Even though everyone suffers from an intense back muscle spasm at some point, most people fail to recognise 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?” Then draw our 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 an ongoing chronic problem where our body is failing to meet the demands of the movement.
Please don’t start thinking: “My core is weak”. No, this is already at the result. The pain is what you get when the structures in your back start failing to support your body weight. The back muscle spasms is a protective mechanism for how your body tries to prevent further damage to tissue.
Yes, the core muscles need to be addressed, but there are more pressing issues that need to be resolved first. We don’t think when we move, knowing what muscles must activate, control the magnitude of each contraction. No, we just do it. Your body has its intricate system on how to adapts to force and change position to accommodate you in whatever you want to do. Hundreds of muscles that need to coordinate with each other.
Back muscle spasms is a protective guarding of other vulnerable structures like joints, nerves and ligaments.
Each person’s case is unique, and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.
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 your body takes is – muscle spasm, where your body has to limit your movements to protect itself. The back muscles usually spasm first to protect the joint, ligaments, and nerves in the area. This protects the deeper structures from further injury.
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 system. We are Stuck 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 it’s 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 it’s just a matter of time that it’ll all come back again.
Your body protects itself from you
Understand the reasons to avoid the consequences. A Back muscle spasm 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 signalled 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 to resolve your back spasms. The risk of going on as you have been can cause more critical and possibly irreversible damage to your back. This is why it so important to understand where we as practitioners come from.
Getting to the Root of the problem
Physiotherapists use a variety of screening and stress tests to determine which muscle is the culprit. We can accurately identify where your back spasm is coming from. Our main focus is to test the more essential structures surrounding your spine to make sure we eliminate any nerve, joint or disc injury. The back muscle spasm may be the least of your problem.
If we suspect you injured the muscles, the best would be to see the tear on Sonar to show you what it looks like, the depth and length of the damage.
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 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 a 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 structure, 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 for your pain, and start to understand the relationship between the muscles, joints, ligament and nerves in your back. It’s 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 can recondition you and gradually get you back to Stage 1.
Muscle spasm from injury to the back muscles
Back muscle 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. Back muscles tend to strain when it is forced to contract or remain contracted for too long under a lot of pressure. For example, picking up a heavy box from the ground your back muscles need to contract to bring you upright. These muscles need to contract while it is at its full length; this makes the muscles very vulnerable to injury.
If the resistance or load placed on the back muscles are too excessive, this muscle can no longer hold the contraction. This combination of muscle fatigue and overload may lead to your back muscles to spasm. There are three layers of muscles in your back; a muscle strain will occur in any of these three layers depending on the direction and movement that caused the overload or overstretch. The muscles surrounding the injured muscle will spasm to protect even further injury to your back muscles.
Lower back muscles usually get injured when you bent forward. When the back spasm set in, it leaves you unable to bend to reach your toes, put on shoes, brush your teeth, or even sit down.
Movements that could cause your back to spasm
- 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. 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.
Grading the severity of your back muscle strain
A small amount of micro test occur within the muscle, usually presents as stiffness rather than pain. There is typically full recovery within three days.
A large number of micro tears occur, and the muscle shows 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 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, to restrict movement and protect the muscle from further injury. This type of protection is known as Muscle Guarding.
Typical examples such as leaning forward 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 tissue. The small micro tears will cause pain.
The muscle surrounding the tears will tighten up to restrict you from bending forward again. Although the damage 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 spasms in your back, it could be due to muscle injury. We can 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. Even shortening of the hip flexor muscles exerts more pressure on the back by tilting the pelvis forward. Remember that back muscle spasms are usually a secondary problem to an underlying cause like joints or nerve injury.
Pain can radiate from 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 runs between muscle groups in your back. Which one came first? Joint or muscle pain, Muscle or nerve pain.
Lower back pain & spasm from sitting
Clearly, we were never made to sit for days on end. Humanity evolved from hard labourers to sitting for hours in front of a computer or a desk, without breaks or interruptions. We train our bodies to sit for these extended periods without us even knowing it. Lower back pain from sitting for long periods is quite common, but you need to understand how it develops to this point. When your body refuses to sit for 5 minutes before it spasms up your back and send you home just to 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”
Causes of these Spasms
It’s 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 puts you in a very vulnerable position. When you sit, your body relaxes almost all of the muscles you don’t need at that moment except for some small stabilising 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 from the weight of your upper body squash the lumbar discs and facet joint, not just for a few minutes, but hours on end. Your body detects the tissue damage and spasms the muscles surrounding your spin to give it some support. Usually, the back pain is worse when standing up after you’ve sat for so long.
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 you are not moving. But when the small muscles that stabilise 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 our 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 have a dual role of stabilising 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 move 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, 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 stabilise 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 weight 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 overstretch 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 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, you must be retrained by reducing the backwards tilt, activation and reconditioning of the small stabilising 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 can sit without any pain.
What you should do
Consult our Physiotherapist that can tell you exactly what the problem is, it might sound bias, but there is no way you can know 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 lower back joints and discs. Never mind the occasional back spasms that come & go.
Scoliosis is the result that you get when you add tilt to the side (left or right).
Why medication is only a temporary relief
Pain killers mainly stop the pain impulse travelling 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 change the muscle’s physiology, nor does it change the pressure or position that you are sitting in; in fact, it only masks the pain. The spasms will come back, just wait and see.
Muscle relaxants tend to help for the first three days but can make the whole situation worse. The muscles are trying to keep your back supported and stable, now you tell them to – shut down. Initially, its good for the muscle to receive an external input to tell it to relax but then when the medication wears off, 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 vertebra 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… It’s still there, and you’re still sitting.
The spasms in your back may decrease in frequency, but you might find yourself caught in a vicious cycle.
What scans & 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. MRI or CT-scan could be very informative, but a bit of an overkill in this case. Our Physios are more than capable of pinpointing the root of the back spasms, so before you rush off to take scans of your back, let us guide you to get a better idea of what’s happening in your back.