It happens so quickly. It happens when you are doing the most pedestrian movement or simply reaching to pick up a pencil. But when it happens - 'oh lord have mercy'! A spasm in the back can be earth shattering and leave you sobbing on the couch as you are stuck, immobilised, face down with your derrière stuck up 'in the air', clutching at your mobile to call someone to come to your aid. It's a debilitating pain that rarely allows any respite. Wakes you up at night, never lets you get rest, makes the most mundane of tasks a battle of conviction and you can't even lie in the couch watching the latest Netflix series because its too darn painful!
What Happens in a Back Spasm
A back spasm is usually in response to an excessive load. This can be due to insufficient support in the trunk from the abdominal muscles, or core muscles, or be inefficient biomechanics when lifting. That old adage of bend from the knees not from the waist is known for a reason!
Often with a 'locking of the back' the muscles spasm to provide support when there is indeed insufficient support from the aforementioned areas. The reason for this is to prevent the spine from being overloaded. The spine is one of the most important structures that provides not only support but protection for the all important spinal cord. Suspected damage to this vital and sensitive collection of primary nerves is to be avoided at all costs, and our bodies know this.
The Thoracolumbar Fascia is a supportive connective tissue (or fascia) at the base of our spinal column that is a like a triangular bandage that offers support, conducts compressive force (ie landing from a jump) and gives a basis for a great deal of rotational and transverse movement. Every time you throw a ball you are twisting through your lumbar spine, thus it is important the this connective tissue remains pliable and strong to give support and 'torsional strength'. When a back is overloaded this connective tissue 'locks on' to provide a sense of support and prevent the spine from becoming overloaded or 'unsupported'. Where there once was movement, now there is just restriction to provide support. Hence the 'locked' feeling.
The other main factor that comes into play in this instance is that the core muscles (transverse abdominus) actually turns off. There is no tension in the cake tin (see my article on the cake tin analogy) to provide a stable base so the thoracolumbar fascia becomes the tension control for the abdominal area. Without the core muscles to be able to control tension and control the base of support for any trunk movement, you are left with the feeling of being... rather fat! It feels like your stomach is popping out! This is because there is no muscular tension in the all important core muscles to hold on to the stability of the lumbar spine. This is the reason why you should definetly NOT exercise with a back spasm.
There can be other reasons for the spasming which are more sinister, such as a disc bulge. But that is another article.
What Can I Do?
Pretty much - NOT MUCH. A back spasm does not respond to aggressive treatment. When treating lower back spasms and locked lumbar, a fascial approach often yields the most fundamental results. You can't release too much as the fascial locking is there to provide support. Getting a 'neutral curve' is the most important priority. Regaining the alignment of the pelvis and the lumbar spine is primary to making sure that the spine begins to move as it did before. It is about getting the pelvis and lumbar back into a position of balance before you can even begin thinking about getting strength or conditioning back into the equation. This means NO PLANKS, NO CORE WORK, NO SIT UPS. Your muscles are turned off so any exercise is just going to be detrimental to any healing that could be going on.
“Popping an anti-inflammatory and a Panadol with a good dose of Belvedere is not going to do you any favours ”
Treatment
Range of Motion becomes the main focus in this injury and re-introducing movement into the equation is vital and yet must be done with great care. Finding a position that is supported and yet allows your to move into a curve is vital. The best exercises for this are the 'sphinx' pose where you gently begin to work into lumbar extension - AS YOUR BODY ALLOWS. The big brake is always pain. The moment you feel a grab, you should stop and return to the prone position. See my PDF on Back Stretches on this website. It's about reintroducing MOVEMENT not strength back into the equation. This only should happen once your body is ready for movement. In the acute phase this is not advisable. Sitting straight up is best. This means not slouched in the couch. You have to sit on the floor and be the best 3rd grader you can be and sit tall with the small of your back supported by the strict upright of the couch whilst your legs are out in front of you. No slouching!
When treating a lower back spasm, I tend to take a 'softly-softly' approach. Too much release and the fascia and muscles just re-engage as they sense a weakness or instability in the structure. In this instance, shorter and brief treatments more frequently are more the prescription rather than spending hours on a massage table getting beaten up and large amounts of soft tissue release happening.
Often a back spasm has been caused from a muscular imbalance or more probably a pelvic misalignment so making sure that the pelvis is in good balance and the lower spine is not in a lordotic or 'flat' position is the next line of defence. Getting the postural integrity back is probably the most important of any of my treatment protocols. This is the foundation of all movement so ensuring the beginning position and foundational support of the structure is primary.
Then you need to look further afield from the actual injury and start to assess the contributing influences, such as leg tension or stresses that may be pulling on the pelvis and pulling it out of place. Are the hamstrings causing a posterior tilt, stiff quads bringing the anterior pelvis forward, or the often missed adductors that are pulling on the pelvis downward and increasing a lordosis of the lumbar spine? Working into these areas brings about a great deal of relief on the pelvis and the alignment of the lumbar spine. You cannot discount the importance of pelvic alignment in relation to the spine. The pelvis is the bowl upon which the entire spinal column sits. It's the middle of the pond where small ripples create large waves of impact further outward - ie the neck and head.
Prognosis
This varies between cases. Severe cases can take up to 2-3 weeks before a Range of Motion can be achieved that allows even the slightest of movements. But usually you are able to get some movement in the lumbar in 3-4 days. Then it s slowly re-introducing simple movement patterns that don't stress the muscular system too far and have fast, complex contractions stressing the connective tissue. Being able to arch is a good indicator. The ability to bend forward and put your shoes on is another. These base measures of movement are the things to watch for - not being able to hold a plank position.
Treatment is advantageous and should help the movement factor along. Don't wait. Popping an anti-inflammatory and a Panadol with a good dose of Belvedere is not going to do you any favours - unless it helps you sleep and in that case - knock yourself out! It does take some patience and you have to work within the parameters of your injury. As I said, shorter and more frequent treatments can help with that all important re-introduction of movement.
Prevention
MOVE IT. Move it in all the planes that you can. Forwards, backwards, flexion, extension and the all important ROTATION. Our spines are meant to move in all planes of movement, so if we aren't regularly doing that, is it any wonder when we twist just slight 10 degrees too far as we go to pick up the suitcase off the conveyer belt, that the body can't handle it? Move it at different speeds as well. Its not just about slow sustained stretching - a tennis ball in a stocking is a great toy to use as you bounce it from wall to wall twisting through your lower lumbar (I think I just came up with an idea for another video). Keep your legs loose. The pelvis is determined by the legs so keeping them in check by stretching and opening your hamstrings and quads is important too. Getting into a squat. Deep knee bends. Lunges. It's all movement people and you can get a great deal of benefit from just moving through the big movements to keep everything in check. Learn how to use your core. You don't need a Pilates degree to understand how to keep tension in your abdomen. It's not about a 6 pack!
Its not a death sentence and as appealing as being waited on hand and foot as you lie helpless with your back sounds, its not ideal. Back spasm pain is one of those conditions that is completely debilitating and it will leave you wishing that you could just get down on the floor and do a push up. Nothing like an injury to make you appreciate your gym membership.
Peter Furness
