From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

What is a low back strain or lumbar sprain?
Muscle strains and lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscle fibers are abnormally stretched or torn. A lumbar sprain occurs when the ligaments, the tough bands of tissue that hold bones together, are torn from their attachments. Differentiating a strain from a sprain can be difficult, as both injuries will show similar symptoms. Many doctors refer to both injuries as a category called "musculoligamentous injuries" of the lumbar spine. In general, it doesn't matter what you call the problem because the treatment and prognosis for both back strains and sprains is the same.

Nearly everyone will experience low back pain at some point in their life--it is the second most common cause of missed days of work in the United States! (Only a common cold causes more missed work). Almost all of these low back injuries are due to injuries of the muscle or ligament. If you don't know the cause of your back pain, you should have it evaluated by a doctor. Some warning signs of a serious injury to the spine include:

• Loss of control of bladder or bowels

• Progressive lower extremity weakness

• Severe, constant pain

As said earlier, most back pain is caused by a muscle strain or ligament sprain. However, there are serious conditions that require more immediate treatment. If you are unsure of the cause of your symptoms, you should be evaluated by a physician.

Why are sprains and strains of the low back so common?
The spine is supported by large muscles called the paraspinal muscles. These muscles both support the spinal column as well as the weight of the upper body. The five lumbar vertebrae are connected by tough ligaments that help to maintain the position of the spinal column.

These muscles, ligaments, and bones all work together to provide control and strength for nearly all activities. The lumbar spine and its muscles are needed for most all movements and activities. For this reason, the lumbar spine is prone to injury, and when an injury has been sustained, we are prevented from performing many activities.

What are the symptoms of a low back injury?
Most lumbar muscle strains and sprains cause symptoms isolated to the low back, usually they do not cause problems in the legs like some other spine conditions. The most common symptoms of a lumbar strain or sprain are:

• Pain around the low back and upper buttocks

• Low back muscle spasm

• Pain associated with activities, and generally relieved with rest

What causes these symptoms of low back pain and spasm?
When the lumbar spine is strained or sprained, inflammation of the soft-tissues results. This inflammation causes pain and can cause muscle spasm. People are often surprised at how painful and debilitating a lumbar strain or sprain can be--these are not small injuries. They often force patients to remain in bed for a day or two, and can cause intermittent symptoms for weeks. That said, over 90% of patients are completely recovered from an episode of lumbar muscle strain or sprain within one month.

Why do some patients tend to have low back strains and sprains more often?
Good question! We do know some factors that tend to influence the development of this type of problem, but often these symptoms strike in unexpected situations. Most commonly, patients who develop a lumbar strain or sprain are doing an activity that places their back at risk. This may be a sudden forceful movement, lifting a heavy object, or twisting the back in an unusual manner. Knowing how to properly lift can help to prevent many back injuries.

Some well known factors that contribute to low back pain include:

• Poor conditioning

• Obesity

• Smoking

• Improper use/lifting technique

If you have persistent problems with your lumbar spine, consider these issues. If you smoke, are overweight, or do not perform regular back strengthening exercises, then you have steps that you can take to help control your symptoms.