As a practicing orthopedic physical therapist, I see low back pain patients all the time and for a variety of reasons. One of my favorite low back pain conditions to see is a lumbar strain, which is a tear of one or more of the low back muscles. This is an injury that I see in teenage athletes, as well as, older adults. The reason that I like them so much is that it is a fairly straightforward diagnosis and the patients almost always improve quickly. Read on to learn more about lumbar strains and how to treat them. Let’s start with anatomy!
The spine
In order to understand a lumbar strain, you need to be familiar with the structure of the spine. The spine is made up of 33 vertebrae. The vertebrae are the bones of the spine. Each is stacked on top of one another to make a column. The spinal cord travels through the column with nerves exiting at each vertebral level. The first 7 vertebrae make up the cervical or neck region. The middle 12 vertebrae are the thoracic or mid back region. The next 5 vertebrae are the lumbar, which is also known as the low back. The next five make up the sacrum which is the triangular bone at the base of the spine. The sacral vertebrae are fused meaning they have grown together. The last 4 vertebrae are also fused. This is the coccyx or tailbone. The discs are in between the cervical, thoracic, and lumbar vertebrae. The sacrum and coccyx have grown together and have no space between the vertebrae for a disc.
The lumbar spine
The lumbar spine is made up of 5 large and incredibly strong vertebra. It is designed to protect the spinal cord while also being extremely flexible. The lumbar spine can bend forward, backward, side to side, and also rotate. There are many muscles that attach to the lumbar spine. These muscles move the spine in all the different directions and are susceptible to strain.
What is a lumbar strain?
A lumbar strain is a tear of one or more of the muscles of the low back. Muscles typically tear at the musculotendinous junction. This is where the muscle transitions to tendon in order to attach to bone. Lumbar strains account for the majority of mechanical low back pain. Strains occur with excessive tensile forces to the muscles. These are forces that are going is an opposite direction. For example, trying to lift something heavy from the ground. The weight of the object is pulling down while the lumbar muscles are pulling up to lift the object.
What causes lumbar strains?
The most common cause of lumbar strains is lifting. However there are many different ways to strain your low back muscles. It could also be caused from forceful pushing, pulling, or twisting. Some sports that are at a higher risk of lumbar strain include:
- Weight lifting
- Football
- Golf
- Tennis
- Baseball
About 1/3 of people do not remember the incident that caused their lumbar strain.
What are the symptoms of a lumbar strain?
There are several symptoms associated with a lumbar strain. These include:
- Pain in the muscles of the lumbar spine (the low back)
- The pain is most intense 24-48 hours after initial injury
- Pain could increase with standing and twisting
- Increased pain with contracting and stretching the low back muscles
- Muscle spasms of the low back muscles
- Decreased motion of the low back
- Possible swelling and tenderness to the touch in the low back
Are their risk factors for a lumbar strain?
There are certain risk factors for developing a lumbar strain. However, it really could happen to anyone. These risk factors include:
- Increased inward curvature of the low back
- Weak core muscles
- Tight hamstrings
- Tight hip flexors
Who should I see?
- Physical therapist – PT is the preferred treatment for those suffering from a lumbar strain. Your physical therapist can address your pain with manual therapy and other techniques. They can help improve your flexibility, strength, and stability of your spine and hips with stretches and strengthening exercises. PT can also help with strategies to help you prevent lumbar strains in the future.
- Primary care physician – Your primary care physician might be needed if your condition is not responding to PT. A PCP can examine you and provide medications such as anti-inflammatories or muscle relaxers if appropriate. Imaging might also be ordered to provide more detailed information. A referral to a specialist might also occur depending on your symptoms and the results of the imaging.
Things you can do
- Relative rest – This includes continuing to do all the activities and chores in your normal, daily life that do not aggravate your symptoms. It is important to stay active but at the same time you do not want to make your condition worse. For example, if vacuuming increases your pain but washing dishes doesn’t, then stop vacuuming but continue to wash the dishes.
- Ice – Ice can help decrease the pain and swelling in the low back. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or if there is still swelling present. Ice immediately after activity.
- Heat – You can use heat for a lumbar strain but wait until a few days after the strain to start using it. This will help minimize the swelling.  Heat is helpful when the back is feeling stiff, like in the morning when just getting up. It can bring blood flow to the area and make movement more comfortable. Sitting with a heating pad for 15 minutes prior to exercise could be helpful in improving back mobility.
- Aerobic exercise – Regular light aerobic exercise that does not aggravate symptoms is important in recovery and prevention.  It brings gentle motion and blood flow to the area. Light aerobic exercise include walking, swimming, or biking. If you do not regularly exercise, then begin slowly at about 5 to 10 minutes. You can increase your exercise time gradually over weeks or months. Work up to 30-60 minutes of aerobic activity most days of the week.
- Light stretching – Stretching of the tissues around the low back and hips can help decrease tension and pain in the area. You will need a stretch strap, dog leash, yoga strap, or something similar.  See the videos below.
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- Core strengthening – Strengthening of the abdominals, back extensors, and hip muscles are important in being able to stabilize and control the low back. Using resistance bands  and ankle weights can increase strength and difficulty of the exercises.  See the videos below.
In review
- The lumbar spine is made up of 5 large and incredibly strong vertebra.
- It is designed to protect the spinal cord while also being extremely flexible.
- A lumbar strain is a tear of one or more of the muscles of the low back.
- Strains occur with excessive tensile forces to the muscles.
- These are forces that are going is an opposite direction.
- The most common cause of lumbar strains is lifting.
- About 1/3 of people do not remember the incident that caused their lumbar strain.
- Symptoms of lumbar strain include pain in the low back that increases with contraction or stretching.
- Physical therapy is the preferred treatment for those suffering from a lumbar strain.
- Your primary care physician might be needed if your condition is not responding to PT.
- There are things that you can do.
- Relative rest
- Heat and ice
- Aerobic exercise
- Light stretching
- Strengthening
As always, if you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Lumbar_Strain
https://www.ncbi.nlm.nih.gov/books/NBK542314/