What is a Lumbar Strain

Lumbar sprain is a common presentation of back pain. It is an acute pain in the lower back region. Lumbar sprain is most often a mechanical blockage of the lower back. According to studies, 40-80% of the population will experience lower back pain during their lifetime (Hoy 2012, Hoy 2014, Thiese 2014, Angst 2017). This is a condition that has a high recurrence. About 2/3 of people who have had low back pain will have a recurrence within the first year after recovering from the 1st episode (da Silva 2019).

Risk factors of a lumbar sprain

Several risk factors have been listed in the scientific literature. There are 3 groups of risk factors: Individual and Lifestyle, Physical and Biomechanical, Psychosocial.

Individual and Lifestyle

• Having ever had back pain, THIS is THE BIGGEST predictor of future episodes of low back pain (Dunn 2013, Taylor 2014, Kjaer 2017).
• Age (Parreira 2018)
• Smoker (Shiri 2010, Cook 2014, Parreira 2018)
• Obesity (Frilander 2015, Suri 2017, Peng, Green B 2018)
• Sedentary lifestyle or excess activity (Heneweer 2009)

Physics and Biomechanics

• Frequent lifting or Lifting heavy loads (Coenen 2014, Cook 2014, Hurwitz 2018)
• Daily loading of the back in the flexion position (Bakker 2007)
• Twist/flexion work position (Miranda 2022, Hurwitz 2018)
• More than 2 hours of driving (Taylor 2014)
• More than 2 hours of standing or walking (Parreira 2018).

Psychosocial

• Depression (Pinheiro 2015, Suri 2017, Green B 2018)
• Post-Traumatic Stress Disorder (Suri 2017)
• Psychosomatic factors (Parreira 2018)

What are the signs and symptoms of a lumbar sprain?

There are several signs and symptoms. They vary from person to person. Here are the main ones:

• Pain in the lumbar region
• Pain with high intensity
• Feeling of stiffness
• Loss of range of motion in the lumbar region
• Difficulty sitting/standing for long periods
• Difficulty getting up from a sitting position
• Difficulty thinking or squatting

What to do with a lumbar sprain?

There is an order of things to do to properly recover from a lower back blockage. Returning to daily activities and sports too quickly, or returning to work too quickly can lead to a relapse. It is important to respect this order and accept the recovery process.

1. Temporarily stop the irritating factors
2. Unlock the mechanical blockage of the lumbar region
3. Keep the lumbar region unblocked during the day and activities
4. Reintegrate the initially irritating movements and positions

Possible treatments

There are several types of treatments available. Following an assessment by your physiotherapist, he or she will be able to guide you in determining the best approach for you. Here are some possible treatments:

1. Maintain a good posture, most often the sitting posture
2. Specific exercises to unblock the back.
3. Physiotherapy, Manual therapy when the blockage is more severe
4. Optimization of movement patterns
5. Correction of muscular imbalances
6. Re-training of painful movements
7. For athletes, reconditioning to sport

Recognize the types of mechanical blocking

There are 3 axes of movement in the lumbar region. Depending on the activity performed, the back can become “stuck” or “locked”. The first step to recovery is to “unstuck” the back. The 3 main blockages are:

• Blocking that requires the extension
• Blocking that requires bending
• Blocking that requires lateral movement

What are the ways of healing a lumbar sprain?

Principles to follow when doing the exercises

A key concept to be aware of during exercises is that of centralization/peripheralization of pain in physiotherapy. When your pain in the legs moves up to the back, this is centralization. When your back pain goes down into your legs, this is peripheralization. ONLY CENTRALIZATION IS GOOD. AS SOON AS THERE IS PHERIPHERIZATION AFTER THE EXERCISE, STOP. Better: after the exercise, you are more mobile, with a lower intensity of pain, there is a centralization of the pain towards the back. However, if your back pain becomes more intense, you are not stiffer and there is no 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. Same thing: after the exercise, you are as mobile, with the same pain intensity Worse: after exercise, you are less mobile, with a greater intensity of pain, there is peripheralization of pain in the legs. IMPORTANT

• You only need to do one exercise for a few days to determine the effect.
• Exercises should not be combined initially as their effect may be different.

Blocking that requires the extension

This is the most common, with the highest prevalence at 78% (May 2018). There are several variations of lumbar extension exercises possible to do. Here are the two most common:

Dosage: 10-20 repetitions, 5-6 times a day

• If you feel better, continue the exercise
• If you feel the same, continue for 3-4 days before trying another
• If you are worse, stop the exercise and try another

Blocking that requires bending

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

Dosage: 10-20 repetitions, 5-6 times a day

• If you feel better, continue the exercise
• If you feel the same, continue for 3-4 days before trying another
• If you are worse, stop the exercise and try another

Blocking that requires lateral movement This one has a prevalence of 16% (May 2018). It is to be considered if the extension and flexion exercises made you worse or you stayed the same after trying them all. Generally, you will be evaluated by a physiotherapist to determine which lateral movement is right for you. Lumbar shift is a type of lateral blockage and requires a physical therapy evaluation to treat it.

Prevention

1. On a daily basis, we do a vast amount of movement in flexion. It is therefore necessary to balance this with lumbar extension. We can practice the exercises proposed for the blocks that require extension.
2. Determining the amount of lumbar torsion/flexion
3. Maintain a good sitting posture with a lumbar support, sitting on a chair, sofa or car.
4. Optimize movement patterns. The most common ones to learn and master are the hip hinge or squat. These two movement patterns minimize pressure on the back when bending over.
5. Work on the muscular stabilization of the back. Muscular rehabilitation of the abdominal belt helps support the lumbar spine. Exercises like “The McGill Big 3” can be done.

 

 

Conclusion

Lumbar sprain is an acute back pain that presents as a mechanical blockage. There are several types of blockages, the most common of which requires lumbar extension movements to recover. After having “unstuck” the back, we must keep it unstuck during our activities. We must maintain a good sitting posture, optimize movement patterns and reeducate the muscles to reduce the mechanical stress on the lumbar region. In the end, go see your physiotherapist for suggestions on the best treatment approach for you. If you are looking for a physiotherapist’s opinion, the AMS clinic offers free consultations in person, by phone or via telemedicine.

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