Spinal sprains and strains are among the most common causes of back and neck pain. While they occur in different regions of the spine, the underlying mechanics are similar. A strain is an injury to a muscle or a tendon (the tissue connecting muscle to bone), while a sprain is an injury to a ligament (the tissue connecting bone to bone).
Depending on which section of the spine is injured, the functional impact will vary.
Cervical (Neck): Pain often radiates into the base of the skull or the tops of the shoulders. It can cause tension headaches and a significant loss of neck rotation (difficulty checking blind spots while driving).
Thoracic (Mid-Back): Pain is often felt between the shoulder blades. Because the ribs attach to this section of the spine, deep breaths, coughing, or sneezing can occasionally trigger sharp pain.
Lumbar (Lower Back): The most common site of injury. Pain is localized to the small of the back and may cause a guarded gait. It rarely travels past the buttocks; if pain goes down to the foot, it may be a nerve issue rather than a strain.
Across all regions, soft tissue injuries share several hallmark signs.
Muscle Spasms: The body’s natural defense mechanism where muscles lock up to prevent further movement of the injured area.
Point Tenderness: Specific spots along the spine or paraspinal muscles that are painful to the touch.
Postural Distortion: You may find yourself leaning to one side or "hunching" because it is the only position that does not hurt.
Delayed Onset: It is common to feel fine immediately after a lifting incident, only to wake up the next morning with severe stiffness and pain.
Clinicians focus on ruling out more serious structural issues like fractures or disc herniations.
Physical Examination
Imaging: X-rays are typically only used to rule out bone trauma. MRI is usually reserved for cases that do not improve after 4 to 6 weeks.
The goal of treatment is to move from the protection phase to the mobilization phase as quickly as possible.
Early Protection: Avoiding the specific activity that caused the injury. However, complete bed rest is no longer recommended as it can lead to further stiffness.
Ice vs. Heat: Use ice for the first 48 hours to manage acute inflammation. After the initial swelling subsides, heat is more effective for relaxing tight muscles.
NSAIDs: Over the counter anti-inflammatories like ibuprofen or aleve help break the cycle of pain and muscle guarding.
Physical Therapy: Improving core and neck stability to ensure the muscles are strong enough to handle future loads.
Soft Tissue Mobilization: Professional massage or foam rolling can help release trigger points and improve blood flow to the injured tissue.