Lumbosacral sprains are a common cause of low back pain. The lumbar spine connects to the pelvis at the sacrum. There are five lumbar vertebrae, and the bottom bone is name L5 (5th lumbar). L5 connects to the sacrum and transitions the body weight forces onto the pelvis. Likewise, forces and movements from the pelvis and legs transition to the lumbar spine at this joint complex.
Transition points in the body are common places of injuries because of the direction of forces and the body weight involved. The lumbosacral joint (term for the joint between L5 and sacrum) is supported by several ligaments that resist excessive movements. The lumbosacral joint needs to be able to support the body weight standing, but also absorb the same forces while sitting.
Sitting with poor posture increases the stresses on the ligaments instead of the structural joints. Muscles will try to help and support the lumbosacral joint, but can also become injured with excessive movement or forces. This joint complex is important as we go from a seated to a standing position. As we stand the low back, pelvis, hips, and legs create a significant amount of force and motion. If your body weight is too far forward the lumbosacral joint absorbs the abuse and strain. Likewise, when lifting a box off the ground poor posture can cause excessive stress on the joint.
People often describe a dull ache in their low back with lumbosacral sprains. It might start as stiffness but increase to a constant dull ache with prolonged sitting, standing, bending, or walking. As the pain gets worse, the pain starts to radiate away from the low back. It usually gets bigger and can become "like a big belt buckle pain." In more severe sprains the pain starts to radiate into the butt or gluteal regions. The most severe sprains start to radiate down the leg to the knee. Pain usually doesn't go past the knee, except for only brief moments.
If this does not describe your pain, see other causes of Radiating Sciatic Pain Here.
The facet joints or joint capsules can become sprained or injured. Especially with an acute injury that involve bending, turning, twisting, or lifting. People usually feel a sharp stabbing pain, maybe like " an ice pick right here " feeling. People are usually able to place their fingers right on the joints of the lumbosacral spine.
People with acute first time injuries usually respond very well to a short course of treatment that involves electric, ice, heat, cold laser, stretching, exercises, traction, flexion distraction, massage therapy, physical therapy, and chiropractic. For a mild sprain, the pain is usually gone in 1-2 weeks. Moderate sprains may take another week or two. Severe sprains will take longer to heal from the low back pain.
More common injuries, especially with people experiencing chronic pain in this area, are ligament sprains. There are several small ligaments that connect the sacrum, ilium, and lumbar spine. The iliolumbar ligament runs from the ilium to the 4th and 5th lumbar vertebrae. It prevents excessive movement between the lumbar spine and pelvis. It can commonly be injured with the bending, lifting, or chronic sitting. If the ligaments do not heal correctly they can become a common source of chronic pain.
Injured ligaments can usually repair, heal, and become as strong as before the injury. However, sometimes they end up forming scar tissue patches that become weak points. Since scar tissue isn't as strong as normal ligaments, the scar tissue is the first place to break down and become painful. This is especially prevalent in people who have experienced several exacerbations of pain in the same area.
In addition to utilizing the treatments in a acute sprain, chronic sprains will require treatments to decrease the scar tissue in the ligaments. I like to describe scar tissue like "duct tape." The body likes to use duct tape to hold something together for a short period of time until it has the time and ability to properly heal the area. However, sometimes the duct tape gets pulled and stretched before the body can fix the injury. In this scenario, the body adds more duct tape to the area. Just like at home, bigger problems mean more duct tape.
The duct tape is structurally weaker than normal ligaments, so it will be the first area t o break with increased stress. Duct tape continues to get added with each aggravation or injury. The body sometimes needs help to recognize the duct tape, break it down, and repair the area with normal tissue.
For chronic lumbosacral injuries we utilize Graston Technique to speed the recovery. Graston Technique utilizes specialized instruments to "tear the edges of the duct tape." As the ends of the tape get ripped up, they release chemicals that trigger healing cells to the area. The body recognizes the broken duct tape, and fibroblasts lay down proper ligament fibers in its place. The next Graston Treatment breaks down the next layer of duct tape, and continues the process.
The number of treatments depends on the amount of scar tissue and history of low back pain. To see more on Graston Technique go to our Chandler Graston Technique Page.
Chronic lumbosacral sprains usually require more strengthening exercises than acute sprains. People with a history of chronic sprains tend to have poor core strength. In addition there tends to be a loss of hip and low back flexibility. The body has been guarding with the muscles, and it takes time to return normal flexibility into those muscles.
When treatment addresses scar tissue in addition to joint motion, muscle strength, endurance, and flexibility lumbar pain can permanently disappear. Chronic back pain will improve like any other back injury.