Background & Etiology

The lower back can be divided functionally and anatomically into three separate areas, the lumbar spine, the sacrum, and coccyx. The lumbar spine includes five lumbar vertebra (L1-L5), and five intervertebral discs. Ligaments are fibrous bands of soft tissue that attach bone to bone. In the spine there are two classifications of ligaments, called the intrasegmental and the intersegmental. Intrasegmental ligaments attach and hold individual vertebra to each other. Intersegemental ligaments attach to and hold many vertebra together.

Ligaments in the spine are vital in providing stability and structure to the spine. They also allow for movement in different planes. The ligamentous system of the spine protects the intervertebral discs from injury, and prevents excessive movement of the spine.

Sprain

In the spine the ligaments of the intrasegmental group are the ligamentum flavum, interspinous ligament and the intertransverse ligaments. The major ligaments of the intersegmental ligaments include the anterior longitudinal ligament, the posterior longitudinal ligament and the supraspinatous ligament. These ligaments can become stretched or torn, causing a sprain.

Lumbar sprains are a common injury, most often caused by excess weight bearing or lifting, trauma, motor vehicle or a fall. Sharp increases in physical activity or added stress on the ligaments in the back are also a common cause of lumbar sprains.

  • Back pain or tenderness
  • Swelling or bruising in the lower back
  • Pain when moving or using the back in daily activities
  • A “popping” or “tearing” feeling in the lower back
  • Warmth or redness of the skin over the injured area
  • Decreased ability to move, including performing bending and lifting motions.

If an individual suspects they have a lumbar sprain, the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that includes rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation. If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases surgical intervention may be needed to repair the torn ligament.

Mild

In mild cases rest, ice and medication may be enough to reduce the pain. Many patients will do well with this regiment. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent reoccurrence of the injury. Return to activity should be gradual to prevent a return of symptoms.

Moderate to Severe

If the problem persists, consulting with your health care provider should be the next step. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • Splinting or bracing the affected area
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Your physical therapist will perform a thorough evaluation to assess and determine the following:

  • Spinal Examination: where the patient is put through a series of movements and tests to determine the most probable cause of the condition.
  • Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances.
  • Flexibility: tight muscles can contribute to poor mechanics and weakness creating imbalances and making one more susceptible to disc and back injuries.
  • Posture Analysis, ADL’s and technique: discuss and observe the activity that may have started the problem. An examination of the dynamic and static postures that may have caused or contributed to the back problem. A review of your current activities at home and work that may or may not be causing or prolonging your present condition.

Physical therapy for a lumbar sprain must remain conservative at the onset to avoid aggravating the condition. Emphasis will be on rest, reducing the inflammation, load and stress on the affected area. Once the initial inflammation has been reduced, a program of stretching and strengthening will be initiated to restore flexibility to the joints and muscles involved, while improving strength and stability to the spine. Your program design will be based on the structure and cause of your symptoms. A program not tailored to your problem could aggravate your symptoms.

Common Physical Therapy interventions in the treatment of a lumbar sprain include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility and range of motion of the lumbar spine. Use of mobilization techniques also helps to modulate pain.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to restore joint mobility, range of motion, and strengthen muscles of the back and abdominals to support, stabilize and decrease the stresses place on the spinal joints, discs, and neck.
  • Neuromuscular Re-education (NMR) to improve posture, restore stability, retrain the patient in proper sleeping, sitting and body mechanics to protect the injured spine.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser, traction and others to decrease pain and inflammation of spinal structures.
  • Home programs including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Prognosis

Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of lumbar sprain.

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"I feel that the physical therapy at the Union office is above and beyond the best that I have ever received. They helped me so much and I hope to return as a visitor and utilize their equipment when I am fully recovered from surgery. Thank you Nicole, Elaine and the entire staff for always going the extra mile to make sure I received treatment. Never had a problem with billing either. I have been to a few PT facilities and highly recommend Twin Boro!"

Linda R.

"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

Victor S.

“I loved being a patient at your facility because your therapist went by my and the doctors needs. I was there not only at the old location in somerset but also I went to the new location to in North Brunswick, which I loved it was bigger and better. All of the therapist are so friendly and nice and treated you with respect. I was treated by not only Melvie but also Nick and both are so professional and gentle of the way they did my treatments. If I ever need to have physical therapy in the future I will definitely come back to your facility for you are very professional and well organized. I have been to other places but your facility beats them all.”

Christine

"I went from being almost totally debilitated by a pelvic fracture to being able to negotiate 6 flights of stairs. Therapy was intense, therapist are knowledgeable, helpful,encouraging and respectful. I highly recommend this facility."

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