What happens in muscles and ligaments
The erector spinae muscles act as stretch marks to support the spine. With a sharp force, some of the fibers are torn, and a slight hemorrhage and swelling appears in the tissue. The nerve endings are irritated, and the nervous system turns on a protective mechanism - a persistent muscle contraction to immobilize the damaged area. It is the spasm that is most often felt as unbearable pain and the inability to straighten up. The ligaments and joints of the spine can also be stretched.
- Microtears in muscle fibers
- Swelling and slight bleeding in the muscle
- Protective muscle spasm
- Sprain of ligaments and capsules of small joints
- The pain intensifies the spasm, the spasm intensifies the pain
Causes and risk factors
Most often, the back “breaks” when lifting a weight from a tilted position, especially if the load is held far from the body and turned at the same time. This is facilitated by weak core muscles, lack of warm-up, fatigue and working in an uncomfortable position. A separate risk group is people with sedentary jobs who rarely move, and then take on repairs, moving or gardening and put an unusual load on the body.
- Lifting weights with round back and twist
- Sudden movement without warming up
- Long work while bending over
- Weak back and abdominal muscles
- Overweight
- Hypothermia and general fatigue
Symptoms
The pain occurs immediately or several hours after exercise, is felt in the lower back or between the shoulder blades and intensifies when moving, coughing, or trying to straighten up. The muscles feel tight and painful to the touch, the body takes a forced pose with a slight tilt. An important sign is that the pain remains in the back, radiates maximum to the buttock, but does not go down the leg to the foot and is not accompanied by numbness. Over time, the pain gradually decreases.
- Acute back pain after exercise
- Tight, painful muscles when palpated
- Limiting tilts and turns
- Forced posture, difficult to straighten up
- Increased pain when coughing and sneezing
- No numbness or weakness in the legs
When is an examination needed?
With a typical picture without alarming signs, pictures are not needed: X-rays and MRIs do not change anything in the treatment, but they often show age-related changes that frighten the patient and do not explain the pain. An examination is prescribed if there has been a serious injury, the pain lasts longer than 4-6 weeks, extends down the leg below the knee, there is weakness, numbness or general symptoms. Then the doctor uses x-rays, MRI of the lumbar region and blood tests.
- Examination with neurological tests
- X-ray of the lumbar region in case of injury
- MRI for persistent pain and signs of root involvement
- Complete blood count and C-reactive protein if inflammation is suspected
- Without warning signs, no imaging is required
Treatment and recovery
The main rule of modern medicine is not to lie down. Bed rest for more than 1–2 days slows recovery. Keep as active as possible, walk, change positions, avoiding only those things that sharply increase the pain. In the first two days, cold helps, then dry heat and a warm shower. The doctor may prescribe short-course non-steroidal anti-inflammatory drugs and, in case of severe spasm, muscle relaxants. After the acute pain subsides, massage, physiotherapy and exercises to strengthen the core muscles are included. Treatment is prescribed by a doctor.
- Keep moving, avoid bed rest
- Cold for the first 48 hours, then warm
- Anti-inflammatory drugs as prescribed
- Short course of muscle relaxants for severe spasms
- Massage and physiotherapy after the acute phase
- Exercises for the back and abdominal muscles for prevention