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On the campus of HonorHealth Scottsdale Osborn Medical Center

Back pain limited to the low back

Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ

Overview of back pain from spasm or strain

Back strain is a fairly broad category called “soft tissue injury,” which covers muscles, tendons and ligaments. About 80 percent of back and neck pain is muscle-related.

Back pain can be excruciating, however often times pain that is limited to the low back due to muscle strain can be treated non-surgically, allowing a patient to recover quickly with rest, ice, anti-inflammatories and custom stretches.

First, it’s important to understand a little bit of anatomy. It’s rare to strain a thigh muscle because the tendons (which connect muscles to bone) are long. Unfortunately, in the back, rather than long tendons (as in the thigh) these tendons resemble short tight rubber bands that span only a short distance along the spinal vertebrae. These shorter tendons can be more prone to strain and spasm. Tendons can also be prone to inflammation, called tendonitis.

The stomach muscles, or abdominals, enable the back to bend forward. They also assist in lifting. The abdominals work with the buttock muscles to support the spine. The oblique muscles go around the side of the body to provide additional support to the spine.

A type of common sprain relates to spinal ligaments (which connect bone to bone) that run in front of and behind the back bones (vertebral bodies).
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Understanding pain as a symptom

Ironically, with back problems or neck problems, the symptom of pain itself can be a misleading indicator of the seriousness of an injury. For example, pain from a spasm can knock a person to their knees in agony.

But typically, the more serious symptoms related to back and neck problems are radiating pain into a leg or arm, weakness or numbness in a hand or foot, or loss of control or bowel or bladder.

Long term cure

The good news is that back pain limited to the lower back — when caused by muscle or ligament strain — can sometimes resolve at home with the back pain home remedies found in this Internet site. However, if the symptoms haven’t improved within three days, you should consult a spine center that has spine therapists. The spine-trained therapist can relieve pain symptoms with specialized, hands-on manual therapy and begin to move you toward a long term cure.

The challenging aspect of treating low back pain caused by a strain of muscles or ligaments in the back is to strengthen them and make them more flexible, thereby reducing future strain. Someone who has endured a painful back spasm from lifting an object or strain may be hesitant to trust that stretches can be the cure. However, data has shown that this is the most effective long-term cure for back pain caused by muscle strain.

It is important for the aging population to acknowledge that they are at higher risk for back strain when trying to lift or move heavy objects. Measures should be taken to prevent injury which can be taught by spine therapists.

Causes of strain

Muscles in the back can strain or spasm from lifting something too heavy, or lifting it with incorrect body mechanics. Visit the educational resources section of this Internet site to learn how to lift correctly.

Other times, strain can be caused by a golf swing, tennis swing, or other rotary movement done with violent force, or too many times once the back is fatigued and susceptible to strain.

Another cause of back strain may be linked to fissures in your intervertebral disc which acts as a shock absorber between your vertebrae, the bones in your spine. Researchers believe that as a person gets older, discs become more brittle and more susceptible to herniation. These tiny fissures in the wall of the disc may cause disc disruption which in turn may trigger a back spasm, much like an early warning mechanism to disc herniation. In this sense, a back spasm or “back attack” is somewhat like a heart attack: Your body is sending a message that something is wrong. Either you lifted something too heavy, or your back is not strong enough, or not flexible enough.
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Symptoms

A spasm, defined as an involuntary convulsive contraction of muscle fibers, can be excruciating. The muscle spasm can be steady or come in waves of contractions. Your muscle is sending you a signal that it has been pushed beyond its ability.

When a back spasm or back strain occurs, it can form a hard lump, like a charley horse in the leg. This also supports the logic of using movement to cure a spasm, as the natural reaction to a charley horse is to walk around to relieve the knot in the leg.

About axial back pain

There are times when pain limited to the lower back can be more problematic, and not necessarily linked to muscle strain. Rather than a spasm, the symptom may be a dull ache that is limited to the low back and does NOT radiate pain into the legs. This type of symptom may be referred to as “Axial Back Pain” meaning pain that is limited to the low back.

While this is a somewhat less common problem, it is more complex to treat, it often doesn’t respond long-term to home remedies, and may require physician treatment to resolve the symptoms.

The cause of the problem may be linked to a disc in the lumbar spine, or a problem with the facet joints on the vertebrae. These facet joints are like hinges on a door in that they enable the spine to flex and rotate. If these joints develop problems like arthritis (like a rusty hinge), it can create pain symptoms.

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

  • Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your back and neck pain which can help outline the most appropriate treatment.
  • Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
  • X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones.
  • MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.
  • CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
  • Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.
  • Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
  • Discography is used to determine the internal structure of a disc. It is performed by using a local anesthetic and injecting a dye into the disc under X-ray guidance. An X-ray and CT scan are performed to view the disc composition to determine if its structure is normal or abnormal. In addition to the disc appearance, your doctor will note any pain associated with this injection. The benefit of a discogram is that it enables the physician to confirm the disc level that is causing your pain. This ensures that surgery will be more successful and reduces the risk of operating on the wrong disc.
  • Injections: Pain-relieving injections can relieve back pain and give the physician important information about your problem, as well as provide a bridge therapy.

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Treatment

Surgery is never appropriate for muscle strain.

As with any muscle injury, it’s natural for an individual to stop moving the injured area and wait for it to heal. Ironically, this is counter-productive. Restricting movement causes the muscle to weaken, become less flexible and receive less circulation. In fact, gentle stretching and exercise is the best way to resolve the injury by getting it moving and increasing circulation.

Recommendations:
  • Rest.
  • Apply ice for 15-20 minutes (not directly on the skin) at a time for the first 48 hours, then switch to heat.
  • Take anti-inflammatories, preferably ibuprofen like Advil or Nuprin as directed on the bottle. Acetominophen (Tylenol) may be taken for pain, if you are allergic to ibuprofen.
  • Try our home remedy exercises. But remember, no exercise should be painful. Stop if they cause an increase in pain or symptoms.
  • An appointment with a nonsurgical spine specialist is most appropriate for muscle-related back pain.
  • Call us immediately if you experience any emergency, red-flag symptoms such as new onset weakness, bowel/bladder dysfunction, or numbness in the groin area.

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FAQs
What’s the difference between a sprain and a strain?

While someone may argue that the two words are different, that a sprain is a more serious injury than a strain, in reality, sprain and strain have evolved to mean essentially the same things to doctors and lawyers. Both words relate to an overworked muscle, ligament or tendon that is overstretched.

Some may argue that strain relates to stretching or tearing of muscles or tendons, while sprain relates to tearing of ligaments or tissues in a joint area. For example, if bones in a joint are forced beyond a comfortable range of motion, the joint may be sprained.

Another word that you may hear is “muscle spasm,” where a muscle locks up in an excruciating, hard lump.

What’s the difference between a simple strain or a more serious herniated disc?

Most people erroneously think that the more excruciating the pain, the more likely that you herniated a disc. That is not the case at all. In some cases a back spasm can knock you down to your knees. A person can have excruciating pain, but if it is mostly in the low back, it’s probably not a herniated disc. Typically, a herniated disc in your back will radiate pain down into your leg, or pain will radiate down your arm if you have a blown disc in your neck.
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Do you NEED spine surgery?


Do you have pain that radiates into an arm or leg?

   Yes    No

Do you have any numbess or weakness in a foot or hand?

   Yes    No

Have you had an MRI within the last 12 months?

   Yes    No

Provide contant information below so we can advise you based on your above symptoms:

   

Dr Harvinder Deogun, physical medicine scottsdale, physical medicine phoenix

Harvinder S. Deogun, M.D.

Physical Medicine and Rehabilitation

Dr Harvinder Deogun, neurosurgeon scottsdale, neurosurgeon phoenix
Dr Brian Fitzpatrick, neurosurgeon scottsdale, neurosurgeon phoenix

Brian C. Fitzpatrick, M.D.

Board Certified Neurosurgeon

Dr Brian Fitzpatrick, neurosurgeon scottsdale, neurosurgeon phoenix
Dr Frederick Marciano, neurosurgeon scottsdale, neurosurgeon phoenix

Frederick F. Marciano, M.D., Ph.D.

Board Certified Neurosurgeon

Dr Frederick Marciano, neurosurgeon scottsdale, neurosurgeon phoenix

Francisco Ponce, M.D.

Board Certified Neurosurgeon

Dr Francisco Ponce, neurosurgeon, phoenix, scottsdale
Dr Luis Tumialan, neurosurgeon scottsdale, neurosurgeon phoenix

Luis M. Tumialán, M.D.

Board Certified Neurosurgeon

Dr Luis Tumialan, neurosurgeon scottsdale, neurosurgeon phoenix

John E. Wanebo, M.D.

Board Certified Neurosurgeon

Dr John Wanebo, neurosurgeon, phoenix, scottsdale