Sprain

The most frequent abnormalities are: Lumbosacral transitional anomalies Scoliosis Hyperyphosis Hyperlordosis Rectification Spondylolysis Spondylolisthesis Vertebral arthritis Facet arthritis Spinal stenosis Fissure, protrusion and disc herniation Postoperative fibrosis Dislocation of the coccyx Atlantoaxial Dislocation Sprain Whiplash Syndrome

What it is

A sprain an injury of the ligaments which join the two bones that make up a joint. If the injury is so serious that it prevents the ligament from keeping the bones in position and these should separate, a dislocation is diagnosed.

The difference between a sprain and a dislocation is that in the former there is no variation in the positon of the bone, whereas in dislocation the bones separate, and this larger than normal separation may be observed in an X-ray.

How it happens

Mainly through forcing the maximum limit of movement of the joint. The most usual mechanisms which cause a sprain are:

Some joints have powerful muscles which help to fix the joint, assisting the ligaments in their task. Therefore, a powerful and well-trained musculature will protect the ligaments, so that if movement is exaggerated , it is the ligament which distends before the muscle, and its reflex contraction prevents the ligament from exceeding its maximum limit of movement.

Most sprains happen in the cervical spine, as this is the most mobile part of the spine with the comparatively weakest musculature.

Symptoms

Ligaments are innervated by nerve fibers, so that their strain or tear results in pain.

A sprain usually causes localized pain in the area, sometimes with referred pain, with muscular contracture and painful restriction in range of movements. Subsequently, a neurological mechanism may result in inflammation.

Risks

Sprains in themselves usually have a good prognosis and tend to heal spontaneously.

The only possibility which may worsen the prognosis is that the sprain, on causing pain, swelling and muscular contracture, should trigger an episode of common back pain which persists when the sprain has already healed.

Diagnosis

The medical history, considering the background and characteristics of the pain, and the physical examination, are normally sufficient. By definition, the radiography is normal.

The differential diagnosis of "sprain" or "pain due to muscular contracture" is sometimes difficult to make. One same precedent - whether a forced movement or an accident - may trigger pain due to both mechanisms. Furthermore, muscular contracture may appear in order to protect the ligament and avoid the injury which would result in a sprain, but the contrary may likewise occur, that is, the existence of a sprain may also trigger muscular contracture.

In theory, a scan or magnetic resonance imaging would allow observation of the injury, but in practice these are not useful for distinguishing between the injury of the ligament and that of the muscle or tendon.

Treatment

In the past, complete rest and total immobilization were prescribed, even with casts and splints, to provide time for the ligament to heal without further injury due to a new excessive movement. As complete rest was also prescribed in the case of common back pain, the precise differentiation between whether the pain stemmed from a sprain or muscular contracture did not present serious problems.

However, complete rest has proved inefficient and counterproductive for back pain. For this reason, currently when the existence of a sprain is suspected, mechanisms are put in place to prevent movement being forced but that do not involve absolute immobilization, such as flexible or semi-rigid cervical collars.

The remainder of the measures are shared with those for common back pain. There are many treatments and those which have proven to be effective are combined in a progressive guideline.