Lumbosacral strain, often referred to as lower back strain, is a condition characterized by injury or overexertion of the muscles, tendons, or ligaments in the lower back region, specifically around the lumbar spine and sacrum. It commonly occurs due to activities involving repetitive motions, improper lifting techniques, sudden movements, or prolonged periods of poor posture. Individuals with lumbosacral strain typically experience symptoms such as dull, achy pain in the lower back, stiffness, muscle spasms, and limited range of motion. In some cases, the pain may radiate into the buttocks or legs, a condition known as sciatica. Diagnosis often involves a thorough medical history, physical examination, and may include imaging tests such as X-rays, MRI, or CT scans to assess the extent of the injury. Treatment options for lumbosacral strain include rest, ice or heat therapy, pain medications, muscle relaxants, physical therapy, chiropractic adjustments, and in severe cases, corticosteroid injections or surgery. Prevention strategies focus on maintaining proper posture, strengthening core muscles, practicing safe lifting techniques, and maintaining a healthy weight. By understanding the causes, symptoms, and treatment options for lumbosacral strain, individuals can take proactive steps to prevent and manage lower back pain effectively, improving their overall quality of life.

1. 10cm
LUMBO-SACRAL
STRAIN
MOHD. SHOIB | 9185
31/BPT/DPSRU/2018

2. 10cm
Introduction
• Lumbosacral strain is a medical term for an injury that
causes low back pain.
• It accounts for 70% of mechanical low back pain.
• It is defined as over stretch injury or tear of para-spinal
muscles and tendons in the low back.
• Non-radiating LBP with a mechanical stress or creating an
abnormal position that puts the muscle beyond it limits.
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3. 10cm
CLINICAL RELEVANT
ANATOMY
01
CAUSE & RISK
FACTORS
02
Physical Stress and many
more
ETIOLOGY &
EPIDEMIOLOGY
03
CLINICAL
FEATURES
04
Characteristics of the
condition
ASSESMENT
05
MANAGEMENT
06
Table of contents
3
Relevant Anatomy &
Mechanics
Onset, Origin &
Prevalence
Medical & PT assessment Medical & PT
management

4. 10cm
CLINICAL RELEVANT
ANATOMY
01
To understand how lumbosacral
strain is produced, aknowledge of
anatomy & mechanics of the
lowerspine is essential.
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5. 10cm
1. Lumbosacral Complex is an important functional unit of the body. It
consists of 5 lumbar movable vertebrae numbered L1-L5 and the
sacrum.
2. The complex anatomy of the lumbar spine is a remarkable combination
of these strong vertebrae, multiple bony elements linked by joint
capsules, and flexible ligaments/tendons, large muscles, and highly
sensitive nerves. It also has a complicated innervation and vascular
supply.
3. It is designed to be incredibly strong, protecting the highly sensitive
spinal cord and spinal nerve roots. At the same time, it is highly
flexible, providing for mobility in many different planes including
flexion, extension, side bending, and rotation.
4. The strain can originate in the following muscles M. erector spinae (M.
iliocostales, M longissimus, M. spinalis) M semispinales, Mm multifidi,
Mm rotatores M. quadratus lumborum M. serratus posterior.
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6. 10cm
CAUSE OF STRAIN
Muscle Fibre
Tearing
Indirect trauma, such as
excessive stretch or
tension.
Decreased
Muscle Mass
Para-spinal muscle becomes
deconditioned after injury.
Spasm
Persistent muscle
contractions.
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02

7. 10cm
A picture always reinforces
the concept
Lumbosacral strain may be caused by a sudden
blow forcing the junction into positions beyond the
normal limits of its mobility, by an effort to prevent
some heavy article falling, or by a sudden
movement of the body in attempting to regain lost
balance; the spinal muscles are caught off their
guard & the ligaments sustain the full force of the
injury. The ligaments & the surrounding muscles
are stretched/torn.
7
While lifting heavy weight with the body in a slightly bent
position, the stoop stressing the sacral obliquity &
increasing the shearing stress at lumbosacral junction.

8. 10cm
THE RISK FACTOR
8
Poor Body
Mechanics
Repetitive/ Heavy
Lifting
Tight/Weak Hip
Girdle Musculature
Prolonged
Abnormal Position
of the Trunk
Core Weakness

9. 10cm
Etiology & Epidemiology
Force by Musculo-
ligamentous
Structures
Injury
9
03
Physical Stress

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ETIOLOGY
Strains are defined as tears (partial or complete) of the muscle-
tendon unit.
• Muscle strains and tears most frequently result from a violent
muscular contraction during an excessively forceful muscular
stretch from lifting heavy objects or sudden twisting motions.
• Any posterior spinal muscle and its associated tendon can be
involved, although the most susceptible muscles are those that
span several joints.
• Acute and chronic lumbosacral strain pain presentation:
a) Acute pain is most intense 24 to 48 hours after injury.
b) Chronic strains are characterized by continued pain attributable to
muscle injury.

11. 10cm 11
EPIDEMIOLOGY
• Greater than 80% of people will suffer from LBA during their lifetime.
• The global point prevalence of LBA is 12-33%.
• There is a higher prevalence among women and people ages 40-80
years old.
• Prevalence of LBA in India is also alarming with nearly 60% of the
people in India have suffered from LBA at some time during their
lifespan.
• Exact numbers regarding the international frequency of low back
injuries are not known.

12. 10cm 12
Pain in the lumbar
muscles or nonspecific
pain.
Pain exacerbates during
standing and twisting
motions
Active contractions and
passive stretching of the
involved muscle increases
the pain.
Tenderness
Muscle spasm
Possible swelling in
and around the
involved musculature
A possible lateral
deviation in the spine
with severe spasm
Decreased range of motion
CLINICAL FEATURES
04
Non-Radiating Pain

13. 10cm
CLINICAL STAGES
ACUTE
• Pain usually most
severe at the time of
injury,
• Onset to 4 weeks.
SUB-ACUTE
• 4 weeks to 12
weeks.
• Improvement in pain
& function within 1
month.
CHRONIC
• Longer than 12
weeks.
• Persistent back pain
of at least 1 year.
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ASSESMENT
14
05

15. 10cm
● Degenerative Disk - localized & diffused muscle pain
● Herniated Disk -due to herniation
● Osteoarthritis -weak reflexes & decrease in extension
● Ankylosing Spondylosis - decreases back ROM &
Sacro-iliac joint tenderness
● Spondylolysthesis - tight hamstrings
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DIFFERENTIAL DIAGNOSIS
HISTORY
● History of pain, numbness, tingling or weakness are
usually present.
● Pain is usually worse with movement and better with
rest.
● Psychosocial factors and emotional distress should
also be assessed.

16. 10cm
Medical Assessment
16
In the absence of the Red Flags, no laboratory or Radiographic Imaging are
necessary to diagnose or manage mechanical back strains in the acute
setting.
1. Inflammatory biomarkers, e.g. erythrocyte sedimentation rate (ESR) and
C-reactive protein (CRP), are useful for risk stratification of patients
with risk factors for infectious spinal pathology or malignancy but have
no neurologic deficits on examination.
2. Plain radiographs and computed tomography are useful when
suspecting fractures.
3. Routine imaging for mechanical back strains is not recommended, as
many may have incidental abnormal findings that are unrelated to their
pain.

17. 10cm
PHYSICAL ASSESMENT
17
• In standing – postural shift (+).
• ROM – limited & painful.
• Tenderness over the lumbosacral complex para-spinal
muscles with absence of spinous process tenderness.
• Hip examination & special test, including FABER’s
(FlexionAbductionExt. rotation) and Gaenslen’s maneuver
can help rule out other sources of pain.
FUNCTIONAL ASSESMENT
• Lumbo-pelvic strength core through observation of trunk and hip
control.
• Mobility and function- can be impaired.
• The Oswestry Low Back Pain Disability Index (OLBPDI) is a
questionnaire that assesses the impact on low back pain on ten
aspects of daily life (such as lifting, walking, self-care, and work).
• A Functional Capacity Evaluation persons Capacity to return to
work.

18. 10cm
MANAGEMENT
18
06

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PHARMACOLOGICAL
THERAPY
● Acupuncture
● Exercise therapy
● Yoga
● Spinal Manipulation
● NSAIDs - Low Back Pain.
● Opioid analgesics – for severe chronic low
back pain.
● Tramadol may also be effective as a second-
line analgesic option.
NON-PHARMACOLOGICAL
THERAPY
ACUTE SUB-ACUTE CHRONIC
Pain reduction Physical therapy
treatment :
Comprehensive
treatment:
Control of
inflammation and
spasm
A. To improve
muscular stability
A .
Pharmacological
Prevent
Deconditioning
B. To improve
strength
B. Non-
pharmacological

20. 10cm
Physical Therapy Management
20
1. Cold Therapy: In the acute phase of a lumbosacral strain cold therapy should be applied (for a short
period up to 48 h)to the affected area to limit the localized tissue inflammation and edema.
2. TENS and Ultrasound: are often used to help control pain and decrease muscle spasm
3. Spinal manipulation applies hand pressure to areas of the low back to relax irritated muscle and
lessen the intensity of pain.
4. Traction, using pulleys and weights to lengthen and stretch the spine can result in temporary relief.
5. Acupuncture fine needles are inserted into various points around the body, naturally occurring
chemicals such as endorphins, serotonin, and acetylcholine are released to relieve pain.

21. 10cm
Stretching: Mild stretching exercises along with limited activity. Stretching Exercises below
• Single and double knee to chest Lie down on your back with your knees bent and your heels on the floor.
Pull your knee or knees as close as you can to your chest, and hold the pose for 10 sec. Repeat this 3-5
times.
• Back stretch Lie on your back, hands above your head. Bend your knees and , keeping your feet on the
floor, roll your knees to one side, slowly. Stay at one side for 10 sec repeat 3-5 times.
• Press up Begin by laying flat on the ground (face down). When doing this exercise it is important to keep
the hips and legs relaxed and in contact with the floor. Keep your hands in line with your shoulders.
Inhale, then exhale and press up using the hands keeping the lower half of your body relaxed. Hold until
you need to inhale, then move down, lay flat on the ground to rest, and repeat ten times.
• Kneeling lunge(stretching iliopsoas)
• Stretching piriformis
• Stretching quadratus lumborum
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22. 10cm
Soft Tissue Manipulation: Soft tissue manipulation was found to decrease
pain and improve ROM.
1. Massage
2. Strengthening Exercises: Progression of strengthening exercises should
begin once the pain and spasm are under control. The muscles requiring
the most emphasis are the abdominals, especially the oblique's, the trunk
extensors and the gluteal. Placing all of the emphasis in the rehabilitation
specifically on the injured muscle is not beneficial. Training the core
stability is an important part in the treatment of a lumbar strain and for the
further prevention of low back pain.
3. As with all spinal injuries, posture and body mechanics should be
assessed and corrected as needed.
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23. 10cm
Prevention
23
Education : Interventions that may aid in injury prevention
● Stretching exercises at the workplace, appropriate rest
breaks, and ergonomic modifications.
● Ergonomic modifications refer to adaptations in the
work environment to reduce the physical stress of the
employees.
● Educating patients regarding the importance of
maintaining proper posture and correct lifting
techniques may aid in prevention. Regular physical
activity.
● Smoking cessation.
● Weight loss for obese patient.
● Resuming normal physical activity (recent studies have
found that continuing ordinary activities within the
limits permitted by the pain leads to more rapid
recovery than bedrest).

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