Lumbar Strain

Lumbar strain is a form of mechanical low back pain caused by injury to spinal structures, intervertebral discs, or surrounding soft tissue¹.This condition accounts for approximately 70% of all cases of mechanical low back pain².

This article focuses on muscle and tendon injuries of the lumbar region, referring to overuse or tears in the paraspinal muscles and tendons.Knowledge of this condition largely derives from experience with similar muscle injuries in other parts of the body³⁴⁵.

Mechanism of Injury

Lumbar strain occurs when muscles are subjected to abnormally high tensile stress, leading to tearing of muscle fibers—particularly at the musculotendinous junction⁵.Acute injuries can occur during physical activity, such as heavy lifting or sudden twisting.In many cases, patients cannot identify a specific triggering event¹.

Anatomy and Biomechanics

The lumbar spine consists of five robust vertebrae, various bony structures connected by joint capsules, flexible ligaments, and tendons, as well as large and small muscles.Sensitive nerves also pass through this region.The spine protects neural structures while allowing multidirectional movement, including flexion, extension, lateral bending, and rotation⁶⁷.

Muscles commonly affected by lumbar strain include⁸⁹¹⁰:

• Erector spinae (iliocostalis, longissimus, spinalis)

• Semispinalis

• Multifidus

• Rotatores

• Quadratus lumborum

• Serratus posterior

How Does Lumbar Strain Occur?

Muscle injuries of the lower back most often result from forceful contractions during simultaneous stretching, such as lifting or sudden rotational movements¹¹.All back muscles and their tendons can be affected, but muscles spanning multiple joints are particularly vulnerable.Acute injuries usually cause the most intense pain after 24–48 hours.If healing is incomplete, the condition may become chronic, with persistent muscle-related pain¹².

Epidemiology

Between 80% and 90% of all people will experience low back pain at some point.The global point prevalence is between 12–33%, with the highest risk among women and individuals aged 40–80 years¹.

In the United States, lumbar injuries account for 7–13% of all sports injuries in college athletes, with muscle injuries (60%) being the most common, followed by disc disorders (7%)¹³.In France, over half of people aged 30–64 report at least one day of low back pain annually, while 17% report such pain for more than 30 days within a year¹⁴.In Africa, point prevalence is around 32%, with a one-year prevalence of 50% and lifetime prevalence of 62%¹⁵.

Symptoms and Findings

Patients often experience pain localized to the lumbar muscles or diffuse pain across the lower back³.Pain typically increases during standing, twisting, active movement, and passive stretching of the injured muscles¹⁰.

Other symptoms include:

• Tenderness on palpation.

• Muscle spasms and swelling around the injured area.

• Asymmetrical posture caused by severe spasms.

• Reduced range of motion¹⁶.

Differential Diagnoses²

• Spondylosis

• Disc herniation

• Compression fracture

• Spinal stenosis

• Spondylolisthesis

• Ankylosing spondylitis

Diagnostic Evaluation

In the absence of red flags, laboratory or imaging studies are generally unnecessary in the acute phase of mechanical low back pain.

Inflammatory markers such as ESR and CRP can be helpful in patients with suspected infection or malignancy of the spine, especially in the absence of neurological deficits.

Routine imaging is not recommended, as many findings are incidental and unrelated to symptoms.If trauma is suspected, conservative treatment fails, or neurological symptoms develop, advanced imaging is indicated.X-ray and CT are used primarily to evaluate fractures.

Clinical Examination

Lumbar evaluation is conducted through a comprehensive physical examination of the lumbar spine, assessing posture, range of motion, muscle tone, and neurological function.

Medical Management

Treatment depends on symptom duration, comorbidities, and underlying cause.The American College of Physicians (2017) recommends non-invasive first-line options for acute low back pain.

Non-pharmacological first-line treatments (acute phase):

• Spinal manipulation.

• Acupuncture.

• Massage therapy

.• Superficial heat application.

Pharmacological first-line treatments (acute phase):

• Nonsteroidal anti-inflammatory drugs (NSAIDs).

• Muscle relaxants.

Opioids should not be used routinely but may be considered for short-term pain control if other treatments fail.

For chronic low back pain, the following non-pharmacological treatments are recommended:

• Exercise therapy.

• Tai Chi.

• Yoga.

• Multidisciplinary rehabilitation.

• Spinal manipulation.

• Acupuncture.

• Psychotherapy.

• Low-level laser therapy.

• EMG biofeedback.

If medication is required, NSAIDs are first-line, while tramadol and duloxetine can be used as second-line options.Opioids should only be prescribed if no other treatment is effective and after careful evaluation¹.

Physiotherapy Management

Patient Education and Prevention

• Regular breaks during work.

• Stretching exercises.

• Ergonomic adjustments to reduce physical strain.

• Proper lifting technique.

• Weight management in overweight patients.

• Smoking cessation.

• Gradual return to normal activity — studies show this leads to faster recovery than bed rest¹⁷.

Therapeutic Techniques

Cold Therapy:

Used during the acute phase (within 48 hours) to reduce inflammation and swelling¹⁸¹⁹.

TENS and Ultrasound:

May help decrease pain and muscle spasms²⁰²¹.

Stretching Exercises

• Single and double knee-to-chest:

Lie on your back with knees bent and feet flat on the floor. Pull knees toward your chest and hold for 10 seconds. Repeat 3–5 times.

• Supine trunk rotation:

Lie on your back with arms extended overhead. Bend your knees, keep feet flat, and slowly lower knees to one side. Hold for 10 seconds and repeat 3–5 times.

• Press-up exercise:

Lie prone with hands under shoulders. Keep hips and legs relaxed, press the upper body up with arms, hold for a few seconds, lower slowly, and repeat 10 times.

• Kneeling hip flexor (iliopsoas) stretch.

• Piriformis stretch.

• Quadratus lumborum stretch²².

Soft Tissue Therapy

Targeted soft-tissue treatment helps reduce pain and improve mobility²³, often through:

• Massage therapy.

• Myofascial release.

Strength Training

Begin once pain and spasms are under control.Focus should be on core stability, emphasizing the oblique abdominals, spinal extensors, and gluteal muscles.Isolated training of the injured muscle is less effective.Postural and movement pattern assessment is crucial for long-term prevention¹⁸.

Prognosis

Most patients improve within two weeks, with full recovery in 4–6 weeks²⁴.Early mobilization, proper rehabilitation, and patient education are key to preventing recurrence.

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