The first time I ever suffered a genuine “back spasm” was a day I will never forget. I was in a car park, sitting in the car, and I bent down sideways to pick up my wallet from the floor on the passenger side (trunk in flexion and rotation). Whilst I was in this position I sneezed and felt this almighty thump in my back like someone had shot me with a bazooka. I was stuck in that position for a good 5 minutes. Sweet relief only came with a cocktail of pain killers – Valium, Tramadol and Voltaren.
We often see clients who present to the clinic with acute onset of back pain associated with a degree of protective muscle spasm. Genuine back spasms are an example of common low back disorders, along with the more frequent lumbar spine disc injuries, facet joint sprains and rib joint sprains. A muscle spasm can be defined as an acute onset of uncontrolled and involuntary muscle contraction. Most of us may be familiar with the sensation of muscle cramps such as the calves and hamstrings that usually accompany fatigue in the affected muscles. These types of cramps (a form of spasm) are usually caused by fatigue related dehydration and/or electrolyte imbalance. These can be quite debilitating and painful and usually resolve with aggressive stretching and rehydration and are short term.
Back muscle spasms are rarely this type of phenomenon. Back spasms are more often caused by a sudden ill directed movement that causes a muscle to spasm. For example, if someone is bent over and sneezes, they may cause a sudden spasm in a thoracic muscle that “locks” the back up. Or the person may attempt to lift a heavy weight (gym or occupation) and they may feel a muscle spasm. Golfers often complain of acute back spasms following big tee shots with driving woods, due to the sudden forceful muscle contraction involved in rotating the spine.
Often the spasm is a warning sign that something under the surface is waiting to become problematic. For example, if someone sprains a facet joint or tweaks a disc, often the muscles in the back area will spasm as a protective mechanism. The common muscles to spasm are the quadrutus lumborum (QL) and the thoracic paraspinals. Red flag symptoms such as bladder and bowel problems or neurological sensations down the leg such as numbness, pins and needles and weakness are usually indications something much more sinister is happening at the spine level. The spasm is purely a warning sign. In these instances, a thorough workup is needed involving doctors, radiology and the like.
If the spasm is a true and genuine spasm caused by the uncontrolled contraction of the muscle, then there are number of things the therapist can do to relieve the spasm. Primarily, if the spasm is debilitating they may need referral to a doctor to obtain some muscle relaxants and/or anti-inflammatory medication. These can be quite effective in dulling the spasm very quickly. The more therapist orientated interventions are directed at relieving the spasm via gentle soft tissue massage to “work out” the spasm. This is particularly useful on muscles such as the QL in the case of low back spasm or the paraspinals and QL in the case of rib joint sprains.
The Side Lie Stretch can help alleviate the spasm. A safe stretch for the QL is the side lie stretch. Lie on the affected side and bend the knees and hips up. Prop up on the elbow and slowly let the body sink in towards the floor to create lateral flexion of the trunk. This can be held for 5-10 minutes and is quite safe to do even in the case of an acute and painful spasm.