In twenty-two years of practice, I have to say that some of the hardest pain cases I have had to manage involved, in some way, severe muscle spasms of the low back. Muscle spasms, to some degree, accompany most low back issues involving the spinal joints – what we call subluxation in chiropractic. But spasms can be somewhat mild to severe. The severe variety are what I am talking about. They are not only difficult to treat, but they are also extremely hard to watch somebody go through, and I know they are even worse to experience. I have had two recent cases where severe muscle spasms were involved, and I will use them to illustrate what you must do if you ever find yourself in the throes of this painful situation. I will also discuss what you can do to minimize or prevent severe low back muscle spasms from happening to begin with.
The first thing to understand is that some level of spasm generally accompanies subluxation. A vertebral subluxation is the fixation, or locking up, of a joint (could be spinal, could be an extremity). Sometimes the joint just diminishes in movement. Other times, a part of the joint structure itself, the synovial membrane, can get caught between the joint ends. This is a very painful situation called facet syndrome. The facet joints, more formally known as the zygapophyseal joints, are bilateral structures at each spinal segment, which along with the intervertebral disc (IVD) provide support and stability of the segment, along with movement. The spinal joints allow for flexion (bending forward), extension (bending backward), lateral flexion (bending side to side), and rotation. These joints are diarthrodial, which according to Taber’s Medical Dictionary:
A diarthrodial joint is one in which the adjoining bone ends are covered with a thin cartilaginous sheet and joined by a joint capsule lined by a synovial membrane, which secretes synovial fluid.
Facet syndrome can range from arthritic-like degeneration of the joint surfaces to the synovial membrane being caught and pinched between the joint ends. Think of the latter like a piece of skin caught in a zipper – an extremely painful situation, indeed.
Facet syndrome can typically have the following symptoms*:
- Hip and buttock ache and pain
in the leg above the knee
- Low back stiffness especially in the morning or with inactivity
- Absence of paresthesia (numbness/tingling)
- Transient sharp pains with sudden movement
It is the latter which I would like to focus on here, although I do wish to point out that unlike disc herniation, there is generally no associated neurological dysfunction like numbness or tingling. Saying that, it is the transient sharp pains of facet syndrome which can lead to severe pain and debilitating muscle spasms.
Although we do not totally know what causes this transient sharp pain, some of us believe that it is the pinching of the synovial membrane between facet joint ends which cause this to happen. As I have already pointed out: imagine getting your skin caught in a zipper, or your finger in a closing door – very painful! That is very likely, in my opinion, to cause the sharp, often described as “grabbing pain.” This alone is enough to stop you in your tracks if your ever have the misfortune of feeling it, but ultimately it can lead to reflexive spasms which can, in turn, drop you to your knees.
Let’s take a minute to understand muscle spasm. My best description is to think about a muscle spasm as a contracting muscle that exists on a severity spectrum. When you perform a contractive action, you pull (or push) one bone closer to (or farther away, depending on the muscle in question). Take bringing a piece of food to your mouth; it mimics a biceps curl. You flex (contract) at your biceps bringing your forearm closer to your upper arm. If you were to push open a door, you would flex your triceps pushing your forearm farther away from your upper arm. Both movements are contractions of one muscle, and relaxation of their antagonist (opposite) muscles.
If a muscle starts to develop shortness or tightness, it begins to resemble a tightened rubber band – that is, it develops a tensile tension. This would be the next level of the contraction spectrum. Further, some muscles enter dysfunctional states in which they fail to recognize the neurological signal to relax – this is the pathology of the muscle spasm. It is a contracture dysfunction. If you are unsure if you have ever felt a muscle spasm, you can get a slight idea of how it feels by taking a hand weight, and doing a biceps curl to full contraction, squeezing hard at the top of the contraction, and holding, no release, just hold for 60 seconds…try 120 seconds. The pain you will feel will give you a small taste of what a spasm can feel like. Now add days and sometimes weeks to that sensation. Obviously, an active contraction held for weeks would most certainly be as extreme a pain as you could ever imagine, but spasms essentially work in this way. Now, your body, in its miraculous wisdom, will attempt to remedy the situation by releasing neurological signals and even natural muscle relaxant chemicals to release the contraction. Unfortunately, the muscle tissue, and often the neurological unit itself, does not respond to the signal, and thus, a spasm can in fact last for days, weeks, months, as well as vary in severity.
This brings me to two recent patients I saw, both in the throes of severe low back spasm, roughly two weeks apart. The first, I’ll call him Frank, is a man in his late fifties, morbidly obese (more than 100 lbs. overweight, BMI > 40), with multiple mental health issues (self-reported), and low physical activity. The second is Jonathan, an elderly man in his mid-seventies, significantly deconditioned physically, possibly an alcoholic, on several medications for organ dysfunction, and highly likely depressed. Both men called me in distress – both reported that they were severely challenged with movement, and both had waves of transient pain that would incapacitate them when it hit. Frank said the pain would nearly drop him to his knees; Jon said he could basically not get out of bed. I saw both on an emergency basis.
The first point I wish to make is to not let yourself get to the point where you cannot move without pain or to the point of dropping. Both men reported having been in pain for weeks. I understand that life happens, we do not always want to jump the gun. However, the sooner you address the pain, the better – I get this is obvious. A good rule of thumb is: If the pain is around for a week, call yesterday. In other words, 5-7 days of pain is good reason to call your West Hollywood chiropractor. Even if the pain comes and goes, has gotten better, or is only present under certain conditions (only when I walk, only when I sit, or only when I get out of the car…stuff like that), get in to see a chiropractor right away. Will massage therapy help? Maybe, but less likely, and certainly less effective. While some muscle spasms are purely muscular, and thus a massage could do the trick, most spasms are associated with subluxation, facet syndrome, or disc herniation. For each of these, you will need a spinal adjustment.
Next, if you do let it get too far, most certainly get in to see your chiropractor, but you will need to go back for follow-up care. How much care; how long? That is hard to say. That will really depend on how acute your current situation and how chronic the underlying condition. The worst thing you can do is expect a quick fix. Having that as your expectation will likely get you frustrated and on to medication (which you might need) and possibly even surgery. To keep things simple, let me say that only spasms due to disc herniation are likely in need of surgery, and even these only on the most extreme cases. Vertebral subluxation and facet syndrome are both treatable by conservative chiropractic care.
Saying that, depending on how severe your current situation, you might need medical intervention to get you out of immediate spasm. This was true for both Frank and Jon. Both needed immediate muscle relaxant medication and strong pain killers. Yup, you are hearing me right – a drugless chiropractor, and advocate for drug-free, conservative pain relief care is saying: If you are in the throes of severe muscle spasm that has you unable to get out of bed or dropping to your knees, then you will likely need strong meds to get you through the crises. However, once the spasms diminish, you absolutely must see your chiropractor and have your spine adjusted straight away. If you fail to do this important step, your current acute low back spasms can turn chronic. And the more episodes of spasm you have, the more likely you will be a candidate for surgery. Yes, surgery is sometimes necessary, but it is important to note that low back surgery is one of the most failed surgeries performed (back pain returns or never goes away). Unfortunately, many low back surgeries are recommended simply because a conservative solution cannot be found – many times that is associated with poor follow through on the point of the patient.
So, what can you do? First and foremost is to manage your weight and physical conditioning. Both Frank and Jon were in horribly poor shape. Jon needed to exercise if even just light calisthenics at home and regular walking. He was not as large as Frank was but he had a level of softness that was not conducive to spinal support. He also reported neck, shoulder, and hip/knee pain which will probably get worse over time. As I tell all my clients: It does not suck to get old unless your body breaks down. Jon definitely reported feeling like it sucked for him.
Frank desperately needs to lose weight – more than 100 lbs. If he continues on his current path, pain is inevitable, then organ breakdown, and he could even be at high risk for suicide. Being in pain is no fun. It is a primary cause of suicide, in fact, many elderly people ask for assisted suicide for precisely this reason. Add to that already significant mental health challenges, especially if being treated with psychoactive drugs and quality of life diminishment and high suicide risk are likely.
Let me reiterate, both Frank and Jon really need to get in to see me at least a month sooner. If you find you have low back pain and stiffness radiating into you hip, buttock and thigh (not below the knee), and transient sharp pains with sudden movement, then you need to call your chiropractor right away. If you are in Los Angles, Beverly Hill or West Hollywood, then call my office. If I cannot help you immediately with you low back pain and disability, I will direct you where you need to go to get the most effect low back pain relief. Finally, you absolutely must put attention into your physical fitness no matter what. Getting in shape, slowly but surely, is the best preventative for low back pain, and the best tonic for mental health in existence. Yes, you will need massive lifestyle changes, but believe me the quality of your life will improve dramatically. It’s worth it to not be in pain.