Thursday, August 28, 2014

Lumbar Muscle Spasms

Definition

Lumbar muscle spasms are involuntary contractions of the muscles of the lumbar region of the back (the lower back).

Description

The back's muscles and any of the ligaments can be injured or irritated. What causes trouble may be a sudden movement in the heat of a tennis match or a game of touch football, or a fall, twist, or sudden muscle contraction to avoid a fall. Sudden pain usually follows a clear-cut injury, though there may be a delay of hours or even a day or two. Specific movements tend to aggravate pain, and muscle injury may bring with it a palpable muscle spasm.

Muscle spasms can also happen without muscle injury, as a reflex phenomenon from irritated deeper structures, including torn ligaments, infections, tumors, or chronic disc irritation, or hernia ion. The way you move, your posture, and other tests permit the doctor to separate a primary muscle spasm from that caused by some underlying disease.

Many so-called disc abnormalities are actually a combination of the aging process and cause no symptoms. Although pain from an abnormal disc may come on suddenly, the process by which it was caused generally occurs gradually, sometimes taking years to develop.

Discs begin to dry up, or become desiccated, starting in young adulthood. The most likely places for changes to begin are the discs at the junctures called L4-L5. No one knows exactly why these two discs are the most vulnerable, but one speculation is that it is due to the sheer stress accentuated by the presence of the lumbar curve.

As a result of this process of wearing out or degenerating, the disc slowly loses its ability to bounce back. In the first stage of anatomic abnormality, the soft interior (nucleus pulposus) of the disc bulges outward. This causes pressure on the nerve, which irritates it. If stenosis, or narrowing, of the spinal canal is also present, the likelihood of pain increases.

While some people with a stage-one bulge may never appear in the doctor's office complaining of back pain, the classic stage-one patient comes to the doctor because of sudden, acute onset of pain. The reason for the pain is not so much the bulging disc itself but the fact that the back muscles are in spasm, usually on one side of the back. This is why a person with this kind of backache characteristically walks tilted over sideways and with great difficulty.

Causes

The cause of the muscle spasm lies in the fact that the bulging disc is pressing against the ligament that holds it in place. Since this ligament contains nerves, the result is pain. Because of the initial pain, the back muscles go into spasm as part of the body's effort to immobilize the painful area. Rather than improving matters, the result is more pain.

After several episodes of this type, the bulge may become what is called herniated, indicating that the problem has worsened involving the sciatic nerve and spinal nerve root compression.

Symptoms

Severe pain and palpable tension in the muscles of the lower back.

Diagnosis

Diagnosis is based upon the clinical history, physical exam and x-rays.

Treatment

Initial Treatment:

Activity and walking as tolerated combined with the nonsteroidal anti-inflammatory drugs (NSAIDS) are also frequently prescribed. Some of these drugs are now available over-the-counter. Patients with bleeding problems or a history of stomach ulcers should not take these medications without them being recommended by their physician. Acetaminophen (Tylenol) is a reasonable and safe alternative for those who do not have chronic liver disease.

Muscle relaxants can also be used, but they are no more effective than NSAIDS and can cause sedation. Spinal manipulation may be helpful in some cases, but consult your physician first. Narcotic analgesics, such as Percodan and Demerol, are very rarely needed and usually not prescribed for more than a few days at a time.

If pain fails to resolve

Patients who have persistent back pain beyond 1-2 weeks should consult with their physician. Physical therapy and in some cases counseling on how to cope with the pain can be helpful. Continuing to exercise and trying to be as functional as possible at home and work may also be helpful. Spinal manipulation is not thought to be helpful. Massage can help in the short term. For acupuncture, the evidence is conflicting as to whether there is benefit.

If your physician becomes concerned that your lumbar spasms are caused by a disc compressing nerves, he may refer to a pain or orthopedic specialist. A pain specialist can inject cortisone into the area around the spinal cord where the nerve is being compressed. In severe cases that do not resolve or which worsen include leg weakness or bowel/bladder control problems, urgent consultation with an orthopedic surgeon so that he can perform a procedure to remove the part of the disc compressing the nerve.

Cortisone and other steroid drugs are occasionally used for a short period to reduce pain and inflammation. They can be quite effective in relieving the symptoms of acute back pain, but they can also cause serious side effects and are not useful as a long-term approach. When pain is more severe, more potent painkillers may be prescribed, again for a brief periods.

Questions

What is causing the spasm?

Is this a simple muscle strain causing spasm?

Is it indicative of a more serious problem?

Is there a hernia?

Is the sciatic nerve involved?

What medications are useful?

How long the medication should be taken?