Unrelenting back spasms
October 18, 2020 5:22 PM   Subscribe

For the past ten years, about every two years, the muscles parallel to my spine go into spasm. It can happen from lifting something heavy, or it can be triggered by banal things such as standing up from a sitting position, crouching, leaning over, or for no apparent cause. The pain can vary from an inconvenience, to being so bad I struggle to walk and once I even fainted. Right now, my back muscles have been spasming for a month, and every time things feel like they’re improving, something triggers the spasms again. What can I do to prevent this?

I'm a mid-50s male.

I’ve been to doctors and have had x-rays. This is all muscular; nothing neurological seems to be going on. I’ve been seeing a physical therapist. In fact, when the current spasms started, I was seeing a PT for both knee issues and minor back pain, getting some bodywork and doing exercises and stretching to help the back pain. Right now, I’m only getting bodywork and some time with a TENS unit at the PT, and doing some very mild stretching as my back can’t really handle the exercises at the moment.

The pain is in my lower back, mostly one side, but sometimes the other. Luckily, it’s mild when laying down or slouching, so sleeping and TV binging has been reasonably comfortable. Sitting is painful, and standing or walking is even worse. I do try and move around regardless of the pain as I know moving is helpful. At its worst, to walk I had to use two hiking sticks.

I am naturally very inflexible; my muscles are always tight. But with the spasms, the muscles are contracting and aren’t releasing. I’ve been told that the muscles are in a feedback loop preventing them from calming down.

As for medication, I’ve taking a prescribed high dosage of naproxen (Aleve). I’ve tried some muscle relaxants, but although they mellow me out, they don’t help the problem. I was prescribed hydrocodone, but I’ve found opiates only help me not care about the pain, and given that slouching and lying down are positions I’m relatively pain free in and the side-effects of opiates, I prefer not to take them. I’ve had some cannabis edibles, and like the muscle relaxants, they mellow me out, but haven’t relieved the spasms. I’ve also had some acupuncture and mild manipulation by an osteopath.

I’ve used both ice packs and heat on my back (with a heating pad in in baths). The ice does seem to calm things down a bit, and the heat does seem to reduce the tightness, at least temporarily.

Yesterday, I would have said I was maybe 70% better. I could stand with only minor pain, and could walk at my normal pace. But this morning in bed, while turning to my side, I triggered another spasm, and much of my progress regressed (although it’s not as bad as it was before).

The fact that I was already in physical therapy and doing exercises for my back when this hit me has been quite discouraging. I imagine some people will suggest yoga. I’ve tried it before and it just doesn’t work for me due to my lack of flexibility, even gentle yoga classes. I’ve previously injured my back and shoulders in yoga from overstretching, which is too easy for me to do.

Any suggestions to help calm my current spasms and to prevent future ones?
posted by Sock, Sock, Sock, Sock, Sock, Goose! to Health & Fitness (21 answers total) 5 users marked this as a favorite
 
There are different muscle relaxers for different problems, it's worth talking to your doctor about how you can't get that muscle to release and what the next steps should be, or even talking with the PT about what they suggest. Maybe you need PT dedicated just to that issue or a different PT.

You didn't mention wearing a brace, a brace that covers the lower spine may be helpful for preventing future flare ups, and reducing stress. I'd ask your PT before you go out and grab one, but it may help you not set it off as much.

Of course keeping up exercises when when you are well is important.

I'd been told that stretching while on the muscle relaxer was important, but i can't tell you where i got that piece of information or how true it is.
posted by AlexiaSky at 5:31 PM on October 18, 2020 [1 favorite]


IANAD. I am someone who used to have frequent debilitating back spasms. I have had very good luck with oral magnesium supplements. There are side effects but most are manageable, tho you may want to check for drug interactions. IIRC mag oxide is the most commonly found in stores but has less absorption than other forms (like mag chloride). You can read more here about both oral and topical forms.

https://www.ancient-minerals.com/transdermal-magnesium/magnesium-supplements/

From what I’ve been told, ice would not be recommended for chronic hypertonicity. Inflammation, yes. Tightness, not so much. Heat better for that.

Also, do yourself a favor and check out the work of Dr. Eric Goodman. Once you get to a less spasm-y place, you need to re-train your back how to work properly. When back muscles spasm it is usually because they are trying to protect the spine. Many of us have over the course of years forced our back musculature to un-learn the proper way to support the spine. This video is a good place to start. MeMail me f you are interested in more.

https://youtu.be/BZcZenvWBlg


Good luck.
posted by armoir from antproof case at 6:04 PM on October 18, 2020 [5 favorites]


IANAD. I am also someone who used to have debilitating back spasms at least once every couple of years. A good friend recommended this book. It sounds very woo, but it was life-changing for me. I highly recommend it.
posted by mefireader at 6:18 PM on October 18, 2020 [1 favorite]


I’ve been told that the muscles are in a feedback loop preventing them from calming down.

When this happened to me about a decade ago - also intense lower back pain, although it was mostly my butt muscles that were spasming - my doctor prescribed Flexeril as a muscle relaxant and my PT had me come in once or twice a week for an hour of traction, as in literally being gently pulled on & stretched by a machine. It took about a month and a half of this for me to recover. (Plus some of the normal PT exercises & DIY stretches and things.) So Nthing maybe a different muscle relaxer & PT.

What can I do to prevent this?

AFAIK the current best knowledge is that strengthening your core muscles is an important element in preventing back problems. I'm guessing your bodywork stuff addresses this to some extent, but you need to keep up with some core exercises after you've recovered.

I imagine some people will suggest yoga. I’ve tried it before and it just doesn’t work for me due to my lack of flexibility, even gentle yoga classes. I’ve previously injured my back and shoulders in yoga from overstretching, which is too easy for me to do.

As an also 50's male, I'm gonna kinda challenge you on this, and ask you to consider the extent to which our social conditioning may be a factor here - whether we're really consciously aware of it or not, we approach lots of things as a challenge to be bested and overcome. So we start a yoga thing and we're feeling pretty good and our brain thinks, "Oh man, I totally got this, I can do yoga RIGHT" and then we ignore the pain and tension signals from our muscles and so we strain things.

So maybe be aware of that tendency and work mentally on letting go of this. Yoga is not something you're necessarily supposed to get right the first time, the benefits are cumulative over time, it's ok if you can only do stuff partway for a long while, maybe always. Pay more attention to the signals your body is sending you while you do yoga, and back off a little at the first sign of problems.

I have also found Tai Chi forms (minus the woo-ier parts) to be helpful in enhancing my awareness of how my body is moving and what my muscles are doing. The forms are intentionally slow and flowing so there's lots of time to consider how you are moving and feeling as you do them.
posted by soundguy99 at 6:49 PM on October 18, 2020 [7 favorites]


Another non-doctor here. This book is by the same author that mefireader mentions. However, there is (arguably) less woo and it really only focuses on back pain. I had a problem like yours for a few months, but reading this was all it took.
posted by Calvin and the Duplicators at 6:53 PM on October 18, 2020 [2 favorites]


I’ll second what soundguy99 says about strengthening.

With the caveat that you should follow the advice of your doctors and physical therapists before embarking on anything, I’d suggest looking into doing more strength training on a regular basis if it’s feasible.

I’m a bit younger than you but your situation sounds a lot like what I used to experience. I tore soft tissue in my lower back in a cycling accident about 12 years ago. Even after I’d done a lot of PT and everything healed, I’d still get random spasms and tightness for years afterward just from doing stuff like tucking a bedsheet under a mattress or sneezing.

I began strength training, doing mainly compound exercises (sometimes known as functional exercises), without any intent for it to be a solution to my back issues. But after a few months I realized I wasn’t having spasms or even mild tightness anymore... like at all. When I took about a yearlong break from working out I noticed the occasional tightness/spasms came back.

I’ll emphasize again, don’t do anything without asking for professional guidance first. You can really screw up your back (and various joints) if you do strength exercises incorrectly or try to take things too fast.
posted by theory at 7:13 PM on October 18, 2020 [1 favorite]


I had very similar issues as you, albeit in my 30s. Things that helped:
Less sitting. Got a standing desk for work.
Strength training. Found a gym that does small group training. Improving core muscles, flexibility and learning hows to hip hinge properly all helped.
When driving, this helps a ton.
Medical massage to help the tension.

Something to keep in mind: it's most likely the issue doesn't start where it hurts. In my case it's mostly coming from my hips. Find somebody who can explain to you the underlying issue, and how to fix it.

Good luck.
posted by pyro979 at 7:13 PM on October 18, 2020


I use a home TENS unit for some of these types of issues. Generally, for me, the TENS unit provides enough relief that I start moving more normally, which helps me relax and break out of the pain cycle.
posted by hilaryjade at 7:48 PM on October 18, 2020


yoga will do unimaginably bad things to your lower back if you are a total amateur who happens to have undiscovered disc damage. anyone helped by it should do it, but do not let yourself be "challenged" into forcing something that involves bending and stretching if those bends and stretches are similar to the ones that have set off your back in the past and/or if you do not have a professional paying full attention to you and only you at all times.

but do do the cat-cow thing, if you're able to.

it can be triggered by banal things such as standing up from a sitting position, crouching, leaning over, or for no apparent cause.


don't do those things! those are THE things that fuck up your back. this is as if you said Pain in my knee can be triggered by banal things such as striking it with a hammer or having it kicked. like: yes, that will happen.

stop crouching until you have a rock solid sense of whether your back is arched or rounded or straight without having to feel it with your hand or look in the mirror to check. stop leaning over right now and don't start again ever. or, if you must, not until you've had a solid year with no relapses.

standing up from sitting is not something you have to put on indefinite hiatus, if only because you can't, but you can/should/have to find the angle at which you must hold your back to keep it from going under the same tension you get from leaning over. if you have to look ridiculous by holding your back perfectly vertically upright and straining very hard with your thighs every time you stand up, then do that. you do not want this to progress any further. and it can.

walking an increasing distance every day until you're up to 5-10 continuous miles every day can help, if you don't already do that and if it doesn't aggravate the pain.
posted by queenofbithynia at 8:24 PM on October 18, 2020 [2 favorites]


Sarno's book (recommended by Calvin) sounds like it's on the right track, and he may or may not be up to date on pain science, although a few of the reviews I read on amazon suggest he isn't quite there. I generally recommend this article as an intro to modern pain science. Pain is not a property on your tissue - and you are likely uninjured as it sounds like your doctors have suggested. Pain is an output of the brain, and it's your brain's way of telling you that it thinks a part of your body is under threat. Like our other sensory experiences, there is sensory input involved, but to turn it into information our conscious agent can use, it requires incredible amounts of processing that includes the sensory input, past experience, cultural context, emotions, and a few other things to frankly fill in the gaps. That goes for all our senses - it's why we can be pretty sure we saw ghosts, and why sometimes our brain gets it wrong and has us experience pain when nothing is wrong, or not feel pain when something is very much wrong for that matter.

At the other end though, as one other person did suggest, I would check out your electrolyte levels - magnesium and potassium for sure, and maybe even sodium depending on your diet. If you supplement magnesium, get it in magnesium glycinate form. Potassium is harder to supplement, so try upping intake of vegetables and fruits that contain it (although "light salt", available at most grocery stores, is potassium chloride, so you can use that too).
posted by MillMan at 9:25 PM on October 18, 2020 [2 favorites]


I too didn't get much relief from the hydrocodone beyond what Aleve offered. I have tried 2 different relaxers for my back spasms. I found that Soma did very little, but the Flexiril really helped break out. If there are medication options you haven't tried, you might consider that.
Also seconding heat at this stage, not ice.
posted by Horselover Fat at 9:54 PM on October 18, 2020


Have you heard of Bowen Therapy? It's a very gentle but very effective form of physical therapy. I have the spasming back issue, though not nearly as severe as yours, and a series of regular Bowen definitely calmed it all down
posted by Zaire at 10:01 PM on October 18, 2020


If you're stuck in this spasm cycle, consider acupuncture; find someone who combines acupuncture with focused muscle massage.

Once you break this pain cycle the only successful treatment I find is core strengthening and flexibility training.

Best wishes.
posted by mightshould at 3:49 AM on October 19, 2020


I'm very interested in the fact that you mention that when you slouch it's better. Is the pain right at the bottom of your back ie below your belly button (though of course, at the back)? I used to go through the same cycle of ok - spasms - ok - spasms. Once I had to walk around bent double for a week. I was (am, but improving) very stiff everywhere as well.

Yoga and strengthening are the right answer, but posture is the key that's missing. As long as you use your body in its current set-up you're just using the same muscles you always have, and that's a problem because you keep having a problem.

Yoga should help with posture and alignment, but most of the classes I see are more focussed on "achieving" poses than mind-body awareness. You could look for one specifically for people with injuries. Anything "flow" should be out. I do Iyengar. If you want to try it again (obviously I think you should), look for an old teacher - one who uses the right alignment rather than strength to do the poses. Ask what experience they have and say what went wrong before with your shoulders.

Standing and walking are the answers - but only if you can improve your posture whilst you do them. Stand with your back to the wall, your shoulders and buttocks should touch it. Try to use the muscles at the front half of your body to flatten yourself towards the wall. If you're using your legs properly you should be able to bend forwards without falling. Using your legs right is the foundation to a better back.

When out walking, make sure you're using your feet right. Facing forward, even pressure, keeping the weight on the back leg rather than sort-of tipping yourself forward into a half-fall you have to save with the other foot.

I'm not sure any of this makes sense but please memail me if you want!
posted by london explorer girl at 6:44 AM on October 19, 2020 [1 favorite]


My wife has a prescription for medical marijuana for her back problems. Granted, her pain is not related to spasms, but the marijuana helps.
posted by alex1965 at 7:03 AM on October 19, 2020


Those muscles are what keep you upright when you've developed anterior pelvic shift from sitting too much. Your front hip tendons have shortened, which pulls your pelvis forward. This prevents your glutes and core from engaging when you stand, which means those muscles along your spine are forced to do the job of keeping you upright, which they are not meant to do and when they are overtaxed it can lead to spasms.

Work with your physical therapist to correct this. There are many exercises to strengthen your core and glutes, and to stretch your front hip tendons to correct this. It takes a long time to do this, because the amount of time you sit daily is counteracting the exercise. This is not to say you cant improve. Just that it takes time and consistency. Sitting less and standing with good posture helps. Try an exercise ball as a chair to strengthen your core as well as lots of PT before using a standing desk, as too-weak muscles being used to stand can worsen the problem when you get fatigued and your posture defaults to using those spinal muscles you're body is accustomed to relying on.
posted by ananci at 8:01 AM on October 19, 2020 [1 favorite]


Have you tried injections? I have had intermittent issues with back spasms and was greatly helped by injections of lidocaine into the spasming muscles, given by a Physical Medicine physician. It is a quick in-office procedure. I had a series of 3 or 4 over the span of a couple of months (or so), but had definite relief right away after the first one.
posted by tentacle at 10:37 AM on October 19, 2020 [1 favorite]


If the TENS helps at PT, I would recommend trying a home TENS. I have chronic spasms in my neck and I recently started using TENS at home and it's made a huge difference.

What exactly does the PT do on you? Have they tried ultrasound? I find that extremely helpful on my neck. In fact, sometimes when I am really bad I go in again mid-week and my PT just does an ultrasound session for 15 mins.

Also if you feel like your PT is not a specialist on back pain, it might be worth it to find another PT. There is such a range of quality in therapists and also they all specialize in different things.
posted by radioamy at 8:24 PM on October 19, 2020


This is a long shot, but it's worth mentioning. I had terrible back pain once, and I was told to go home and rest. It went away. The next time my doctor was more cautious, and told me to get a chest x-ray in case it was pneumonia. I had a collapsed lung. This has happened repeatedly, and it's set off by the kind of trivial things you mention. Inevitably I think, "I've strained a muscle," and the next day I realise I'm running on less than two lungs. This isn't a big deal unless you get below about 80% (I think) blood oxygen. Mine was down to 65% once, which was serious. If it really is muscle spasms, my friend who had them said nothing really helped until he learned some appropriate back exercises. If it's a recurring partial pneumothorax ... it's a good idea to know.
posted by AugustusCrunch at 8:27 PM on October 19, 2020 [1 favorite]


Also agree with AlexiaSky that you should look into different meds if you haven't tried a variety. For example, in the "big guns" category there's SOMA, Zanaflex, Flexeril. I take Baclofen 3x/day which is not a game-changer but takes the edge off. Also a benzodiazpene can be helpful, they're for anxiety but often helps relax muscles (Klonapin, Valium, Ativan, Xanax).
posted by radioamy at 8:27 PM on October 19, 2020


Thanks for all the replies. I appreciate all the suggestions. It's calmed down appreciably the last couple of days.
posted by Sock, Sock, Sock, Sock, Sock, Goose! at 6:35 PM on October 21, 2020


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