BACK STRAIN, DORSAL- OR THORACIC-SPINE REGION
DEFINITION--Injury to muscles or tendons that attach to the vertebral column at the dorsal or thoracic region of the back. The dorsal or thoracic spine is that part where ribs attach to surround the lungs. Muscles, tendons and vertebrae comprise units. The units stabilize the spine and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles of the dorsal or thoracic spine.
One or more vertebral bones.
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
SIGNS & SYMPTOMS
Pain with motion or stretching of the back, or generalized pain in the back.
Muscle spasm when moving the back.
Swelling along a muscle of the back.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or its tendon (visible with X-rays).
Inflammation of the tendon sheath.
Prolonged overuse or stretching of muscle- tendon units in the back.
Single violent injury or force applied to the dorsal region of the back.
RISK INCREASES WITH
Major exertion in an off-balance position, such as a shotputter throwing from an imperfect stance.
Sports such as gymnastics, weight-lifting or diving.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Previous back injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Application of tape (sometimes).
Self-care during rehabilitation.
Physical therapy (moderate or severe strain).
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the back to rule out fractures.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Chronically painful or arthritic back following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured back with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain.
Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.
ACTIVITYRest in bed until pain improves. Resume your normal activities gradually after treatment.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe back strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.