and it often intensifies with movement.
• Muscle stiffness: difficulty moving or bending forward, rotating, or to the sides.
• Swelling or inflammation: In some cases, slight swelling may appear.
• Muscle spasms: The muscles in the lower back may contract involuntarily, causing additional pain.
• Decreased mobility: Trunk movements may be limited due to pain or stiffness.

Diagnosis and Medical Care

To establish a clear diagnosis of a lumbar sprain, a clinical evaluation conducted by a healthcare professional such as a physiotherapist remains the preferred method. During the initial assessment of a lumbar sprain, the physiotherapist begins by asking about the injury, the location of pain, aggravating factors, medical history, and limitations in daily activity. They then observe the posture and alignment of the body to check for muscle imbalances, stiffness, or abnormal curvatures of the spine. They next assess the range of motion to identify stiffness or pain triggers. The therapist also performs palpations to check for tenderness, muscle tension, or inflammation. Special tests are performed to rule out nerve involvement, pelvic misalignment, or other conditions if necessary. Assessment of functional movements, such as walking, lifting, and moving from sitting to standing, helps identify pain-related movement problems. After gathering all this information, the physiotherapist explains the diagnosis, recovery goals, and a personalized treatment plan, including exercises, posture corrections, and possible manual therapy. The session may end with an initial hands-on treatment, pain relief techniques, and a home exercise program to promote recovery. Unless symptoms persist, no additional examinations are usually required.

However, if pain disrupts daily life after a few weeks, additional investigations, such as magnetic resonance imaging (MRI), may be considered to check for more profound or complex injuries.

 

How to Relieve a Lumbar Sprain?

Following a structured rehabilitation process is essential to ensuring complete and adequate recovery after a lumbar sprain. Premature return to daily activities, sports, or work can increase the risk of recurrence or chronic pain syndrome. Respecting an appropriate recovery schedule is essential for long-term healing and preventing relapses.

1. Limit aggravating factors (rest) – Temporarily reduce or avoid activities that exacerbate pain to allow injured tissues to begin healing.

2. Restore spine mobility (physiotherapy) – Address mechanical restrictions in the lumbar region through targeted physiotherapy techniques, including manual therapy and prescribed exercises.

3. Modify activities during rehabilitation – Avoid movements or tasks that cause pain to prevent additional strain while gradually improving strength and flexibility.

4. Gradual return to pre-injury activities – Once symptoms subside, gradually reintroduce daily activities, work, and sports, while ensuring proper mechanics and movement control.

When to See a Doctor?

If pain persists beyond a few weeks, worsens, or is accompanied by symptoms such as loss of sensation, muscle weakness, or urinary problems, it is imperative to consult a doctor. These signs could indicate a more serious condition requiring immediate attention. If you consult a physiotherapist in the early stages of your lumbar sprain, you will be well guided. If something arises that requires additional medical consultation, the physiotherapist will be able to identify it and refer you to a doctor.

What Are the Treatments for a Lumbar Sprain?

The treatment of a lumbar sprain depends on the severity of the injury. Here are the most common options:

1. Physiotherapy

Our physiotherapy service will offer specific exercises to address the source of pain by identifying the movements necessary to unlock mobility. Subsequently, strengthening exercises will be prescribed to strengthen the back muscles, improve posture, and prevent recurrences. Massage and mobilization techniques can also be used to relieve pain.

Possible treatments:

• Education on good posture, most often sitting posture
• McKenzie method with specific exercises to unlock the back
• Manual therapy when the blockage is more significant
• Optimization of movement patterns
• Correction of muscle imbalances
• Retraining of painful movements
• Reconditioning for sports or work

2. Medications

In addition to NSAIDs, muscle relaxants may be prescribed to reduce muscle spasms. In cases of intense pain, more powerful analgesics may be necessary.

3. Injections

In severe or persistent cases, corticosteroid injections may reduce inflammation and relieve pain.

4. Surgery

Surgery is rarely necessary for a lumbar sprain unless it is associated with another condition, such as a herniated disc or vertebral instability.

How to Heal a Lumbar Sprain: Exercises

A physiotherapist can propose specific exercises adapted to the patient’s individual needs, to promote not only immediate healing but also the prevention of future recurrences. Nearly half of the people who have experienced a lumbar sprain risk suffering a new episode in the following year.

A key concept to consider during exercises is pain centralization/peripheralization in physiotherapy. When your leg pain moves up towards the back, this is called centralization. When your back pain moves down into the legs, this is called peripheralization. Only centralization is beneficial. As soon as there is peripheralization after the exercise, stop.

Improvement: After the exercise, you are more mobile, with less pain, and the pain centralizes towards the back. On the other hand, if your back pain intensifies without stiffness or peripheralization, you should consider yourself better. It is normal for pain intensity to increase locally in the back in the absence of peripheralization and loss of mobility.

Stable: after the exercise, you are as mobile, with the same intensity of pain.

Worse: After the exercise, you are less mobile, have a higher pain intensity, and the pain peripheralizes into the legs.

• To determine an exercise’s effect, it must be done for a few days.
• Exercises should not be combined at the start because their effects may be different.

Blockage Requiring Extension

This is the most common exercise, with a maximum prevalence of 78% (May 2018). There are several variants of lumbar extension exercises. Here are the two most common:

Dosage: 10 repetitions, 5 to 6 times a day

• If you feel better, continue the exercise
• If you think the same, continue for 3 to 4 days before trying another.
• If you feel worse, stop the exercise and wait to see your physiotherapist again

Figure 1: Extension exercises for lumbar sprain

Blockage Requiring Flexion

This is the least frequent exercise, with the lowest prevalence (6%) (May 2018). There are several variants of lumbar flexion exercises. Here are the three most common:

Figure 2: Flexion exercises for lumbar sprain

Dosage: 10 repetitions, 5 to 6 times a day

• If you feel better, continue the exercise
• If you think the same, continue for 3 to 4 days before trying another.
• If you are worse, stop the exercise and consult a physiotherapist

Blockage Requiring Lateral Movement

This type of blockage has a prevalence of 16% (May 2018). It must be determined if the extension and flexion exercises have worsened your condition or if it remained unchanged after you tried them all. Generally, a physiotherapist will assess you to determine your proper lateral movement. Lumbar displacement is a type of lateral blockage and requires a physiotherapy assessment to treat it.

Practical Tips to Prevent Recurrence

1. In daily life, we perform many flexion-related movements. It is, therefore, necessary to balance them with lumbar extension. We can practice the exercises proposed for blocks requiring extension.

2. Determine the amount of lumbar torsion/flexion
3. Maintain good sitting posture with lumbar support, sitting on a chair, couch, or car.
4. Optimize your movements. The most common are the hip hinge and squat. These two movements minimize pressure on the back when bending.
5. Work on muscular stabilization of the back. Muscular rehabilitation of the abdominal belt contributes to the support of the lumbar spine. Exercises like “The McGill Big 3” can be performed.

 

 

 

Positions that promote lumbar sprain versus positions that prevent lumbar sprain

What is the Recovery Time for a Lumbar Sprain?

The recovery time depends on the severity of the sprain:

• Mild sprain: Generally, the pain disappears in one to two weeks with appropriate treatment.
• Moderate sprain: Recovery can take three to six weeks.
• Severe sprain: In severe cases, healing may require several months, especially if complications arise.

Following the physiotherapist’s recommendations is essential to avoid worsening the injury or prolonging the recovery time.

Differences Between Lumbar Sprain and Herniated Disc

Pain that extends to the legs or is accompanied by tingling or numbness could indicate a herniated disc, requiring a thorough medical evaluation.

Lumbar sprain and herniated disc are two common causes of lower back pain, but their origin, symptoms, and treatment differ.

Unlike a lumbar sprain, which results from an injury to the muscles or ligaments of the lower back, a herniated disc damages the intervertebral discs. A part of the disc comes out of its envelope and can compress a nerve, causing radiating pain (sciatica), numbness, or muscle weakness.

While a lumbar sprain generally heals in a few weeks, a herniated disc may require prolonged conservative treatment or, in severe cases, surgical intervention.

Conclusion

Lumbar sprain is a frequent injury, but most people recover completely with rapid diagnosis and appropriate treatment. By following prevention advice and adopting an active lifestyle, you can reduce the risk of recurrence and maintain a healthy back. If you suffer from lumbar pain, do not hesitate to contact our physiotherapy service.

Sources:

• Angst F, Angst J, Ajdacic-Gross V, et al. Epidemiology of Back Pain in Young and Middle-Aged Adults: A Longitudinal Population Cohort Survey from Age 27-50 Years. Psychosomatics 2017;58:604-613.
• Bakker E, Verhagen A, Kucas C, et al. Daily spinal mechanical loading as a risk factor for acute non-specific low back pain: a case-control study using the 24-Hour Schedule. European Spine Journal 2007;16:107-113.
• Coenen P, Gouttebarge V, van der Burght, et al. The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis. Occupational and Environmental Medicine 2014;71:871-877.
• Cook CE, Taylor J, Wright A, et al. Risk Factors for First Time Incidence Sciatica: A Systematic Review. Physiotherapy Research International 2014;19(2):65-78.
• Da Silva T, Mills K, Brown BT, Pocovi N, de Campos T, Maher C, Hancock MJ. Recurrence of low back pain is common: a prospective inception cohort study. Journal of Physiotherapy 2019. https://doi.org/10.1016/j.jphys.2019.04.010
• Dunn K, Hestbaek L, Cassidy J. Low back pain across the life course. Best Practice & Research Clinical Rheumatology 2013;27:591-600.
• Frilander H, Solovieva S, Mutanen P, et al. Role of overweight and obesity in low back disorders among men: a longitudinal study with a life course approach. BMJ Open 2015;5:007805.
• Green B, Johnson C, Haldeman S, et al. A scoping review of biopsychosical risk factors and co-morbidities for common spinal disorders. Plos One 2018;13(6):e0197987.
• Heneweer H, Vanhees L, Picavet HS. Physical activity and low back pain: A U-shaped relation? Pain 2009;143:21-25.
• Hoy D, Blain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatology 2012;64:2028-2037.
• Hoy D, March L, Brooks P, et al. The global burden of LBP: estimates from the Global Burden of Disease 2010 study. Annals of Rheumatic Diseases 2014;73:968-974.
• Hurwitz E, Randhawa K, Yu H, et al. The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. European Spine Journal 2018;27(6):796-801.
• Kjaer P, Korsholm L, Lebaoeuf-Y de C, et al. Individual courses of low back pain in adult Danes: a cohort study with 4-year and 8-year follow-up. BMC Musculoskeletal Disorders 2017;18:28.
• McGill SM. Back Mechanic: The step by step McGill Method to fix back pain. Backfitpro Inc. 2021. www.backfitpro.com
• McKenzie R. Treat Your Own Back. Orthopedic Physical Therapy. 2011.
• Miranda H, Viikari-Juntura E, Martikainen R, et al. Individual Factors, Occupational Loading, and Physical Exercise as Predictors of Sciatic Pain. Spine 2022;27(10):1102-1109.
• Parreira P, Maher C, Steffens D, et al. Risk factors for low back pain and sciatica: an umbrella review. The Spine Journal 2018;18(9):1715-1721.
• Peng T, Perez A, Gabriel K. The Association Among Overweight, Obesity, and Low Back Pain in U.S. Adults: A Cross-Sectional Study of the 2015 National Health Interview Survey. JMMT 2018;41(4):294-303.
• Pinheiro M, Ferreira M, Refshauge K, Ordonana J, et al. Symptoms of Depression and Risk of New Episodes of Low Back Pain: A Systematic Review and Meta-Analysis. Arthritis Care & Research 2015;67(11):1591-1603.
• Shiri R, Karpinnen J, Leino-Arjas P, et al. The Association Between Obesity and Low Back Pain: A Meta-Analysis. American Journal of Epidemiology 2010;171(2):135-154.
• Suri P, Boyko E, Smith N, et al. Modifiable risk factors for chronic back pain: insights using the co-twin control design. The Spine Journal 2017;17:4-14.
• Taylor J, Goode A, George S, et al. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. The Spine Journal 2014;14:2299-2319.
• Thiese M, Hegmann K, Wood E, et al. Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskeletal Disorders 2014;15:283.