Lower back sprain is an injury to the ligaments of a joint that causes a disruption or tearing of the ligament fibers.
Ligaments are what holds bones together at the joint. Your ligaments are like a fibrous rope made up of many smaller fibers. When these fibers are stressed beyond their holding or “checking” length they are torn.
There are seventeen joints that can be sprained in the lower back:
There are three types of sprain:
If the injury is of a mild nature there will be minimal fiber tearing with mild signs and symptoms.
However, when the injury is of a severe nature, such as a fall or car accident, there are more fibers disrupted and potentially more extensive damage. When severe there is significant swelling, bleeding, loss of motion and pain.
There can also be said to be two types of trauma that can cause sprains:
All too often one assumes that because they have back pain they suffered a sprain. This is usually not the case.
Because the muscles need to exceed their length before the ligaments are impacted you will usually suffer a lumbar strain instead of a sprain or in addition to it. In order for a macro-trauma sprain to occur there needs to be a very forceful injury.
In the lower back a sprain usually involves a sacroiliac joint and/or one or more facet joints of the lumbar vertebrae. The lower back can withstand much force compared to the cervical spine so it takes a lot of force to disrupt healthy ligaments of the facet or sacroiliac joints in a well conditioned individual.
However, in one who is not fit and possesses imbalances, deficits, degeneration and structural faults the joints are more susceptible and prone to injury.
The muscles of the lower back will usually be strained before any ligament or joint sprain occurs. Unless there is disc degeneration, spinal curvature or facet joint degeneration, a sprain is unlikely without a muscle strain occurring first. So... you are most likely dealing with a lower back strain (muscle injury) and not a sprain (ligament injury).
If there is disc degeneration, the facet joints are already undergoing microscopic disruption and there exists some degree of chronic stress, degeneration and inflammation of the facet joint and its surrounding ligaments.
This degeneration will cause repetitive micro-trauma (sprains) to the facet ligaments. Overtime you have extensive ligament weakening, tearing and scar tissue.
This leads to the lumbar facet joints and surrounding ligament being prone to further sprains arising from minor incidents or micro-trauma.
Because there are no, or very little, pain nerve endings in the disc, any injury there is usually not noticed unless there is extensive tearing of the disc capsule resulting in herniation of the disc material.
When there is disc degeneration or spinal curvature there will be stress on the facet joints resulting in abnormal joint function. This will in-turn promote ligament degeneration and subsequent micro-trauma or chronic micro-sprains.
With any degree of sprain, there is always some tissue tear. The body then wants to heal this tear. So...
Immediately an inflammatory reaction develops. It is this inflammatory process that initiates the repairing and healing process.
Ideally, you want to minimize swelling and control the inflammation and at the same time encourage healing of the torn fiber ends.
This healing process results in production of scar tissue. If the joint is not immobilized long enough and positioned in a manner that does not help to approximate the torn ends then you end up with inferior scar tissue and a lax or sloppy joint.
This laxity will then predispose you to chronic recurrent sprains.
Ligaments have poor blood supply and are very dense tissue so it takes longer for them to heal compared to tissue that has a rich blood supply such as muscles.
Treatment success may depend on severity and length of time before treatment is rendered following a sprain. The more tissue damage is minimized and the quicker it starts to heal the less residual long-term affects will be found.
With mild lower back sprains one to three days of rest may be all that is needed.
Walking should be encouraged as soon as pain permits. This will improve resolution of damaged tissue, increase needed circulation and encourage cell respiration.
Moderate to severe injuries should be
treated by a healthcare provider as soon as possible.
It is important with moderate to severe sprains to minimize motion long enough to permit proper scar tissue. At the same time, you don't want to limit motion too long or too much that normal scar tissue creation is impeded and you end up with excessive scar tissue and joint adhesion with its attendant fixations or loss of motion.
So, make sure you see your doctor as soon as possible following any moderate to sever sprains to assure maximum healing with minimal permanent damage.
To prevent recurrences of sprains and to achieve maximum improvement and restoration of normal function all structural deficits (short leg, pelvic tilt, foot pronation, fallen arches) need to be corrected as much as possible.