Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109

( 617)720-2329




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Understanding Lower Back Strain

Most episodes of acute lower back pain are caused by damage to your soft tissues, or the muscles and ligaments that support your lumbar spine.

This type of injury is called a lower back strain, but it’s popularly referred to as a pulled muscle. The pain resulting from a lower back strain can be surprisingly severe, sending many patients to the emergency room.

See Pulled Back Muscle and Lower Back Strain

Your back is supported by a large, complex group of muscles that hold up the spine. Watch: Lower Back Strain Video

Our animated video on lower back strains can help you better understand this type of injury.

See Sport Injuries, Back Injuries, and Back Pain

Video highlights

Your spine is made for movement: lifting, bending, twisting, and arching. The discs between the vertebrae enable this movement, but your muscles surrounding your spine power the movement.

See Lumbar Spine Anatomy and Pain

The back muscles that power the movement of your spine, shown here in red, include the extensor, flexor, and oblique muscles.

See Back Muscles and Low Back Pain

These muscles are made up of individual fibers, seen here.

In This Article:

Movements that place stress on your back, such as lifting heavy objects, falling to the ground, or twisting while lifting can cause a fiber in one of your back muscles to become over-stretched or tear. This injury is called a lumbar muscle strain. When a ligament in your back tears it is referred to as a sprain.

Watch Back Strains and Sprains Video

Symptoms of muscle strain

Symptoms of a lumbar muscle strain may include tenderness in your lower back, the sudden onset of pain, and localized pain that does not radiate into your leg.

See Lower Back Muscle Strain Symptoms

Lumbar muscle strains may be accompanied by muscle spasms as your body works to stabilize your injury.

Watch Back Spasm Treatment Video

The good news is that the initial pain from your lower back strain typically subsides in a short amount of time. The bad news is that low levels of pain or periodic flare-ups may continue for weeks or months after your initial injury.

See Early Treatments for Lower Back Pain

After 2 weeks, back muscles can atrophy—shown here as a white area in the muscle—from lack of use. This may lead to additional pain.

Treatment options for lower back strain

Most back strain injuries heal on their own within 3 to 4 weeks. But to prevent your muscles from atrophying it’s best to engage in various stretches and strength building exercises after 1 or 2 days of initial rest.

See Exercise and Back Pain

Other treatment options for your pain include:

We hope this video helps you better understand lower back strain injuries. Keeping your back muscles well-conditioned and flexible with strengthening and stretching exercises will help you avoid this type of injury.

See Pulled Back Muscle Treatment

Learn More:

Causes and Diagnosis of Lower Back Strain

Exercises for Lower Back Muscle Strain

5 Ways Motion Causes Low Back Pain

Our spines are remarkable—they're made up of incredibly intricate systems of bones, ligaments, tendons, and muscles that work together to enable movement in all directions. While all of this movement is great, the potential downside is that it can contribute to injuries and wear-and-tear damage over time that may lead to back pain and stiffness.

The spine is made up of strong bones, flexible ligaments and tendons, large muscles, and highly sensitive nerves. Watch: Lumbar Spine Anatomy Video

Understanding how movement impacts your spine can help you better communicate with your physician and hopefully get an accurate diagnosis for faster treatment and pain relief. With this in mind, here are 5 common ways that motion can contribute to back pain:

1. Large spinal muscles are easily strained with twisting motions

The most common reason motion causes back or neck pain has little to do with the bones in your spine. Instead, it’s related to the muscles and ligaments that surround your spine.

When you twist your lower back, such as during a golf swing or while bending to unload grocery bags, you run the risk of overstretching or tearing any of the large muscles or supporting ligaments around your spine. In response to this damage, the surrounding area will usually become inflamed. This inflammation can lead to a back spasm , which can potentially lead to severe lower back pain.

See Pulled Back Muscle and Lower Back Strain

Strains and tears in the spinal muscles and ligaments are a common cause of lower back pain. Watch: Lower Back Strain Video

2. Lumbar spine motion can cause a disc herniation

Your lumbar spine (lower back) is constantly in motion, and it also carries the entire weight of your upper body. This makes your lumbar spine particularly prone to injuries.

See Causes of Pain in the Lumbar Spine

The motion in your lumbar spine is divided into 5 spinal motion segments. Each of these segments is made up of 2 cartilage-covered facet joints and a spinal disc that provides shock absorption and prevents adjacent vertebrae from grinding together.

Your two lowest discs (the L4-L5 and L5-S1) endure the most strain, and therefore are the most likely to become herniated.1 A herniation can lead to sciatic pain that radiates down your leg and to your foot.

Watch Sciatica Overview Video

Symptoms of a lumbar herniated disc vary widely. Watch: Lumbar Herniated Disc Video

3. Overuse and injuries can lead to cartilage breakdown

Repetitive motions and overuse injuries, especially for athletes, can lead to spinal osteoarthritis—or the mechanical breakdown of the cartilage between your aligning facet joints in the back portion of the spine.

See Causes of Osteoarthritis and Spinal Arthritis

When this happens, the facet joints become inflamed, and progressive joint degeneration creates more frictional pain. As your back pain progresses, the motion and flexibility of the spine decreases.

See Symptoms and Diagnosis of Facet Joint Problems

Typical symptoms include:

  • More stiffness and pain in the lower spine and sacroiliac joint in the mornings and later in the day.
  • Decreased pain during the day as normal movements stir the fluid lubricant of the joints.
  • Low back pain radiating to the pelvis, buttocks, or thighs—and sometimes to the groin.

While overuse and injuries can potentially accelerate the development of osteoarthritis later in life, it is important to remember that staying active is a key part of a healthy lifestyle. Check with your doctor as to which exercises are appropriate for you, and how to perform exercises safely.

Excessive motion in the spine can lead to cartilage breakdown. Watch: Lumbar Osteoarthritis Video

4. Disc degeneration may lead to pain from micro-motion

Disc degeneration in your spine can create excessive micro-motion at a vertebral level and lead to lower back pain, a condition termed lumbar degenerative disc disease.

Common symptoms of degenerative disc disease include:

  • Low back pain that generally worsens with prolonged sitting or holding stationary positions
  • Worsened pain with certain movements, such as bending, lifting, or twisting.

See Causes of Degenerative Disc Disease Pain

Potential pain relief may be experience when changing positions frequently, and lying day may be most comfortable.

Micro-motion from disc degeneration can lead to lower back pain. Watch: Lumbar Degenerative Disc Disease Video

5. Bone spurs can form to compensate for too much motion

Over time, excessive motion in your spine can lead to inflammation and enlarged spinal joints. When this happens, bone spurs—or small, irregular growths on the bone—typically form on your facet joints in response to joint instability from the degeneration. The bony overgrowths can eventually become big enough to reduce joint motion and cause more swelling and stiffness.

See Diagnosis of Bone Spurs

While spurs can be a normal part of aging and do not directly cause pain, they may become large enough to irritate or compress nerves passing through spinal structures. This may result in diminished room for the nerves to pass—which is referred to as spinal stenosis.

Over time, degeneration of the facet joints in your lower back can result in the formation of a fluid-filled sac called a synovial cyst. These cysts are benign, but if they put pressure on the spinal canal they can, like bone spurs, cause symptoms of spinal stenosis.

See Treatment Options for Bone Spurs

Bone spurs are a marker of spinal degeneration, and are quite common in people over the age of 60.

Watch: Lumbar Osteophytes (Bone Spurs) Video

When discussing your back pain with a doctor, try to remember which activities make the pain better or worse. Sharing this information with your doctor may help him or her more accurately identify the specific cause of your pain.

Learn more:

Back Care for Lower Back Pain

Causes of Lower Back Pain

5 Exercises for Upper and Middle Back Pain

Upper and middle back pain is less common than pain affecting the lower back or neck. But that doesn’t make it any less aggravating to deal with. Here are 5 common exercises that target the muscles surrounding the thoracic spine. It’s advised you try these exercises under the guidance of a health care professional.

See Early Treatments for Upper Back Pain

Cobra pose

This back extension exercise is referred to as the cobra pose in yoga. It targets your back extensor muscles, which are attached to the back of your spine.

  1. Lie down with your stomach on the floor, with your hands in a push-up position.
  2. Slowly push through your arms until you straighten your elbows, lifting the top half of your body off the ground.
  3. Keep your lower body relaxed against the ground. This position is typically held for 1 to 2 seconds and repeated 10 times.

If this exercise is difficult for you, try a modified version where you rest on your forearms.

See Exercise and Back Pain

Back extension exercise

Here’s an advanced extension exercise that targets your upper back muscles:

  1. Lie face down on your stomach with a pillow tucked under your hips.
  2. Reach your hands straight back. You can clasp them together behind your back.
  3. Raise your head and chest off the ground.
  4. Hold this position for 5 seconds while looking at the ground.
  5. Gradually work up to 20 seconds at a time. Aim to complete 8 to 10 repetitions of this exercise.

See Back Strengthening Exercises

To increase the intensity slightly, you can lift your legs off the ground, too.

Cat-cow pose

The cat-cow pose is a gentle stretch that can help ease the pain in your middle back.

  1. Get on your hands and knees. Align your arms straight under your shoulders, your knees directly under your hips, and your head straight in line with your torso and spine.
  2. Round your back, lifting your spine toward the ceiling. Your eyes should face your belly. Hold this pose for a deep breath.
  3. Slowly lift your chest and tailbone toward the ceiling, letting your stomach sink toward the ground. Your eyes will look up toward the ceiling.
  4. After another breath, gently round your back and lift your spine toward the ceiling again.

Alternate between the two poses.

See Stretching for Back Pain Relief

Opposite arm/leg raise

This exercise, sometimes called the bird-dog pose in yoga, strengthens your abdominals and back muscles.

  1. Get on your hands and knees. Keep your spine straight, with your hands directly below your shoulders and your knees aligned directly under your hips.
  2. Slowly reach out with one arm while extending the leg on its opposite side. Keep both straight and level.
  3. Hold for a few deep breaths, then gently lower your arm and leg to starting position.
  4. Repeat this exercise with your other arm/leg.

Try for 10 to 15 repetitions on each side.

See Back Exercises and Abdominal Exercise Recommendations

Corner stretch

Upper back pain is often due to poor posture, which may be exacerbated by tight chest muscles. The corner stretch is an easy and effective way to open up the chest muscles and encourage healthy posture.

  1. Face a corner of a room or stand in a doorway. Place your forearms against each wall (or each door jamb) with your elbows slightly below shoulder level.
  2. Lean forward until you feel a stretch in your chest under your collarbone.

Hold this stretch for up to a minute.

See Easy Chest Stretches for Neck Pain

A health care professional can create for you an exercise plan specifically tailored to treat your underlying condition. Stop immediately if any of these exercises cause pain.

Learn more:

All About Upper Back Pain

Causes of Upper Back Pain

Sciatica is a term used to describe radiating pain that travels along the path of the sciatic nerve, running from your lower spine through the buttock and down the back of the leg. It flares when the sciatic nerve is irritated or pinched by any of a range of problems in your lower back.

See What You Need to Know About Sciatica

Animated video still of an irritate sciatic nerve

The term sciatica describes radiating pain that travels along the path of the sciatic nerve, which runs from the lower spine through the buttock and down the back of the leg. Watch: Sciatica Overview Video

Sciatica is nerve pain

There are a series of nerve roots that exit from your lower spine. When any of these nerve roots on either side of your lower spine becomes irritated or pinched, pain may radiate from the nerve root to the sciatic nerve. The pain may travel down the sciatic nerve – through the buttock and down the back of the leg and into your foot and/or toes. It typically occurs only on one side of the body.

See Types of Sciatic Nerve Pain

The pain is unique – often described as a shooting, searing pain that is felt deep in the buttock and radiates down the back of the leg. Numbness, tingling, or burning may also be felt along the nerve. Some people describe the nerve pain as electric-like. Conversely, sciatica symptoms may be experienced as more of a constant, dull pain.

See Sciatica Symptoms

Medical terms used for sciatica include lumbar radicular pain and lumbar radiculopathy.

Common lower back problems that cause sciatica

The most common cause of sciatica is a lumbar herniated disc1. Other common causes may include lumbar spinal stenosisfacet joint osteoarthritislumbar degenerative disc disease, or spondylolisthesis.


See Sciatica Causes

The term sciatica is often misused, and people may be tempted to self-diagnose and self-treat the wrong cause of their sciatica. Knowing the underlying cause of your sciatica symptoms is important in order to get the right treatment.

See Diagnosing the Cause of Sciatica

Some conditions mimic sciatica

Illustration of the sciatic nerve

A number of conditions can mimic the radiating pain, numbness, and tingling of sciatica.
Learn more:
 Leg Pain and Numbness: What Might These Symptoms Mean?

Many people refer to any type of leg pain as sciatica, but in fact, there are many causes of leg pain that are not medically classified as sciatica and need to be treated differently.

Examples of problems that are not sciatica but can cause similar symptoms include:

  • Joint problems in the spine. Pain may be referred from the spinal joints down into the leg. This problem is technically not sciatica, and the treatment for it is different. For example, joint degeneration from spinal arthritis may cause pain that has sciatica-type symptoms.
Sacroiliac Joint Pain

Sacroiliac joint dysfunction can cause symptoms similar to sciatica.
To learn more, watch 
Sacroiliac Joint Dysfunction Video

  • Sacroiliac joint dysfunction. Too much or too little motion in the sacroiliac joints can cause pain that radiates down your leg and feels like sciatica. Treatment for sacroiliac joint dysfunction is usually non-surgical and focuses on restoring normal motion in the joint. Sacroiliac joint fusion is available if the pain is severe and debilitating.

    See Sacroiliac Joint Dysfunction (SI Joint Pain)

  • Piriformis syndrome also causes symptoms similar to sciatica. It occurs when the piriformis muscle in the buttocks irritates the sciatic nerve, which can cause pain to radiate along the path of the nerve into your leg. This type of pain is technically not sciatica, because the nerve irritation does not originate in the lower back. Treatment for piriformis syndrome usually includes anti-inflammatory medication and specific physical therapy.

    See Piriformis Syndrome Treatment

Piriformis Muscle and Sciatic Nerve Anatomy

The piriformis muscle in the buttocks can sometimes irritate the sciatic nerve.
Piriformis Syndrome Video

Self-diagnosis of sciatica is not a good idea

As many underlying conditions can cause sciatic pain, it is important to consult a doctor for a clinical diagnosis. While rare, sciatica-like pain may be caused by medical conditions that need immediate treatment, such as:

While the vast majority of causes of sciatica symptoms are not serious, it is always advisable to see a doctor for any troubling symptoms.

See When Sciatica Pain Is a Medical Emergency

If you feel symptoms of pain in your buttocks or leg, or numbness, tingling, or other neurological symptoms in your leg, it is important to see a doctor for clinical diagnosis that identifies the cause of your symptoms.

As you can see by reading the peer-reviewed articles on this site, treatment can be quite different depending on the underlying cause of your symptoms. For example:

  • A lumbar herniated disc and lumbar stenosis can cause similar sciatica symptoms; however, physical therapy for each condition can be different—while bending forward at the waist may be comfortable if you have spinal stenosis, it can cause increased pain if you have a lumbar herniated disc.
  • If spondylolisthesis is causing your sciatica, a doctor may advise fusion surgery to align and stabilize the affected segment before doing any sort of exercise.

Commit to a progressive exercise program for long-term pain relief

When your doctor gives you the go ahead, make sure to make a focused effort to follow through with a controlled and progressive exercise program. Without it, your symptoms are likely to return and get worse over time.

See Physical Therapy and Exercise for Sciatica

There are many options to help provide enough pain relief for you to engage in exercise and physical therapy, such as use of ice and heat, pain medications, and possibly an epidural steroid injection. Physical therapists and spine specialists can tailor a pain relief treatment to make exercise tolerable.

See Sciatica Treatment

Learn more:

The Truth About Sciatica

Myths About Sciatica Treatment Options

Many people experience neck pain and dizziness at the same time. Sometimes this is referred to as cervical vertigo or cervicogenic dizziness. This dizziness may come and go or occur with motion of the cervical spine (neck), and it can involve unsteadiness, light-headedness, blurry vision, ringing in ears, nausea, headaches, and/or other troubling symptoms. Here are a few possible ways that a neck problem may contribute to dizziness.

Image of the impact of the head hitting a car seat

Besides neck pain, whiplash can cause other symptoms, such as dizziness. Watch: Whiplash Video

Whiplash injury

When the neck is abruptly whipped back and forth, it can cause a whiplash injury. A rear-end auto collision is one of the top causes of whiplash. While neck pain is the most common whiplash symptom, many other symptoms may be present, such as dizziness.

See Sources of Whiplash Pain

When dizziness accompanies whiplash, it could be due to a concussion (brain injury) that occurred at the time of the collision. Another possibility is that specialized receptors (proprioceptors) within the neck’s muscles or joints become injured. The muscles and joints in your neck are believed to have receptors that send messages to the brain. These receptors give feedback on the position of the head and neck. Along with the inner ear and eyes, the proprioceptors in the neck are believed to play a role in maintaining balance. An injury to these proprioceptors may contribute to feeling dizzy or unsteady.

See Whiplash Symptoms and Associated Disorders

Vertebrobasilar insufficiency

When one of the vertebral arteries gets compressed or inflamed within the cervical spine, it could cause vertebrobasilar insufficiency (VBI). With VBI, a reduced amount of blood reaches the brain, inner ear, or brainstem. When this happens, serious symptoms can occur, including dizziness. One type of VBI is called Bow Hunter’s syndrome, which involves temporary dizziness or other symptoms occurring when the head is turned to the side (like a bow hunter does). While this type of compression is rare, it most commonly occurs between the C1 and C2 vertebrae in the cervical spine.1 It is typically caused by a bone spur on a vertebra in the neck that pinches the artery when the head is turned.

Watch Spinal Motion Segment: C1-C2 (Atlantoaxial Joint) Animation

Cervical myofascial pain syndrome

Myofascial pain syndrome occurs when painful trigger points develop in the muscles and surrounding connective tissues. When this condition is primarily felt in the neck region, it is called cervical myofascial pain syndrome. In addition to having tender trigger points than can flare up when touched or during activity, muscles can become achy and stiff, and pain can spread to the head or shoulders. While cervical myofascial pain syndrome is rare, it is estimated that about one-third of people with this condition also have dizziness. 2

Watch Myofascial Pain Syndrome Video

Cervical myofascial pain syndrome has no known cause. Some suspected causes include previous injury, overuse or repetitive neck movements, poor posture, and/or stress. While the connection between this neck pain and dizziness is unclear, some evidence suggests that treating myofascial pain syndrome— such as with trigger point injections, physical therapy, or medication—can reduce both the pain and dizziness.3

See Home Remedies for Neck Pain and Dizziness

When to see a doctor

Unexplained dizziness needs to be evaluated by a doctor, especially if it lingers or keeps coming back. A qualified medical professional can perform a physical exam and conduct diagnostic tests to help identify the possible cause of neck pain and/or dizziness. While there is currently no diagnostic test to prove a neck problem is causing dizziness, a doctor can narrow the list of possible causes and recommend treatments. Spinal injections and/or additional testing may help clarify the source of the pain and help improve your quality of life. When neck pain and/or dizziness are accompanied by other troubling symptoms, seek medical attention immediately. Some examples include persistent nausea, severe headache, fevers, chills, weakness, numbness, or bowel/bladder dysfunction.

See When Back Pain May Be a Medical Emergency

Learn more

What Causes Neck Pain and Dizziness?

Stretches and Exercises for Neck Pain and Dizziness

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