Back Muscle Spasms

Muscle spasms in the back are defined as sudden involuntary tightness of the muscles surrounding the spine. Back spasms may affect people of all age groups and are commonly caused by certain movements/activities or underlying spine disease. Muscle spasms in the back are frequently treated with conservative therapies and rarely need surgery in case of structural spine diseases.

Anatomy of the Spine

Muscle groups surround the spine both in the front and the back of the spine. These muscles work together to support the spine during various movements such as bending, lifting, twisting, turning, walking, running, etc. The muscles not only aid in the movement but also provide stability to the entire spinal column. The muscle commonly involved in muscle spasms in the neck is the trapezius, and erector spinae or latissimus dorsi in the lower back.

 

Back Muscle Spasm Causes & Pathology

Back muscle spasms usually occur as a result of injury to the muscles involved during abnormal or repetitive activity. Patients commonly complain of muscle spasms after lifting of heavyweight, improper sleeping posture, or after sports involving repetitive spine motion. These activities may cause small tears in the muscle fibres or the tendons leading to inflammation. The involved and the surrounding muscles tighten to prevent further strain.

Excessive exercise or absence of exercise may both cause back spasms. Excessive repetitive exercise with improper technique may result in muscle strains. Similarly, inadequate exercise results in weak abdominal or back muscles which become more vulnerable to injury from day to day activities. A more serious injury such as motor vehicle accidents or a fall from a height may cause muscle spasms due to direct damage to the muscles or the structures of the spinal column.

Back spasms may also indicate an injury/disease of the structures forming the spinal column. Disk herniation, facet joint disease, spinal stenosis, degenerative disease of the spine may irritate the spinal nerves and roots leading to muscle spasms. The back muscles in the case of spinal disease tighten to act as a brace and prevent further compression/irritation of the spinal roots/nerves.

Metabolic bone diseases such as osteoporosis may lead to compression fractures of the vertebrae that may lead to subsequent muscle spasms. Inflammatory bone diseases such as ankylosing spondylitis may also cause muscle spasms.

Rarely, infection or tumors of the spinal column may also cause muscle spasms by direct irritation of the involved muscles. There may be infection or inflammation of organs such as kidneys or gallbladder leading to muscle spasms in the back.

Symptoms
The symptoms of back muscle spasms may include pain, stiffness, and tightness of the back. Pain may be worse on activities such as bending forward or lifting. Pain may be radiating in the case of an underlying pinched nerve due to spinal stenosis or herniated disk. There may be associated with numbness and tingling in the case of a pinched nerve.

Rarely in the case of cauda equina syndrome, the muscle spasms may accompany red flag signs such as loss of bladder bowel control and weakness/numbing of the lower extremities. Other red flags associated with severe spine disease are fever, weight loss, back pain at night. These symptoms require immediate medical attention and may require surgery.

Management
The management of back muscle spasms is generally conservative and most patients experience relief in 2-3 weeks. The physician may extract through history regarding the events preceding the symptoms and conduct a physical examination. Conservative management of muscle spasms includes using heat or cold therapy, over-the-counter medications, activity modification, and physical therapy.

Cold therapy involves icing the involved area for 10-20 mins and repeating it multiple times during the day. Cold therapy is effective in the period immediately after an injury. The cold temperature prevents further swelling/inflammation and decreases pain. The cold therapy is delivered with the help of ice-packs.

Heat therapy works by increasing the blood flow to the involved area and thereby hastening recovery. The heat also relaxes and soothes the damaged muscles, tendons, ligaments, and nerves. The heat therapy works best after 1-2 days after the injury and in chronic conditions. The heat therapy is usually delivered with the help of heating pads or warm bottles.

Pain medication such as Tylenol or Nonsteroidal Anti-inflammatory medications such as Advil/Naproxen may be used to help relieve pain and inflammation associated with muscle spasms. These medications are used cautiously in a patient with underlying conditions such as gastritis or bleeding diathesis. Sometimes, the physician may prescribe muscle relaxant medications to provide relief from severe muscle spasms.

Activity modification forms an important aspect of the management of the muscle spasms of the back. The patients are advised to avoid any activity aggravating the muscle spasms or pain. The patients are otherwise advised to remain physically active and continue day-to-day normal activities.

The majority of the patients experience significant relief with the above treatments. Patients exhibiting red flag signs such as weakness/numbness of the lower extremities and loss of bowel/bladder control may require emergency surgery to relieve the pressure off the dural sac.

The patients who fail to benefit from conservative therapy which was tried for at least 4-6 weeks may require further investigation such as an X-ray followed by an MRI to look for the pathology of the spinal column. Trigger point injections may be given to provide relief.

The management of muscle spasms due to an underlying disc herniation, spinal stenosis, metabolic bone disorder, or inflammatory spine conditions receive treatment focused on the underlying pathology. Physical therapy is usually started after the relief from symptoms. The therapy focuses on both strengthening and increasing the flexibility of the muscle in front and back of the spine.

Prevention
The prevention involves strengthening the muscles surrounding the spine and stretching the muscles to improve flexibility. The patients who are overweight or obese are advised to reduce weight. The patient is advised regarding the maintenance of proper body postures during walking, sitting, sleeping, or when engaging in sports activities.