What to do when back spasms attack
A back spasm is a sudden tightness in your back muscles. The pain can come on quickly when you’re lifting something heavy. It can even happen after a particularly violent sneeze. But whatever the cause, it can be excruciating.
Back spasms are generally the result of a small tendon or ligament strain. The muscle spasms to protect the irritated structure. “It’s your body’s way of trying to protect your tendons, discs and ligaments from more damage,” says David Hanscom, MD, a retired orthopedic spine surgeon in Oakland, California, and author of Back in Control and Do You Really Need Spine Surgery?
In most cases, once the injury heals, the spasms stop. But how do you speed up the process?
What to do when you first experience a back spasm
The good news is that back spasms can resolve fairly quickly. And you can help your recovery along by doing the following:
- Stay as active as you can. “We used to recommend bed rest, but we now know people with muscle spasms recover faster when they move around,” says Dr. Hanscom. “It prevents muscle stiffening.” Studies on back pain show that people who are told to stay somewhat active report less discomfort and recover faster than those told to stay in bed. Try to take several 5- to 10-minute walks throughout the day. Flat surfaces will be less painful than hills or stairs. As the pain recedes, you can work up to longer and more challenging walks. (Optum Perks can take the pain out of buying medication: Download our discount card to save at checkout.)
- Apply heat. Whether it’s a hot shower or a heating pad, warmth helps relieve spasms. The reason: It causes blood vessels to dilate, pumping more oxygen and nutrients to the injured area, says Mara Vucich, DO, a physiatrist at the Maryland Spine Center at Mercy Medical Center in Baltimore. There’s less evidence that ice helps, she says, but anecdotally, some patients report that it relieves pain.
- Pop an over-the-counter pain reliever. For muscle spasms, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), or acetaminophen (Tylenol®) can help with the pain, says Dr. Vucich. And be consistent: It may be more effective to take pain relievers on a regular schedule for 3 to 5 days, rather than only when the pain flares up.
- Try spinal manipulation. This treatment involves moving the joints of your spine beyond their normal range of motion. Spinal manipulation is done by chiropractors, physical therapists, osteopaths and some massage therapists. A 2017 review found that spinal manipulation improved pain and function for people with acute lower back pain. “It can improve joint mobility in the spine and back, which can help reduce muscle tightness,” explains Dr. Hanscom.
- Book a massage. A soft-tissue massage can help break up some of the tightness around back and spine muscles, says Dr. Vucich.
- Wear a back brace. These wrap around your torso to mimic the support you get from your back and abdominal muscles. “These can be helpful for a few days, but you don’t want to use them for longer than that,” says Dr. Hanscom. “Over time they can weaken core muscles.”
When to see a doctor for back spasms
If you’re still in pain after a week or 2, or if the pain radiates down your butt or thighs (a condition known as sciatica), see your doctor. In some cases, back pain reveals a bigger issue, such as a fracture, tumor or infection. However, it is more common for a relatively normal disc to tear from physical activity or sports, says Dr. Hanscom. This can cause pain or stiffness that triggers spasms.
If necessary, your doctor will assess the situation with imaging tests such as X-rays or an MRI. She or he might also recommend a prescription pain medication. Common options include:
- Muscle relaxants. Despite the name, these medications don’t directly affect your muscles. They act on your brain and spinal cord to relieve pain. Since muscle relaxants can be habit-forming and cause drowsiness, they’re only recommended for short periods of time (usually a week or 2) and only in certain situations, such as before bed. One example is methocarbamol (Robaxin®), which tends to be less sedating than other muscle relaxants.
- Steroid injections. If your back pain is accompanied by sciatica, your doctor may inject a steroid into your spine to relieve inflammation. This can provide short-term relief while you try other strategies, such physical therapy, to relieve pain.
- Opioids. On rare occasions, your doctor might prescribe morphine or oxycodone for severe back pain. However, according to the Centers for Disease Control and Prevention, opioids are usually no more effective than NSAIDs. And the downside is that they’re very addictive.
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How to prevent future back spasms
The best way to reduce your risk of another painful episode is to stay active, says Dr. Hanscom. He recommends both aerobic exercise (such as walking, jogging and swimming) and strength training. “The stronger your core muscles are, the less likely they are to spasm,” he explains.
Need suggestions? Dr. Hanscom recommends yoga and tai chi, both of which are good for back pain. At home, you can also do knee-to-chest stretches, planks, hip bridges and bird dogs. (That’s the one where you drop to your hands and knees and raise 1 arm straight out while extending the opposite leg. See an example here.)
And if you lift anything heavy, do it properly: Keep your knees bent and tighten your abdominal muscles, rather than reaching your arms out.
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Moving helps ease back pain: The Cochrane Database of Systematic Reviews. (2010). “Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.”
Spinal manipulation helps ease back pain: JAMA. (2017). “Association of Spinal Manipulative Therapy with Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis.”