Even though everyone suffers from an intense back muscle spasm at some point, most people fail to recognize that there might be a bigger problem. We wait for the spasm to subside by itself, sometimes medication help, but what if it didn’t.
We tend to pick out the cause of the pain by thinking “What did i do?” and we draw our own conclusion e.g. like it must have been that box I picked up. Even though in the vast majority of cases, the cause is not the activity involved, but a ongoing chronic problem where our body is failing to meet the demands of the activity.
Please don’t start thinking: “My core is weak”. No, this is already at the end result. This is what you get when the structures in your back starts failing to support your own body weight.
Yes the Core muscles needs to be addressed, but there are more pressing issues that need to be sorted first.We don’t really think when we move, knowing what muscles to activate, controlling the magnitude of contraction. No, we just do it. Your body has its own intricate system how to adapts to force and change position to accommodate you in whatever you want to do. Hundreds of muscles that need to coordinate between each other.
There were warning signs, believe me
Stiffness, discomfort in the lower back and a feeling described as “It’s NOT lekker”. This is your warning that sign of a deeper, more complex problem. Your body is taking the first steps to protect itself and attempts to bring it to your attention. We ignore it. The next step would be the muscle spasm, where the body has to limit your movements in order to protect itself. The muscles usually act first to protect the joint, ligaments, and nerves in the area.
How strong is your foundation?
Stage 1 – Healthy
A healthy core along with all the supporting muscle groups, joints, discs, and ligaments. This makes a system that works in perfect synchronization and can react to any stress and load that you put on it. It’s like a tower of Jenga blocks stacked on top of each other.
Stage 2 – Falling apart
As each block that is removed from the tower and it becomes less aligned or re-positioned incorrectly, the chances of the tower collapsing becomes more likely. Then sufficient blocks are removed, a very stable structure, becomes stable but still appears to intact. The slightest movement can topple the whole structure.
Stage 3 – The last block
At this point the tower appears to be just as stable as in Stage 2 but is far from keeping the tower supported. It is at this point when a back spasm occurs, when the last stable block is removed from its position. The other blocks are no longer able to provide the support needed and the tower crumbles. Your back attempts to desperately save the structure from collapsing that it contracts all the muscles to prevent the vertebrae from shifting.
Stage 2 is where most of us are and we rarely ever return to Stage 1.
This is because we find inadequate ways to return to Stage 1 by fooling our own system. We are actually Stuck at at stage 2 because we try to build up the same deck of blocks and desperately try to make it work with that last block ready to be removed again. We take medications, go for a massage, do some stretches and fool our system to believe that its all “back to normal” when in fact the tower of blocks are on the edge of collapsing again.
To prevent or reduce back spasm, we need to re-position all of the other blocks and not just the last one. Part of the reason that we do not do this is because pain relief occurs as soon as we replace that one stable card. The first sign of such relief gives us reason to believe that we have fixed our back spasm. When its just a matter of time that it’ll all come back again.
- Dull, cramp like pain
- Spasm eases when lying down
- Single point or over a broad area
- Spasms slowly get worse
- Pain when sitting or driving
- Unable to stand upright after sitting
- Sharp stabbing pain when moving
- Spasms don’t ease
- Numbness & tingling in legs & butt
- Sharp electrical pain when walking
- Unable to walk without pain
- Pain when lying down
- Numbness in legs
- Sharp Pain with breathing, sneezing & coughing
- Weakness of leg muscles
- Legs giving away when walking
- Dead feeling over skin
- Unable to control bladder
Your body protects itself from you
Understand the reasons to avoid the consequences. Back injury is usually due to poor overall conditioning resulting in a lack of protection of our lumbar spine. That area of the lumbar spine sends feedback to the muscles to protect it, by any means necessary. When the muscle surrounding your lower back is signaled to contract, it will contract as a full force.
These mechanisms protect you from moving into directions that will cause more damage to deeper structures like discs, joints and nerves.
Take action! What’s your plan?
The different sources and reasons of pain from the back makes treatment selection very complex. Each structure needs to be addressed individually in order to resolve your back spasms. The risk of going on like you have been, can cause more critical and possible irreversible damage to your back. This is why it so important to understand where we as practitioners come from.
Common mistakes with recommendation
Where are always people who offer advice and say “Try this, it worked for me.” A shotgun approach (hoping you’ll hit something). You have no idea if the source of your problem is the same as his/hers. So please don’t…
Some medical practitioners even disregard the source of the problem and only treat your pain. This will only leave you back in Stage 2. Lists of exercises and stretches to help you with your pain can cause more harm than good, because you are left to do it on your own, you make up your own mind what the exercise is trying to achieve. In most cases when we ask a patient ‘why are doing this, and what are you trying to achieve’ they have no idea.
Now you would like list of medication that could relieve your back pain, well I’ll ask you “What structure are we trying to target?” Medications are designed to act on a specific structures e.g. Spasmed (Muscle relaxant), Diclofenac (Joint anti-inflammatory). You get the idea. Don’t take muscle relaxants if the problem’s origin is in the joints or nerves.
What you should do
To avoid this mistake, you should consult with a physiotherapist to identify the reasons of your pain, and start to understand the relationship between the muscles, joints, ligament and nerves in your back. Its hard to hear, but there are no quick fixes, unfortunately.
Your plan must involve a physiotherapist that you trust. There must be guidelines, goals, time to recovery and deadline to get you pain free. Each patient differs, but we are able to recondition you and gradually get you back to Stage 1.
Lower back muscle strain
Strains occur when a muscle is pulled or extended beyond its limits. This usually happens when the muscle is contracted while it is being overstretched. Muscles can also strain when it is forced to contract or remain contracted beyond it’s normal limits. For example picking up a heavy box from the ground your back muscles need to contract to bring you upright, your back muscles need to contract while it is at its full length this makes the muscles very vulnerable to injury.
If the resistance load placed on the back muscles are too excessive the muscle can no longer hold the resistance, this causes small micro tears. There are three layers of muscles in the back, the muscle strain will occur in any of these three layers depending on the direction and movement that caused the overload or overstretch.
Lower back muscles usually get injured when the back is flexed (bent forward).
Overexertion while lifting heavy e.g. Picking up heavy objects off the ground.
Pulling a muscle as a result of holding a heavy object for a long period of time. e.g. Carrying a heavy couch or new furniture around the house. If the muscle is unable to sustain the contraction under high load it will cause damage to the muscle tissue.
Repetitive bending or twisting in an awkward angle. e.g. Picking up the children’s toys.
Slipping or falling causing a weaker muscle to overextend.
Identify which muscle
Physiotherapists use a variety of screening and stress tests to determine which muscle is the culprit. We are able to accurately identify where the problem is coming from. We also visualize the tear on Sonar to show you what it looks like, the depth and length of the tear.
Grading the severity of the muscle strain
A small amount of micro test occur within the muscle, usually presents as stiffness rather than pain. There is usually full recovery within 3 days.
A large amount of micro tears occur and the muscle show signs of pain when it is stretched. Rupturing of the small blood vessels may be present causing visible bruises or swelling.
The muscle tears along a large area. This is the most severe muscle strain that you can get. This degree of muscle strain will cause intense sharp pain, even the slightest movement stretching or contracting will cause severe lower back pain.
Our body automatically activates mechanisms to protect itself in order for it to heal. Lower back muscle strains can trigger spasms as our body activates the set of muscles on either side of the tear, in order to restrict movement and protect the muscle from further injury. This type of protection is known as Muscle Guarding.
Typical examples such as leaning forwards to pick up a too heavy object, the muscles in your back won’t be able to withstand the force and cause tears in the muscle. The small micro tears will cause pain.
The muscle surrounding the tears will tighten up in order to restrict you from bending forward again. Although the tear will repair over time, the guarding muscles may produce pain for a few weeks. Any sudden bending movements will cause the muscles to seize up, effectively locking you up to prevent it from happening again. This is associated with the intermittent sharp stinging pains in your back.
We can help
If you are currently struggling with back pain it could be due to muscle injury or far worse problems. If you are looking for someone to help you through this process and to ease the pain, give us a call and let’s discuss your problem.
Other structures that can cause lower back spasms
Muscle stiffness due to overexertion of the back extensor muscles by doing repetitive movements e.g. bending down to pick up papers off the floor. An overload can also cause the muscles to seas up like picking up something too heavy, too fast. Shortening of the hip flexor muscles exerts more pressure on the back by tilting the pelvis forward. Back muscle spasms are usually secondary to a underlying cause like joints or nerves.
Pain radiating form the joints. When the muscles that run between joints shorten, they compress the two bony surfaces together and puts more pressure on the joint. Muscles could tighten up and pinch a nerve that run between muscle groups. Which one came first? Joint or muscle pain, Muscle or nerve pain.
Lower back pain from sitting
Clearly we were never made to sit for days on end. Mankind evolved from hard laborers to sitting for hours in front of a computer or a desk, without breaks or interruptions. We train our bodies to sit for these long periods without us even knowing it. Lower back pain from sitting for long periods of time is quite common, but you need to understand it develops to this point. When your body refuses to sit for 5 minutes before it cramps up your back and send you home to just go lie down to get any form of relief.
You argue with yourself “How the hell can this be! I didn’t do anything, hell if I’d do any less, I’ll die”
Its important to understand that although you ‘feel’ rested in a seated position, your spine is not actually in a restful state, not to mention the load that you are putting it under. Sitting actually puts you in a very vulnerable position. When you sit, your body relaxes almost all of the muscles you don’t really need at that moment except for some small stabilizing muscles that keep you from flopping over your desk or falling off the side of your chair.
This is a static position when the pressure on the structure is very high without a lot of support form the surrounding muscles. The pressure form the weight of your upper body squash the lumbar discs and facet joint, not just for a few minutes, but hours on end.
Lower Back pain from Sitting for Long periods of time = Not good, here’s why…
While sitting, the muscles that MOVE the lower back are not recruited, because your are not moving. But when the small muscles that stabilize and keep the spine upright fail to support your back, the larger moving muscles are activated to help. This in itself causes some problems. Have you ever carried a 5 kg bag for a few hours (not very pleasant experience). Well new research has shown this to be the case, that your bodies automatically react to pain by recruiting the larger muscles that should only be MOVING us, instead they are trained to STABILIZE the lower back leaving them confused to what their role is.
When we reach this point there are only problems waiting to happen. The lager moving muscles now has a dual role of stabilizing the spine AND moving it. These larger muscles now activate when we are sitting. Back to the example of carrying a bag for hours. The Biceps is a movement muscle (but you activate it when you carry something) in this case there is no movement taking place at the shoulder or the elbow, the biceps must maintain its contraction then there is no movement taking place, but a load (5 kg bag) must be sustained. This type of muscle contraction is called a myotonic contraction. This is what the lower-, middle- and upper-back muscles must do to hold you in a sitting position. You can maintain the contraction for a short period of time, but it was never designed to contract for hours on end.
This constant contraction of the lower back muscles leads to shortening of the muscles in your back, putting more and more pressure on the facet joints and discs.
Sitting posture and back pain
While sitting, the muscles that stabilize the lower back, hips and pelvis lose their support. The spine itself ‘relaxes’ and forms an excessive curve forwards that is unsupported by the surrounding muscles. The wight of your upper body (20-30 kg) rests on the lower lumbar vertebrae and place unbalanced pressure on your facet joints and discs. In some cases when you lean so far forward (e.g. working on a laptop at a coffee table) you over stretch your back muscles that should provide support for your back, these muscles tend to fatigue much faster.
Lower back muscle spasms can be seen as the ‘prequel’. This is the first warning signs that something is wrong. Your pelvis tilts backwards and loses its neutral position(which puts you even more at risk of overstretch and fatigue your back muscles. When you ignore the lower back stiffness, spasms, pain and just carry on, you will end up with bigger problems like a slipped lumbar disc or disc bulge that develops into a full prolapsed disc.
Good sitting posture for your back
When sitting you must be able to roll your pelvis forward and backwards. This will give you a good idea how far forward and backward you are able to roll. As you do this movement you will feel how your lower back changes position. The further back you tit your pelvis, the more the lower back curves, and the more you tilt forward the more your back arches forward. In between these two extreme ranges, we have a neutral position. The neutral position is the point where there are the least amount of strain on the back muscles, joints, discs, ligaments and all the other structures in the back. This neutral point is where we want to be.
Physiotherapists’ plan of action (PVA)
To return to neutral the pelvis must be retrained by reducing the backwards tilt, activation and reconditioning of the small stabilizing muscles. Deactivation of the moving muscles in sitting. Stretches of the Psoas and Iliacus muscles are vital. Strengthening and shortening of the Gluteus maximus, medius and minimus muscle groups will help with lumbar support and protection. Strengthening and re-conditioning of your back extensor muscles (upper and lower back) to help maintain a neutral sitting position, so you are able to sit without any pain.
What you should do
Consult with a trained physiotherapist that can tell you exactly what the problem is, it might sound bias, but there is no way you are able to tell if you only have a few shortened and tight muscles or if you’re sitting with a lumbar disc bulge(that is far more serious) that requires a totally different course of action.
For now: Limit your sitting time. No seriously!! Sit for a maximum of 20-30 minutes and take a ‘break’. Stand up for 2 minutes, get some movement going, walk around the office/ block.
But in all seriousness, you should give us a call and we can guide you through the process.
How scoliosis affect your back pain when you are sitting
If the alignment of your spine curves to the right or left, you should consider the implication of how the load is distributed through your lumbar vertebrae. As we have already discussed how this ‘resting state’ affects your body, you will be at a much higher risk of causing irreversible damage to the facet joints and discs.
Scoliosis is an end result that you get, when you add a tilt to the side (left or right). If you continue to.
Why medication is only a temporary relief
Patients tend to try anything on the other side of the ‘self medicate’ counter, before they realize its not working. Well let me tell you why:
Pain killers mainly stops the pain impulse traveling to the brain to tell you there is something wrong. Stop that impulse, and the pain will go away… For a while. The medication doesn’t really change the pressure or position that you are sitting in, in fact it only masks the pain. The pain will come back, just wait and see.
Muscle relaxants tend to help for the first 3 days, but makes the whole situation even worse. The muscles are trying to keep your back supported and stable, now you tell to shut down. Initially its good for the muscle to receive an external input to tell it to relax but then (as a normal reflex) your body will activate those muscles again, even with more force than before. This leads to severe back spasms due to the battle between you and the muscles trying to tell it what to do. Relax or Support.
Anti-inflammatories tend to be quite effective at relieving the pain due to its action on the lumbar facet joints. The pressure from your upper body squash and compress the joints between each vertebrae on top of each other. This compression, irritates the joint surface and activates an inflammatory reaction. The anti-inflammatories help the lumbar facet joint to become less irritated, but the pressure… Its still there, you’re still sitting.
What scans and tests are necessary
In some cases physiotherapists may send you for X-rays to determine the current state of your spine. Diagnostic Sonar could show muscle tears of fascia restrictions. MRI or CT-scan could be very informative, but a bit of an overkill.