Acute lumbar strain is probably the most common cause of low back pain. Typically, patients present with a rather sudden onset of pain that is localised to one side of the lower back or sometimes diffusely across the lower back. Pain may radiate into the buttock region and rarely into the leg, but usually the pain is localised to the lower back.

Most patients develop lumbar strain as part of an overuse pattern. That is, either the patient has repetitively engaged in an activity for which the lumbar spine is inadequately prepared, or the patient has engaged in a more sudden strenuous activity that overloads the normal muscular support structure of the lumbar spine. Typically, patients are more comfortable lying down or sitting and feel increased pain when standing or, especially, with certain bending motions of the spine.

Cause of Lumbar Strain

Although the exact cause of lumbar strain is not completely clear-cut, a pattern generally occurs in which supporting, musculature of the lumbar spine is relatively underdeveloped relative to the demands placed on it. This leads to a situation of muscle fatigue that increases vulnerability for a sudden stretch or tear of the muscle, possibly with associated spasm.

Imaging and Diagnostic Studies

A plain X-ray may reveal evidence of muscle spasm by way of straightening of the normal curvature of the spine.

MRI is needed if there is doubt as to the diagnosis or if the symptoms persist.

Treatment Considerations for Lumbar Strain

• Medicines
• Physiotherapy
• Epidural Injection
• Surgery for severe back pain

Summary Points

• Lumbar strain is most common cause of low back pain; it is usually short-lived and self-limited.
• Most patients develop lumbar strain because of physical imbalance, emotional imbalance, or both.

• Muscle relaxants, spinal manipulation, and hands-on physical therapy are effective treatments for lumbar strain.