A low back strain is an injury to the muscles or ligaments of the lower back, often after lifting, twisting or overuse. It is the most common cause of acute back pain, and most people get better within a few weeks.
Key symptoms
- Aching low back pain after lifting or twisting
- Muscle spasm and stiffness
- Pain worse with movement and better with rest
- No pain below the knee
What you find on exam
- Tenderness and spasm of the paraspinal muscles
- Range of motion limited by pain
- Normal strength, reflexes and sensation
- Negative straight leg raise
Tests
- Screen for red flags: trauma, cancer, fever, IV drug use, neurologic deficits
- No imaging in the first 6 weeks without red flags
- X-ray or MRI only with red flags or persistent symptoms
Treatment basics
- Stay active and keep up daily activities
- Heat and NSAIDs such as ibuprofen
- Short course of a muscle relaxant such as cyclobenzaprine if needed
- Physical therapy and core exercises if pain persists
Red flags
- Saddle numbness, urinary retention or incontinence
- Fever, weight loss or history of cancer
- Major trauma or progressive leg weakness
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.