“I pulled my back” is a common description of pain after an unfamiliar movement or physical effort. Muscle or ligament overload can be the cause, but a sensation alone cannot identify the source of pain. Muscle strain itself is not an indication for spine surgery.
What is meant by lumbar muscle strain?
The lumbar muscles help move and maintain the position of the trunk. Ligaments connect bone structures and help limit excessive movement. Excessive loading can overstretch or injure these tissues. Pain is sometimes accompanied by protective muscle tension, making it difficult to straighten up, turn or find a comfortable position.
Pain severity does not precisely show the extent of tissue injury. Tenderness to pressure does not prove a muscle tear either. At consultation, I assess how the pain began, its nature and examination findings, rather than relying solely on the everyday term “strain”.
Which activities can lead to low back pain?
Common situations include lifting an unusually heavy object, turning while carrying a load, a sudden jerk, a sporting movement or working in an awkward position. Weight is not the only factor: readiness for the load, fatigue and repetitions also matter.
After a fall, impact or another injury, pain cannot automatically be considered muscular. Examination is particularly important with osteoporosis or previous fractures: the doctor needs to exclude vertebral injury. If a compression fracture is suspected, we assess it and select treatment separately. When vertebroplasty and kyphoplasty are considered. If pain started without an identifiable physical trigger, that is also worth discussing when you seek advice.
Which symptoms should be described to the doctor?
Muscle and ligament pain may cause localized low back tenderness, stiffness and increased pain with certain movements. Getting out of a chair, turning in bed or staying in one position for long periods may be difficult. These symptoms also occur with other causes of back pain.
Describe whether pain spreads to the buttock or leg and whether there is numbness, weakness or a change in walking. Based on symptoms, examination and investigations, the doctor determines whether separate assessment is needed for a herniated disc or lumbar stenosis. Symptoms alone do not confirm these diagnoses; treatment should match the established cause.
When not to wait for a routine consultation
Seek medical help immediatelyif urinary retention, loss of bladder or bowel control, saddle numbness or new marked or increasing leg weakness develops. Do not wait for a reply in a messenger.[2]
Urgent assessment is needed after serious injury, for pain with a high temperature or a sudden deterioration in general condition. Tell the doctor about previous cancer, unexplained weight loss and pain whose usual pattern has changed. This information helps determine the necessary assessment.[1][2]
Examination and investigations: is an immediate MRI needed?
I clarify when pain began, whether there was an injury, what makes it worse and how everyday abilities have changed. Previous episodes, operations, coexisting conditions and medication are important. During examination, I assess movement and, where symptoms indicate, strength, sensation and other neurological signs.
MRI or X-rays are not automatically required for every episode of low back pain. An investigation is ordered when a specific cause is suspected or its result could change treatment. This follows NICE recommendations for low back pain.[1]
If an investigation has already been performed, bring the images and report. MRI/CT studies require complete DICOM series. How to prepare and send investigations. You do not need to purchase a new investigation before your first enquiry.
What to do at the start of treatment
If serious causes have been excluded, continue manageable everyday activities and short walks while temporarily reducing activities that sharply worsen pain. We gradually increase movement; prolonged bed rest does not help restore usual activity.[1]
- Alternate body positions, movement and rest.
- Break household tasks into small stages.
- Note changes in pain, sleep, walking and ability to work.
Medication for pain relief is discussed individually, considering other conditions, current medicines and possible risks. Do not prescribe yourself a course from an old article or another patient's recommendations. If you feel worse, the plan needs review.
Exercises and return to usual activity
Exercises are selected according to your abilities and recovery stage. Comfortable movements and tolerance of usual activity come first, followed by gradual work on strength and endurance. The aim is to return to activities you need, rather than perform any programme through pain.
A physical therapist will help select exercises and practise everyday movements. Loading is adapted to your condition and aims; there is no single mandatory programme for everyone.[1]
Stop an exercise if it causes sharp, increasing pain, new numbness or weakness. These changes need assessment. Massage and other passive procedures, if discussed, do not replace a gradual return to movement.
Work, sport and preventing recurrent episodes
Return to work is planned according to actual tasks: computer sitting, travel, bending or carrying loads. A shorter day, temporarily lighter duties and breaks may help. There is no single recovery date that applies to everyone.
After improvement, increase loading gradually. For unfamiliar physical work, assess your capacity, use assistance and change body position.
When to reassess the cause of pain
If pain persists, returns frequently or increasingly limits walking, sleep and work, seek reassessment. We will review the initial assumption and clarify the next plan. The word “strain” itself does not lead to surgery. Surgical treatment is discussed only for another confirmed condition with appropriate indications.
If symptoms developed after surgery, report the changes to the operating team. When pain returns, we compare new symptoms with the previous procedure and existing images at consultation. How we assess the need for revision surgery. Postoperative recovery has its own plan; ordinary low back exercises cannot automatically be applied to it.
Discuss low back pain with the professor
Describe what preceded the pain, where it spreads and what is difficult now. Include existing reports and investigations. Preliminary review of materials is free. You can book an in-person consultation without an existing MRI.
Discuss the cause of low back pain
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