Overview Acute lumbar sprain is an acute sprain of soft tissues such as muscles, fascia, ligaments, and joint capsule of the lumbar region. There are many ligaments and muscles and other soft tissues around the lumbar spine that play an important role in maintaining posture and enhancing the stability, balance and flexibility of the spine. When acute sprains of these soft tissues occur, the stability, balance and flexibility of the spine are affected. Etiology The lumbar region, under load, relies on the surrounding muscles, ligaments and other soft tissues to maintain its balance and coordination, and once it exceeds its capacity or fails to adapt to external force transfer, it can cause injury. When the external force at work or in sports exceeds the physiological load of the lumbar region or when the lumbar muscles and other soft tissues lose control of their function or become dysfunctional for any reason, it can cause acute sprains of muscles, fascia, ligaments, joint capsule and other soft tissues to varying degrees. Clinical symptoms Most patients have an obvious history of lumbar trauma, usually when lifting heavy objects or doing a certain action suddenly feel severe pain in the lumbar region, or even the patient feels a tearing sound and the action is forced to stop. Low back pain is aggravated by coughing, sneezing or lumbar activities, and in severe cases, the patient cannot sit up, stand up or walk. Sometimes the pain can radiate to the buttocks and thighs, but there is no pain in the calves and feet. Signs (a) Lumbar deformity and limitation of activities The patient’s lumbar stiffness and lumbar muscle spasm cause compensatory physiological foreshortening of the lumbar spine, sometimes with scoliosis. Any lumbar activity can stretch the injured soft tissues and cause increased lumbar pain. (B) Local pressure pain There is obvious fixed pressure pain at the injury site. In the case of lumbar muscle injury, the pressure point is mostly at the sacral or iliac bone attachment point of the sacrospinous muscle, and may also be near the spinous process or transverse process. In the case of supraspinous or interspinous ligament injury, the pressure pain point is in the supraspinous or interspinous process. (C) Lower limb movement, sensation and reflexes In acute lumbar sprain, nerve function is not impaired, and lower limb movement, sensation and reflexes are normal. However, examination of nerve function can help in the differential diagnosis with acute lumbar disc herniation. Diagnosis Acute lumbar sprain has a clear history of lumbar sprain and fixed pressure points. The diagnosis can be made based on the history and physical symptoms. However, attention should be paid to differentiate it from lumbar disc herniation. Treatment (a) Bed rest For acute lumbar sprain caused by trauma, bed rest should be taken for 3 to 4 weeks so that the injured tissue can recover completely. It is best to take a non-weight-bearing position of the lumbar region, such as supine flexion of the hip and knee position, which can make the lumbar muscles completely relaxed. (B) pelvic traction pelvic traction can relieve the lumbar muscle spasm. (C) massage muscle, tendon and ligament injuries are treated with tendon manipulation such as pressing, kneading, pinching and plucking. For synovial impingement, tendon manipulation is used first, followed by inclined plate or rotation manipulation. (D) painful point closure Available prednisolone acetate or tretinoin and other corticosteroids for painful point injection, generally closed once can be effective, if there is still pain, can be injected once every other week, 2-3 times for a course of treatment. (E) heat therapy Except for the first few days of acute injury, local heat therapy can be used to relax the patient’s muscles, increase blood circulation and lymphatic reflux, and reduce pain. (vi) Functional exercise After the lumbar muscle spasm and pain are relieved, physical therapy and functional training of the low back can be used to promote local blood circulation and prevent tissue adhesion, degeneration and migration into chronic low back pain.