What are Sprains & Strains?

Sprains and strains are soft tissue injuries that can affect the neck, mid back, or lower back. A sprain involves stretching or tearing of a ligament, which is the tissue that helps connect bones and support joints. A strain involves injury to a muscle or tendon, which helps the body move and stabilize the spine.

Spine-related sprains and strains may cause pain, stiffness, muscle spasm, and reduced range of motion. They are often related to lifting, twisting, falls, sports injuries, motor vehicle accidents, poor posture, or overuse. Many sprains and strains improve with non-surgical care, but evaluation may be important when pain is severe, persistent, related to trauma, or associated with neurological symptoms.

De Novo Brain & Spine evaluates adult patients with sprain or strain symptoms when there is concern for cervical, thoracic, or lumbar spine injury, nerve compression, fracture, instability, disc herniation, spinal stenosis, or another structural condition that may require neurosurgical review.

Common Signs and Symptoms

Sprain and strain symptoms depend on the location of injury, severity of tissue irritation, and whether the cervical, thoracic, or lumbar spine is involved.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Aching, soreness, tightness, or stiffness
• Muscle spasms
• Pain that worsens with movement, lifting, bending, twisting, or certain positions
• Reduced range of motion
• Tenderness over the injured area
• Pain after a fall, lifting injury, sports injury, or motor vehicle accident
• Pain that improves with rest or position changes in some cases
• Pain that spreads into the shoulder, buttock, hip, or nearby muscle groups
• Difficulty standing upright, turning the neck, bending, or walking normally
• Headache related to neck muscle strain in some cases
• Temporary activity limitation because of pain or stiffness

Seek urgent medical evaluation for sprain or strain symptoms with progressive weakness, numbness, tingling, trouble walking, loss of coordination, bowel or bladder changes, fever, unexplained weight loss, history of cancer, severe pain after trauma, or pain that does not improve with appropriate care. Seek emergency medical care or call 911 for sudden weakness, sudden speech difficulty, chest pain, loss of consciousness, or symptoms that may suggest a stroke, heart-related emergency, or serious traumatic injury.

What Causes This Condition?

Sprains and strains occur when soft tissues around the spine are stretched, overloaded, irritated, or injured. A sprain affects ligaments, while a strain affects muscles or tendons.

Possible causes and related factors may include:

• Lifting a heavy object
• Twisting suddenly or awkwardly
• Bending while lifting
• Fall or direct injury
• Motor vehicle accident
• Whiplash injury involving the neck
• Sports injury or sudden athletic movement
• Repetitive motion or overuse
• Poor posture or prolonged positioning
• Weak core or spinal support muscles
• Deconditioning or reduced flexibility
• Muscle fatigue
• Work-related lifting, pushing, pulling, or repetitive movement
• Prior spine injury or recurrent soft tissue irritation

These causes and risk factors do not mean every sprain or strain involves a serious spine condition. Treatment planning depends on the location of pain, injury mechanism, neurological examination, symptom duration, response to prior care, and whether imaging suggests another condition.

How It Is Diagnosed?

Sprains and strains are usually diagnosed through medical history and physical examination. Imaging is not always required for typical mild soft tissue injuries, but testing may be needed when symptoms are severe, persistent, traumatic, or associated with neurological changes.

Common diagnostic steps may include:

• Medical history and injury review to understand when pain started, how the injury occurred, pain location, symptom severity, prior injuries, and activity triggers
• Physical examination to evaluate tenderness, range of motion, posture, muscle spasm, painful movement, and functional limitation
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, and signs of nerve or spinal cord involvement
• X-rays in selected cases when fracture, alignment change, arthritis, instability, or trauma-related injury is suspected
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is a concern
• MRI of the cervical, thoracic, or lumbar spine when disc herniation, nerve compression, spinal cord compression, fracture, infection, tumor, or significant soft tissue injury is suspected
• CT scan when bone detail, fracture, or surgical planning requires further evaluation
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may involve radiculopathy, peripheral neuropathy, or another nerve disorder
• Blood tests in selected cases when infection, inflammatory disease, or another medical condition is suspected

The goal of diagnosis is to confirm whether symptoms are consistent with a sprain or strain, identify red flags, and determine whether another spine or nerve condition may be contributing to the pain.

Treatment Options

Sprain and strain treatment depends on the location of injury, severity of pain, injury mechanism, neurological examination, imaging findings when needed, prior treatment, activity needs, and overall health. Most spine-related sprains and strains are treated without surgery.

Treatment options may include:

• Activity modification to avoid movements, lifting, or positions that worsen symptoms
• Short-term relative rest while avoiding prolonged bed rest when possible
• Gradual return to normal activity as symptoms improve
• Heat or ice for short-term symptom relief when appropriate
• Anti-inflammatory medication, acetaminophen, or muscle relaxants when medically appropriate
• Physical therapy to improve mobility, posture, flexibility, strength, and safe movement mechanics
• Stretching and home exercise when recommended by a clinician or therapist
• Core strengthening to improve spinal support and reduce recurrent irritation
• Posture and ergonomic changes for work, driving, computer use, or daily activity
• Manual therapy, soft tissue treatment, or myofascial care when appropriate
• Trigger point injections in selected cases when muscle spasm or myofascial pain is a major contributor
• Treatment of an underlying spine condition when symptoms are related to disc herniation, spinal stenosis, radiculopathy, instability, fracture, or another structural problem
• Rehabilitation and follow-up care to monitor pain, range of motion, strength, function, and return to activity

Surgery is not a treatment for an uncomplicated sprain or strain. Neurosurgical treatment may be considered only when evaluation shows a separate structural condition, such as significant nerve compression, spinal cord compression, spinal instability, fracture, tumor, infection, or another surgically treatable problem.