Intense, unrelenting pain in your lower back muscles that prevents you from bending forward to do something as simple as put on your pants. Severe, uncomfortable muscle tightness that feels as if it is pulling your lower back into one direction. Suddenly you feel much older than you actually are because you can’t move. This is what a lower back muscle spasm feels like. And, even though everyone gets a muscle spasm in their lower back at some point, most people fail to recognise that there might be a bigger problem lurking underneath.

Usually, you first try to wait and see if the muscle spasm will subside by itself. But what if it doesn’t go away? What if it doesn’t ease? Or even worse it comes back again. This can happen because lower back muscle spasms are a way that your body protectively guards other vulnerable structures like joints, nerves and ligaments. Thinking back, you might be able to remember something that caused the muscle spasm in your back. “It must have been that heavy box I picked up.” However, in the vast majority of cases, it is not what you did, but an ongoing chronic problem where your body is not strong enough to meet the demands of the movements you want it to do. Now, your body tries to protect you from causing damage to other tissues by causing muscle spasms in your back.

It is vital that you get help to get to the root of the problem and get the right treatment from the start.

Let’s first look at the underlying structure of your lower back so that you can understand where and how lower back muscles fit in.

The basic structure

Your spine is what gives your upper body structure. The part that is referred to as your ‘lower back’ consists of five bones (vertebrae) stacked on each other. They are named L1-L5. These vertebrae are large and thick as they greatly support the weight of your entire upper body. Between each vertebra, there is a disc, made up out of a gel-like material. These discs act as shock absorbers and are responsible for most of the mobility of your spine, without sacrificing the supportive strength of your vertebral column. Ligaments connect the different bones and provide extra stability. Between each vertebra, a nerve root exits on each side, branching out to connect to other nerves.

The complex anatomy of your lower back is a remarkable combination of these strong vertebrae, linked by joint capsules, flexible ligaments, large muscles, and highly sensitive nerves. If you look at the sheer size and solid stability of your lower back, would you be surprised to hear that it is the part of your spine that is also the most flexible?

Muscles allow movement

All muscles are made of an elastic kind of tissue that can contract and relax, giving you the ability to move.  Each muscle consists of thousands and thousands of small muscle fibers and the stronger the muscle, the more fibres. With more movement and more muscle contractions, muscles grow bigger (hypertrophy), but with less movement they become smaller and weaker (atrophy).

Lower back muscles

Some muscles have the job of helping with movement and others with stability. Thus, they are called mobilisers or stabilisers.

• Stabilisers (stabilising muscles): These muscles can be found in deep layers of tissue, attaching directly onto the lumbar spine (vertebrae). Therefore, they can exert a segmental stabilising force, meaning they can directly stabilise the lumbar segment of your spine. They activate before you even move so that your spine is already stabilised as you start moving. Throughout the day, they stay activated and contract at a low intensity, making sure that each vertebra stays in place. Overall, if each vertebra is stable, your whole lumbar spine segment is stable. In the end, instability is what leads to injury. These muscles are also called local muscles or local stabilisers, because they connect only to your lower back.
• Mobilisers (moving muscles): Big, strong muscles responsible for moving your upper body/trunk. These muscles cross multiple segments (connecting different parts of your body) and do not attach directly to the vertebrae. They are also called global muscles or global mobilisers, because they don’t only connect locally to the lower back. Their job is to generate a lot of force, move your spine and give you the necessary strength to pick up something heavy.

Different directions of movement

The muscles in your lower back can be divided into four groups moving your lower back in four directions (backward, forward, sideways and turning sideways)

• Extensors: Erector spinae/sacrospinalis (global mobiliser) and Multifidus (local stabiliser)
• Flexors: Rectus abdominis (global mobiliser), External obliques (global mobiliser), Iliopsoas (global mobiliser), Internal obliques (local stabiliser) and Transversus abdominis (local stabiliser)
• Lateral flexors and rotators: Quadratus lumborum (global mobiliser), External obliques (global mobiliser), Internal obliques (local stabiliser) and Intertransversarii (local stabiliser)

Take note: Stabilisers and mobilisers work together and help each other out. That means that stabiliser muscles will also help you with movement and global mobilisers will also help you with stabilisation.

What is your core and where does ‘core strength’ come in?

Your core can be described as all the muscles around your middle (the core of your body). It forms a protective cylinder around your spine that helps to keep it stable. The main core muscles are your diaphragm, pelvic floor muscles, transversus abdominis and multifidus.

The term ‘core strength’ is a term we all know, and most people think that a weak core is why they get back pain and muscle spasms. However, core strength or core stability is actually the ability that the body has to control the core. This includes using the core muscles but also using stronger mobilising muscles like your iliopsoas, gluteus muscles, erector spinae muscles, quadratus lumborum and rectus abdominis. Good core stability is using the right muscles at the right time with the right intensity to control your lower back during the task at hand.

Muscles in your lower back allow you to move, bend and twist your upper body. Even though the muscles are divided into different groups,  each responsible for a different action, they never work in isolation.

When you bend forward to pick up a heavy box, you don’t think about each muscle you should contract. No, you simply move when you want to move. With each movement, the different muscle groups coordinate with each other. For example: when you bend forward, your flexors would be the main muscle group responsible for that. They contract and shorten, pulling you forward. However, your extensors need to lengthen, to control this movement and to prevent you from bending too far forward or even falling over.

Actions of each seperate muscle group:

• Flexors: Flexor muscles bends your spine forward, but also bends your hip. Examples of this:bending over to pick up your grocery bags, bending down to brush your teeth or lifting your leg up when you put on your pants.
• Extensors: Extensor muscles pulls your spine backwards, allowing you to straighten your back, look up and bend over backwards.
• Rotators and lateral flexors: These muscles allow you to turn and bend sideways. Sitting in the car and reaching over onto the backseat to grab your bag is an example of this.

Together, different muscles give your spine the stability it needs

Lower back muscles, together with ligaments, prevent the vertebrae in your lower back from moving or shifting out of place. Ligaments provide static stability as they can’t move or contract. Muscles provide dynamic stability. That means that even though they move your spine, they still keep it as stable as possible. Without stability, any movement would put increased pressure on your lumbar discs, joints and nerves and cause an injury.

Flexors, extensors, rotators and lateral flexors provide the best stability when they work together. A good example of this is when you sit. You probably thought that your lower back is ‘rested’ when you sit. Even though you are not moving, all these muscles are actively contracting to keep you upright. This is where local stabilisers and global mobilisers come in as well. While sitting, your local stabilisers are working hard to stabilise your spine, but your global mobilisers are not completely relaxed. Together they give the best stability.

A muscle spasm can be defined as a “persistent, involuntary muscle contraction”. The main reason why this involuntary muscle contraction causes pain, is because it causes a decrease in circulation to the area. This pain is a message and a warning that the muscle tissue is not getting enough oxygen.

There were warning signs, believe me

Lower back muscle spams usually starts with stiffness, discomfort, and a feeling of “something is not right in my back”. This is your warning sign of a deeper, more complex problem and your body is trying to bring it to your attention.

Ignoring the early signs and pushing through the pain puts you on course for a more serious and powerful lower back muscle spasm. By doing this, your body is limiting your movements to protect deeper vulnerable structures like lumbar joints, ligaments, discs and nerves. It protects you from further injury. Don’t ignore it or mask it with meds. Get it checked and know what you’re dealing with.

Your lifestyle contributes too

In today’s world we sit more than anything else. Work has become something where you sit, looking at the work on your desk or computer screen on a daily basis. You don’t get enough sleep, your stress levels increase, and physical exercise and your overall sense of well-being takes the backseat.

Your lower back, especially the lowest lumbar joints and discs (L4/L5), helps to carry your upper body’s weight. If you are overweight or don’t have the necessary core stability and lower back muscle strength, your spine takes a lot of strain on a daily basis. Ultimately, this causes instability of your spine.

Instability causes increased pressure on the intervertebral discs, joints and nerves, leading to injuries like a bulging disc, lower back joint pain or nerve compression. Injuries like these will always be accompanied by lower back muscle spasms. We call this muscle guarding. Muscles are protectively guarding the injured site by forming painful spasms in your lower back. in an attempt to protect your spine.

Take a step back and look at the bigger picture

Imagine your lower back is strong tower of Jenga blocks stacked one on top of the other, without any of the pieces missing.

Stage 1 – Healthy and strong

You have a strong lower back, no underlying injuries and an overall healthy lifestyle that allows you proper sleep, enough exercise, good health and manageable stress. This is a body that works in perfect harmony and one that can react to any load that you put on it. The tower of Jenga blocks is stable and solid.

Stage 2 – Falling apart

Now, one by one, the Jenga blocks are removed. If you don’t get enough sleep, remove a block. Working long hours in a terrible posture? Remove a block. Weak lower back muscles? Remove a block. With each block that is removed, the chances of the tower collapsing becomes more likely. When a sufficient number of blocks are removed, the tower becomes so unstable that it is still standing, but the slightest movement can topple the whole structure.

Stage 3 – The last block

The last block is removed and now the muscles in your lower back attempt to desperately save your vertebrae from shifting or your spine from collapsing, the same way the tower is about to collapse. This is how you end up with a painful muscle spasm in your lower back.

Stage 2 is where most of us are and we rarely ever return to Stage 1.

You thought you fixed it

We try to find ways to return to Stage 1, by trying to fool our system. We desperately try to build the tower of Jenga blocks back up and make it work by taking medication, going for massages or doing some stretches. This way, you feel a bit better and fool your body to believe that “it’s all back to normal”. But in fact, you have not built the tower of Jenga blocks back up to its original state of stability, you only do damage control. The tower is standing, but on the edge of collapsing again when a piece is removed in future.

To really prevent lower back muscle spasms from returning again and again, you need to start building the blocks from the bottom up and not just reposition the last one. Part of the reason that we don’t do this is because we feel better halfway through. The first sign of relief gives us reason to believe that we have ‘fixed’ the problem. But the fact is, it will just be a matter of time before it all comes back again.

Pushed to the limit

When a muscle in your back is forced to contract under a lot of pressure or remain contracted for a long time, a back muscle strain occurs. It becomes too much, the muscle can no longer hold the contraction and this combination of muscle fatigue and overload lead to a muscle injury (strain). It is pushed beyond its limits, beyond a point of simply spasming. Now, you end up with a torn muscle and inflammation that causes swelling and further irritation. The muscles surrounding the injured muscle will spasm protectively to prevent even further injury (muscle guarding). Now, you are left in even worse pain and you won’t be able to do the easiest things like bending down to brush your teeth.

Muscle spasms caused in response to instability and underlying injuries

Instability of your spine leads to increased pressure on structures like your discs, joints and nerves. This leads to injuries like a herniated disc, osteoarthritis or nerve compression. On top of this, protective muscle spasms (muscle guarding) form to prevent you from injuring yourself even further. The muscle spasms are likely to keep recurring if the instability and inflammation is ongoing.

Back muscle spasms due to a muscle strain

A muscle strain is a muscle injury where the muscle gets overstretched or torn. The injured muscle and surrounding muscles will spasm (muscle guarding) in an attempt to protect you from worsening the injury. Pain and stiffness will make it impossible for you to move. This protects you from bending too far and overstretching or completely tearing the injured muscle.

Bending to pick up a heavy object

Bending forward puts the muscles in your lower back in a stretched position. To get back up, requires these muscles to pull your whole upper body back up. Now, imagine how much harder they need to contract when you bend forward to pick up a heavy box from the ground. If the effort is too much, you end up with a muscle strain and protective muscle spasms in your lower back, due to overexertion.

Holding or carrying a heavy object for a period of time

Carrying a very heavy hiking backpack or carrying new furniture around the house puts a heavy load on your back. Your muscles grow tired from contracting under extra pressure, causing a muscle spasm in your lower back.

Repetitive bending or twisting movements

While picking up the children’s toys, you repeatedly bend and twist your body in an awkward way to reach the toys and you get back up to put them back in their place. A repetitive movement like this means the muscles in your back has to contract and relax again and again. Your muscles get tired and while you want to push through to finish the task, you could strain a back muscle or end up with a severe muscle spasm.

Slipping or falling

You slip on a wet floor and in the wink of an eye you’ve fallen over, hurting your back. While you are falling, your body responds and tries to protect you. The suddenness of the fall, leads to a protective reaction where you tense the muscles in your lower back. Usually, it’s not the direct impact that hurts you the most. It is the quick, intense contraction of the muscles trying to stabilise you, that leads to a muscle spasm.

Sitting for many hours on end

Clearly, we were never made to sit in front of a desk or computer for such a long time without breaks or interruptions. Although you feel ‘rested’ while you’re sitting, your spine is not actually relaxed. The local stabilisers in your lower back will have to contract and work the whole time you are seated to keep you upright. They get tired and fail to support your back. The pressure and the weight of your upper body squash the discs and joints together, not just for a few minutes, but for hours on end. Your body detects the tissue damage and causes muscle spasms in response.

Overloading the wrong muscles

If your local stabilisers are not strong enough or get overworked when you sit for hours on end, they won’t do a good job of stabilising your lumbar spine. To compensate, your global mobilisers will now be recruited to help with stabilisation. If this continues to happen, the local stabilisers grow weak and won’t automatically activate as you move. Now, the global mobilisers have to get used to a dual role of stabilising the spine AND moving it. They can’t maintain contractions like this and will fatigue, leading to muscle pain and spasms in your lower back.

There is no specific grading for the severity of a muscle spasm. A good way to determine the severity of the muscle spasm in your lower back, is to look at how much it is influencing your life. Are you able to bend, sit, get up to stand, walk, run or exercise? A severe lower back muscle spasm is so disabling that simply putting on pants will be excruciating.

It starts with a muscle spasm, but could get worse

If the load placed on your lower back muscles is too excessive, the muscles won’t be able to hold the contraction. Standing stooped over a box while you sort through some things will cause the muscles in your lower back to get tired. Your back muscles are now forced to contract while being overstretched and this makes them vulnerable to injury. This combination of muscle fatigue and overload may lead to a muscle spasm at first. This spasm is to warn you to not push any further. Pushing through it leads to a muscle strain.

What is the difference between a muscle spasm and a muscle strain?

A muscle strain is an injury that leads to tears in the muscle tissue and a muscle spasm is a continued, involuntary contraction of a muscle. Muscle spasms usually serves as a warning for you to stop doing what you’re doing because it could lead to a muscle strain. Lower back muscle spasms can ease with the right treatment, whereas a muscle strain is a tear in the muscle that needs to heal with time.

Grading of a muscle strain:

• Grade 1: A small amount of micro tears occur within the muscle. It usually presents as stiffness rather than pain.
• Grade 2: A large number of micro tears occur, causing a partial tear of the whole muscle. It is painful to move or stretch the muscle.
• Grade 3: The muscle tears along a large area or tears completely. This is the most severe muscle strain that you can get. This degree of muscle strain will cause intense sharp pain and even the slightest movement or stretch will cause severe pain.

Recurring, chronic muscle spasms in your lower back is a secondary problem caused by an underlying injury. Instability and repeated pressure and compression of the joints, discs and nerves in your back, will cause protective muscle spasms. If you ignore the warning signs and push through the pain, you could be injuring yourself even further. With time and with recurring back muscle spasms, you become afraid of doing certain movements. You never know when your back will seize up. Now, you think twice before you say yes to jump on the trampoline with your kids. It could happen any moment and you know by now, how bad it is. You want to avoid it at all costs.

Our physiotherapists are experts in human anatomy and movement, with the necessary experience to diagnose a muscle spasm or muscle strain in your lower back. We fully understand the intricate way muscles work in coordination with each other and can accurately diagnose which muscle has been injured and if any underlying structures in your lower back can cause a muscle guarding reaction. Doing a full clinical assessment and getting the necessary information about your pain is the starting point.

During your physiotherapy evaluation, we will stretch and stress the muscles in your lower back to determine which one has been injured. We can accurately identify where your spasm is coming from. We will also test other structures like joints, discs and nerves.
Thorough evaluation makes our physiotherapists the best at diagnosing this type of problem.

Muscles cannot be seen on an x-ray, so it will not be effective to diagnose a muscle spasm. X-rays will however show the integrity and alignment of joints in your spine. This will enable us to see if something is wrong with the structure of the bones in your spine or if there is a loss of disc space.

Your physiotherapist will refer you to get x-rays taken if deemed necessary.

Diagnostic ultrasound can be used to show the presence of a muscle tear (muscle strains), inflammation, swelling or simply increased contraction of a muscle (muscle spasms).

If you need an ultrasound, your physiotherapist will refer you.

An MRI scan can image all of the structures in your lower back, including soft tissue, discs, nerves and bones. However, for a muscle spasm an image like this is unnecessary and very expensive. If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

A lower back muscle spasm might start out as a protective mechanism. It protects you from injuring yourself any further. However, if you do nothing about it and the muscle spasm continues to bother you, it will prevent you from getting your full movement back. If you don’t move fully and with ease, your muscles become weaker, joints become stiff and your spine less stable. You become stuck in a cycle of pain, not knowing if it is safe to move or not.

Make sure you are getting the right treatment from the start

The sooner you sort out exactly what is causing the pain & muscle spasms in your lower back, the better. Certain treatments like medication might ease the pain, but it won’t prevent the lower back muscle spasm from coming back if there is something deeper causing it. If it was a muscle strain and not just a muscle spasm, it will take longer for the tear to heal.

You might feel frustrated that the pain in your lower back isn’t easing, but there could be something else that needs your attention. There is a risk of more critical and possibly irreversible damage to your back if you don’t take the warning signs seriously.

Waiting too long and not getting a proper diagnosis

A common problem we see is that patients wait too long before they seek help. By the time patients come to us for treatment, they have had problems with recurring lower back muscle pain and spasms for months or even years. The problem with this attitude is that by the time you come to see us, the problem is a lot more advanced and it will take a lot longer to get better.

If you don’t get a proper diagnosis from the start, it wastes time. If anyone treating your lower back muscle pain is not looking for the cause, they will keep on treating the incorrect thing. This is ineffective and the muscle spasms will simply return.Over time, you learn that you never know when a severe muscle spasm is going to hit you and that is scary. You start to think twice about doing the things you love like gardening or playing with your kids, because you anticipate that you’ll have pain. The longer you wait, the bigger your chances of causing permanent damage.

Trying out, but not completing different forms of treatment

Often, patients try to get relief by taking medication or getting a voltaren injection in the hopes that it will ease their pain. They also try massages, foam-rolling, cupping or stretching. However, these treatments only mask the pain and stiffness that comes with a lower back muscle spasm. You are not addressing the root of the problem by trying any of these treatments in isolation.

Wearing a brace to ‘support’ your back will also not be a good form of treatment. The brace might be giving you the stability that you feel you need, but once you take it off, you simply feel weak and sore. Wearing a brace long-term is a big problem, because you could get very dependent on it.

And then, a lot of people tend to feel that their back spasm is easing halfway through their treatment programme, so they stop. You need to address the root of the problem and get your core stability and local stabilisers stronger to handle more load. That is the best long-term solution. Patience is key. 

Resting too much or too little

Resting too much leaves you weaker than before. Moving too much causes extra spasms, inflammation or even injury to the muscle. Finding the balance between resting and doing safe movements is key!

Let us help you get the right treatment for your lower back muscle spasms and stop it from bothering you again in the future.

We can provide the best treatment for muscle pain and spasms in your lower back. We understand that you would want to pick something up without any fear of ‘spasming up’ or do a deadlift in the gym with confidence. That is why we are here to provide guidance and answers. Physiotherapists can implement a very effective and structured plan of action that treats all the aspects of your back spasms and gets you back to your life asap. Our physiotherapy treatment will help you to improve your muscle strength so that you are able to regain control of your local stabilisers and restore normal movement of your lower back.

The basic structure of our treatments:

1. Determine which lower back muscles are injured
2. How bad is it injured?
3. Protect it from further injury
4. Give it time to heal
5. Strengthen
6. Re-evaluate to monitor progress

We will be looking at different aspects, like testing your lower back’s ability to bend and turn in different directions. And we will also look at muscle strength, range of motion, flexibility and stability. Treatment for back muscle spasms will include: soft tissue massage, joint mobilisations, dry needling, strapping, laser therapy, nerve mobilisations and guiding you through a rehabilitation program of gradual strengthening, control and conditioning. It’s important that you commit to the treatment plan, as this improves your chances of successful long-term recovery.

A lower back muscle spasm is a secondary problem, not necessarily the PRIMARY problem. So, we must first determine if it is a pure muscle injury or if there are any other structures, like nerves, joints or discs, that the muscle spasm is trying to protect. “Releasing” your lower back muscle spasm without understanding why it is there in the first place will be the wrong place to start. Just like a faulty component, that cannot simply be replaced by a new one, we need to help you understand how it broke in the fist place.

Depending on the severity of your symptoms and initial inflammation, you will need physiotherapy treatment twice a week for the first two weeks. After this, your treatment sessions can be spread out to once a week or once in two weeks. You only spend an hour at a time with your physiotherapist. How fast you recover will greatly be up to you. If you complete your physiotherapy treatment protocol, you should be able to recover completely and return to your sport.

• Your doctor will probably prescribe anti-inflammatory medication or give you a voltaren injection to get the muscle spasm to ease. Both of these medications will give temporary relief to the pain and stiffness that you are experiencing. However, it will not be the solution to your problem. Once the effect of the medication wears off and you try to get back to working or exercising, your pain could simply return.
• Getting your back or neck ‘aligned’ or ‘clicked’ in the hopes of improving the lower back muscle spasm will not improve the state of the muscle or change your pain. It could even worsen or trigger a muscle spasm. You need to look at the bigger picture.
• A biokineticist will be able to help you in the final stages of your rehabilitation or to get you back to actively training for your sport.
• Wearing a back brace in the hopes of giving it extra stability might ease the spasm and make you feel better while you’re wearing it, but it won’t be the solution to your muscular problem. In fact, muscles become weaker when you wear a brace and you become dependent on the brace. It will only worsen your problem.
• Stretching or foam-rolling your back might ease your lower back muscle pain temporarily, but if the real problem isn’t addressed, the muscle spasm will simply return.

Surgery is not an option for lower back muscle pain or spasms. Recurring muscle spasms in your back is due to the loss of stability or due to other underlying injuries. An orthopaedic surgeon will use instrumentation to ‘fixate’ your spine to decrease compression on discs, nerves and joints. However, this will grossly reduce movement of your spine and movement between each vertebra (segment). It might be a solution for you, but you run the risk of future surgeries because the levels above and below the fixation will wear out and degenerate faster. That means that future surgeries will be inevitable.

If your physiotherapist finds the underlying cause of your lower back muscle pain and spasms as worrying, you will be referred to the right specialist.

• Disc bulge/herniated disc: Pain in your lower back, with the possibility of pain referring down your leg as well. It is especially painful when you bend forward or when you sit or drive.
• Spondylolisthesis: One vertebra slides forward on top of the vertebra below it. This causes your spine to become unstable leading to pain when you bend forward and especially when you try to come back up. You will feel the need to push yourself up with your hands.
• Lower back OA: Pain caused by degeneration in the joints in your spine. The pain feels worse when you overdo it with walking too far, standing too long or sitting to long. It also feels worse in cold weather and in the mornings, but better when you rest.
• Sciatic nerve pain: Pain, pins and needles and numbness spreading down your leg. Caused by compression or irritation of your sciatic nerve.

• Lower back muscle pain
• Muscle spasms in lower back
• Pulled muscle in lower back
• Low back muscle spasm
• Low back muscle cramp