Paraspinal Muscle Spasm- Causes, Symptoms & Treatment
Medically Reviewed By : Dr Sravya, MBBS, MS
Introduction
Have you felt a sudden catch in your lower back after lifting something heavy? Is it difficult to turn from side-to-side? Is it challenging to bend forward or even sit for a period of time? What you have experienced is called a paraspinal muscle spasm. But why do paraspinal muscle spasms happen? What should you do when you experience a paraspinal muscle spasm? Why do they happen and is paraspinal muscle spasm avoidable? Let us understand them better.
A spasm is a strong muscle contraction that is out of your control (involuntary). They have a sudden onset. They are often vigorous and uncomfortable due to intense pain which is localised to the site of the spasm. A muscular spasm is a symptom and is caused by an underlying disease.
Paraspinal muscles are the strip of muscle fibres that run parallel to the spine in our back. A spasm of these muscles is called a paraspinal muscle spasm.
What are the symptoms of paraspinal muscle spasm?
Their symptoms are painful and often interrupt daily life. Paraspinal muscles are important for stabilising the back during any kind motion, be it sitting, standing, or running. Hence when they go into spasm, it can make your life very difficult. Symptoms include:
- Cramping sensation in the back.
- Restricted mobility of the back.
- Uncomfortable sensation in any position.
- Relief only when the back is in resting position.
- Weakness of the back and hips.
Paraspinal muscle spasms are prevalent in every age group and gender.
What causes a paraspinal muscle spasm?
Reasons for muscle spasms to occur can vary from a simple electrolyte imbalance to severe neurological degenerative disease. Paraspinal muscles have the same composition as that of a normal muscle and can be affected similarly. They can be grouped into 3 major causations.
- Muscle-related: This may be seen at the cellular level. Usually caused by electrolyte imbalance. For example, adequate release of calcium is important for normal muscular contraction. If you are experiencing recurrent paraspinal spasms, it can be due to low levels of calcium. Similarly, in conditions where the muscle has been overused, due to increased oxidative stress (where oxygen supply to the muscle does not meet its demand) there is lactic acid build-up which leads to spasm. This is often seen in individuals who exercise regularly.
- Peripheral nerve related: Denervation of the muscle due to injury or disease may lead to involuntary contractions from the muscle in the form of a spasm. For example, in spinal cord injury; muscle spasm is chronically observed below the level of injury. This is mainly due to the disruption in the flow of impulses to the brain, steering the impulse back to the muscle which presents like a spasm/jerk. This can happen in the paraspinal muscle as well.
- Centrally related: in conditions like stroke and cerebral palsy, there is an increased tone in certain groups of muscle which may represent itself as a spasm. The loss of inhibitory impulses from the cerebral cortex (brain) leads to increased tonicity of spasticity. Spasticity of the paraspinal muscle can lead to difficulties in walking, running and other basic activities
Reasons for paraspinal muscle spasm categorised based on disease.
Muscle | Nerve | Central |
|---|---|---|
● Hypokalemia ● Hypomagnesemia ● Hypocalcemia ● Addison’s disease ● Renal disease |
● Peripheral neuropathy ● Benign fasciculations and cramp syndrome ● Neurodegeneration with iron deposition. ● Strychnine poisoning |
● Tourette syndromeI ● Tumor/Mass ● Wilson’s disease ● Infections/Inflammation (encephalitis) |
How is a paraspinal muscle spasm diagnosed?
There are a vast number of triggers that can present in muscle spasms. Therefore, to administer an accurate mode of therapy, a thorough evaluation is required. A detailed history of the onset, distribution, frequency, occurrence, and severity of the paraspinal spasm is taken. The history-taking should be able to narrow down the causation to one of the 3 major groups.
Physical examination is focused on palpation of the paraspinal muscle in the back, meaning the doctor is going to check if the muscle is taut or painful.
- Range of motion: This is a movement based examination. Your doctor will check the available range of movement allowed by your back, neck and hips when the muscles are in spasms. This gives an indication about the severity of the spasm.
- Strength: Strength test or Manual muscle testing (MMT) is a normal routine physical test. If your pain allows, the doctor may perform a series of tests to gauge the strength of the muscles. Weak muscle strength may indicate some muscle fibre damage.
- Reflexes: The doctor may routinely check for your reflexes as well. Paraspinal muscle spasms can impinge nerve roots. This test may indicate the area of impingement.
- Sensory test: This is a non-invasive check of your sensitivity to stimulus like touch, pain, vibration, etc. This added information may be useful for the doctor to come to a diagnosis.
- Gait Analysis: Since paraspinal muscle spasms tend to affect the postural muscles required in your daily activity, your doctor may assess your walking pattern as well.
- Electromyography: invasive or external electrodes are used to measure the electrical activity of the muscle at rest or in action.
- Neuroimaging: MRI/CT imaging gives a clearer picture of muscle health, density, and girth which can be used to contribute to laboratory results. Also, if any involvement of the spinal cord is present, as it might contribute to the paraspinal spasm.
How do I treat my paraspinal muscle spasm?
1. Immediate symptomatic relief from paraspinal spasms:
This mode of therapy is effective for sudden painful muscle spasms which usually are observed in people who regularly exercise or are weight training. Even in diseased conditions, this may help to alleviate the spasm.
- Stretching: Stretching the muscle under spasms for 30-60 seconds, or repetitive stretch-relax motion to help blood flow into the muscle. For your paraspinal muscles, a simple forward-backward bending or a side-to-side twist stretch will help elevate the spasm.
- Massage: Slow deep tissue massage which guides the drainage of lymphatic channels, facilitating blood flow. For example, in a paraspinal muscle spasm, deep tissue massage should start from the lower back upwards to the back of the neck. Self-massage can be administered using a foam roller or tennis ball.
- Ice or heat therapy: Slow icing or using hot packs for 15-20 minutes significantly provides relief from spasms. Ice is usually used in sports or overuse-related muscle spasms. It is also seen to be effective in relieving spasticity in central conditions (e.g., Stroke or cerebral palsy). Heat is usually used for generalized aches and pain.
- Hydration: adequate hydration (2-3L of water) and electrolyte replenishment is a must to avoid recurrent spasms.
- Supplements: Calcium, Magnesium, or Vitamin B12 can be taken to replenish any deficiency which may cause spasms. Speak to your doctor about taking supplements to get the appropriate dosage.
2. Pharmacotherapy
In diagnosed diseases, your doctor may advise certain medications which may help you relieve spasms/spasticity. These drugs can ONLY be prescribed by a doctor and must be taken according to their orders. These drugs cannot be self-administered and have severe side effects like drowsiness, tremors, or nausea.
- Centrally acting drugs: Baclofen and Alpha 2 agonists are inhibitory types of drugs that reduce spasticity.
- Anticonvulsants: Drugs that are used in seizure disorder also help in reducing spasticity e.g., Diazepam or gabapentin.
- Phenol/alcohol injection: Phenol (3-7%) or alcohol (50-100%) injection into the spastic paraspinal muscle can help relieve the symptom via chemical neurolysis. These injections should be administered by a doctor to ensure an appropriate percentage. Higher concentration may lead to nerve damage.
- Botox injection: Botulinum toxin injection is a rare mode of therapy for spastic paraspinal muscles. It is a form of a reversible neurolytic drug and its effects last for 3-4 months till the toxin degrades.
- Dantrolene sodium: This is an oral antispastic drug that works peripherally by preventing calcium release, therefore, inhibiting contraction of the muscle.