What is a lower back muscle strain?
Lower back muscle strains are probably the most common muscle injuries among dancers. They are also referred to as “pulled back muscle” or “torn back muscle”. Typically, the pain is localized in the lower back and does not radiate down the leg. Back stiffness or deep cramps of the back muscles are often associated with this pain.
Acute pain from a lower back strain can resolve quickly if treated efficiently, however, low levels of pain may persist over weeks, and flare-ups can occur.
How can it occur?
An uncontrolled movement or a lift that is not properly stabilized are among the most frequent causes of a back muscle strain. Usually, this kind of accident is related to previous overuse of the back and to muscle fatigue. Muscle dysfunction can seriously affect core stabilization and muscle tension in the back and is an important contributing factor to back injury and overuse. Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.
The psoas muscle is probably the most important muscle involved with low back issues in dancers. It can affect the lumbar spine in many ways as it connects to four of the lumbar vertebrae in two different planes. Psoas dysfunction will pull the lumbar vertebrae forward, creating hyper lordosis (over arching of the spine) and will exert high pressure on the intervertebral disks and joints. Usually, only one of the two psoas muscles is tight. This will twist and torque both the lumbar spine and the pelvis. As a result, muscle dysfunction will extend toward the trunk (erector spinae, quadratus lumborum muscle) and the lower extremity (rectus femoris muscle, hamstrings), causing severe muscle dysbalance. It is often mutually dependent on a weakness of the abdominal muscles and the glutes. This pattern of imbalance creates “blocks”, particularly at the lumbar spine, the si-joints and the hip joint.
What are the typical symptoms of a lower back muscle strain?
Typically, you may experience an acute sharp pain, following an uncontrolled movement or lift. Your back may instantly feel stiff and deeply cramped and a long-lasting severe pain may develop during the next days. Probably you have felt cramped or blocked already before the accident.
The pain is typically localized in the lower back with no radiation to your buttock or leg. You should be aware of the warning signs that may indicate a more severe back injury. They include pain that is felt in the buttock and down the leg and the foot or numbness, tingling or weakness of your legs.
How can a lower back muscle strain be diagnosed?
Your doctor will examine your spine and review your symptoms as well as your current training activities. This will include a functional examination of the spine and pelvis to find out about joint dysfunction (“blocks”) in the different areas of the spine and pelvis. He will check for muscle dysfunction of the back muscles and also on the legs. Some basic neurological tests will be performed to find out if typical reflexes are normal and if any muscle weakness or palsy is present.
Your doctor may order X-rays to get an overview of the anatomy of your spine, especially if you have a scoliosis. X-rays will also be helpful to detect structural abnormalities and degeneration. He will specifically search for for osteochondrosis and alignment problems of the vertebral bodies referred to as spondylolisthesis. If any neurological symptoms or a severe radiating pain to the arms or legs is present he may order an MRI scan. An MRI scan will show all the soft tissues of the back, whereas the intervertebral disks and the spinal nerves will be of particular interest. An MRI scan could also reveal bony stress reactions of the spine that cannot be seen on x-ray.
This MRI scan shows an overview of the lower trunk and pelvis. An MRI scan of the back is not necessary to diagnose a back muscle strain. However, the picture perfectly shows all the muscles around the spine. The deep back muscles are located close to the vertebral bodies. They provide stability to the spine.
What are the treatment options?
Acute pain from a lower back strain can resolve quickly if treated efficiently. If you have severe or constant back pain or pain radiating to your legs, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain. First aid of acute back pain includes taking a painkiller and resting in a comfortable position. A pillow under your knees may help when lying down. It is also recommended to apply warmth to the affected area, as it will help to alleviate muscle cramps.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.
You have severe or lasting pain after a lower back muscle strain and want to have it sorted out? These are the next steps:
- See a doctor
Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.
- Find a specialist in manual medicine
Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.
- Start working on your problem
There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:
Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.
- Talk to your ballet master or dance teacher
Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.