Lumbosacral strain is an injury to the lower back musculature caused when a muscle is overworked or overstretched causing a tear of the muscle and tendon.

Low back pain and strain are usually due to improper posture; trauma; lifting; bending; twisting; prolonged standing; and degenerative changes. Cervical strain is usually a result of trauma or a stretch injury to the muscles, ligaments or joints of the cervical spine.

Signs and symptoms of lumbosacral strain include: pain, stiffness, swelling, bruising, and aching lower back; pain that radiates to the thigh, but not below the knee; restricted spinal motion; spasms and tenderness; abnormal walking; difficulty in sitting; and sciatic lists.

Signs and symptoms of cervical strain include: dizziness, pain in the shoulder or between shoulder blades, tinnitus, blurred vision, difficulty concentrating, memory problems, irritability, sleep disturbances, and fatigue; neck pain and stiffness; headache; and limited range of motion of the neck.

Physical examination during which the type, character, and precise location of pain is determined. In addition, if pain persists, and the cause has not been identified, other measures may be instituted. These measures include: x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI); myelography; bone scan; electrodiagnostic studies; and electromyography. However, in cases of suspected trauma, baseline x-rays, particularly a lateral c-spine film, should be done prior to a full examination.

Initial treatments include: bed rest with limitation of activities; ice massage; anti-inflammatory medications; muscle relaxants; patient education regarding posture and body mechanics; and exercise training.

For lumbosacral strain, treatment with bed rest should only be done for one to two days. Other treatment modalities include heat, electrical stimulation with transcutaneous electronic nerve stimulation (TENS), intramusculature (IM) injections of muscle relaxants or non-steroidal anti-inflammatory drugs to control muscle spasms. For severe strains, immobilizing the muscles through use of a brace aids recovery.

For cervical strain, stretching exercises can help recovery once pain is under control.

As with most musculoskeletal conditions, in spite of therapy, there may be varying degrees of impaired physical mobility, and limited activities of daily living (ADL).

Use of a lumbosacral muscle corset to support the back muscles during weight bearing activities may be helpful to reduce the incidence of reinjury. For cervical strain, avoidance of unusual postures for long periods of time and use of ergonomic devices can limit the incidence of reinjury.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Evaluate under the General Rating Formula for Diseases and Injuries of the Spine for diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine.) The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.