by Dr. David Borenstein M.D. updated 11/2018
The most common low back pain problem is an injury to muscles in or surrounding the lumbar spine, or the corresponding fascia, the membrane surrounding the muscles. Muscle strains may occur when you cough or sneeze. Lower back injuries are associated with lifting a weight too heavy for your muscles to support. When muscles are injured they contract, or shorten, so that the two damaged ends can come close together to form a clot or scab to start the healing process. The injury signal goes to the brain that sends a reflex message to the injured muscle to shorten. In addition, signals are sent o surrounding muscles to protect the injured muscle. Muscle spasms are the result of these signals. The severity of the spasm can vary. The associated pain can be minimal to severe and immobilizing. Stories of individuals who fall to the fall and are unable to get up for hours are not uncommon. Other individuals may have great difficulty getting out of bed the following day because of severe muscle stiffness.
The diagnosis of a muscle strain is based on the story of the onset associated with an injury, the decreased mobility of the spine, and the presence of muscle contraction. Many times describe the muscle as “swollen” but this is not the case. The muscle is enlarged because of severe contraction. Laboratory tests, x-rays, and magnetic resonance imaging (MRI) studies are not helpful in a making a diagnosis.
The best way to heal a muscle strain is gradual movement. I call it “healing on the move.” Muscles do not like to remain in one place for any sustained period of time. They get the greatest blood flow when they contract and relax. Even injured muscles like to gradually move. Gradual stretching relieve spasms and allow the muscle to test how far they can move. Self-management programs include ice massage initially to decrease swelling and pain relief, and later, a heating pad to increase blood flow to hasten healing. The use of analgesics (acetaminophen) or anti-inflammatory/analgesic medicines (ibuprofen, naproxen) facilitate function by decreasing pain and allowing gradual, increased motion. The last area of muscle pain to improve was the initial area of injury.