Chronic Lumbar Strain : as a musculoskeletal cause of chronic back
pain
1. Definition & pathophysiology
Chronic back pain is a prevalent issue affecting individuals across various age groups and lifestyles.
Mechanical back strain is a subtype of back pain where the aetiology is the spine, intervertebral discs, or the surrounding soft tissues. Lumbar strain accounts for 70% of mechanical low back pain
Chronic lumbar strain refers to the prolonged injury or overuse of the muscles, ligaments, and tendons in the lower back. This condition often results from repetitive movements, poor posture, or heavy lifting, leading to microtears in the soft tissues of the lumbar region. Over time, these microtears can accumulate, resulting in chronic inflammation and pain. The pain associated with lumbar strain is typically localized to the lower back and may radiate to the hips or buttocks.
2. Etiology
The etiology of chronic lumbar strain can be multifactorial.
Common causes include:
● Repetitive Activities: Jobs or activities requiring repetitive bending, lifting, or twisting can lead to strain. ● Poor Posture: Prolonged sitting or standing with improper alignment can place excessive stress on the lumbar region. ● Lack of Physical Conditioning: Weak core muscles and insufficient flexibility can increase the risk of strain. ● Previous Injuries: A history of acute lumbar injury may predispose individuals to chronic strain.
In strains, the muscle is subjected to an excessive tensile force leading to the overstraining of the myofibres and consequently to their rupture near the myotendinous junction
Lumbar strain can originate in the following muscles:
● M. erector spinae (M. iliocostales, M longissimus, M. spinalis) ● M semispinales, Mm multifidi, Mm rotatores ● M. quadratus lumborum ● M. Serratus Posterior.
3. Risk factors
Greater than 80% of people will suffer from low back pain during their lifetime. The global point prevalence of low back pain is 12% to 33%. There is a higher prevalence among women and people ages 40 to 80 years old.
● Occupational Hazards: Manual labor jobs, frequent heavy lifting, or long hours in static positions can increase the likelihood of developing chronic lumbar strain. ● Lifestyle Factors: Sedentary behavior, obesity, and lack of regular exercise can weaken the muscles supporting the spine. ● Age: The risk of chronic strain increases with age due to natural degeneration of spinal structures.
4. Clinical features
● Patients with chronic lumbar strain typically present with persistent, localized pain in the lower back. ● The pain may be described as dull, aching, or throbbing and can be exacerbated by movement, prolonged sitting, or changes in posture. ● In some cases, patients may experience stiffness, decreased range of motion, or muscle spasms in the lumbar region. ● Unlike pain originating from visceral causes, lumbar strain pain tends to improve with rest and may worsen with activity.
5. Diagnosis
● Diagnosing chronic lumbar strain involves a thorough clinical evaluation, including a
detailed history of symptoms and physical examination. ● Healthcare providers may assess the patient’s range of motion, strength, and posture to identify contributing factors.
6. Treatment
Management of chronic lumbar strain typically includes a combination of conservative
treatments: ● Physical Therapy: Targeted exercises to strengthen the core and improve flexibility can alleviate strain on the lumbar region. ● Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics can help reduce pain and inflammation. However, the use of these medications should be carefully monitored. ● Activity Modification: Educating patients about proper body mechanics, posture, and ergonomics can prevent further injury. ● Heat or Cold Therapy: Applying heat or cold packs can relieve muscle tension and pain.
In more severe cases, where conservative measures are ineffective, healthcare providers may consider interventions such as corticosteroid injections or, in rare instances, surgical options.
7. Complications
● If left untreated, chronic lumbar strain can lead to significant complications, including ● chronic pain syndromes, reduced mobility, and decreased quality of life. ● Patients may also develop compensatory movement patterns that lead to further musculoskeletal issues in other areas, such as the hips or knees.
