Sprains, strains and low-back pain: Is there a connection?

Low-back pain is the primary reason patients pursue chiropractic care. Still, doctors of chiropractic have become equally adept at treating conditions of the upper and lower extremities.

The conservative, noninvasive treatment techniques employed make chiropractic care a widely sought-after service, often incorporated with athletic teams ranging from high school leagues to Olympic contenders. DCs have long been acknowledged for facilitating athletes’ return to their sport post-injury. And with an array of new modalities at our disposal, recovery is faster than ever before. Nevertheless, it’s crucial to consider potential methods to predict and prevent injuries before they occur. 

Unraveling the mysteries of recurring sprains and strains

As a practicing DC, I find it intriguing to hear patients recount the events preceding a sprain or strain injury that brought them to my office. One recent new patient limped in, explaining he hadn’t done anything in particular; he merely got out of bed, felt a twinge in his lower back and sensed it beginning to “go out.” He mentioned this occurs every two to three years and can typically be amended with two or three chiropractic adjustments, after which he feels fine. While the cause remains a mystery to him, he’s grateful for the relief; however, we must strive to identify the factors contributing to the recurring patterns resulting in strain and pain. 

A common frustration for both patients and doctors is that with chronic conditions, the acute pain relief phase takes longer to set in, and neither party can pinpoint why this happens. This may lead to questioning the DC’s skill or technique, comparing it unfavorably to treatments the patient received 20 years ago. However, it is essential to consider the undeniable fact that the patient’s body has aged 20 years since then. 

Physiology laws and observational skills

It’s beneficial to remind patients that a sprain involves a stretched or torn ligament, with ligaments serving as connectors between bones. On the other hand, a strain indicates a stretched or torn muscle or tendon, where tendons are the tissues linking muscles to bones. Luckily for our patients, strains tend to be more common and respond more promptly to treatment. 

Sprain strain injuries usually result from activity t exceeding the capacity of the connective tissue involved due to the activity’s frequency, duration and intensity. The activity may be intense, athletic or as mundane as reaching for a sock or getting up from a chair or bed.  

Clinical experience indicates most injuries are unilateral and can involve the shoulders, elbows, wrists, ankles, knees and hips; inflammatory responses in the tissue can be acute or chronic. One of the main challenges is helping patients understand why these sprains and strains happen, especially when they often feel they haven’t done anything to cause such an injury. 

As I accompanied this patient to the exam room, I noted he was limping and appeared misaligned, with one hip higher and one foot turning out moreso than the other. He shrugged his shoulders and said, “Well, I guess that’s possible,” but the observation was lost on him at that point in time. He didn’t understand how those things could be related. 

I reminded myself of a couple of laws in physiology that helped me understand the process that leads patients to experience these mysterious sprains, strains and low-back pains. For example, Wolff’s Law details how bones remodel in response to the stresses placed on them. Similarly, Davis’ Law dictates that soft tissues adapt based on the stresses subjected to them. When I see postural imbalances and gait abnormalities, I know bony tissue and soft tissue must respond to the stresses imposed upon them. It’s a law. These stresses cause inflammatory changes that can lead to the calcification of ligaments and the weakening of tendons. 

There are also imbalances in the activation of muscles from the sensorimotor input from the feet, which cause functional disorders affecting balance and coordination. The effects are gradual and are often unnoticed by our patients until they have a symptom-causing event. This fact has been studied, revealing that a weakness of hip abductors/extensors and knee extensors is present in patients with low-back pain compared to healthy controls.1 These weaknesses are often a difference in the activation of muscles due to structural asymmetry and nociceptive reflex inhibition, not a lack of strengthening exercise. 

I began my examination by first excluding the possibility of a disk injury. Once we identified that it was not a severe injury, I evaluated the patient’s posture, functional movement and asymmetrical foot architecture. Quantifying these findings with pictures and printed reports was eye-opening for him. He exclaimed, “I didn’t realize my feet were so flat and my posture was so bad!” The consistent alignment of his muscle spasm location with the postural distortions I highlighted further lent credibility to my explanation. 

As the appointment progressed, the patient began to comprehend how the imbalances and misalignments in his body had existed for a prolonged period. The incident wasn’t merely a random freak accident but a ticking time bomb destined to explode eventually. 

Building a path to wellness

His first adjustment provided significant relief, which is always a good start to building credibility. I usually ask patients what they think will happen if we don’t correct the cause of the postural imbalances and movement disorders causing the tight muscles leading to sprains, strains and back pains. Will it get better or worse over time? I let them think about it and wait for them to answer me as they look back on their own history. Most patients intuitively grasp that the condition will deteriorate over time if left unchecked. This recognition allows us to chart a path toward improved health. This wellness journey can encompass corrective measures such as stabilizing asymmetrical, excessively pronating feet using custom flexible orthotics, chiropractic adjustments and rehabilitative exercises to strengthen posture. Additionally, nutritional guidance can support soft tissue healing, and appropriate treatment modalities can expedite healing outcomes. 

Final thoughts

Sprains and strains are related to back pain, and the mystery of what causes them can be solved with good observational skills and treatment that addresses foundational causes.   

BRIAN JENSEN, DC, is a graduate of Palmer College of Chiropractic and owner of Cave Spring Chiropractic in Roanoke, Va. He has been in practice for more than 35 years. As a Foot Levelers Speakers Bureau member, he travels the country sharing his knowledge and insights. Jensen’s continuing education seminars  and other Foot Levelers Speakers can be viewed at footlevelers.com/continuing-education-seminars. 

Reference

DeSousa CS, et al. Lower limb muscle strength in patients with low back pain: a systematic review and meta-analysis. J Musculoskelet Neuronal Interact. 2019;19(1):69–78. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454257/. Accessed Jan. 25, 2024.