Introduction

People often think a muscle strain is the same as a sprain, but they're actually different injuries.

A sprain in your spine is when the one or more ligaments that connect your facet joints have been damaged by an injury. Ligaments give the vertebrae in your spine stability, they help to control the flexibility of your spine, and they protect your spinal cord and nerve roots by absorbing energy when stress is put on your spine.

A muscle strain is when a muscle in your spine and the tendon that attaches the muscle to your vertebra become stretched or overloaded, resulting in a partial or complete tear.

Causes

Any of the ligaments in your back can be sprained. Injuries that can cause a sprain include a sudden contraction or twisting of the ligament, a hard blow to the ligament, or a fast and forceful straightening of the ligament.

Muscle strains usually occur as a result of a sudden and severe muscle contraction, such as a whiplash injury to your cervical spine (your neck) due to a car accident. Muscle strains occur most frequently in muscles that span several facet joints.

Muscle strains and sprains are common injuries in athletes. The two conditions often occur together, which can make them difficult to differentiate.

Muscle strains and sprains usually affect the underlying structures of your spine, which can cause temporary or permanent damage. Permanent damage can lead to chronic back problems and make it easier for you to injure yourself again.

Symptoms

In the cervical spine, the chief symptom of a muscle strain or sprain is pain. A cervical strain may also be accompanied by stiffness. Torn muscle fibers may result in localized bleeding at the affected site of the tear, causing pain, swelling, and tenderness. The pain may subside within a few minutes after the initial injury, leading you to believe that you are okay. It can take several hours or longer for the pain and neck stiffness to reach their peak. The pain from a cervical muscle strain or sprain may affect your shoulder as well, but should not cause pain or numbness in your arm or hand.

In the thoracic spine (your mid back) and lumbar spine (your low back), the typical symptoms of muscle strain and sprain are pain and spasm in the area where the injury occurred. You will also likely have difficulty bending or twisting. If deeper structures are not involved in the injury, such as intervertebral discs, you should not have any neurologic symptoms such as radiating pain, numbness, or weakness. If one of your discs is also injured, or if the damage to your spine causes a pinched nerve (called radiculopathy) or narrowing of your spinal canal (called spinal stenosis), you may experience numbness or weakness in the part of your body served by the affected nerve. In severe cases, nerve damage could cause you to have difficulty sensing the need to urinate or defecate.

Diagnosis

To diagnose a muscle strain or sprain your doctor will start with a complete history and physical exam. Your doctor will ask you to describe how you hurt your spine, where your spine hurts, how long the pain lasts, whether the pain radiates to any other part of your body, what movements make the pain feel better or worse, and whether you have ever had a previous spine injury. During the physical exam your doctor will check your strength, reflexes and range of motion in the affected area.
Lab tests to rule out rheumatoid arthritis or ankylosing spondylitis.

To confirm a diagnosis of muscle strain or sprain, your doctor will probably take X-rays of your spine. Although soft tissues such as muscles, tendons, and ligaments do not show up on X-ray, doctors often order X-rays when you have back or neck pain to rule out the possibility that a spinal fracture, tumor, or degenerative joint disease could be causing or contributing to your pain.

If you have an abnormal finding on X-ray, or if you do not respond to conservative treatment for your pain, your doctor may order other diagnostic tests to get a better look at your spine. These tests include a CT scan to further evaluate the vertebrae and facet joints, and an MRI to evaluate your intervertebral discs, ligaments, spinal cord, and nerve roots.

Treatment Options

Conservative Treatment
Muscle strains and sprains of the spine are usually treated conservatively with of physical therapy, which may include the use of manipulation, ice, electrical stimulation, and exercises to improve mobility and strength, and massage. In some cases, a brace may be recommended to immobilize the affected joints. Brief rest may also be recommended, although muscle strains and sprains generally respond better to careful movement than to restriction of movement.

Medications to relieve your pain, such as muscle relaxants and nonsteroidal antiinflammatory drugs (NSAIDs). Unless there is a more serious underlying problem with your spine, surgery is generally not needed to treat strains and sprains.

Epidural Steroid Injection (ESI)
An epidural steroid injection (ESI) can be used to relieve the pain of a muscle strain or sprain, as well as to decrease inflammation. Injections can also help reduce swelling. Steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through your back into the epidural space. ESI is not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed.