Lumbosacral Spine Sprain/Strain Injuries Clinical Presentation

Obtain the following key information:

• The mechanism of injury, with an exact description of the event leading to the pain
• The exact localization and duration of the pain
• Any pain radiation
• Movements that aggravate or minimize the pain

Typical symptoms are pain and spasm that are localized over the posterior lumbar spinal muscle bellies lateral to the spinous process or at the insertion of the muscle at the iliac crest.

If the injury is confined to a sprain or strain injury, then structural deformities, a generalized midback pain indicating disc involvement, and neurologic symptoms should be absent.

(See also the eMedicine articles Lumbar Disk Problems in the Athlete [in the Sports Medicine section], Lumbar (Intervertebral) Disk Disorders [in the Emergency Medicine section], Lumbar Degenerative Disk Disease [in the Physical Medicine and Rehabilitation section], and Lumbar Disc Disease [in the Neurosurgery section].)

Range of motion (ROM), particularly in flexion, is usually painful and decreased.

Any neurologic compromise, (eg, numbness in the lower extremity, motor weakness) or any urinary or fecal incontinence syndrome indicates the possible presence of disc prolapse, nerve root impingement, or spinal canal stenosis.

(See also the eMedicine articles Urinary Incontinence [in the Emergency Medicine section], Fecal Incontinence [in the Obstetrics/Gynecology section], Nerve Entrapment Syndromes of the Lower Extremity [in the Orthopedic Surgery section], Spinal Stenosis [in the Neurosurgery section], and Spinal Stenosis and Neurogenic Claudication [in the Physical Medicine and Rehabilitation section].)

With the patient in a standing position, evaluate for obvious deformities, changes in alignment, or difficulties in achieving changes in position or full ROM. Evaluation of these signs may provide clues to muscle spasm(s) and activities that worsen the patient's pain.

Palpation of painful area: Palpation, performed with the patient in a prone position, helps to reveal the area and the size of muscle spasm(s) and the location of any point tenderness, if present. A point-specific midline back pain between the spinous processes indicates a ligamentous injury or lumbar interspinous bursitis ("kissing spines").

Neurologic examination: Evaluation of the lower extremities should include a motor examination, a sensory evaluation, and reflex testing at the knees and ankles. The straight-leg raising test helps to evaluate disc involvement, sciatica, or a neurologic deficit. A positive Patrick test points to a sacroiliac joint inflammation, but this test should be negative in lumbosacral sprains and strains. (See also the eMedicine article Sacroiliac Joint Injury.)

Most athletes who sustain a low back injury do so while lifting weights during their training sessions or while performing unexpected coupled motions (eg, lateral bending and flexion, lateral bending and axial rotation). During such activities, tremendous loads are placed on the lumbar spine, which may cause a temporary instability and lead to a subsequent injury to the soft tissue that surrounds the spine.

Risk factors for LBP include the following:^{[9, 10]}

• Muscular imbalances or weaknesses of the abdominal and posterior spinal muscles may constitute a risk factor to sustain a low back injury.
• Deficits in the afferent or efferent pathways or proprioceptors are known risk factors for spinal soft-tissue injuries.
• Preexisting structural deformities, such as scoliosis, spondylolysis, or spinal fusions, may predispose to a spinal injury. Preexisting injuries make athletes more vulnerable to sustaining a reinjury of the same area.

  • See also the eMedicine article Scoliosis, Idiopathic and Spondylolysis [in the Radiology section], Lumbosacral Spondylolysis [in the Sports Medicine section], and Lumbar Spondylolysis and Spondylolisthesis [in the Physical Medicine and Rehabilitation section],
  • as well as Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation, Biomechanics of the Posterior Lumbar Articulating Elements, Prevalence of Musculoskeletal Disorders at the NFL Combine - Trends from 1987 to 2000, and Lumbar SpineInjuries in Athletes on Medscape.