Spine Injuries

This contains information about spinal injuries

Lumbar Sprain and Strain

What is it?

Muscular or ligamentous injuries to the lumbar spine can cause significant pain and or disability in the individual which could lead to pain in the legs. Understanding the extent of tissue damage depends on the grade to which damage has occurred.

Grade 1: can take approximately 7days to 4 weeks for full recovery

  • Simple sprain/strain with minimal dysfunction
  • Minimal fibre damage
  • Minimal loss of function and pain
  • Reduced range of motion

Grade 2: can take approximately 2 weeks to 1 year for full recovery

  • Moderate sprain/strain, partial tear
  • Moderate fibre damage, approximately half of fibres may be torn
  • Loss of function and significant pain
  • Typically as a result of sports injury, trauma or faulty lifting movements

Grade 3: may take 8 weeks to over a year to recover

  • Significant damage, complete rupture
  • Severe fibre damage
  • Significant function loss and pain
  • May need to consider surgical consultation

Sprains are classed as ligament injuries which are typically painful during active and passive range of motion, and generally exhibit little to no pain during muscle contraction. In strains muscles are usually painful during active range of motion and muscle contraction, passive range of motion is typically not painful unless stretching to end of range.

Causes

  • Direct trauma as a result of injury following a fall, impact during sport or car accident
  • Overuse: repetitive movements and sustained postures can weaken structures in the spine leading to possible tissue damage.
  • Postural: poor working postures can also cause structural imbalances which can lead to weaknesses which when performing daily or sporting activities may increase risk of injury.
  • Sudden unguarded movement: bending down to pick something up without using knees and core can increase the pressure on the spine, increasing the risk of spinal injury.
  • Muscle imbalance can predispose muscle/ligament injury due to poor movement patterns.
  • Previous injury can leave weakness in the area if correct rehabilitation protocols were not adopted.
  • Poor core musculature

Signs and symptoms

  • Pain in the lumbar spine with possible referred pain into the legs, pain can be unilateral or bilateral. Muscle spasm may be present as part of the bodies protective mechanisms. Pain may be a dull ache with sharp pain during movement.
  • Reduced mobility: stiffness in the lumbar spine as well as hip stiffness may be present.
  • Guarded movements: movement may be restricted, especially turning, twisting, getting into and out if a chair. Guarded movements typically occur due to pain, however these altered movement patterns can increase risk of muscle imbalance and further injury.
  • Local swelling
  • Tenderness on palpation

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce further stress on the lumbar spine. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS). Once initial inflammation has subsided heat may be more beneficial to facilitate movement.
  • Initiation of flexibility and strengthening programmes for the core musculature as soon as the initial pain has subsided and movement is no longer guarded.
  • Hydrotherapy may be an option in the early stages to facilitate correct movement patterns without too much impact on the joints of the spine.

What can Sports Injury Scotland Do?

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with lumbar spine sprains and strains, increasing the mobility at the joints and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a safe return to activity. Postural education will help individuals with reducing the likelihood of recurrence. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Cervicogenic Headache

What is it?

A cervicogenic headache is head pain which originates from the cervical spine. A complex musculoskeletal syndrome thought to be caused by abnormalities in the joints, muscles, fascia and nerves. Research suggests that this type of headache often goes untreated due to its often intermittent nature.

Causes

  • Prior neck trauma: any previous injury to the head or neck may predispose an individual to this type of headache, for example whiplash type injury as a result of a car accident. Improper management following these injuries could result in long term movement compensation patterns which could lead to chronic headaches.
  • Movement compensations: sustained postures associated with sitting at a computer for extended periods, playing computer games for extended periods, improper desk set up leading to forward head postures which increases the stresses on the joints ligaments and muscles leading to over activity. Repetitive movements of the head and neck can also lead to head pain, especially in jobs requiring excessive cervical extension (eg. painters)
  • Cervical joint dysfunction: joint stiffness and muscle weakness as a result of faulty movement patterns at work or in daily life. Imbalances can be developed over a long period causing weaknesses and poor muscular endurance in the cervical flexors and extensors.
  • Stress and tension due to work or home life can increase the tension on the neck and back musculature, which can increase the risk of sustaining headaches.

Signs and Symptoms

Diffuse dull ache which is typically located in the neck and occiput region, however in more chronic pain further referral into the forehead can occur. Pain experienced is usually unilateral (single side) and typically of gradual onset. A reduction in neck and shoulder range of motion is usually apparent. Individuals typically wake with a headache which can ease once up only to return later in the day. In the more chronic patient pain in the shoulder and arm may be apparent, however it doesn’t follow a typical distribution pattern.

Management

Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the cervical spine. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from heat application and some non-steroidal anti-inflammatory medication (NSAIDS). It may be beneficial (when appropriate) to lie down when you are suffering from a headache, this will allow the cervical muscles time to relax.
  • Initiation of flexibility and strengthening programmes for the cervical flexors and extensors
  • Correcting any posture issues, ensure your desk set up is unique to you to avoid any unnecessary postures.

What can Sports Injury Scotland do?

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with Cervicogenic headaches, increasing the mobility at the joints and improving the muscles strength and flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure adequate recovery. Postural re education is essential to ensure correct movement patterns in the future. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.

Back and Core Stretching

Lower Back Stretch

Stretching should form an integral part of any training regime. Research suggests the best time to stretch is after exercise, making sure the muscles are warm. stretching a cold muscle can lead to potential muscle damage.

Attached is some stretches focusing on the main muscles of the Back and Core.

Back Stretching Program

Core exercises

A strong core is essential to optimal performance and the reduction of injury.

Attached is a beginners program to strengthen the core.

Core training program

Initial Management of an Acute Injury

Once an injury occurs, whether to muscle, bone or ligament, it is imperative that you seek the most appropriate treatment for this. Injury often varies in severity, and therefore symptoms will differ. The most common signs of inflammation are heat, redness, swelling, pain and loss of function, not all of these symptoms may be present and some may even appear at a later date.

When you suspect you have sustained an injury to soft tissue (Muscle or Ligament) you must first minimize the symptoms of inflammation. The first 24 hours following the initial injury are critical in management. The following acronym is designed to control the bleeding and thus reduce inflammation and scar formation.

R: Relative Rest

I: Ice

C: Compression

E: Elevation

Relative Rest

Following any musculoskeletal injury, depending upon the severity, may require some immobilization, generally research suggests that a short period of reduction in motion can result in a stronger scar, which will be able to withstand more force, thus improving tissue regeneration and promotion of parallel alignment (Brukner and Khan 2012).

It is important however not to rest the injured area for too long, extended periods of immobilisation can weaken not only the injured tissue but also the surrounding areas, making return to activity a slow process.

Ice

One of the most important components of inflammation recovery, is the application of ice, Ice has been thought to reduce tissue metabolism, thus reducing blood flow and accumulating fluid, which results in reduction of swelling. Application of ice should happen as soon after injury as possible and should continue for the first 48 hours.

Two application procedures have been suggested, continuous and intermittent.

Continuous: 20 mins every 2 hours

Intermittent: 10 mins, with 10 mins rest then another 10 mins ice every 2 hours.

There are a number of ways to apply ice, with the most common being reusable packs (which can be kept in the freezer and used when required), Chemical ice packs (these are one use, disposable packs which are good for travelling, can be an expensive long term option tho), and frozen veg (frozen peas** have been found to be a good alternative to ice, as they conform to the body easily and can be re frozen for further uses).

** Mark bag with do not eat.

Prolonged exposure to ice can cause burning or nerve damage.

Compression

To reduce bleeding and swelling compression should be applied to the injury site, this should be used during and after ice application. The pressure should be firm but not to tight that it causes pain.

When using a bandage pressure should be initially applied distal to the injury and with slight overlap move proximal to one handbreadth above the injured area.

Elevation

The injured limb should be, where appropriate be raised above the heart, to reduce the pressure within the injured structure. This will also help in reducing the accumulation of fluid into the area, which will therefore reduce swelling.

Precautions in the Acute Stages

During the initial 72 hours there are a number of things that the injured person should avoid

Heat: Which will increase blood flow to the injured site, therefore increasing swelling,

NO hot baths, showers, saunas etc

Alcohol: this can mask the level of pain and severity of the injury

Aggravating Activity: Can result in worsening of the injury or re-injury

Massage and aggressive manual therapy: can increase blood flow, thus increasing swelling and risking further injury.

Relieving Neck Pain

The neck region is a highly complex series of joints, which offers great mobility; this increased mobility increases the vulnerability of the structure (Prentice 2011). Neck pain is extremely common with research finding the prevalence of non specific neck pain to be as high as 66.7% in a 1 year period (Sarig-Bahat 2003). Non specific neck pain has typically no known cause (Brukner and Khan 2012). A well known reason for neck pain, is the number of hours an individual sits at a desk, increases in flexion when reading, and lateral flexion when on the phone can place additional stress on the intervertebral disks, joints and muscles (Prentice 2011).

Many Treatment strategies have been evaluated for the management of non specific neck pain, the most common forms of treatment are exercise therapy, postural education, mobilisations and massage. success has been demonstrated when a combination of therapies are adopted. It is important when suffering from neck pain that you do not ignore it, the quicker you seek treatment the shorter the recovery. A number of stretching exercises which can be done at the end of a stressfull day or on the onset of neck stiffness, if these exercises do not help to relieve your pain, a course of treatment can be provided at the clinic.

References

Brukner, P. and Khan, K. (2012). Clinical Sports Medicine. 4th Edition, McGraw Hill, Austrailia

Prentice, W. E. (2011). Principles of Athletic Training: A Competency Approach. 14th Edition, McGraw Hill, New York.

Sarig-Bahat, H. (2003). Evidence for exercise therapy in mechanical neck disorders. Manual Therapy, 8(1), 10-20

Exercises