Assess & Address: Lumbar Muscle Strains by Whitney Lowe

Pathology Assessment & Evaluation Treatment Massage Techniques

Assessment and evaluation
Lumbar-muscle strains occur most often as an acute injury. However, there may be repetitive loading forces on the muscle that cause small degrees of fiber tearing and produce a chronic strain situation. This is especially common in the lumbar region where these muscles are exposed to long periods of isometric contraction to maintain upright posture. The constant isometric tension causes the muscles to fatigue, making them more susceptible to fiber tearing from overload. Swelling may have occurred in the area immediately after the injury, but is likely to have subsided after the initial acute inflammatory phase of about 72 hours.

People often describe their pain with a phrase such as, "My back went out." This description is related to the mechanical model people hold for the reason their back hurts. They moved, then heard this pop and suddenly had pain - so something must be out of place. However, the popping sensation may come from soft tissues tearing during a muscle strain and not because anything is being forced out of position.

The most characteristic visible indicator from a strain is bruising. However, this is not always the case, so its absence does not indicate the lack of muscle strain. It is common not to see bruising in strains of the lumbar spinal muscles, for example. If the strain is severe, a defect in the continuity of the muscle fiber may be apparent.

There will usually be a localized area of tenderness in the muscle where the fiber tearing has occurred. If the strain is more severe, there may be a palpable defect in the muscle at the site as well. Tenderness to palpation throughout the remainder of the muscle is also likely. When combined with knowledge of anatomical structure, the well-developed palpation skills of the massage therapist are invaluable for identifying muscle strains. This is particularly important because there are no special orthopedic tests or high-tech diagnostic procedures that are used consistently to identify muscle strains. These conditions are generally identified based on clinical presentation alone.

In addition to pain with palpation, a muscle strain is likely to produce pain during manual resistance and stretching. In order to accurately identify pain during manual resistance or stretching, you must have a thorough working knowledge of kinesiology. It is essential to understand the function of the lumbar muscles during contraction and stretching if any valuable information is to be derived from these assessment procedures. All of these procedures should be thoroughly evaluated because lumbar strain is a common generic diagnosis for low-back pain. In order not to do further damage and to offer the very best solution, practitioners need to be as confident as possible about the nature of the problem and refer the client if necessary.

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