Lower Back Spasms

What Is Lower Back Spasms?

Lower Back Spasms represents an excessive tightening of the muscles that surrounds and supports the Lower Back Spasm region of the spine, causing back pain. At least 10% of the population consults a physician, physiotherapist, or chiropractor each year about back pain. Backache is a nonspecific term used to describe back pain. More than 80% of people experience back complaints during their lifetime.

Low back pain, the most common complaint, typically occurs between the ages of 30 and 70. Back injuries occur frequently in competitive sports and in industrial and automobile accidents.

In severe injuries, the examiner must be careful not to cause further damage. For example, if an injured person complains of back pain and is unable to move the limbs, the vertebral column may be fractured.

If the neck is flexed or the injured person sits up, the spinal cord may be (further) injured. Improper handling of an injured person can convert an unstable lesion without a neurological deficit into one with a deficit that produces permanent disability.⁽¹⁾

Anatomy Of Lumbosacral Region

The back spine consists of the posterior aspect of the trunk, inferior ro the neck and superior to the gluteal region.

 

In adult individuals, the vertebral column consists of 33 vertebrae. There are five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4 coccygeal groups. The lowermost 5 sacral vertebrae are fused creating the sacrum. Later, at the age of 30, the 4 coccygeal vertebrae fuse and form the coccyx.

Lumbar vertebrae are positioned in the lower back in the region of the torax and sacrum. They are characterized by massive bodies.Their articular processes extend vertically, with articular facets sagittally oriented initially (beginning with the T12-L1 joints).The L5-S1 facets are distinctly coronal in orientation. The transverse processes project posterosuperiorly and laterally. ⁽²⁾

Ethiopathogenesis

Chronic pain in the spinal region is caused by two large etiopathogenetic groups: myogenic and vertebrogenic.

Myogenic causes include chronic myositis, Lower Back Spasms due to the forced position or sometimes due to the psychological tension as well as muscle tissue degeneration of the paravertebral musculature towards myofibrositis.

Myogenic pain is caused by the accumulation of lactic acid which gives the local tissue acidosis. Local tissue acidosis stimulates the nerve endings.

Vertebrogenic causes of pain include osteoarthritis and vertebral joints of the spine (spondylosis, spondiloartritis) and disorders of the intervertebral disc (disc herniation and protrusion) which leads to the compression on the nerve roots.

The pain in the lumbar region may be caused by certain movements. Consequently, it is followed by protrusion and herniation of intervertebral disc as well as constant pain.

Signs & Symptoms

The most prominent symptoms of lower back pain are difficult movements that may endanger walking or standing. In such condition, pain may radiate to the groin, upper thigh or gluteal region. Muscle spasms are present as well as dull pain with local sensitivity of the skin and nerve fibers.

Diagnosis

Diagnosis is based upon a medical history, palpation of the paravertebral region (spasm of the paravertebral muscles, the finding of spastic isolated fibers within the mass of musculus erector spinae or painful miofibrous nodules) as well as on the basis of a neurological examination.

The radiographic findings may show the lumbosacral region as corrected cervical or lumbar lordosis, smaller or larger arthrodesis curve, narrowed intervertebral space, occasiaonally osteophytic osteophytes and structural changes of intervertebral space and narrowed intervertebral spaces.⁽³⁾

Treatment

In the majority of patients with acute or subacute Lower Back Spasms back pain or spasms, such condition resolves spotaneously. The treatment of choice is nonmedicamentous procedures such as superficial heat application, massage, acupuncture or local manipulation.

If such treatment is ineffective, further treatment should be obtained via nonsteroid antiinflammatory medications or muscle relaxants.

In case of chronic Lower Back Spasms  back pain, excerises, electromyography, laser therapy, cognitive-behavioural therapy or spinal manipulation are advised.

Antispasticity Agents

Baclofen

Baclofen represents a skeletal muscle relaxant with central effects. It is structurally alike the ץ-aminobutyric acid (GABA). The main site of baclofen’s action is the presynaptic GABA site, where it decreases synaptic transmission on the spinal cord. The incidence of CNS depression is minor in case of baclofen administration.

The most common adverse effects are weakness,dizziness, drowsiness, vertigo and insomnia.

Dantrolene

Dantrolene represents a skeletal muscle relaxant that has a specific peripheral mechanism of action. It interacts with the secretion of calcium ions in the skeletal muscle cells which slows the contraction duration in malignant hyperthermia.

Dantrolene is indicated in the treatment of upper neuronal disorders such as spinal cord injury, multiple sclerosis and cerebral palsy.

Antispasmodic Agents

Metaxalone

Metaxalone is a central nervous depressant. It is indicated for the treatment of aute musculoskeletal spasmodic pain. Due to its sedative attributes, it has antispasmodic effects. It represents an additional regimen to the musculoskeletal pain. Its daily dose is 800 mg 3-4 times per day.

There are certain adverse effects such as dizziness, drowsiness, nausea and vomiting. More severe complications are hemolytic anemia, leucopenia and jaundice. Metaxalone is contraindicated in case of severe hepatoreanl impairment. Thus, regular hepatic investigations are necessary.

Methocarbamol

Methocarbamol represents a centrally acting muscle relaxant. It is available fort he oral and parenteral use. It is indicated as an additional regimen for the relief of acute musculoskeletal pain. Its exact mechanism of action is still unknown. Methocarbamol shows appears to have a general CNS depression effect.

Methocarbamol is present as tablets in 500 mg and 750 mg. In case of musculoskeletal pain it is dosed as 1,500 mg 4 times per day. The maximum dose is 4 to 4.5 grams divided into 3 to 6 doses per day.

Orphenadrine

Orphenadrine citrate is a medication used to treat skeletal muscle spasms and belongs to a group of skeletal muscle relaxants.

Skeletal muscle relaxants have a depressing effect on the central nervous system with an onset of action between 30 and 60 minutes.

Chlorzoxazone

Chlorzoxazone is administered for the symptomatic treatment of muscle Lower Back Spasms as well as pain associated with acute musculoskeletal disorders.

Its main mechanism of action represents the spinal cord and subcortical regions of the brain. It inhibits multisinaptic reflex function that are involved in the onset of skeletal muscle Lower Back Spasms.

Chlorzoxazone is available in 375 mg, 500 mg and 750 mg tablets. The recommended dosage is 500 mg 3 -4 times per day. The highest dose is 750 mg 3-4 times per day if needed. Its peak effects are evident within an hour.

There are certain central nervous effects of chlorzoxazone such as dizziness, drowsiness and light-headedness. An idiosyncratic and hepatocellular toxicity have been noted as well. In case of fever¸rash and dark urine it is advisable to discontinue the medication.

In case of chronic use of chlorzozaxone, it is necessary to obtain periodic liver tests.⁽⁴⁾

References

1. Roland MO.A critical review of the evidence for a pain-spasm-pain cycle in spinal disorders.Clin Biomech (Bristol, Avon). 1986 May;1(2):102-9.
2. N Bogduk. The human lumbar dorsal rami.J Anat. 1982 Mar; 134(Pt 2): 383–397.
3. Xuefei Deng. CT and MRI Determination of Intermuscular Space within Lumbar Paraspinal Muscles at Different Intervertebral Disc Levels. PLoS One. 2015; 10(10): e0140315.
4. Vikram B. Patel.Interventional Therapies for Chronic Low Back Pain: A Focused Review (Efficacy and Outcomes). Anesth Pain Med. 2015 Aug; 5(4): e29716.