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Study Guide
Instructions: Answer the following questions in 2-3 sentences each.
- What are the definitions of a low back strain and a low back sprain?
- Describe the two most common causes of low back strains and sprains.
- Why is squat bending recommended over stoop bending to prevent low back injuries?
- What are the common signs and symptoms of a low back strain or sprain?
- Explain how the location and intensity of pain during a straight leg raise (SLR) test can indicate the location and severity of a low back injury.
- Describe the role of palpation in assessing low back strains and sprains.
- What is the purpose of Nachlas and Yeoman’s tests, and how are they performed?
- How can you differentiate between a low back strain and a simple muscle spasm?
- Describe the initial steps in manual therapy treatment for a low back strain or sprain, particularly in managing muscle spasms.
- What are some important self-care recommendations for individuals with low back strains or sprains?
Answer Key
- A low back strain involves tearing of muscular tissue, typically the paraspinal muscles, while a low back sprain involves tearing of ligamentous tissue, such as ligaments and joint capsules in the lumbar spine or sacroiliac joints (SIJs).
- Macrotrauma, often involving sudden forceful bending or lifting, and repetitive microtraumas, caused by repeated bending and lifting over time, are the two most common causes of low back strains and sprains.
- Squat bending is recommended over stoop bending because it keeps the center of gravity closer to the spine, reducing strain on low back muscles and ligaments. Additionally, squat bending maintains the spine in a more stable extended position.
- Common signs and symptoms include low back pain, muscle spasms, increased pain with motion, particularly flexion, limited range of motion, and inflammation.
- Pain during an SLR test can help pinpoint the injury site. SIJ pain typically manifests at 30 degrees of hip flexion, lumbosacral (LSJ) pain around 40 degrees, and pain at higher flexion angles suggests injury higher in the lumbar spine. Pain intensity reflects the severity of the injury.
- Palpation helps identify specific muscles or ligaments involved. Tenderness upon palpation of the paraspinal muscles may indicate a strain, while tenderness over the SIJ suggests a sprain.
- Both tests assess for SIJ and LSJ sprains by inducing pain at the affected joint. Nachlas involves bringing the foot towards the buttock in prone, stretching the hip flexors and stressing the SIJ. Yeoman’s is similar but involves lifting the thigh into extension with pressure on the same-side PSIS, placing greater stress on the SIJ.
- A muscle strain often involves a palpable “pop” sensation during injury and presents with more persistent pain and inflammation compared to a muscle spasm, which typically resolves more quickly and completely.
- Initial treatment focuses on reducing muscle spasms through soft tissue manipulation (massage) and heat application, unless significant swelling is present, in which case ice is applied. Stretching is also employed to further reduce muscle tension.
- Self-care recommendations include avoiding bending and lifting, minimizing prolonged sitting or standing, applying ice for swelling or heat followed by stretching for muscle spasms, and engaging in core-strengthening exercises once spasms subside.
Essay Questions
- Explain the biomechanics of how bending and lifting can lead to both low back strains and sprains. Discuss the role of leverage, muscle length-tension relationships, and the differing roles of muscles and ligaments in resisting flexion forces.
- Describe in detail the assessment process for a suspected low back strain or sprain. Include specific orthopedic tests, palpation techniques, and differential diagnosis considerations.
- Compare and contrast the clinical presentations of a low back strain, a low back sprain, a muscle spasm, and a herniated disc. How can a skilled clinician differentiate between these conditions?
- Outline a comprehensive manual therapy treatment plan for a patient with a low back strain. Include specific techniques, treatment progression, and precautions.
- Discuss the importance of patient education and self-care in the management of low back strains and sprains. What are the key recommendations you would provide to a patient to prevent future injury and promote long-term spinal health?
Glossary of Key Terms
Active Straight Leg Raise (SLR): A test where the patient actively raises their leg while lying supine. This test can indicate either a strain or a sprain. If either muscle or ligamentous tissue is torn, the stress of this movement will evoke pain.
●Arthritic conditions: A group of conditions that cause pain and inflammation in the joints. Strains and sprains need to be differentially diagnosed from arthritic conditions.
●Closed-pack position: The most stable position of a joint, where the surfaces of the bones are in maximal contact with each other.
●Coccygeus: One of the pelvic floor muscles that may be affected by a sacroiliac joint strain or sprain.
●Differential diagnosis: The process of distinguishing between different possible diagnoses.
●Double knee to chest stretch: A stretch that targets the paraspinal muscles in the low back.
●Erector Spinae: A group of muscles that run along the length of the spine. These muscles are often torn with a low back strain.
●Facet syndrome: A condition that causes pain in the facet joints of the spine. Strains and sprains need to be differentially diagnosed from facet syndrome.
●Figure-4 stretch: A stretch that targets the piriformis muscle.
●Gluteal muscles: The muscles of the buttocks, which can be affected by a sacroiliac joint strain or sprain.
●Herniated disc: A condition where the soft, jelly-like center of an intervertebral disc pushes through the tough outer layer of the disc.
●Horizontal adduction stretch: Another stretch that targets the piriformis muscle.
●Hypomobile: A joint that has less than normal range of motion.
●Inflammation: A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection. Acute strains and sprains present with inflammation.
●Joint mobilization: A manual therapy technique used to restore normal joint movement.
●Lateral flexion: Bending to the side.
●Levator ani: One of the pelvic floor muscles that may be affected by a sacroiliac joint strain or sprain.
●Ligamentous tissue: The strong, fibrous tissue that connects bones to each other.
●Low back spasm: Involuntary contraction of the low back muscles.
●Low back sprain: A tear of ligamentous tissue (including joint capsule and other fascial tissues) in the low back.
●Low back strain: A tear of muscular (myofascial) tissue in the low back.
●Lumbosacral joint (LSJ): The joint between the lumbar spine and the sacrum.
●Macrotrauma: A single, traumatic event that causes injury, such as a fall or a car accident.
●Manual Resistance (MR): A test where the therapist applies resistance to the patient’s movement. This test should be positive only with a strain, as the muscles are engaged but the joints are not moved.
●Microtrauma: Small, repetitive injuries that can accumulate over time and eventually lead to a more serious injury.
●Multifidus: A deep muscle of the spine that helps to stabilize the spine.
●Muscular tissue: The tissue that makes up muscles.
●Myofascial trigger points (TrPs): Hyperirritable spots in skeletal muscle that can produce pain locally or in a referred pattern.
●Nachlas test: A test to assess for sacroiliac joint or lumbosacral joint sprain.
●Passive SLR: A test where the therapist passively raises the patient’s leg while they are lying supine. This test is usually only positive for a sprain because the muscles do not need to contract, but the ligaments are stretched
●Piriformis: A muscle in the buttock that can be affected by a sacroiliac joint strain or sprain.
●Psoas major: A muscle that connects the lumbar spine to the femur.
●Quadratus lumborum: A muscle that helps to stabilize the spine and pelvis.
●Repetitive microtraumas: Repetitive motions or activities that place stress on a particular area of the body, leading to small injuries over time.
●Sacroiliac joint (SIJ): The joint between the sacrum and the ilium.
●Scar tissue: Fibrous tissue that replaces normal skin after an injury.
●Sciatic nerve: A large nerve that runs from the lower back down the back of the leg.
●Self-care: Activities that individuals can do to help prevent and manage health conditions.
●Single knee to chest stretch: A stretch that targets the gluteal muscles.
●Soft tissue manipulation: Manual therapy techniques used to treat the soft tissues of the body, such as muscles, tendons, and ligaments.
●Spinal extension exercises: Exercises that strengthen the muscles that extend the spine.
●Stoop bend: Bending forward with a rounded back.
●Transversospinalis: A group of muscles that help to rotate and extend the spine.
●Yeoman’s test: A test to assess for sacroiliac joint or lumbosacral joint sprain.
