How to Tell the Difference Between a Lower back Sprain and a Fracture in the Lower back. - Nose Creek Sport Physiotherapy
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How to Tell the Difference Between a Lower back Sprain and a Fracture in the Lower back.

Lower Back Pain

Both lower back sprains and fractures can share a large portion of the same symptoms such as sharp pain, muscle spasms, and limited mobility. A sprain is an injury to the ligaments that help stabilize the lumbar vertebral bones and usually results from a sudden or gradual irregular movement or an unnatural twisting motion of the joint or an improper heavy lift.

A fracture refers to a break in the actual vertebral bone. The lower back is comprised of 5 lumbar vertebrae attached to your pelvis. Your pelvis is made up of 3 bones the sacrum which is an upside down triangular shaped bone in the middle of your pelvis, between 2 innominate bones that form the pelvis. I have seen many lumbar sprains and fractures while covering sports and dealing with active weekend warriors for a lot of years. Initially, the Lumbar spine disks will tend to swell up quickly and often you will feel like someone kicked you in the back and you experience a bruised feeling. Bones when broken or chipped do tend to bleed a lot, but often you cannot see the bruising right away as the tissue is deep under 2+ inches of spinal muscles. If the Lower back has a CONSTANT intense ache that is unrelenting no matter what position the back is in, and there is limited ability to weight bearing in sitting and stand up on your legs, you should go get an X-ray to rule out a fractured bone in the lower back.

Sprains will tend to have INTERMITTENT pain once you have iced and settled the pain down and a movement pattern of pain reproduction, meaning when your reproduce the mechanism of injury you get pain, but at rest when lying down (non-weight bearing) there is little or minimal pain, whereas the fracture will keep thumping away constantly telling you something is really wrong no matter what position the lower back is in.

Lower Back Fractures

There are some differences that might clue you in on whether or not your accident may have resulted in an lower back fracture. They can include the following:

  • Generally caused by a sudden impact or twisting pivot from a fall
  • Hearing a popping or cracking noise
  • Range of motion is reduced significantly
  • Muscle spasm that are splinting your movement
  • Numbness of pins and needles in the back or down one leg or both legs
  • Constant intense dull ache that is unrelenting
  • With an lower back fracture, you will normally see the pain worsen over a period of time with the inability to bear any kind of weight on the bone, prolonged standing and sitting is both painful, some relief maybe experienced in lying down, but the pain will still be there and constant.

Here is an example of a spinal fracture I have seen in our clinic that I referred out for X-rays before starting any Manual Therapy:

Mountain Biking Accident

A loyal client was mountain biking down a hill and the front tire got stuck and he flipped over the bike handle bars and landed on his right lower back and hip. He complained of the symptoms above, and felt it was just mechanical and wanted me to manipulate his lower back to give him some pain relief.


Upon assessment he had no right side bend and his pain increased with the specific movement in the back with no referred pain down his leg. He had hypertonicity in his right paravertebral spinal muscles which where splinting his back and guarding any further movement. At that point due to the history and his symptoms I sent him off to his doctor for X-rays that came back the next day as positive for oblique fractures of all 5 transverse processes of the lumbar spine. The transverse processes are the boney horizontal arms come off the sides of the vertebrae that attach to muscles in the back.


He returned for treatment once the fractures were healed, to restore his mobility, CORE strength and endurance, and overall function for his active life. He had to slow down for 6 to 8 weeks to allow for healing, but did well in his rehab and has returned to full activities and an active lifestyle.

Lower Back Sprains

With lower back sprains, pain will usually be tolerable if there is no fracture present. Muscle and joint pain does somewhat differentiate itself from bone pain. The following symptoms may indicate an lumbar ligament sprain:

  • Lower back can move, but causes you great discomfort, usually worse with forward bending then backward bending.
  • Redness or warmth at the lower back
  • Stiffness due to swelling in the disk
  • Muscle hypertonicity of the spinal muscles, especially guarding on forward bending
  • exclamation-triangle
    Intermittent pain with movement (not constant dull ache)
  • exclamation-triangle
    Maybe experiencing some referred pain down the back of the leg called sciatica, due to a pinched nerve in the lower back.

Here is an example of a lower back ligament sprain presentation:

Lower Back Pain

A loyal client presented at the clinic with pain in left side of his back, and intermittent left leg pain down the back of his left leg, when he bent forwards or sat for more than 10 minutes. His walking was limited to no more than 10 minutes, otherwise his symptoms worsened. When he bent forwards his pain was worse on the affected side and he could not bend all the way only about 1/3 of the way down to his toes.


If he lied down his pain would reduce especially with the application of ice for 15 minutes. He did get some relief with repetitive backwards arches in prone, so that become part of his daily home exercise routine with ice. He was advised to not sit for the next 2 weeks to allow the swelling in his lower back disks to settle down.

If you injure your lower back, lie down and take the weight off you back, place a cold ice pack over a washcloth to prevent frostbite, and decrease swelling and reduce your pain, by numbing the affected area, until you can get medical treatment. You can be icing your back once an hour for 15 minutes.

With a lower back sprain and fracture you want to off load the compression forces through the spine by lying down. Let just say that if you are lying down you have 100% compression in your lower back, when you stand up there is 200% compression, when you sit in the perfect ergonomic position at work it is 500%, when you slouch like we do in a vehicle or couch, it is 900% more compression. That is why I always recommend to reduce sitting for the first 2 weeks of an acute lower back injury. Short intermittent walks and lying down are two preferred activities to speed up the healing of a sprained lower back.

In the initial stages we want to reduce pain and any further swelling or bleeding to the injury. Thus the importance of lying down with ice frequently in the first 2 weeks of your recovery.

Ruling out a fracture early on is important for us as your Physiotherapist, because our management of your injury will differ depending on the injury. Lumbar sprains can start rehab within 2 days of injury, whereas the fracture will not start rehab until the bones are stabile and weight bearing is possible. With a fracture you will be asked to rest for a specific period of time to allow for bony healing to occur. Usually vertebral fractures can take 6 to 8 weeks to fully heal, so you can start your rehab after that period.

Because it can be very difficult to tell between lower back sprains and fractures, an x-ray is almost always advisable. If you have a history of trauma to your lower back and are experiencing the characteristic symptoms of a fracture we described earlier, your doctor should obtain an x-ray of the lumbar spine to make sure none of the bones have been fractured.

If you have continuing pain from a back sprain or fracture, please call our Beddington clinic at 403.295.8590, or or click here to learn more about how we can help you to end your back pain.

Blair Schachterle BScPT, Dip Manip PT, Dip Sport PT, FCAMPT, CGIMS

Blair Schachterle BScPT, Dip Manip PT, Dip Sport PT, FCAMPT, CGIMS

Blair has been a Physiotherapist at Nose Creek Sport Physiotherapy since 2001. Blair graduated from the University of Alberta with a BScPT in 1992. He has focused on Orthopaedic Manual Therapy and Sport Therapy. Blair completed his Sport Therapy Diploma in 1997, and his Advanced Manual and Manipulative Diploma in 1998. Blair is also certified for IMS (Intramuscular Stimulation) Dry Needling. Blair has a keen interest in active rehabilitation of recent and chronic, spinal and peripheral, joint and muscle injuries. He enjoys treating upper neck pain that is associated with cervical tension headaches, sciatica (pinched nerve in lower back), shoulder injuries and traumatic knee injuries. Blair previously served for 6 years as the Executive Chair of the Canadian Academy of Manipulative Therapy (CAMPT).

Blair balances his busy professional life by staying active. He enjoys cycling, swimming, working out, hiking, camping and snowboarding, depending on the season. Blair shares his free time with his wife, son and daughter outside on the weekends. He has learned to enjoy the journey, as life really is too short.
Blair Schachterle BScPT, Dip Manip PT, Dip Sport PT, FCAMPT, CGIMS

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