When a muscle is overstretched, asked to contract hard against a sudden load, or overused, injury can occur. Small tears in the muscle fibers or the fibers of the tendon that connect the muscle belly to nearby bone are called muscle strains. A back strain involves one of the many muscles and tendons positioned along the back. We can categorize back muscles based on function:

• Deep muscles that help control the spine
• Superficial muscles that help move the spine
• Superficial muscles that move the scapula and shoulder girdle

A back strain can occur in several ways:

• Overuse–Example: a dad who lifts his child repeatedly or a landscaper working long hours to finish a job
• Sudden high load–Example: lifting a weight that is too heavy at the gym
• Overstretch–Example: suddenly twisting during a fall or hyperflexion of the spine

WHAT DOES A BACK STRAIN FEEL LIKE?

When a muscle or tendon is strained, you will experience pain in that specific muscle or tendon when it is contracted strongly or stretched. Because many back muscles overlap, it can be difficult to tell exactly which muscle is injured. An examination by a doctor or physical therapist can usually identify the muscle based on the motions that provoke symptoms. If the strain is moderate in severity, you may also notice some localized stiffness, tenderness, and swelling. You may also observe that the muscle feels weaker than usual. If the strain is severe, the muscle belly can tear completely or separate from the tendon causing the range of motion in the joints at either end of the muscle to be either significantly reduced because of guarding or excessive because the torn muscle or tendon is no longer limiting it.

It is important to note that when a muscle or tendon has been severely torn, your doctor may recommend surgery to repair the injury so the muscle can function normally again. After surgery, or when it is not needed, physical therapy is just what the doctor ordered.

If you decide to work with a physical therapist to help correct your back strain issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your back strain PT sessions yet in the comfort of your own home.

PHYSICAL THERAPISTS CAN HELP YOU RECOVER

While mild back strains often recover on their own within a couple of weeks, you may choose to see a physical therapist to address a more severe strain or if the symptoms of a mild strain are interfering with your activities. The goals and interventions for rehabilitation of a back muscle strain can be broken down into three stages:

Early/acute phase (first 5-7 days):

• Protect the injured muscle or tendon to allow healing to begin
• Use bracing and taping as needed to minimize painful motions
• Consider ice, ultrasound or other modalities to manage inflammation and promote healing
• Range of motion that is pain-free may be used to prevent stiffness, maintain range of motion and reduce pain
• Low-grade joint mobilizations for pain may be administered
• Exercising nearby but uninjured areas of the body is helpful

Middle/subacute phase (7-21 days or so after injury)

• Advance active range of motion
• Wean off bracing, taping, etc
• Begin submaximal exercise to lightly load the muscle and promote good fiber alignment
• Begin very light stretching as needed
• Apply gentle soft tissue mobilization to promote healing, reduce pain and mobilize edema

Late/chronic phase (21 days to many months)

• Begin loading the muscle more intensively while monitoring for signs of acute regression including lasting soreness or inflammation
• Increase the load on resistance training
• Increase stretching and mobility
• Begin exercises to improve tendon stiffness
• Incorporate more dynamic spinal exercises
• Perform work and sport-specific drills to prepare the back to return to full activity

DON’T GO IT ALONE