**8. Lumbar strains**

Lumbar sprains are the most common causes of low back pain. A low back muscle strain occurs when the muscle fibers are abnormally stretched or torn. The injury can occur because of overuse, improper use, or trauma. It is classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic".

Almost all of these low back injuries are due to injuries of the muscle. Certain risk factors, such as excessive lower back curvature, forward-tilted pelvis, weak back and/or abdominal muscles, and tight hamstrings, can increase the risk for this injury.

The symptoms are: Pain around the low back and upper buttocks, Low back muscle spasm, Pain associated with activities, and generally relieved with rest spasms in the lower back that result in more severe pain and lower back feels sore to the touch

Trauma of great force can injure the tendons and muscles in the lower back. Pushing and pulling sports, such as weight lifting or football, can lead to a lumbar strain.

The diagnosis of lumbar strain is based on the history of injury, but in the physical examination we palpate all the back of the patient facing down, to locate the pain (fig.14 a). We also ask him to try to rise the head while we are holding the ankles(fig. 14 b) and another maneuver is ask him to rise the leg with the knee straighten,on at the time, (fig. 14 c).

**Figure 14.** a) With the patient facing down palpate the paravertebral muscles all along; b) Ask the patient to rise the neck to provoke and discomfort; c) Ask the patient to rise the leg straighten
