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- One of the things that cause muscular injuries
of the low back include twisting
or bending or violent maneuvers
that would exert a force on the muscles.
You can have a sudden contraction
and you can injure either the rotators of the lumbar spine,
the oblique muscles.
You can injure the forward flexors of the lumbar spine,
the abdominal muscles or the hip flexor muscles.
Or you can also injure the lumbar extensors
as well too, including your gluteal muscles.
Often this could be due to the fact that the
patient may be deconditioned
or the muscles aren't properly trained.
Usually the symptoms of muscular injuries
include localized low back pain.
Usually we do not see a large radiating component
to the legs.
We don't usually see numbness or tingling
or weakness but usually could be either
a stiffness or aching pain.
Sometimes, honestly, the worst type of pain that we see
coming in to our office is due to just muscle spasm.
It could be a very sharp knife-like pain as well too.
Usually we see that the patient's range of motion
as far as bending forward and bending backwards
as if he's limited by this.
Usually the patient pretty much localize
where the pain is.
- For an evaluation regarding muscle-related injury
it's very similar to any other evaluation.
We're doing a full functional evaluation.
We're evaluating her flexibility issues
and we're essentially watching the patient move
with their activities to try and figure out
what aggravates this area.
Help patient in addition to evaluating
the skin temperature and so on and so forth and redness
can also give an indication that there might be
underlying muscular injury.
One of the most important muscles that I found
that can get injured with low back problems
is the iliopsoas which runs from your lower back
through your pelvis and attaches to your inner thigh.
This muscle is the main hip flexor.
So when it is tight and you have difficulty
extending yourself back because of it
then you put additional pressure on your lower back.
Vice versa, if you have really tight hamstrings
in the back part of your leg
then bending forward is limited by your hips
and then you put additional forces bending forward
in your lower back.
Now we're gonna have you rotate to the left
and now add the hips in
and rotate to the right
and now add the hips in.
Once again you can see where you can rotate a lot more
when you add the hips in.
When we have limitations in our legs and in our hips,
you're putting additional motion in that lower back.
Imaging regarding a muscle-related injury
is more for to rule out
that there's anything else going on.
- Usually I recommend ice as the treatment modality
for muscle strain and sprain the first 48 hours.
Beyond that if heat provides more relief than ice
certainly that could be used to alleviate muscle spasm.
Anti-inflammatories, non-steroidal is what we usually use.
We usually do not go to a steroidal anti-inflammatory.
Stretches and physical therapy can help us both too.
We also at Coordinated Health have chiropractic care,
however, usually I avoid it in the first two to three days
after a muscular sprain, strain as you don't want
to exacerbate the symptoms by any manipulation.
- The idea is that our bodies work in concert.
Our legs work well with our back,
work well with our arms and so on and so forth
and limitations in certain areas can really affect
the other areas.
One of the most important things for us early on
on a diagnostic evaluation
is to try and find out where the limitations
throughout the body that can affect the muscular injuries
or other injuries to the lower back
and make sure that those areas are addressed.
When we talk about functioning,
we talk about what do patients do?
They bend over and they pick things up.
Other limitations with being able to do that in their hips
and then that's putting additional stress on their back
and has created the problem.
These are the types of things that we would want to work out
not only diagnosing-wise in the exam
but then also addressing those things
in a physical therapy program.
It's really important for the patients
to really understand what causes these problems.
So getting an education about what their problem area is
from their doctor, from their physical therapist
and then starting to move will help expedite
the recovery itself.
In general, getting an exercise program
that addresses these problem areas
is gonna be the most important
in doing the exercises the right way and safe way
and progressing these exercises the right way and safely.
- At home, patients with lumbar strain or sprain type
condition can perform a regular daily stretching activity,
stretch out their back extensors and their abdominal muscles
and their side rotators, their gluteal muscles as well too.
They can ice 15, 20 minutes,
two, three times a day initially.
They can also use over the counter anti-inflammatories.
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