What is Mechanical Back Strain?
Back pain is a frequent reason why people visit the emergency room. It’s also a top cause of disability and high medical costs around the world, affecting people of different ages and backgrounds. A specific type of back pain, called mechanical back strain, is due to problems with the spine, discs between the vertebrae, or nearby soft tissues.
While most people who come to the emergency room with mechanical back pain can be treated with simple measures, it’s important that doctors look out for warning signs which could indicate more serious and urgent causes of back pain. These serious causes can lead to serious health problems and even death if they are not diagnosed on time.
What Causes Mechanical Back Strain?
In the past, mechanical back pain was referred to in vague terms like “non-specific back pain,” “lumbar strain,” or “lumbago.” This was because we didn’t have good ways to accurately diagnose what was causing the pain. But now, thanks to better imaging technology and a more detailed understanding of the spine and how the body’s nerve system works, we can pinpoint the cause of the pain more accurately. So now, the diagnosis is more specific and based on the actual cause of the mechanical back strain, usually due to problems with parts of the spine.
While lower back pain is most common, problems can occur in any part of the spine. This includes the bones, ligaments, discs that act as cushions between the bones, joints, spinal cord, spinal nerves, or muscles around the spine. There are several common conditions that might be diagnosed as mechanical back pain:
– Spinal foraminal stenosis: a narrowing of the space where the nerves exit the spine.
– Herniated discs: also known as slipped disc, when one of the discs that cushion the bones of the spine becomes damaged and bulges.
– Spinal stenosis: a narrowing of the spaces within your spine.
– Degenerative disc disease: changes in the discs that can cause pain.
– Vertebral fractures: a break in one or more of the bones of the spine.
– Sacroiliac joint dysfunction: pain in the joint between the spine and the hip.
– Facet joint syndrome: wear and tear on the joints in the spine.
– Ligamentous and muscular injury: damage to the ligaments and muscles around the spine.
– Myofascial pain syndrome: chronic pain involving a specific muscle or group of muscles.
Risk Factors and Frequency for Mechanical Back Strain
Over 80% of people will experience low back pain at some point in their lives. The worldwide occurrence of this condition varies between 12% and 33%. It is more common among women and people aged between 40 to 80. In the United States alone, the financial impact of lower back pain, including missed work and lower wages, is estimated to be between 100 to 200 billion dollars annually.
Signs and Symptoms of Mechanical Back Strain
To diagnose back strains, doctors need to get a full patient history and conduct a thorough physical exam. The goal during the initial phase is to check for any serious ‘red flag’ symptoms that might require advanced imaging or a surgical consultation. ‘Red flags’ to watch out for include:
- Fever
- Unintended weight loss
- Night sweats
- Loss of bladder or bowel control
- Severe injury
- Frequent falls
- History of cancer
- Use of blood thinners
- Long-term steroid use
- Injecting drugs
- Weak immune system
During the physical exam, doctors will also assess for other red flags like muscle weakness, unsteadiness, numbness around the butt area, decreased reflexes, and lessened rectal muscle control.
Acute back strains can be caused either by physical or non-physical activities. Lifting heavy items is often a cause, but sometimes, people can’t recall any events leading to the strain. In some cases, back pain could indicate more specific issues. For instance, a slipped disc can cause radiating pain from the lower back, worsened when straightening the leg. Spinal stenosis, on the other hand, can cause back and leg pain that gets worse with walking and leaning backwards, but feels better with rest and leaning forward. People who regularly take steroids, or are at-risk for osteoporosis, could be prone to compressed spine fractures even from minor injuries. This is often associated with localized tenderness when touched.
Testing for Mechanical Back Strain
When there are no warning signs – also known as “red flags” – of more serious conditions, tests or scans aren’t necessary to diagnose or manage common back strains right away. Blood tests that look for inflammation, like the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) can be helpful to assess risks for patients who could possibly have an infection in the spine or cancer, but have no signs of nerve damage.
Routine scans for simple back strains aren’t recommended because they can often show abnormalities that have nothing to do with the patient’s pain. However, more detailed imaging may be needed if the patient was injured, if the symptoms aren’t improving with basic care, if the symptoms are getting worse, or if new symptoms related to nerve damage are appearing.
Standard X-rays and CT scans can be useful if there’s a chance the patient has a fracture. However, if there are signs that the spinal cord might be compressed or if there are red flag symptoms, an MRI is needed for an accurate diagnosis.
Treatment Options for Mechanical Back Strain
When dealing with mechanical back strains, treatment depends on various factors. These factors include how long you’ve had the symptoms, any other health problems you may have, and the specific cause of your back pain. In 2017, The American College of Physicians updated their guidelines on treating low back pain without surgery or procedures.
For recent or acute lower back pain, the first treatments tried are usually non-drug options. These treatments include spinal manipulation (adjustments done by a chiropractor or other healthcare professional), acupuncture (a therapy in which thin needles are inserted into the skin), massage, and applying heat to the area. If medication is needed, anti-inflammatory drugs and muscle relaxants are usually the first choice. Based on limited evidence, pain relievers like acetaminophen and corticosteroids (steroid hormones) weren’t found to help acute back pain more than a placebo (a treatment with no active drug). There isn’t enough evidence to tell whether other drugs such as benzodiazepines (used for anxiety and sleep problems), antidepressants, epilepsy drugs, and opioids are helpful. Opioids should only be used when other medications don’t control the pain, or when a person is dealing with severe pain.
Physical therapy can be a key part of treating mechanical back pain. If the initial treatments like pain relievers and heat don’t work, you might be referred to a physical therapist. Studies have shown that starting physical therapy early can cut healthcare costs, reduce the use of opioids, and decrease the need for back surgery.
For chronic, or long-term low back pain, non-drug options are also recommended as the first treatments. These include exercise, tai chi, yoga, multidisciplinary rehabilitation (a treatment plan involving various types of therapy), spinal manipulation, acupuncture, psychotherapy (talk therapy), low-level laser therapy (use of low-level light to relieve pain), and electromyogram biofeedback (a technique that teaches you to control bodily functions like heart rate). Nonsteroidal anti-inflammatory drugs are the first choice of drug treatments, followed by tramadol (a pain reliever) and duloxetine (an antidepressant) as the second choices. Opioid therapy is only considered if the other treatments don’t work, and this decision is made on a case-by-case basis, weighing the benefits and risks.
The American Pain Society released a set of recommendations in 2009 on more invasive procedures for diagnosing and treating low back pain. Intensive interdisciplinary rehabilitation (a comprehensive treatment plan involving various types of therapy) was recommended for chronic low back pain, as it has been found to be as effective as fusion surgery (a procedure that fuses two or more bones in the spine). For low back pain radiating down the leg, the evidence for steroid injections into the spinal canal was mixed, so shared decision-making between the patient and doctor was recommended.
For surgical treatments, open discectomy (removal of disc material pressing on the spinal cord or nerve roots) and microdiscectomy (a less invasive form of discectomy) can provide moderate short-term relief for constant, severe leg pain due to a herniated disc. Decompressive laminectomy (surgery to relieve pressure on the spinal cord or nerves) has been found to help severe spinal stenosis (narrowing of the spinal canal). However, these benefits usually decrease over time, so a discussion between patient and doctor is necessary before choosing surgery. For patients who continue to have severe leg pain after disc surgery, spinal cord stimulation (use of a device to send electrical signals to the spinal cord to control pain) may be an option.
What else can Mechanical Back Strain be?
When looking into the causes of back strains, doctors also consider other non-mechanical causes of back pain. Such conditions fall into the following categories and include specific diseases:
- Rheumatologic conditions like ankylosing spondylitis, Reiter syndrome, psoriatic spondylitis, and polymyalgia rheumatica.
- Oncologic or cancer-related causes like metastatic disease, spinal cord tumor, lymphomas, leukemia, and multiple myeloma.
- Infections like spinal epidural abscess, osteomyelitis, and discitis.
- Gastrointestinal issues such as pancreatitis, cholecystitis, and bowel perforation.
- Vascular conditions like aortic aneurysm, spinal epidural hematoma, and aortoiliac disease.
- Renal or kidney-related issues such as pyelonephritis, nephrolithiasis, and perinephric abscess.
- Genitourinary conditions like endometriosis, prostatitis, and pelvic inflammatory disease.
What to expect with Mechanical Back Strain
Acute episodes of mechanical back pain, which is pain in your back due to a physical problem, usually get better on their own within 12 weeks. However, up to a third of patients might continue to experience chronic, or long-term, symptoms. Even those who get over their acute symptoms have a 20 to 40% chance of the symptoms returning during the first year and an 85% chance of them coming back at some point in their lifetime.
Several factors related to your environment and mental health can affect how mechanical back strains progress. These include having a body mass index (BMI) over 25, smoking, poor overall health, depression, fear avoidance (which means avoiding physical activities because they cause pain), demanding physical work, job dissatisfaction, and receiving compensation for an injury.
Possible Complications When Diagnosed with Mechanical Back Strain
Mechanical strains in the back can lead to various complications, depending on the specific cause. One of the most frequent drawbacks is the continuation of symptoms, which could develop into a long-term disability. More severe physical issues such as the cauda equina syndrome, a severe spinal condition, and physical deformities, are less common.
Additionally, long-term consumption of drugs like NSAIDs or treatments like injections and surgeries may lead to new health issues. Chronic back pain can also cause financial and social hardships, not just for the patient, but for their employers as well. This is due to the income lost as a result of missed workdays.
- Persistent symptoms and disability
- Rare complications like cauda equina syndrome and physical deformities
- Health complications from long-term use of medications and treatments
- Financial and social problems caused by missing work
Some statistics to note—between 5% and 10% of adults with lower back pain develop chronic pain. Recurrence is also common, affecting between 20% and 72% of patients. In cases where the lower back pain is severe enough to cause adults to miss work, 60% to 70% make it back to work within six weeks, and between 80% and 90% return within twelve weeks.
Preventing Mechanical Back Strain
Avoiding heavy physical work is one way to prevent injuries to your back. But because back injuries are so common, it’s more practical to focus on preventing a second injury after the first one happens. If you’ve had a back injury before, you are more likely to have another one.
Employers can help reduce the risk of back injuries. They can do this by encouraging stretching exercises at work, allowing enough breaks for rest, and making changes to the work environment that make it easier for employees to do their jobs without straining their backs. These changes might include designing workplaces in a way to lessen the physical stress on employees – a concept known as “ergonomics”.
Education is also very important. It’s beneficial to learn about how to keep your back healthy, such as maintaining the correct posture and lifting things properly. There are also other things that can help prevent back injuries. They include regular exercise, quitting smoking, losing weight if you’re overweight, and getting back to your regular activities as soon as possible after an injury.
