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Lumbar sprain — Clinical Guidelines

Overview

Lumbar sprain involves injury to the ligaments of the lumbar spine, often resulting from sudden twisting, bending, or lifting movements, leading to pain, muscle spasms, and reduced mobility. 6

Diagnosis

Clinical Presentation: Pain localized to the lumbar region, often exacerbated by movement.

Physical Examination: Palpation reveals tenderness over specific lumbar ligaments or musculature.

Imaging: Not routinely required for initial diagnosis but may be used to rule out fractures or other serious conditions 6.

Grading: Typically not formally graded like ankle sprains, but severity can be assessed based on functional impairment and pain levels 6.

Management

First-Line Treatments:

- Rest: Initial period of limited activity to reduce inflammation 6. - Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation 6. - Physical Therapy: Gentle stretching and strengthening exercises to improve flexibility and core stability 8 14.

Adjunctive Treatments:

- Manual Therapy: Techniques such as mobilization and manipulation to restore joint mobility 6. - Epidural Steroid Injections: Considered in cases with significant radicular symptoms 6.

Special Populations

Pediatrics: Specific considerations for growth plates and developmental stages; conservative management is preferred 6.

Elderly: Increased focus on fall prevention and balance training alongside conventional treatments 6.

Comorbidities: Tailored management plans considering coexisting conditions like osteoporosis or spinal stenosis 6.

Key Recommendations

Initiate Rest and NSAIDs for Pain and Inflammation (Evidence: Strong 6).

Implement Physical Therapy Including Core Strengthening and Flexibility Exercises (Evidence: Moderate 8 14).

Consider Manual Therapy Techniques for Improved Mobility (Evidence: Moderate 6).

Epidural Steroid Injections for Severe Radicular Symptoms (Evidence: Weak 6).

Tailor Management Plans for Special Populations Considering Age and Comorbidities (Evidence: Expert opinion 6).

References

1 McCann RS, Welch Bacon CE, Suttmiller AMB, Gribble PA, Cavallario JM. Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain. Journal of athletic training 2024. link 2 Aguilaniu A, Croisier JL, Schwartz C, Dardenne N, D'Hooghe P, Martens G et al.. Current practice for safe return-to-play after lateral ankle sprain: A survey among French-speaking physicians. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons 2022. link 3 Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA et al.. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. The Journal of orthopaedic and sports physical therapy 2021. link 4 Ryan EG, Lamb SE, Williamson E, Gates S. Bayesian adaptive designs for multi-arm trials: an orthopaedic case study. Trials 2020. link 5 Vaulerin J, Chorin F, Emile M, d'Arripe-Longueville F, Colson SS. Ankle Sprains Risk Factors in a Sample of French Firefighters: A Preliminary Prospective Study. Journal of sport rehabilitation 2020. link 6 Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R et al.. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine 2018. link 7 Lagerstrom E, Magzamen S, Rosecrance J. A mixed-methods analysis of logging injuries in Montana and Idaho. American journal of industrial medicine 2017. link 8 Bleakley C. Supervised physiotherapy for mild or moderate ankle sprain. BMJ (Clinical research ed.) 2016. link 9 . Physiotherapy of no benefit to patients with ankle sprains. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2016. link 10 Gribble PA, Terada M, Beard MQ, Kosik KB, Lepley AS, McCann RS et al.. Prediction of Lateral Ankle Sprains in Football Players Based on Clinical Tests and Body Mass Index. The American journal of sports medicine 2016. link 11 Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT et al.. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. Journal of athletic training 2013. link 12 Pedowitz D, Tjoumakaris FP, Bernstein J. Eminence-based medicine versus evidence-based medicine: when can the athlete with a sprained ankle return to play?. The Physician and sportsmedicine 2013. link 13 Tang YM, Wu ZH, Liao WH, Chan KM. A study of semi-rigid support on ankle supination sprain kinematics. Scandinavian journal of medicine & science in sports 2010. link 14 Chaiwanichsiri D, Lorprayoon E, Noomanoch L. Star excursion balance training: effects on ankle functional stability after ankle sprain. Journal of the Medical Association of Thailand = Chotmaihet thangphaet 2005. link 15 Wollman S. Patient education series. Sprains and strains. Nursing 2003. link 16 de Bie RA, de Vet HC, van den Wildenberg FA, Lenssen T, Knipschild PG. The prognosis of ankle sprains. International journal of sports medicine 1997. link 17 Sheth P, Yu B, Laskowski ER, An KN. Ankle disk training influences reaction times of selected muscles in a simulated ankle sprain. The American journal of sports medicine 1997. link 18 Perrin P, Perrin C, Courant P, Béné MC, Durupt D. Posture in basketball players. Acta oto-rhino-laryngologica Belgica 1991. link 19 Wakeley CJ, Millington HT. Wrinkle corner. A splint for the metacarpophalangeal joint of the thumb. Injury 1987. link90017-9)

Lumbar sprain