Lower Back Sprain: Causes, Symptoms & Treatment

A lumbar sprain is an overstretching or tearing of the ligaments supporting the vertebral column. It differs from a strain (muscle/tendon injury) but often co-occurs.

Common Causes

• Sudden heavy lifting with poor mechanics.
• Twisting while bent forward.
• Falls or direct trauma.
• Repetitive microtrauma (prolonged sitting, vibration).

Symptoms

• Localized low back pain (often unilateral), worse with movement.
• Muscle guarding/spasm.
• Reduced range of motion (flexion, extension, rotation).
• Possible referred pain to buttock/thigh (sclerotomal), rarely past knee.
• No true radiculopathy (numbness, weakness, reflex loss) unless nerve root compressed by associated disc herniation or hematoma.

Grading

• Grade I: Microscopic tearing, mild pain, minimal functional loss.
• Grade II: Partial tear, moderate pain/spasm, limited function.
• Grade III: Complete rupture, severe instability, significant disability.

Management

• Acute (0–72 hrs): Relative rest (avoid bed rest >1 day), ice, NSAIDs, muscle relaxants if spasm severe.
• Subacute: Gradual mobilization, physical therapy (core stabilization, McKenzie, manual therapy), heat.
• Chronic/recurrent: Address biomechanics, ergonomics, deconditioning; consider imaging if red flags.

Red Flags (Urgent Evaluation)

Cauda equina symptoms (saddle anesthesia, bowel/bladder dysfunction), progressive neurologic deficit, fever, history of cancer, trauma, osteoporosis, age >50 with new onset.

Key Takeaway

Most lumbar sprains resolve in 2–6 weeks with active rehabilitation. Early mobilization and core strengthening prevent chronicity.