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Soft Tissue Mechanical Low Back or Neck Strain

The discussions following from this page deal with soft tissue strain and should not be applied to situations such as disc protrusions, stress fractures of bones or bone fractures of any kind. Muscle and ligament injury of the back and neck are very common injuries in sports and in other incidents such as car accidents and work related activities. Advice applying to these other incidents is presented in the back pain section of this web site. It is a good idea to read the pages associated with back pain but it also helps to apply the two themes of sports injury: overuse and symmetry. The  overuse component can be a repetitive strain but it is more usually an excessive muscle load from an awkward lift and turn or impact in a contact sport. It can also be a rotational excessive load in a racquet sport, golf, or hockey. The symmetry theme usually plays as follows with back and neck strain. The muscles of the back are the ones that hurt and in comparison to the abdominal muscles and the front of the neck are the ones that are the strongest. They also have an impressive ability to hold a contraction (spasm) for a considerable length of time. This is a natural defense against spinal injury. This means, for treatment, the back muscles have to relax first and then stretch and the abdominal muscles and muscles of the front of the neck have to exercise and be strengthened. Easy to say and quite hard to implement.

Spasm in back muscles can last for days. It is very important to be patient and to rest these muscles immediately after the strain for perhaps up to 5 days. Soaking in a hot bath and lying flat on a firm bed with a small pillow behind the head and a pillow behind the knees is time consuming but worth it. Muscle relaxants are useless and narcotics are ineffective and dangerous. In some cases non-steroidal anti-inflammatory medication can be useful if taken in adequate dosage and for sufficient length of time. Exercise or physiotherapy that is started too soon runs the risk of re-stimulating the spasm and prolonging the required rest period.

Stretching low back and neck muscles also is a challenge for several reasons: there is a risk that too aggressive stretch activity will re-stimulate spasm; the body's posture can affect the strain by forcing awkward positions for long periods; the career and leisure activity of the injured person may encourage or demand holding fixed positions for long periods (computer worker or heavy labourer). In the back pain pages there are recommendations about using firm mattresses and proper footwear. The former recommendation tries to address the long sleep period when a fixed position is maintained and has to be anatomically correct to prevent re-strain during the night. Proper footwear should provide shock absorbance on the bottom of the feet to diffuse forces that would otherwise be transmitted up the leg to irritate the already strained soft tissue. Gentle cervical/ lumbar stretch exercises should be done regularly every 20 to 30 minutes during waking  hours to achieve and maintain the level of stretching required to recover from back strain and to prevent further recurrence of strain.

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