Why are back muscles subject to strain?
The muscles that move the spine are not large muscles grouped together, but rather a large contingency of very small, individual muscles layered and aligned to produce contractions of varying intensities. Because they are small, they are more at risk for injury.
What are the classifications of muscle strains?
Classifications of muscle strains are divided into three categories including minor (first degree), moderate (second degree), and severe (third degree).
First degree muscle strains are the most common and involve either overstretching or minor tearing of one or more muscle fibers. Because the injury is mild, the individual is typically functional (can move the spine) but with some discomfort. Increased movement exacerbates the pain and may lead to localized muscle spasm. There may also be some weakness in the muscle that has been strained.
Second degree muscle strains involve a partial tear of one or more muscles. Because the tear is greater in a second degree, the symptoms of the injury are more pronounced. The individual may be guarded in all back movements due to muscle spasm. All movements are affected and may be limited in all directions. The pain is significantly greater both because of the torn tissue and the associated muscle spasms.
With a back strain, the individual may have significant difficulty standing, sitting, and lying down. Because the muscles responsible for spine extension are used any time the body is in movement, all movements may be guarded and painful.
A third degree muscle strain involves a complete tear of one or more muscles. The tear may either be in the muscle or at the musculotendinous junction (common location for a rupture). Significant muscle tears may have a palpable indentation or gap. Swelling and discoloration maybe present. As in the second degree strain, muscle spasm will be present and may cause increased pain during any attempted movement.
How is a back strain diagnosed?
The best and most common tool for diagnosing a back strain is a comprehensive medical history with specific attention to the mechanism and signs and symptoms of injury. The sports medicine professional will initially rule out more serious injuries that may involve the spine, nerve roots, intervertebral discs, and/or ligaments.
The location of the pain (either to the right or left of the spine), absence of neurological symptoms (numbness, tingling, radiating pain down the legs), functional movement, and manual muscle tests can all be used to diagnose a muscle strain.
If a second or third degree strain is suspected, an MRI may be ordered. The MRI can clearly distinguish a tear in soft tissue injury.
How do I treat a back strain?
The healing of muscle and soft tissue proceeds systematically through a three phase process. The phases include the inflammatory phase, the proliferation phase, and the maturation phase.
The initial treatment should focus on relieving the muscle spasm, decreasing pain, and minimizing swelling. As the muscle spasm decreases, treatment should focus on engaging the injured muscles in light isometric contractions so that the new collagen fibers being laid down in the torn muscle area can be aligned in the direction of tension.
If early treatment is too aggressive, re-injury can easily occur. As the pain decreases, range of motion exercises can begin and concentric muscle contraction exercises can be added. Once the individual has full range of motion and full strength without pain, then sport specific functional exercises can be added to prepare the individual for return to sport.
Initial Treatment (Inflammatory Phase – 1-3 days)
The treatment focus initially is on reducing muscle spasm, controlling the swelling (if present), and decreasing pain. The most important treatment during this phase is to rest the area which means placing the individual on bed rest in a comfortable position with knees bent (pillow under the knees to take stress off of the low back)
Early Exercises (Proliferation Phase – 3 -7 days)
The purpose of the proliferation phase is for new collagen tissue to be laid down to bridge the gap in the muscle left by the tear. This tissue needs to be carefully realigned from its original position to that of aligning in the direction of the muscle fibers. This is accomplished by gradually adding isometric muscle contractions (contractions without movement).
Intermediate Exercises (Proliferation Phase – 7 – 14 days)
Once isometric contractions can be sustained pain free and the individual has gained some mobility through the initial stretching exercises, the individual is ready to begin adding additional stretching exercises (rotation and lateral bends) and concentric exercises (strength exercises with movement).
Advanced Exercises (Maturation Phase)
The last phase of rehabilitation is to add power exercises to the protocol. Power exercises are specifically designed to add a “speed” component to the strength component that has already been regained. Any strength exercise can become a “power” exercise if the exercise is done explosively through either the addition of speed through the range of motion, maximum height (vertical jump), and/or distance (medicine ball work).
Plyometric exercises are classified as power exercises, but care must be taken to ensure that the athlete is strong enough and fit enough to perform them safely.