Sprains/Strains

By Edward S. Pratt, M.D., M.B.A.

Cervical and lumbar sprains/strains are some of the most common injuries for which patients will see a physician. A strain is defined as a tearing of the muscles about the spine, while a sprain refers to the tearing of ligaments that hold the spine segments together. Unless associated with major traumatic injuries such as falls from great heights or motor vehicle accidents, these injuries will heal over a period of several weeks. In 1987 a very large interdisciplinary group published the “Quebec Study” in the journal SPINE which evaluated the scientific evidence supporting the various treatments used on patients with acute back pain. This study, which was very well accepted by the medical community, recommended mainly over the counter analgesics, mobilization, and no more than two days of rest as the only treatments that were well supported in the literature. Traction, narcotics, and prolonged bed rest were not effective in treating acute back pain.

50% of these injuries will resolve in four weeks. 90% will resolve by 3 months, and the remainder may continue to have non specific complaints indefinitely. Pain and disability that continues longer than two to three months should be evaluated for additional problems. Although these injuries will resolve in 95% of cases with only supportive care, they often occur due to risk factors that can be identified and minimized. If these risk factors are not addressed, recurrence is very likely. Patients in very poor physical condition have a significantly greater chance of back injury. Lifting with poor technique, using you back instead of your legs, lifting bulky items without help, or performing heavy lifting or sports without stretching and warming up, can also increase your chances of injury. Ligaments and muscles that are worked regularly and warmed up before activity are stronger more flexible, enabling them to stretch instead of tear. The bottom line? Warm up and stretch before you perform activities which stress you back. Keep fit with a combination of aerobic, stretching and strengthening activities.