Acute Musculoskeletal Strain: Causes, Symptoms, and Treatment

Medical Diagnosis:  Pain 

Acute musculoskeletal strain or muscle strain occurs when a muscle is torn or overstretched. The patient medical diagnosis is a sharp shooting pain on the lower back. The pain increased and spread to her right buttocks.   

Pathophysiology 

An acute musculoskeletal strain occurs due to indirect distress or stress due to excessive application of force. Often joint muscles contract leading to the tension. Some of the most predisposing factors that may lead to muscle strain include warm-up and inadequate rehabilitation. An acute strain may be due to indirect or direct trauma. In the case of direct trauma, a contusion is produced at the contact point. Indirect trauma is whereby there is no contact, but myofibers are dislocated ( Derry, Moore, Gaskell, McIntyre, & Wiffen, 2015) . Injuries also cause an acute musculoskeletal strain. Severe strains are characterized by complete tear and can be due to fatigue, reduced flexibility, and lack of warm-ups before physical activity. An acute strain can occur when one is running, jumping, lifting a heavy object, standing or working in an awkward position, or while one slips. The situation is often worse during the cold season since muscles stiffen when temperatures are low.   

Risk Factors 

Acute musculoskeletal strains vary on the angle of movement and direction of applied force. Strains and contusions make the most significant number of strain complications. Often they take place in contact areas where significant compression occurs on a muscle. The main muscles at risk of an acute musculoskeletal strain include;  

Muscles with a high amount of type II fibers; they involve muscles most involved in movements such as rotator cuff, deltoid, erector spinae, hip abductors, hip flexors, quadriceps, gastrocnemius, and hamstring.  

Muscles that contract eccentrically; Eccentric and concentric contractions occur during practical sessions that lead to tensions and later myofiber overload tear.  

Two joint muscles; Movement at a joint may trigger muscle-tension leading to overstretch (Derry et al. 2015) 

Most acute strains are mainly due to repetitive movements. Movements that can increase one’s risk include poor posture, playing sports such as baseball, golf, tennis, and rowing. Acute musculoskeletal strains risks mainly include one’s hobbies and work where a lot of physical activity is required, and muscles are put in high use. For example, failure to condition the body muscles before a vigorous exercise may increase the likelihood of acute musculoskeletal strain. Failure to warm up before strenuous activity is often risky, and the chances of getting a muscle strain are high (Derry et al. 2015). Body muscles are more likely to experience a strain when they are fatigued. Other risk factors include excessive or overuse of the muscles.   

Prevention 

There are many ways of preventing acute musculoskeletal strain. They include: 

Proper hydration  

Stretching muscles daily 

In the case of an injury, one should wait to heal before engaging in any activity 

Slight physical exercise/warming up 

Eating potassium-rich diet 

It is also vital to engage an expert if one has a frequent acute musculoskeletal strain that lasts for long on daily management practices 

Clinical Manifestations 

Evident clinical symptoms of acute musculoskeletal strain include muscle weakness, pain at the joints or specific muscle, pain while resting, and redness at the point of injury. Other clinical manifestation includes pain while relaxing and discomfort while moving/walking.  

Assessment and Diagnostic Findings 

The assessment of acute musculoskeletal strain should focus on the mechanism of the strain, the timing of the injury, pain intensity, and pain location ( Derry et al.2015) . Other assessments should focus on observing the point of injury, the temperature of edges, movement range, visible deformity, and bone tenderness.   

Medical Management 

Pierik et al., (2016) argued that medical management entails pain relief strategies such as relaxing, using ice over the strained part, compressing the area to keep from swelling, and elevating the injured part. Raising the injured area helps in reducing the chances of swelling.  

· Pharmacological 

Acetaminophen (Tylenol) or Anti-inflammatory medications are used to minimize swelling or pain. Ibuprofen is effective in reducing the healing period. Paracetamol is preferred for minor strains.  

· Surgical 

Surgery is most preferred if the patient has a torn muscle, although it comes with numerous risks, including reduced healing, pain, blood clots, and excessive bleeding ( Pierik et al. 2016) .  

Gerontologic Considerations 

The primary gerontology consideration in the treatment and management of acute musculoskeletal strain is the fragility of the body due to old age. Due to weakened muscles and bones, it is critical to apply management strategies of treatment that cannot put the patient’s life at risk ( Pierik et al. 2016) . Old age is thus a crucial factor while choosing a management strategy or treatment.  

Bedside Shift Report on Pain 

History: This is Mrs. Brown. She is a 45-year-old female, is an office manager for a busy law firm and a single mother of two children. While cleaning her shower stall she experienced a sharp pain in her lower back. Over the next few hours her lower back became increasingly more painful. By the time she picked up the children from their sporting event and drove to the nearest ER, she had sharp shooting pain into her right buttocks. Her spinal x-rays were not significant and she was diagnosed with acute musculoskeletal strain and given anti-inflammatories, hydrocodone 5mg/acetaminophen 500 mg by mouth every 6 hours as needed for pain, and instructed to rest her back for the next 24 hours. 

Neurological 

Oriented to person, place, time, and situation 

Sleepy but easily roused 

Complains of discomfort when repositioning. 

Cardiovascular 

Heart rate = 90 

No murmurs, clicks or rubs noted 

Blood pressure 118/60 

Respiratory 

Respiratory rate = 20 

Lung sounds clear to auscultation 

GI/GU 

Abdomen is soft, non-tender, and non-distended 

Urine is clear yellow 

Last bowel movement yesterday, large, brown, and formed 

Skin 

Intact 

Musculoskeletal 

Able to reposition herself as needed 

Psychosocial 

Concerned she is missing work 

Does not know what to do with her children 

Assessment  -Data collected from Bedside Shift Report.  Subjective  -A sharp pain on the lower back and buttocks and sudden pain.  -Difficulty in movement  Objective  -Stiffness of the back.	All Potential Problems  -The strain may spread to other parts of the body.  -Loss of body strength.  -Muscle swelling.  -Permanent damage to muscles.	Nursing Diagnosis  -Loss of Muscle strength  -Stiffness of the buttocks  Real Problem = Difficulty in movement  Continuous/persistent pain  Risk for problem  Difficulty in everyday activities  Difficulty in movement	Goals  -The patient will walk for at least 10 minutes  -The patient will stretch the hamstring  -The patient will lie down to strengthen and flex the back muscles	Interventions and Rationale  -The nurse will use an ice cube on the buttocks and back muscles. Ice helps relieve stiffness  -The nurse will help the patient lift light weights to flex the back muscles  -The nurse will help stretch the legs while the patient is lying down to help straighten the back muscles.	Evaluation  GM (Goal met): Patient met the stated goal within the allotted time.  GM (Goal met): Patient met the stated goal within the allotted time.  GM (Goal met): Patient met the stated goal within the allotted time.
		Nursing Diagnosis #1  Loss of back Strength	Goal:  The patient will engage in a short walking session	Intervention #1  The nurse will help the patient make short distance walks to flex the back muscles  Intervention #2  The nurse will help the patient bend and stand with feet wide  Intervention #3  The nurse will help the patient stretch backwards several times	GM (Goal met):  GM (Goal Met)  GM(Goal Met)
		Nursing Diagnosis #2  Sharp pain at the lower back	Goal:  Reduce the sharp pain	Intervention #1  The nurse to apply ice to the lower back  Intervention #2  The nurse to prescribe pain reliever ( ibuprofen)  Intervention #3  The nurse to apply electrical stimulation	GM- Goal met  GM -Goal met  GM- Goal met
		Nursing Diagnosis #3  Stiffness of the buttocks and lower back	Goal:  The patient will lie down to strengthen and flex the back muscles	Intervention #1  The nurse will massage the patient’s buttocks  Intervention #2  The nurse will ensure the patient sits on a comfortable seat  Intervention #3  The nurse will prescribe and give a muscle relaxant medication	GM- Goal Met  PM- Goal met  GM- Goal met

References  

Derry, S., Moore, R. A., Gaskell, H., McIntyre, M., & Wiffen, P. J. (2015). Topical NSAIDs for acute musculoskeletal pain in adults.  Cochrane Database of Systematic Reviews , (6). 

Pierik, J. G., Berben, S. A., IJzerman, M. J., Gaakeer, M. I., van Eenennaam, F. L., van Vugt, A. B., & Doggen, C. J. (2016). A nurse-initiated pain protocol in the ED improves pain treatment in patients with acute musculoskeletal pain.  International emergency nursing ,  27 , 3-10.