It can happen when you bend to pick up a dropped pen. Sudden, excruciating pain makes it difficult to straighten up. Your back is in spasm.
A spasm may occur while performing any number of everyday activities—picking up a child, working in the garden, sitting at a desk for a long time or even sneezing. The resulting pain and stiffness may restrict your range of motion and keep you from maintaining normal posture.
Fortunately, most people who experience back spasms will recover quickly, usually without seeing a doctor. If you experience a back spasm, you’ll need to know how to manage the pain and what to do to help prevent a recurrence.
Back spasms are caused by an involuntary contraction of muscles that brings about pain because the muscles can’t relax. The pain is often described as feeling like a knot in the muscle. The most common area affected is the lower back, because it supports most of the body’s weight.
Spasms can occur when lifting or pulling something too heavy, twisting your body the wrong way, making a sudden awkward movement, overreaching or overstretching, or sitting or standing for long periods of time, particularly if you have bad posture. Some spasms occur because the nerve that connects to a muscle is irritated, such as when a herniated disk irritates spinal nerves.
What makes you susceptible to back spasms? Some factors that may increase your risk include age—years of wear and tear on the spine will make you more likely to suffer from back pain, including spasms—and poor physical condition, especially weak muscles that don’t properly support the spine. A job or other regular activity in which you use your back muscles to lift, push or pull while twisting your spine can cause your back to spasm. So can sedentary work if you have poor posture. And being overweight or obese puts more stress on your back.
First steps to pain relief
If you feel your back muscles start to spasm, stop whatever you’re doing and try to slowly and gently stretch and massage the muscle. Stretch only as far as comfortable, and then hold the stretch for five seconds, if you can, while breathing deeply and slowly to relax. Remain in whatever position causes the least pain, but be aware that sitting may be stressful for your back at this point.
Hot or cold packs—or sometimes a combination of the two—can be an effective short-term remedy for back spasms. Heat will relax the muscle at first—it dilates the blood vessels, allowing more oxygen to reach the muscle. Cold packs or ice (wrap these in a towel or cloth to protect your skin) may be helpful after the first spasm and when the pain has improved.
If your back is still sore, consider taking a nonsteroidal anti-inflammatory (NSAID) medication such as ibuprofen (Advil, Motrin, Nuprin) or naproxen (Aleve, Anaprox, Naprelan, Naprosyn), unless your doctor has advised against it. Avoid NSAIDs if you have kidney or gastrointestinal problems, heart failure or heart disease, hypertension, asthma or inflammatory bowel disease.
Exercise usually isn’t advisable while you’re recovering, but neither is bed rest. Walk around frequently to help ease stiffness and relieve pain.
When to see a doctor
Call your doctor if the pain continues for more than three days, if the pain continues to be severe despite rest and medication or if you’re experiencing pain with muscle weakness or numbness in your legs. Muscle spasms are diagnosed by the presence of tight or hard muscles that are very tender to the touch. Diagnostic testing isn’t usually necessary unless pain persists for more than two weeks. Then your doctor may order an X-ray or magnetic resonance imaging (MRI) to rule out underlying causes such as an undetected disk injury.
Your doctor may prescribe muscle relaxants, an anti-inflammatory or anti-spasm medication, and/or physical therapy.
The American Pain Society and the American College of Physicians recommend that medication use be based on the severity of pain and functional impairment because of the risks involved—NSAIDs have gastrointestinal and cardiovascular health effects, and opioids may cause sedation and dependence. Guidelines issued by the two groups encourage doctors to consider nonpharmacological treatments such as chiropractic care and massage therapy for patients who don’t improve with self-care and prefer not to take pain medications.
If you do seek medical treatment, your doctor should try to identify the cause of the spasm to prevent recurrences. If you have an irritated nerve, you may need physical therapy or even surgery.