While back pain can be caused by many things such as arthritis, disc problems, surgeries and deconditioning, strains and sprains are another common source. By definition, a strain is injury to a tendon, which is the tough fibrous cord that attaches muscle to bone. A sprain is in an injury to a ligament, the tough fibrous cord that holds the bones together and provides support. These types of injuries are commonly caused by improper lifting, falls and motor-vehicle accidents.

A mild back injury usually involves the muscles and the tendons attached to the muscles (a strain). Muscles have a significant amount of blood flow and a generous nerve supply. This is both good and bad. The blood flow helps the injury to heal fairly quickly, but the high content of nerve fibers also may make this injury very painful. With that associated pain, the muscles tend to tighten up and "guard" the back. The result can be significant muscle spasm.

With more severe injuries, the ligaments can be involved along with the muscles and tendons. Since the ligaments help support the spine, when they become torn or stretched, the bones of the spine tend to becomes less stable. This instability can in turn cause irritation in the joints located on the sides of the spine. These joints, called facet joints, have many nerves as well. Since this type of injury includes muscles, tendons, ligaments and facet joints, the pain may become very severe.

Symptoms can be numerous. Usually pain at the site of injury is common, although it may extend to other areas of the back. Pain may only be present with certain movements. Decreased range of motion is typical. Since muscles are involved, decreased strength and endurance are not uncommon. Buttock and leg pain may be present in some cases, depending on the amount of inflammation near the nerves of the low back. Naturally, since the back is the foundation of our body, it is called upon to provide much of what we do in our daily personal and work activities. For this reason, your overall function may be limited, depending on the physical demand levels of your work and daily activities.

Treatment for back strains and sprains depends on many factors, including the extent and severity of the injury, your age, level of activity, work conditions and level of conditioning before the injury. Another important factor is the current stage of healing of the strain/sprain. An injury is usually termed acute within 5-10 days of the injury. Sub-acute is often considered the period between 2-4 weeks following the injury. A chronic situation is usually anything after 4 weeks, although depending on the individual and the nature of the injury, these time frames may differ, and/or overlap.

In the acute stage, modalities can help relieve and control pain as well as promote healing. Modalities may include heat, ice, electrical stimulation, TENS, or ultrasound. Gentle low-level therapeutic exercises can help promote range of motion and general mobility.

Manual therapy such as soft-tissue massage, mobilization or myofascial release techniques may be utilized at any time of the rehabilitation.

Sub-acute injury treatment moves into a higher-level exercise program for further range-of-motion gains as well as strengthening. Modalities may be still used at this time, but less frequently.

In the final stages of rehabilitation, the treatment emphasis is on more extensive exercises to help strength and endurance return to the pre-injury level. Modalities are generally discontinued. Other functional activities, such as lifting and carrying, are integrated into the program.

With proper treatment, consistent attendance and consistent application of the home exercise program, most back injuries can have a favorable outcome.