Lumbar Strain/Sprain Flashcards
Most people will have resolution of back pain within…
- 6 weeks of onset
- 1-4 weeks if no other complicating factors
Most common cause of lumbar strain/sprain
- Age related degenerative disc disease (DDD)
- degenerative facets (DJD)
- Muscle, tendon, fascial and ligament injuries
- strains (musculotendinous)
- sprains (ligamentous/capsular)
Mechanical low back pain symptoms
- Pain at rest
- Activity aggravates painful symptoms
- Guarded gait
- Restricted, painful lumbar motion
- Generally, non-radiating
- must differentiate from infection/malignancy, etc. if symptoms persist or history indicates other pathology
Acute lumbosacral strain/sprain symptoms
- Secondary to trauma
- Unilateral or B/L muscle spasm/ hypertonicity/ guarding/ pain
- May have sciatic scoliosis w/ unilateral strain/sprain
- pelvic shift w/ sacral unleveling
Chronic lumbosacral strain/sprain
- Very common
- Disease of middle age
- Difficult to treat successfully as is secondary to a combination of factors including
- decompensation
- poor health habits
- lack of regular exercise (may be assoc. w/ “flat effect”
Nociceptive sites of lumbar sprain/strain
- Outer annular fibers
- Longitudinal ligaments
- Capsules of the facets
- Erector spinae muscles
- Paraspinous ligaments
Eccentric Contractions
- Traumatic causation of muscle pain
- “Negative work”
- muscle performs lengthening contractions (deceleration) which produce external forces greater than those produced by muscle itself)
- May activate a smaller # of motor units that are activated during pos. contractions of the same intensity
- mechanical stresses on the Z bands in sarcomeres and connective tissue are higher (this has been linked to greater muscle damage)
Rhomboid of Michaelis
- Area formed by the dimples at the PSIS, lines formed by gluteal muscles and the groove at the lower end of the spine
- seen in individuals of good muscular development
- Region where 80-90% of pts with back pain will be complaining of
Rhoboid of Michaelis muscles
- Thoracolumbar fascia, erector spinae (deep), multifidus, latissimus d., quadratus lumborum, iliolumbar ligament, gluteus maximus
Major stabilizing ligament to keep L5 from slipping forward?
- Iliolumbar ligament
Iliolumbar ligament
- Major stabilizing ligament to keep L5 from slipping anteriorly
- Commonly sprained w/ various postural movement, especially in athletics, bending and lifting
- L4 and L5 to ilium
- archaic remnant of quadratus
Thoracolumbar Junction Syndrome
- Role of the thoracolumbar junction (TLJ) in common spinal disorders is freq. overlooked
- Patients infrequently complain of pain at the level of the TLJ
- Only rarely will there be radiographically demonstrable degenerative disease at the lvl of the TLJ (T11-T12-L1)
- Diagnosis can be made only in the light of adetailed and systematic clinical exam, which will show a tender spinal segment at this level
Muscles directly related to movement of the low back region
- Latissimus Dorsi
- External Oblique
- Sacrospinalis (Erector spinae)
- Internal Oblique
- Serratus Posterior inferior
- Quadratus Lumborum
- Psoas major
Latissimus Dorsi Origine and Insertion
Origin
- Spinous processes T6-12, L1-5, sacrum and 4 lowest ribs
Insertion
- Bicipital groove of humerus
Pain exacerbated by sidebending/ rotation w/ extension
Serratus Posterior Inferior Origin and Insertion
Origin
- T11-L3 spinous processes
Insertion
- Ribs 9-12
