Sprains and/or Strains (Myofacial Pain)

Most back pains are caused by sprains and/or strains of muscles, ligaments, and/or tendons in our back. Because so many of us lead sedentary lives, our muscles become lax and lose their ability to properly support the spine. With time, ligaments and tendons can lose their ability to function properly, also leading to problems.

Poor posture puts enormous strain on the spine. Bending over may trigger muscle spasms, especially if the muscle is overstretched. But just as often, back pain may creep up slowly. You may suffer from backache after strenuous activity, in the morning, after sitting, or after standing in one position for long periods of time. In these cases, poor posture is generally as much to blame as an inactive lifestyle.

Sprains and strains often result from excessive physical demands on the back. Lifting something too heavy, a sudden fall, car crash, or sports injury can cause soft tissues (ligaments, muscles, tendons) to stretch too much.

The spine includes vertebrae (bones), discs (cartilaginous pads or shock absorbers), the spinal cord and nerve roots (neurological wiring system), and blood vessels (nourishment). Ligaments link bones together, and tendons connect muscles to bones and discs. The ligaments, muscles, and tendons work together to handle the external forces the spine encounters during movement, such as bending forward and lifting.

Sprains and strains are disorders affecting different soft tissues in the spine. Sprains are limited to ligaments whereas strains affect muscles, tendons, or muscle-tendon combinations. Ligaments are strong, flexible bands of fibrous tissue. Although ligaments are resistant to being stretched, they do allow some range of motion. Muscle is made up of individual and segmental strands of tissue. When back muscles encounter excessive external force, individual strands can stretch or tear while the rest of the muscle is spared injury. To illustrate a sprain or strain, consider what happens when lifting something heavy. Initially muscles are recruited to manage the load. When the load or force exceeds the muscles' ability to cope, the force is shared with the ligaments. When a ligament is stressed beyond its strength, it can tear.

Local tissues swell when ligaments, muscles, tendons, or combinations become overstretched, overused, or torn. Swelling causes pain, tenderness, and stiffness; swelling serves to protect the injured back by restricting movement - similar to a splint on a broken leg.

During the first 24 to 48 hours cold therapy helps to reduce swelling, muscle spasm, and pain by reducing blood flow to the injured area. Never apply cold or ice directly to skin; instead wrap the ice pack or cold product in a towel and apply for no longer than 15 minutes. If the sprain or strain is serious, the doctor may recommend a day or two of rest, cold and/or heat therapy, and medications. Medications may include an anti-inflammatory to reduce swelling, a muscle relaxant to calm spasm, and a painkiller (narcotic) to alleviate intense but short-lived pain (acute pain). Most sprains and strains heal within a few weeks. Mild to moderate pain may be treated with non-steroidal anti-inflammatory drugs (NSAIDs). These work by relieving both swelling and pain. Many NSAIDs are available over-the-counter. Discuss NSAID use with your physician first. Usually, after the first 48 hours, heat therapy is used to warm sore tissues. Never apply heat directly to skin; instead, wrap the heat source in a thick towel. Heat increases blood flow warming and relaxing soft tissues. Heat therapy is often used in physical therapy to prepare patients for gentle stretching and exercise to increase flexibility. When combined with stretching, the benefits of heat therapy are greater than heat alone.

In addition, tears and injuries to small muscle fibers may create scar tissue. Occasionally, this scar tissue may develop around nerve endings, causing small nerve entrapments. These can be painful, causing reflex spasms, which can develop into "trigger points", which are areas of increased sensitivity that may trigger pain. These sites can also cause areas of chronic localized spasms, which in turn will increase the metabolism of the muscle, causing an increase of the by-products of metabolism. These by-products tend to be very irritating to tissues, thereby causing further pain and spasms. The increased muscle tension will compress surrounding vessels traveling in and out of the area. This will result in a net decrease in nutrients, and further accumulation of those by-products of metabolism. The goal of the therapy is to break this viscous cycle. Examples of chronic forms of this are Fibromyalgia and Myofacial Pain Syndrome.