Back Sprains and Strains

The typical picture is pain and stiffness in the injured area, often with muscle spasm as the surrounding muscles tighten to protect it. The pain may be sharp at first and then settle to a dull ache; it is usually worse with movement, bending, or lifting, and it eases with rest. There is often local tenderness and, for a day or two, some difficulty standing fully upright.

One feature matters more than any other: a simple sprain or strain causes pain around the back or neck itself, not down the limbs. Pain that shoots into a leg or arm, or numbness, tingling, or weakness there, points away from a simple sprain and toward a nerve, which is covered below.

A back sprain or strain is diagnosed from the story of how it happened and a physical examination, not from a scan, and most cases need no imaging at all. When imaging is used, each test has a specific role, and none of them confirms the sprain itself:

• X-ray: shows bone, not soft tissue, so it cannot show a sprained ligament or a strained muscle. It is used only to rule out a fracture or an alignment problem after a significant injury.
• MRI: shows the soft tissues, discs, ligaments, and nerves, but it is not used early for a simple sprain. Scanning too soon tends to turn up harmless age-related changes that muddy the picture, so an MRI is reserved for pain that has not settled or where a nerve problem is suspected.
• Ultrasound: is not part of diagnosing spinal sprains and strains. It works well for soft-tissue injuries in the limbs, but the spinal ligaments and deep back muscles sit too deep, and behind bone, to be seen clearly.

Most back pain that starts suddenly is a sprain or strain and settles. A few patterns suggest something else is going on, and are worth having looked at properly:

• Pain that will not settle: a sprain should be improving within a few weeks. Pain that is no better after about six weeks may be coming from a disc rather than the soft tissues.
• Pain that spreads into a limb: pain that runs down a leg or arm, or numbness, tingling, or weakness there, suggests an irritated nerve rather than a simple sprain.
• The same injury, again and again: a back that keeps giving way in the same spot can point to an underlying instability rather than a fresh sprain each time.

Some symptoms need urgent medical care straight away, not watchful waiting: loss of bladder or bowel control, numbness around the groin or inner thighs, severe or spreading leg weakness, or back pain with fever, unexplained weight loss, or pain that is worse at night. These are uncommon, but they matter.

Most back pain settles with time and sensible care. But if yours has not eased after about six weeks, or it is spreading into your leg, it may not be a simple sprain, and it is worth having the cause looked at properly rather than pushing on. Our specialists in Germany and Thailand can review your history and any imaging and tell you what is actually going on, and whether it needs anything more than continued rehabilitation.