Muscle Strain and Ligament Sprain

Muscle strains can happen anywhere in the body. The low back is no exception and muscle strains in this region are very common and can happen for a variety of reasons. One of the more commonly strained muscles in the low back is the Quadratus Lumborum (QL). This muscle runs from the pelvis to the low back and is responsible for the side flank area pain in the low back/hip area that can be hard to localize. The QL is a big meaty muscle in the low back and can get over activated easily. The root cause of QL dysfunction and strain is weak glute muscles (specifically a weak gluteus medius) or weak spinal erector muscles. When these muscle groups are weak the QL will over activate and overcompensate to make up for the weakness in these other muscles. The strain of the QL can happen in one traumatic incident where the person can recall straining the muscle. The strain of the QL can also happen gradually over time as it over works over a period of time before the strain eventually causes symptoms. In physical therapy we work to first release the QL to reduce pain levels. We can do this via dry needling, soft tissue work, stretching, and joint mobilizations/adjustments to the area the QL attaches. Once the QL is released and pain levels start to come down we work on strengthening the inner glute muscles and erector spinae muscles so the QL is less likely to overactive again and cause a recurrence of symptoms. 

 

Another cause of low back muscles strains involve what’s called “Lower Crossed Syndrome”. In this condition weakness in the glute muscles can cause the spinal erectors to overactive, and weakness in the abdominals can cause the hip flexors to overactive. The spinal erectors and hip flexors overcompensate and develop tightness and trigger points causing pain. As opposed to side area flank pain, the pain from the erectors in this case will be in the muscles right along the spine in the low back. The hip flexors can also refer pain into the low back and are a common cause of low back pain even though they are located on the front side of the body. When this condition is present there will also be significant stiffness in the area between the mid and low back called the thoracolumbar junction due to the way the muscle imbalance pulls the pelvis. This condition is also very treatable in physical therapy and involves a similar process to fix. We first work to alleviate the tightness in the spinal erector muscles and/or hip flexor to alleviate the source of pain. Once the pain levels subside we work to strengthen the inner glute and abdominal muscles to prevent overactivation of these muscles again in the future to prevent recurrences of symptoms.

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Ligaments can also be sources of pain in the low back region. The 2 main ligaments responsible for pain in the low back are the sacroiliac ligament and the iliolumbar ligament. These 2 ligaments run from the sacrum and the lumbar spine and attach onto the pelvis respectively. These ligaments can get stressed as a result of awkward movements or lifting items that are too heavy. This can result in a ligament sprain. In physical therapy the process is similar in treating injuries to these ligaments. We can use dry needling and soft tissue work to promote healing of the ligaments and reduce pain levels, and we can stretch the muscles in the low back to reduce tension in the area. Once pain levels start to decrease we then work to strengthen the low back muscles and core muscles to prevent recurrences of the ligament sprain. 

 

Treatment of low back pain tends to get excellent results in physical therapy. Please see below for examples of how we treat muscle strains for low back pain in our clinic.  If you would like to schedule an appointment please reach out to us.