An overstretching injury of the muscles and ligaments of the lumbar spine. Pain is usually localised in the low back and rarely extends below the knee. Pain is often immediate, which is followed by episodes of stiffness. Certain movements may be intensely painful and there is often difficulty standing straight.

A sprain is defined as an injury to a joint where the ligaments are carried beyond their normal range of motion without dislocation or fracture. They can be graded depending on the degree of damage sustained to the ligament. Typically, joint sprains fall into the category of musculoskeletal injuries. Chiropractors, particularly those treating sports-related injuries, manage sprains in athletes and others using traditional manual therapies.

Diagnosis

Diagnosis of Lumbosacral Strain-Sprain is derived from the patient’s history with an unremarkable neurological exam and no indicators of potentially serious pathology. Imaging is only indicated in patients with a positive neurological exam or presence of a “red flag” [64-67].

Chiropractors perform a thorough history of complaint and examination (orthopaedic, neurological and chiropractic testing). Pain is often found to be increased bending away from the side of complaint and reduced bending towards the side of complaint. There is often a diffuse tenderness in the spinal muscles.

Evidence based summary for manual therapy [53]

Randomised controlled research trials (RCT) and reviews (the highest current standards of scientific evidence) suggests that there is high quality evidence (on a scale of inconclusive, moderate and high) that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in adults [63,64,65]. There is moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in older adults [69]. There is also moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for acute LBP in adults [63,67]. It has been found that for massage there is moderate quality evidence that it is an effective treatment for subacute and chronic LBP in adults [66,68].

Other effective evidence based non-invasive treatments or patient education [53] Advice to stay active, interdisciplinary rehabilitation, exercise therapy [70,71], acupuncture, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic LBP and superficial heat for acute LBP [63,66].

Back-in-Action clinical comment

Chiropractic assessment and treatment of low back sprain-strain disorders is aimed at reducing the stress on the damaged joint, so allowing it to heal. Our approach centres on finding and reducing tension and the causes of tension in the other joints and muscles to help normalise overall function. We find much of the discomfort associated with simple low back pain arises from joint dysfunction (tension) or injury through too much movement (sprain). The joints most often involved are in the lumbar spine or the sacroiliac joints, though we may find problems in other areas such as in the legs.

In our experience treating the symptoms and underlying causes of simple low back pain benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, cranial work, back exercises (individually tailored self mobilisation, stretching and strengthening), referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice, other preventative strategies, relaxation counselling and onward referral when indicated. Chiropractors are often involved in the process of rehabilitation and may work alongside other healthcare professionals in delivering effective care strategies.