We all know back spasms and pain are rampant in developed countries. We’d like to mark back pain into a single category and often look for a single treatment for all types of back pain. Unfortunately, this is a pipe dream. Not only is everyone’s back pain different and coming from various origins, how you interpret pain and how it influences your movement/dysfunction is highly variable too.
In physical therapy, many therapists joke about pain interpretation among patients. If I have 100 patients walk in, nearly 40% will tell me they have a very high pain tolerance. On the other hand, 40% will tell me they have a very low pain tolerance. This results in only 20% remaining with average pain tolerance.
With such variance, how can we expect to get valuable information from a single article and how do we repeatedly fall for the “Back Pain Cure” or other too good to pass up titles?
Living with Back Pain
It’s common for many people to just live with the pain and distress that come with some injuries. With the back being a scary structure, however, people almost always want to do something with the back spasms and pain as soon as they can. This is because it is easy to think of the worse scenario whenever you feel something wrong with it.
I remember one patient who suffered from 15 years of back pain. She had bounced around to multiple physicians, therapists, chiropractors, and surgeons. She received a plethora of different diagnoses. She had also attempted numerous treatments, ranging from pain pills and injections, to traction and manipulation. She tried everything but surgery, which she has thought of.
She was considering a discectomy surgery, as it was believed a disc herniation was the source of her pain. She had imaging and yes, a small disc bulge was present. Sure, she had pain with bending forward, a common complaint with a disc injury. However, the pain wasn’t consistent and she verbally admitted having her back “seize” or “lock-up”. When her back wasn’t locking-up, she was doing relatively well.
Causes of Back Spasms and Pain
When providing tips for improving low back spasms, it is essential to understand what causes a back spasm. The most common theory for back spasms is the idea that when a muscle is overused, it tightens, locks, and spasms. Pretty much, the muscle is overloaded, then the nerve short circuits with a spasm. Keep this in mind, as we discuss the tips for improving spasms.
8 Tips for Improving Spasms
These are things we did with the patient who already had her surgery scheduled and got her to pain-free living! In fact, she is now deadlifting (yes, a “horrible” thing for her back, in the eyes of many) more than her body weight.
1.Finding the Source of the Back Spasms: Many find it challenging to find the muscle affected with spasms.
The muscle which is overactive and often “locking” is the quadratus lumborum (QL). This muscle runs from the top of the pelvis to the bottom of the ribs. It also attaches to all the vertebrae in the spine.
To find QL, grab your waist with a big C-grip. How does it feel? Is it hard? Soft? If it is hard, it is likely overused and has a higher likelihood of experiencing spasms.
2. Learn to Relax the Affected Muscle: The old saying “mind over matter” may be a tad whimsy for many of you, but it is true for spasms and an overactive back.
Just last night, a friend called me saying he was stressed all week at work. He was worried he would be fired. He traveled for the weekend, returned, and now his back seized up just putting on his pants! He was shocked this “simple” task set off his back, causing rigidity and preventing him from being able to move.
Like many, this young man holds his stress in his lower back. When stressed, he hyperextends his back during sitting and standing. Hyperextension of the back could overuse these muscles, wear them down, and increase their likelihood to spasm.
Simply lying on your back and taking a few deep, control inhalations and exhalations can help relax the body. During this, focus on relaxing the areas (more likely the lower back, but other areas too) which are tight. Try 30 deep breaths and I bet you can relax the lower back. Another option is to work on posture.
3. Learn how Posture Influences Overactive Muscles: Once again, learning how to relax the lower back muscles is key. Posture also plays a role in the activity of these muscles.
When I was doing ergonomic assessments in the area, it always amazed people how much the head and neck influence back activity. We’d be working with a group of engineers and they were nearly kissing the screen, as they were so excited to do their work.
Simply bringing their head back against the headrest would dramatically reduce the lower back activity in most patients. It reduced back pain and tension in most of the workers. Yes, the spine, head, neck, and shoulders play different roles and are interconnected!
I like to have people feel the low back muscles, then simply move their head forward and back. Then have them round their shoulders and retract their shoulders. Then, I’ll have them rotate their pelvis forward and back.
After this, I’d have them assess how active these muscles were and if these positions altered the activity of these muscles. If so, I’d have them assess when these muscles became rocks and when they transformed into Jell-O. Remember, we want jello 🙂 Jello is a relaxed muscle. We want more Jell-O than rock!
4. Improve Biomechanics: Working on biomechanics isn’t sexy, but it is effective.
We all know keeping the spine straight is helpful during a spasm and with back pain. However, too many people do not work on keeping their spine straight throughout the day or when their back pain isn’t problematic!
Remember, your back spasm didn’t just happen today. It is likely, you’ve been overusing these muscles throughout the day and over the years. Faulty lifting and posture slowly increase your risk of a back injury (like a spasm).
With an injured back, doing a seemingly benign task such as putting on your pants at the gym could lead to excruciating pain! It wasn’t that this one task was too much. It’s because it was too much considering the accumulation of all the wrong things you’ve been doing to your back.
Small Daily Habits Adds Up to Greatness
That is #TEAMCOR quote 101 we use at COR every day for physical therapy, sports performance, or weight loss. Don’t give your back junk all day for 20 years and expect it to be healthy! Take care of it with a famous term from Dr. Stuart McGill: “Spine Hygiene”.
5. Heat, Ice, Does it Matter: The age-old question, icing or heat. Sometimes, I’ll have patients elaborate the heat and ice methods they used for their backs, I had one patient tell me she would ice for 20 minutes, then she would use heat for another 20 minutes, then take a 20-minute break. Sounds simple, but she said she’d do this 8 – 10 times a day! That’s the whole flippin’ day!
When understanding which modality (ice or heat) to use, it is important to know which phase of the injury process you’re in.
In the initial stage of an injury (the acute phase), inflammation appears on the injured site, causing pain and dysfunction. During this phase, constant pain is common.
Now, constant is a funny term, as many patients report they have constant pain, but after investigation, it’s determined, they have constant pain during the painful activity, not 24 hours a day! Therefore, it is key to understand if the pain is truly constant. Another indication of inflammation and the acute phase of the injury is pain that is worse in the morning. Pain worsens in the morning when the body doesn’t move around and pump the fluid out of the body.
Next, it is key to understand ice and heat. Ice is a great analgesic (pain killer) as it works by the gate theory of pain. This theory suggests pain and sensation are interpreted by the same cells. Therefore, if pain is being interpreted and overloading the cells, then providing sensation or altering sensation can reduce pain. Ice often provides a mad rush of sensation, helping reduce pain. Therefore, during the acute phase, ice can be beneficial for most people.
Heat, on the other hand, can often relax an overactive area. Therefore, if someone is having an overactive back and is feeling sensations of tightness, heat is the recommended modality.
With this in mind, these modalities won’t cure all. Instead, they are simply a stop gap for the program. Nonetheless, they can provide some relief during a problematic time for many.
6. Stretching can Make It Worse: The adage of bending forward and touching the toes to stretch out the back is at best a waste of time for low back pain. This doesn’t mean you can never do it or if you love yoga you should remove it completely. Instead, just don’t do it if you have low back spasms.
Remember, spasms occur from accumulation of low back stress overtime, overloading the back, and causing pain and injury. If you are already having a back spasm, the goal is to keep the back straight and not overstress the lower back.
Stretching often helps because stretching can actually place the nerve on stretch, providing an increase in sensation and a reduction in pain signaling, similar to adding ice. However, being in a position to stretch the quadratus lumborum would require forward flexion and rotation away from the spine. This puts a lot of stress on the back, as bending and twisting are two of the worst things for the spine.
Trying to relax the muscle while keeping the spine erect is key. In addition, having helpful self-soft tissue methods for the low back are mandatory for relaxing this overactive muscle.
7. Build Hip and Core Strength to Differ Stress: Many people bend from the waist and spine, because it is easy. Although we have a lot of tools for making our lives easy, health and back pain aren’t there yet. Sure, there are tons of apps out there, but they can’t let you slack on your body, position, and biomechanics. Therefore, building strength in the core and hips is important for keeping the spine and body as healthy as possible.
Here are a few tests we use at COR for assessing hip and core strength. Try them at home and see if you can pass. If not, you need to do something about it.
8. Differentiate the Hips and Spine: Our society causes us to round our spine whenever we extend from our hips. Think about it, each time you sit down, you round your back and extend from the hips.
Try the hip hinge test. What do you feel? Do you feel it in your back? If you answered yes, then you undoubtedly have a tough time differentiating your spine from your hips. This may not sound like a big deal, but if you imagine each time you sit down you are using your back and not your hips, you’ll add more stress to your back over time. Soon, you’ll add unnecessary stress on the back and once again, you’re a few inches closer to the injury line…then boom! Back spasm!
Remember, no back injuries are the same. Just because a friend improved with X or Y, doesn’t mean that will work for you! Get a few more tips regarding back pain and sign-up for our free e-book on low back pain, an excellent guide for those who have had back spasms.
If you live in the Bay Area, consider getting complimentary physical therapy assessment and receive a detailed game plan for improvement so you could return to the activities you love!