Lumbar sprain
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Have you hurt your back and the pain is preventing you from moving normally? It's frustrating, but rest assured: a lumbar sprain is a common injury that heals well with the right care. This injury affects the ligaments in your lower back—the tissues that connect your vertebrae together. It causes pain and stiffness. In Quebec, it is often called a back strain or lumbago. Lumbar sprains are one of the most common causes of acute low back pain in active adults. To understand how this condition fits into the broader context of low back pain and its various manifestations, see our comprehensive guide to low back pain. Physical therapy plays a central role in healing. It creates the best conditions for your body to repair itself naturally. It restores movement and prevents new injuries through a gradual rehabilitation program tailored to your needs.
What is a lumbar sprain in the lower back?
A lumbar sprain is an injury to the ligaments that connect your lower back vertebrae. It occurs when these fibrous tissues are stretched beyond their normal capacity. This causes pain, muscle spasms, and limited movement. Proper rehabilitation helps you regain normal function.
A lumbar sprain affects the ligaments in the lumbar region. This region includes the five vertebrae located between your ribs and your pelvis. Ligaments are bands of tissue that stabilize your joints. They limit excessive movement. During a lumbar sprain, these structures undergo stress that exceeds their normal capacity. This can cause tissue irritation or small microtears in the fibers—similar to a scratch on the skin. These injuries are minor and heal naturally.
It is important to distinguish between a lumbar sprain and a muscle strain. A sprain affects the ligaments between the vertebrae. A strain affects the muscles along your spine, such as the erector spinae muscles. Both cause pain and stiffness in the lower back. However, this difference affects healing. Ligaments have fewer blood vessels than muscles. This means they heal a little more slowly. The good news? In both cases, the vast majority of people recover completely.
Other lumbar conditions include herniated discs. This is different from a sprain. In a herniation, the disc between the vertebrae is affected, rather than the supporting ligaments.
Lower back pain can have many different causes. Some affect the ligaments, such as sprains. Others affect the discs or joints. To better understand the broader context of lower back pain and its many causes, explore how these various conditions differ from one another.
What causes a lumbar sprain?
Lumbar sprains usually occur after sudden movements, lifting with poor technique, falls, or repetitive stress on the lower back. The risk increases when your abdominal muscles are weak, your posture is poor, or you don't warm up before physical activity.
Acute trauma is the most common cause of lumbar sprains. A sudden movement during a combined rotation and flexion puts too much strain on your ligaments. This is particularly true when the movement is rapid and uncontrolled. Car accidents create significant forces on your lumbar ligaments. These are known as acceleration-deceleration forces (your body is thrown forward and then backward quickly). Falls, especially with an asymmetrical landing or twisting, create sudden loads that exceed the strength of your ligaments. Lifting heavy loads with poor technique exposes your ligaments to maximum forces. This is particularly the case when you are in a fully flexed position, leaning far forward.
Repetitive stress is a less obvious but significant cause. Repetitive rotational or flexion-extension movements can gradually weaken your ligaments, even if the range of motion is small. This tissue fatigue explains why you often strain your back during everyday movements. This is typical the day after strenuous exercise.
For example, you spend the whole day moving house. Your lumbar structures accumulate fatigue, which reduces their resistance. The next day, you bend down to pick up a pencil. This simple movement can be enough to cause an injury.
Several factors increase the risk of lumbar sprain:
- Weak core muscles: Deep abdominal muscles such as the transverse abdominis protect your ligaments. Weakness reduces this control.
- Muscle imbalances: Imbalances between flexor and extensor muscles create compensatory movements. This puts excessive strain on certain ligaments.
- Reduced hip mobility: When your hips lack mobility, your lumbar spine compensates. It moves more than it should. This overstretches your ligaments.
- Postural asymmetries: Persistent pelvic rotation or leg length discrepancy places uneven stress on your body. Your ligaments on both sides work differently.
The following conditions also increase the risk:
- History of previous lumbar injuries
- Lack of overall physical fitness
- Poor posture habits (sitting for long periods leaning forward)
- Failure to warm up before physical activity
- Natural aging of tissues (decreases collagen density—the protein that makes your ligaments strong)
What are the main symptoms of a lumbar sprain?
Symptoms of a lumbar sprain include localized pain in the lower back that intensifies with movement, muscle spasms, stiffness (especially in the morning), and difficulty standing upright. The pain may radiate to the buttocks. However, unlike sciatica, it does not usually extend below the knees.
Pain is the main symptom of a lumbar sprain. It manifests as a sharp or stabbing sensation in your lower back. The intensity increases when you move. It worsens during flexion, extension, rotation, or lateral flexion movements. Prolonged static positioning gradually increases discomfort, whether you are sitting or standing. Sneezing or coughing triggers a sudden worsening of pain.
Muscle spasms are an automatic protective response to your ligament injury. It's as if your muscles contract on their own to immobilize the injured area. The erector spinae muscles, quadratus lumborum, and multifidus contract continuously. This creates stiffness that you can feel on either side of your spine. These spasms contribute to limiting your movement. They can also cause secondary pain due to a lack of blood flow in the contracted muscle.
Lumbar stiffness and loss of range of motion characterize the sprain from the very first hours. This stiffness results from several factors: local inflammation, muscle spasms, and fear of movement. You often report significant difficulty putting on your shoes, getting up from a chair, or getting out of bed in the morning. Morning stiffness is particularly pronounced after a night's rest. This is normal and usually improves over time.
How is your sprain pain?
Your pain may worsen when bending (sitting, leaning) or extending (standing, walking). This distinction directly guides your treatment and relief positions.
To understand your directional pattern in detail and discover the right exercises for you, check out our comprehensive guide to directional preferences.
It is crucial to distinguish between sprain pain and radicular pain (nerve pain). A sprain causes localized pain in the lower back. It can radiate to your buttocks or upper thighs. However, it does not extend below the knee. The absence of numbness, tingling, muscle weakness, and changes in reflexes distinguishes a sprain from nerve compression. The latter requires a different investigation.
Functional limitations affect your daily and professional activities. You have difficulty transferring from one position to another. For example, moving from sitting to standing or getting into a vehicle. Household activities become problematic. Vacuuming, taking out the laundry, or picking up objects. Workers who move loads or maintain awkward postures often experience temporary disability. It is frustrating, but these limitations are temporary in the vast majority of cases.
The progression of symptoms generally follows a predictable pattern:
- Acute inflammatory phase (24-72 hours): Maximum pain, marked stiffness, significant spasms
- Subacute phase (3 days to 6 weeks): Gradual decrease in pain, gradual improvement in movement
- Remodeling phase (6 weeks to several months): Scar tissue maturation (your new tissue becomes stronger), gradual functional recovery
Here's the good news: about 50% of lumbar sprains resolve within 1 to 2 weeks. 90% improve within 6 to 12 weeks with or without treatment.
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How do healthcare professionals diagnose a lumbar sprain?
The diagnosis of lumbar sprain is based primarily on a detailed history and physical examination. This includes assessing your movements, palpation to identify tender areas, and specific orthopedic tests to rule out other conditions. X-rays or MRIs are generally unnecessary unless your symptoms persist beyond 6 weeks or warning signs are present. This clinical approach is sufficient in 99% of cases.
Your medical history is the cornerstone of diagnosis. Your practitioner will gather specific information about how the injury occurred. They will explore the type of movement you were performing when the symptoms appeared. They will check whether there was an identifiable triggering event, such as a fall or lifting something heavy. The characteristics of your pain will be explored in detail. Location, intensity, nature, aggravating and relieving factors. The functional assessment documents the impact on your daily and professional activities.
The physical examination consists of several components:
- Postural observation: Often reveals lateral deviation of your trunk, loss of normal lumbar lordosis (the natural curve of your lower back), or asymmetrical positioning of your pelvis.
- Palpation: Identifies areas of maximum sensitivity, excessive muscle tension, and potential deformities.
- Range of motion: Documents limited directions in all planes (flexion, extension, lateral flexion, rotation)
- Neurodynamic tests: Lasègue's test can rule out a significant radicular component (nerve problem).
What clinical tests confirm the diagnosis of lumbar sprain?
Specific orthopedic tests help differentiate sprains from other conditions. Segmental stability tests assess the presence of abnormal hypermobility (segments that move too much). Joint compression and distraction maneuvers reproduce your pain by stressing the ligaments. Instability tests such as the Pheasant test detect segmental control deficits (when certain vertebrae do not move in a controlled manner). Neurological differentiation tests rule out radicular involvement, which would require a different approach.
When is imaging indicated for low back pain?
Medical imaging is not necessary in the vast majority of cases of lumbar sprain. Its systematic use does not improve clinical outcomes. It increases costs and radiation exposure. Current guidelines recommend reserving imaging for specific situations. That is, when warning signs suggest a serious condition.
X-rays only show bone structures. They do not detect ligament injuries. Their use is limited to situations where a spinal fracture is suspected. This is following significant trauma. This is particularly true in patients with osteoporosis (fragile bones), prolonged use of corticosteroids, or advanced age.
Magnetic resonance imaging (MRI) provides visualization of soft tissues. This includes discs, spinal cord, nerve roots, and ligaments. It is indicated when:
- Your symptoms persist beyond 6 weeks despite appropriate treatment.
- Neurological warning signs are present (progressive muscle weakness, loss of sensation in the saddle area, sphincter disorders).
- You have a history of cancer
- Unexplained fever accompanies your lower back pain
- Unintentional weight loss is present
- Your nighttime symptoms are significant.
When a nerve is involved, the pain behaves differently. Lumbar radiculopathy explains how to distinguish local ligament pain from nerve pain that travels down the leg.
How does physical therapy effectively treat a lumbar sprain?
Physiotherapy treatment for lumbar sprains includes manual therapy to restore joint mobility, progressive exercises to strengthen your supporting muscles, pain modulation techniques, and education on proper movement patterns. Treatment progresses from pain management to full functional restoration, typically over 4 to 8 weeks depending on the severity of your injury.
Physical therapy takes an approach based on improving conditions for natural healing. Inflammation is a normal and necessary response to healing. Attempts to suppress it completely can delay your long-term recovery. Your physical therapist's role is to identify and eliminate factors that slow down healing. He or she facilitates an optimal environment for ligament repair. For many patients with lumbar sprains,the McKenzie approach offers effective self-treatment strategies. This method allows you to actively manage your symptoms through specific movements.
Research shows that active physical therapy produces better long-term results than passive approaches. Strengthening and endurance exercises are a central pillar of modern treatment for lumbar sprains. They enable lasting recovery and prevent recurrence.
The initial physical therapy assessment establishes the basis for an individualized treatment plan. Your physical therapist evaluates the mobility of each lumbar vertebral level. This identifies restrictions that may contribute to your symptoms. The sciatic and femoral nerves are tested for nerve sensitivity (irritated nerves). This could amplify your pain. Your postural habits are analyzed to identify positions that overload your lower back. Movement rehabilitation observes the quality of your movements during functional tasks. It corrects dysfunctional patterns. The strength and stability of your core muscles are quantified.
Table 2: Phases of physiotherapy treatment for lumbar sprain| Phase | Duration | Main objectives | Typical interventions |
|---|---|---|---|
| Acute phase | 0-72 hours | Pain management, protection of damaged tissue | Gentle joint mobilization, pain relief methods (heat/ice), relief positions, activity management |
| Subacute phase | 3 days to 6 weeks | Restoration of function, gradual strengthening | More vigorous mobilization, stabilization exercises, deep muscle activation, therapeutic education |
| Return to work phase | 6 weeks and beyond | Preparation for a full return to activities, prevention of recurrence | Specific functional exercises, cardiovascular conditioning, self-management strategies |
The therapeutic methods used vary according to your individual needs:
- Thermotherapy (heat): Improves tissue extensibility (your tissues become more flexible), reduces muscle spasms, increases local blood flow
- Electrotherapy (TENS, interferential): Contributes to pain modulation via nerve stimulation.
Joint mobilization and manipulation can restore segmental mobility and reduce protective spasms. These precise manual techniques complement active exercises during the subacute phase.
The importance of active versus passive treatments is a fundamental principle. Passive interventions such as manual therapy can facilitate your engagement in active exercises. However, they should never constitute the bulk of your treatment. Active therapeutic exercises produce lasting adaptations. Increased muscle strength. Improved motor control. Decreased sensitivity of your nervous system. Increased confidence. Progress toward independence is the ultimate goal. Prolonged dependence on passive interventions is associated with less favorable outcomes and an increased risk of chronicity.
What is the typical recovery time for a lumbar sprain?
Most lumbar sprains heal within 4 to 8 weeks with proper treatment. Your body has a remarkable ability to heal itself. Milder cases resolve within a few weeks, while more severe injuries may require up to 8 to 12 weeks for a full recovery and a safe return to all your desired activities.
The ligament healing process follows three distinct biological phases that partially overlap:
Inflammatory phase (0-72 hours):Local vasodilation (your blood vessels widen) and the infiltration of inflammatory cells at the site of injury are normal. Chemical mediators such as prostaglandins sensitize your pain receptors. This explains why pain is most intense during this period. The goal of treatment is to allow this normal inflammatory response to occur while managing your symptoms.
Proliferation phase (3 days to 6 weeks):Your cells produce new collagen. The initial repair tissue is deposited in a disorganized manner. It creates temporary scar tissue that is less resistant than your intact ligament. Neovascularization (new blood vessels) occurs to support tissue activity. During this phase, the amount of mechanical stress applied to your tissues is crucial. Insufficient stress produces weak scar tissue. Excessive stress may re-injure your ligament.
Remodeling phase (6 weeks to 12 months or more):Collagen fibers gradually reorganize themselves along lines of mechanical stress. Collagen matures and becomes stronger. Excessive vascularization gradually decreases. The strength of your ligament gradually increases. However, it generally never fully regains the properties of the tissue prior to injury. This reality highlights the importance of comprehensive rehabilitation. The goal is to develop compensatory strategies through muscle strengthening.
Several factors influence the length of your recovery:
- Age: Younger individuals generally recover more quickly.
- Medical comorbidities: Diabetes, vascular disorders, or autoimmune conditions can slow healing.
- Smoking: Compromises tissue vascularization and delays regeneration.
- Nutritional status: Protein and vitamin C intake is essential for collagen synthesis.
- Psychosocial factors: High stress, anxiety, depression, or negative expectations are associated with prolonged trajectories.
Considerations for returning to work vary depending on physical requirements:
- Sedentary jobs: Possible return to work within a few days to a week with ergonomic accommodations
- Moderate physical activity: Generally 2 to 4 weeks before a full return
- Heavy physical exertion: May require 6 to 8 weeks with a gradual return period
The return to sport follows a similar progression adapted to specific requirements:
- Low-impact sports (swimming, cycling): Often resumed after 1 to 2 weeks
- Moderate-impact activities (brisk walking, jogging): Typically reintroduced after 3 to 4 weeks
- High-impact sports (hockey, basketball, football, weightlifting): Generally 6 to 12 weeks of progressive rehabilitation
The importance of complete rehabilitation cannot be overstated. It prevents chronicity and recurrence. Patients who interrupt their program as soon as the acute pain subsides are at significantly increased risk of a new episode. This is without having restored their strength and motor control. Residual control deficits, even without symptoms, predispose you to adopting compensatory movement strategies. This increases stress on your lumbar structures.
If your pain persists beyond 3 months, consult our guide on chronic pain. You will understand the mechanisms of sensitization and the appropriate therapeutic approaches.
Need professional advice?
Our physical therapists can assess your condition and offer you a personalized treatment plan.
Book an appointmentHow can future lumbar sprains be prevented?
Preventive strategies for lumbar sprains include maintaining strong core muscles that protect your ligaments, practicing proper lifting techniques that minimize strain, regular flexibility exercises to maintain range of motion, ergonomic design of your workplace, and gradual progression when starting new physical activities.
Strengthening the stabilizing muscles of your core is the cornerstone of prevention. The deep abdominal muscles, particularly the transverse abdominis, create core rigidity. How? By increasing intra-abdominal pressure. This partially relieves pressure on your ligaments. The multifidus is a muscle that attaches directly to your adjacent vertebrae. It provides precise stabilizing control at each level. The oblique muscles control rotational and lateral flexion movements. The quadratus lumborum stabilizes your spine laterally.
Stabilizer muscle exercises develop the capacity of your deep muscular system. This protects your ligaments during your daily movements.
Key prevention strategies: Proper lifting techniques:- Stand with your feet shoulder-width apart.
- Keep the load close to your body to minimize the lever arm.
- Use your leg muscles rather than your back muscles.
- Avoid the flexion-rotation combination that puts your ligaments at maximum risk.
- Plan the route and prepare the destination space
- Divide heavy loads into multiple lighter lifts.
- Use mechanical aids (trolleys, hand trucks) or work in teams for very heavy loads.
- A restriction in hip flexion forces your spine to compensate. It flexes more than it should.
- The tightness of your hamstrings (muscles at the back of your thighs) limits the tilt of your pelvis during flexion.
- Restricted hip extension forces your lower back to compensate by hyperextending.
- A regular stretching program maintains optimal hip flexibility.
- Target your hip flexors, hamstrings, calves, and external hip rotators.
- Adjust the height of your chair so that your hips and knees are at a 90-degree angle.
- Use a lumbar support that maintains the natural curve of your lower back.
- Alternate regularly between sitting and standing positions using an adjustable desk.
- Take movement breaks every 20 to 30 minutes.
- Organize your workspace to minimize repetitive bending
- Adopt alternative positions such as kneeling rather than prolonged bending.
A professional workplace assessment identifies the risk factors specific to your environment. This ergonomic analysis offers practical solutions tailored to your daily tasks.
Gradual progression of activities:- Increase only one training parameter at a time (intensity, duration, or frequency).
- Do not exceed a 10% increase per week.
- Allow adequate recovery periods between demanding sessions.
- Vary the types of activities to avoid repetitive strain.
- Warm up before intense activities to increase tissue temperature.
Preventive strategies developed during physical therapy address your identified individual deficits. Correcting strength asymmetries reduces uneven stress on your ligaments. Improving your dysfunctional movement patterns replaces compensatory strategies. Treating joint mobility restrictions eliminates the need for compensation by your spine. Education on early recognition of signs of minor irritation allows for quick action. This is before mild irritation progresses to a significant injury.
When should you seek emergency care for lower back pain?
Consult a doctor immediately if you experience loss of bladder or bowel control, progressive weakness in the legs that worsens over a few hours to days, numbness in the genital area (saddle anesthesia), fever accompanying your back pain, or severe pain following significant trauma. These symptoms indicate potentially serious conditions that require urgent investigation.
Warning signs or red flags are symptoms that suggest a serious condition. Recognizing them quickly and seeking appropriate medical attention can prevent permanent neurological damage or identify life-threatening conditions.
Rest assured: serious symptoms are rare. They occur in less than 1% of cases. However, you need to be aware of them so that you can act quickly if necessary.
Warning signs requiring urgent medical attention: Cauda equina syndrome (neurological emergency):- Saddle anesthesia (loss of sensation in the perineal area—between your legs)
- Sphincter dysfunction (urinary and fecal incontinence or retention)
- Progressive bilateral weakness in your legs
- Severe bilateral radicular pain
- Action required: Urgent consultation within 24-48 hours
- Inability to perform specific movements despite your best efforts
- Inability to walk on your heels (suggests L5 involvement)
- Inability to walk on tiptoes (suggests S1 involvement)
- Progression over a few hours to days
- Sensory changes in dermatomal distribution (specific areas of the skin)
- Persistent fever above 38°C
- Chills and night sweats
- Risk factors: IV drug use, immunosuppression, recent infection elsewhere, recent spinal instrumentation
- Risk of progression to spinal cord compression or sepsis
- Intense nighttime pain not relieved by rest or changes in position
- Pain that gradually worsens despite treatment
- Unexplained weight loss or extreme fatigue
- Personal history of cancer (breast, prostate, kidney, thyroid, lung)
- Over 50 years of age at the time of the first episode with no apparent cause
- High-velocity impact (car accident, fall from height)
- Risk factors for bone fragility: osteoporosis, long-term use of corticosteroids, advanced age
- Visible deformation of your spine with sudden kyphosis (humpback)
- Even minor trauma in at-risk individuals
- No improvement after 10 days of appropriate self-management
- Progressive worsening of your symptoms despite following the recommendations
- Appearance of new symptoms different from the initial presentation
- Persistence of significant symptoms beyond 6 to 8 weeks despite physical therapy treatment
- Severe uncontrolled radicular pain with major functional impact
If you have questions about the normal progression of your condition or are unsure whether your symptoms require medical attention, contact your physical therapist. He or she will be able to assess the situation and guide you to the appropriate resources.
Ready to start your recovery from a lumbar sprain?
A professional physical therapy assessment ensures an accurate diagnosis and personalized treatment for your lumbar sprain. Our experienced physical therapists at Physioactif will develop a customized program to restore your function and prevent recurrence.
Our approach combines manual interventions to improve your mobility with a primary focus on active exercises that produce lasting changes. Education allows you to understand your condition and develop the autonomy necessary to manage your health in the long term.
Appointments can be easily made online or by phone. We offer flexible hours, including evening and some Saturday appointments. Direct billing to most private insurers simplifies the process.
Don't wait until your condition worsens. Early intervention with physical therapy improves outcomes and reduces the risk of chronicity. Contact us today to begin your recovery.
References
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- Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75.
- van Tulder M, Becker A, Bekkering T, et al. Chapter 3: European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):S169-S191.
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