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Lower Back

Common Lower Back Injuries

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Lumbar sprain or strain
Lumbar facet syndrome
Lumbar disc herniation
Definition

Soft tissue damage (ligaments, muscles, tendons) surrounding the lumbar spine (low back), sacrum and pelvis.

Structure and Function

There are numerous connective tissues surrounding the structures of the low back and pelvis that enable movement and promote stability.

Why does it occur?

Injury to these areas are often a result of over stretching or sudden unguarded movement, i.e. being bent forward, rotated and lifting something places the patient in a vulnerable position for injury.

Symptoms

-Pain in the surrounding area with possible radiation into the buttocks and thigh.
-rarely, sensation of pins and needles, numbness or weakness.
-Pain on bending forward, or leaning backward

Treatment

Pain free ROM exercises and avoiding prolonged rest / immobility is advised during the acute phase. Massage, therapy and mobilisation should be considered when tolerable.

What to avoid

-Prolonged rest/immobility.
-Prolonged bracing

Definition

Low back pain caused by injury to the zygapophyseal (facet) joint and/or joint capsule

Structure and Function

Each vertebra has a pair of facet joints which enables movement with the adjacent vertebra.

Why does it occur?

Repetitive trauma or sudden movement can cause injury to these structures.

Symptoms

– Pain on extension (arching the spine backward) is common

Treatment

-Facet syndromes tend to respond well to osseous manipulation, especially if a meniscoid entrapment is apparent. The prognosis for facet injury is good, with most cases responding well to conservative treatment over a few weeks.

What to avoid

– Compression of the spine e.g. heavy squatting
– Movement forcing the spine into extension

Definition

Protrusion of the nucleus pulposus (inner disc material) into the outer section (annulus fibrosus) of the intervertebral disc.

Structure and Function

Intervertebral discs enable shock absorption for spine. This type of injury is commonly seen at the lowest 2 vertebra (L4-L5, L5-S1).

Why does it occur?

Continuous overloading of the disc, poor posture and muscle imbalances are key contributing factors to disc herniation. The injury is often elicited from bending forward as this increases discal pressure, or sneezing, laughing, coughing or straining on the toilet.

Symptoms

-Neurological symptoms such as pins and needles, numbness and weakness radiating to the lower body are common with discal injury. This occurs due to pressure/inflammation of the nerve root causing pain referral to other areas distant to the site of injury.
-Pain on sneezing, laughing, coughing
-Pain on standing that resolves again once moving
-Pain on sitting

Treatment

Address biomechanical issues such as muscle imbalance, poor posture, weight gain that may be predisposing. Mobilisation techniques and massage can be used when tolerable.

What to avoid

-High impact activities