Back spasms are the symptom, not the cause

Here’s what to do when your back is spasming: Stop the movement that set it off (for now). Get into a position that takes the load off your spine, usually lying on your back with your knees bent and feet flat. Let the muscle settle for a few minutes before you try to move again. A spasm is your muscles attempting to increase stability to guard the area. The way through is to submit to the spasm and get yourself in a safe and stable position.

What a back spasm actually is

When your back "goes out," it rarely means something is structural broken. More often a small strain or an awkward twist sets off a reflex, and the muscles around the joint contract hard involuntarily to stabilize it. The pain that you feel could be the irritation/compression of a spinal nerve but the cramped muscle itself can produce pain too. A constant contraction can lead to a lack of oxygen and build up of metabolites - which can trigger pain signals.

Additional muscular activity in the muscle of people with back pain can be thought of as protective guarding. Their nervous systems have become hyper sensitive and ramp up muscular activity to compensate for the perceived (or real) lack of spinal stability.

We can see this illustrated in a study that examined the ‘flexion-relaxation phenomenon’ [1]. They had people with and without back pain bend forward into flexion and measured the muscular activity of their back muscles. Pain-free backs decreased muscular activity once full flexion was reached (relaxation), but in the back of people with back pain, the muscles stayed active during full-flexion.

What to do if your back flares up and spasms

Try to stay active and calm. It also helps to remember this is common and usually settles on its own in a few days.

1. Take it easy for a couple hours, not days. Find the position that calms the spasm and stay in it until things cools off.
2. Start moving early. Once the sharpest pain passes, get up and walk for 5 to 10 minutes at an easy pace. Do this a few times throughout the day. Gentle motion tells your nervous system that movement is safe.
3. Use heat. A heat wrap or hot water bottle for 15 to 20 minutes helps relax guarded muscle and eases pain in the early stage [2]. You can do this daily at home as needed.
4. Consider short-term pain relief. Over-the-counter anti-inflammatories or a muscle relaxant, used briefly and within the label, show one of the better harm-to-benefit balances for acute back pain [2]. Consult with a pharmacist before taking muscle relaxants and tell them about your other medications.
5. Keep living your day where you can. Light normal activity beats lying still.

When to see a doctor

Most spasms are not dangerous, even though they feel like they are. A few signs mean you should see a doctor immediately rather than manage this at home. Watch for:

• Loss of bowel or bladder control
• Numbness in the groin or saddle area
• Leg weakness that is getting worse
• Back pain with a fever or feeling generally unwell
• Unexplained weight loss alongside the pain
• A recent fall, crash, or other significant trauma

Any of those, get assessed. They are uncommon, and worth getting checked out immediately.

How to stop it coming back

Once the acute episode subsides, the goal shifts to making your back harder to startle and your nervous system less nervous (I couldn’t help myself). Build up your walking. Add gentle movement so that your nervous system learns that moving your spine is safe. Over a few weeks, load it a little more each week so the tissue and the nervous system both get more tolerant. None of this needs to be dramatic. A short daily walk and a few seated good mornings each day and you’re heading in the right direction. See my newsletter from last week to learn how to perform seated good mornings.

As always, have a great weekend.

Best,

Mitch

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References

[1] Gouteron A, Tabard-Fougère A, Bourredjem A, et al. The flexion relaxation phenomenon in nonspecific chronic low back pain: prevalence, reproducibility and flexion–extension ratios. A systematic review and meta-analysis. Eur Spine J. 2022;31(1):136-151. [Gouteron et al., 2022 — 10.1007/s00586-021-06992-0]. https://doi.org/10.1007/s00586-021-06992-0

[2] Gianola S, et al. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. Br J Sports Med. 2021;56(1):41-50. [Gianola et al., 2021 — 10.1136/bjsports-2020-103596]. https://doi.org/10.1136/bjsports-2020-103596

Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.