Muscles make up a large part of the anatomy of the back. They begin at the top of the neck and go down to the tailbone. The back’s structure is very complex – it is made of the spine, discs, nerves, muscles, tendons, ligaments, and other structures. Each of these parts are individual structures, which function or work together…here is how they work:
- The spine is made up of bones called vertebrae.
- Ligaments hold the vertebrae together.
- Between each vertebra, discs provide cushioning.
- Nerves extend through small holes in the vertebrae to different parts of the body.
- Tendons attach the muscles to the vertebrae.
- These muscles support the spine and allow for movement.
As mentioned earlier, the back’s muscles start at the top of the back and go to the tailbone. Therefore, some of these muscles are quite large and cover broad areas. Other muscles are small and cover much less space. Certain back muscles extend to other areas, like the shoulders, upper arms, and thighs. In the back and elsewhere in the body, tendons attach muscles to bones; they help support and making them move.
The back, especially the lower back (lumbar), bears much of the body’s weight during walking, running, lifting, and other activities. A back strain (also known as a pulled muscle) is an injury to either a muscle or tendon. Tendons are the tough, fibrous bands of tissue that connect muscle to bone. With a back strain, the muscles and tendons that support the spine are twisted, pulled, or torn. Most episodes of lower back pain are caused by damage to the soft tissues supporting the lower spine, including muscles, tendons, and ligaments. The lower spine (lumbar spine) depends on these soft tissues to help hold the body upright and support the weight from the upper body. If put under too much stress, the low back muscles (or soft tissues) can become injured and painful. When a back strain may seem like a minor injury, the resulting pain and muscle spasms can be surprisingly severe.
Causes & Symptoms
The twisting or pulling of a muscle or tendon can result in a strain. It can also be caused by a single instance of improper lifting or by over-stressing the back muscles. A chronic strain typically results from overuse after prolonged, repetitive movement of the muscles and tendons. Back strains can also lead to experiencing sprains – a sprain often occurs after a fall or sudden twist, or a blow to the body that forces a joint out of its normal position. All of these conditions stretch one or more ligaments beyond their normal range of movement, causing injury. Additionally, when soft tissues in the low back are stretched or torn, the surrounding area will usually become inflamed. Inflammation, or local swelling, is part of the body’s natural response to injury, in which blood is rushed to an injured tissue in order to restore it. Inflamed muscles may feel tender to the touch, or cramp, and contract tightly, causing intense back pain.
Most cases of back muscle strain start to abate within a couple of hours or days and do not lead to long-term problems. If pain has continued for more than a week or two, or if it is severe enough to disrupt daily activities, seeking medical attention is required. Symptoms to expect from a back strain (or any type of lower back strain) usually include:
- Intensified pain with movement – Back strain typically worsens with specific movements that activate the affected muscles. For instance, there may be a flare-up of pain when getting up from a seated position, when bending forward, or when first getting out of bed in the morning.
- Pain that is localized in the lower back – The pain is typically concentrated in the lower back. However, it may also be in the buttocks and / or hips, as these muscles help support the lower back. In rare cases, pain can travel down the legs and into the calves and feet (sciatica).
- Achy back pain – Strained muscles usually feel sore, tight, or achy. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle.
- Stiffness, difficulty walking, or standing – Typically movements may be limited when a back muscle is strained, making it difficult to bend, shift positions, or walk or stand for extended periods.
- Pain relief when resting – Briefly resting the back muscles allows them to relax, alleviating tension and spasms. Reclining in a supported position, such as sitting in a recliner with your legs elevated or lying in bed or on the floor with the knees slightly elevated, may temporarily reduce pain. However, the pain will most likely intensify when getting up to move again.
- Local tenderness – A muscle strain may become inflamed and feel tender to the touch. Muscle spasms and cramps can cause intense pain and temporarily limit mobility, as the affected area in the lower back may be swollen for a few days.
Who gets a Back Strain?
Several back strains can occur during everyday activities, such as exercising or at work. Some common risk factors for back muscle strain include the following:
- Starting a new activity – Beginning a new sport or activity may lead to a muscle strain by putting sudden, unfamiliar stress on a muscle or group of muscles.
- Heavy lifting – Strain from heavy lifting, twisting the spine, lifting from the ground, or an item overhead are common causes of low back strain.
- Age – Due to general wear and tear, older adults are more prone to back muscle strain if they twist their back or lift heavier objects.
- Repetitive motions – Stressful, repeated motions can cause muscles to tighten or tear. Sports such as rowing, golf, or baseball may cause chronic strain due to repeated, forceful motions. Chronic strain may gradually become painful over time, or pain can suddenly worsen if a muscle is already sore and then put under intense stress.
- Weak back muscles – When your back and core abdominal muscles are weak, the back becomes more susceptible to injury. Slouching forward puts added strain on the low back muscles and on the spine.
How Does it Affect You? How Serious is it?
There aren’t many complications that are accompanied by back strains. However, the most common complication of a back strain is a reduction in activity, which can lead to weight gain, loss of bone density, and loss of muscle strength and flexibility in other areas of the body.
Recommended Treatment & Rehabilitation
A doctor will begin by collecting a medical history and conducting a physical exam to help diagnose muscle strain:
- Medical history – This includes information about current symptoms, as well as when and how your symptoms began, such as whether pain began after an injury or had worsened. Medical history also includes information about typical exercise levels, sleep habits, and past medical problems.
- Physical examination – Physical exams include range-of-motion and flexibility in your back, as well as in the hip, pelvic, or hamstring muscles. Feeling along the lower back (palpation) can detect spinal abnormalities that may be the source of pain.
While an imaging test such as an X-ray or Magnetic Resonance Imaging (MRI) scan is rarely needed for a muscle injury, one may be used to check for other possible pain sources, such as a fracture or herniated disc, if those conditions are suspected.
If any symptoms linked to back strain have lasted between two to six weeks, or if there are frequent recurrences of back pain, physiotherapy is often recommended. Generally, the ultimate goal of physiotherapy is to decrease pain, increase function, and provide education on a maintenance program to prevent further recurrences.
Active physiotherapy is mainly necessary to rehabilitate your spine. Certain exercises designed by your physiotherapist may include:
- Low-impact aerobic conditioning – Low-impact aerobics are important for long-term pain reduction. There are several options available, such as walking, bicycling swimming, or water therapy. Aerobic exercises are often done for 30-40 minutes while performing these three times a week.
- Stretching – Almost every patient who has suffered from back strains should stretch their hamstring muscles once or twice daily. Hamstring stretching exercises are best done at the same time every day so it becomes part of your daily routine.
- Muscle-strengthening – To strengthen the back muscles, 15-20 minutes of dynamic lower back stabilization or other prescribed exercises should be done three times a day. Core muscle strengthening is also important in lower back pain treatment.
Certain modalities are commonly employed to reduce back pain. They are especially useful in alleviating acute low back pain. Here are some examples for physiotherapy modalities:
Ultrasound is a form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues. Ultrasound is also necessary for relieving acute episodes of pain and may enhance tissue healing.
A Transcutaneous Electrical Nerve Stimulator (TENS) unite uses electrical stimulation to modulate the sensation of low back pain by overriding the painful signals that are sent to the brain.
Iontophoresis delivers steroids through the skin. The steroid is applied to the skin and then an electrical current is applied that causes it to migrate under the skin. The steroids then produce an anti-inflammatory effect in the general area that is causing pain.
Heat and cold therapy
Heat and / or ice are easily available and are the most commonly used type of modality. Each type of therapy helps reduce muscle spasms and inflammation. Some patients find more pain relief with heat therapy using heat packs and others with cold therapy such as ice massage. Both heat and ice are generally applied for 10-20 minutes once every two hours a day.
To improve your back strain symptoms, focus on strengthening your core, hip, and back muscles with these exercises. Here are some exercise examples for you to try:
Cat cow pose
This specific yoga pose offers gentle stretching to warm you up. Firstly, get on your hands and knees on a mat. While breathing, arch your back and extend your neck while raising your gaze to the ceiling. Hold for 10 seconds, then bring your head down and your chin toward your chest while simultaneously bringing your abdomen up and rounding your back like a cat stretching. Lastly, hold for 10 seconds, then repeat these movements 10 more times a day.
Lower back release
Lie on your back with knees bent and feet flat on the floor. Contract your abdominal muscles to pull the navel toward the spine and flatten the lower back to the floor. Hold for 5-10 seconds, then release before repeating 20 times a day.
Stand with your feet together and bring your hands together over your head. Gently reach your hands backward while arching your back without causing pain. Hold for one minute, then slowly stand upright and bring your hands to your sides. It is recommended to repeat this exercise 10 times a day.
Lie on the floor with your knees bent and feet flat on the floor. Position your arms at your sides, with palms down. As you exhale, raise your hips off the floor and push them toward the ceiling to create a slope from your knees to your chest. While continuing to breathe, hold the pose for up to 30 seconds, then return to the starting position, repeating 10 times a day.
Alternative & Homeopathic Treatment
Choices of back strain treatments depend on what is causing your symptoms, the location of the problem, and the severity of your symptoms. If your symptoms are mild, your healthcare provider may recommend some homeopathic treatments first. Here are some home remedies you can try:
- Heat application – Heat typically is the better choice for pain due to spinal injuries in general. Heat increases blood flow, which relaxes muscles and relieves aching joints.
- Ice application – If heat is not relieving your symptoms, try an ice pack or frozen gel pack. Usually, ice is applied 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness, and inflammation.
- Pain relievers – Pain medications such as ibuprofen, naproxen, and acetaminophen may be used temporarily to ease the discomfort of back strains.