Dealing with Muscle Spasms in lower back.

Pain & Rehab Forum [Moderated]
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Good Morning all,

Quick history. I’ve suffered multiple back tweaks/injuries since 2009. The worst being in 2016 when my wife had to drive me to the ER. I was unable to walk a few feet and had to be put in a wheelchair due to the pain. Afters hours in the ER and some imagery taken the doctor said I had two bulged discs (S1,L5 and L5,L4). I saw a physical therapist, chiropractor, and even a massage therapist. I was afraid to deadlift and squat for months.

Fast forward to Dec 2018, I suffered another back tweak. I conducted heavy squats the day prior (90% 1RM). When I felt the tweak I was conducting lighter deadlifts at 70%. I felt similar pain in my lower back and even was stuck on the floor when I got home from the doctor. I discovered barbell medicine a couple months prior and this time around tried to stay more active and conduct the main lift movements with lighter weight. After 3 days, I was back to pulling 315 on DL, and 5 days I was at 365. Currently I dont plan to lift over 400 for a couple more weeks unless back gets readapted to the stress.

My question to you is, how do you deal with intense back spasms? I understand pain is output from the brain, but this pain was so intense it pretty much crippled me. I assume the spasms are putting pressure on my nerves thus causing me pain. I was prescribed flexeril and percocet to help with the spasms and pain. Any other preferred methods you would recommend for rehab that wouldnt resort to taking medication? My new approach now is using RPE and I plan to start the Bridge this week.

-Chris

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Hey @Chrisgarcia1287 , thanks for sharing your story.

Unfortunately, this is an example of our linguistic limitations to describe the symptoms (pain) we are experiencing.

Back “spasms” (and muscles spasms in general, which is different from spasticity we see in Cerebral Palsy or Multiple Sclerosis) as it were, appear to not actually exist, at least we can’t demonstrate they do in research as of yet.

Paul Ingraham wrote about this and I think you will find this blog useful: https://www.painscience.com/articles…es-tremors.php.
As an aside - I disagree with his stance on trigger points but the rest of the article appears well informed.

Regarding muscle “relaxants” - the question should be considered, if we can’t accurately identify back “spasms” as a legitimate issue necessitating treatment, then what are these drugs doing to help. Given I do not prescribe meds, I’m tagging @Austin_Baraki for further insight to drugs such as Flexeril. Happy to discuss more.

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Hi there, sorry to hear about this.

I assume the spasms are putting pressure on my nerves thus causing me pain.

I would not assume this to be the case, and agree with Dr Ray’s discussion above.

I was prescribed flexeril and percocet to help with the spasms and pain. Any other preferred methods you would recommend for rehab that wouldnt resort to taking medication?

Unfortunately, when we combine the made-up terminology of a muscle “spasm”, with the description of the medicine as a “muscle relaxer”, the treatment seems to make sense … but unfortunately neither appear to be accurate. Flexeril (cyclobenzaprine) is a centrally-acting medicine (meaning it acts on the brain), and I describe it to patients as a “tranquilizer” effect, rather than any specific effect on perceived “spasms”. Similarly, Percocet (oxycodone) is an opioid narcotic that doesn’t do anything for the muscles in particular. In the real world, I suspect these medicines “work” by a combination of placebo, known pharmacologic analgesic mechanisms, and by facilitating continued activity (or just allowing natural history to take its course – i.e., things getting better over time on their own).

My question to you is, how do you deal with intense back spasms?

Part of the difficulty here is that you have a lot of previously conditioned experiences, memories, associations, and fears associated with this pain. It has been attributed to the “disc bulges” (which is probably not accurate), to “spasms”, and presumably to many other potentially scary things. I’ve experienced seemingly “severe” back tweaks like this, as has my wife. But you’ll note that the last time this happened you were back to pulling 315 just a few days later … which should be very reassuring.

The general strategy is to 1) NOT PANIC (which is much easier said than done, until you’ve repeatedly practiced the skill of identifying your own thought processes & fears, calming yourself down, & accepting what is happening, rather than catastrophizing and assuming the worst possible case), and 2) formulate a plan to patiently begin movement through progressively larger ranges of motion, even with a little discomfort – again while continuously calming yourself down and accepting the situation as you progress. Finally, although most of the time these sorts of things just happen with no clear inciting cause, managing training loads (as we’ve discussed in our injury podcast) is likely the best way we have to reduce the risk of such things.

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@Austin_Baraki …and @Michael_Ray , I really appreciate the response. This time around I did have a more positive outlook since Ive listened and watched a few of your pod/vid casts. This was thanks to you all at Barbell Medicine.

Moving and slowly increasing volume has greatly helped but I would still like to understand why this pain was so intense. I have a pretty high pain tolerance but the past couple back tweaks have crippled me.

If not muscle spasms, how would I classify these symptoms of muscles that tighten up on me?

Once again I appreciate all the information. I’m here to learn and expand my knowledge on this sort of stuff.

–Chris

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Hi Chris,

“I would like to understand why this pain is so intense”

What does intense pain really mean or signify? I am someone that has “episodic cluster headaches.” (google it). The pain is more severe than any other I’ve experienced as a human. But here is the kicker; no injury, no damage, no harm. To answer your question in truthful fashion, we don’t know exactly because there are many factors that drive the pain “intensity” and those factors rarely have much to do with the tissues and structure.

For example: if you lacerate the hand and fingers of a runner and a pianist; who’s pain is more intense?

Maybe if you can answer or think about these ideas, you can start to understand things a little better.

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Chris, you are asking great questions and this is part of the process for re-conceptualizing the meaning of pain.

We don’t have an answer to explain intensity/severity of pain because it is an individualistic experience. No matter how hard I try and put myself in your shoes - I will never experience what you are experiencing or even my patients because our experience with pain is heavily rooted in our prior experiences, our thoughts, learned behaviors, and social/cultural influences.

What the research has consistently demonstrated is intensity/severity are not indicative of anything really and instead what matters is what the patient thinks about the meaning of pain, their self-efficacy to manage the issue (control and confidence in the situation) - which dictates their learned behaviors.

Pain in a nutshell is a threat detection system predicated on attentional focus to ensure protection. If we have a prior experience (like low back pain) then we can have situations such as sensitization (central and peripheral). What this means is we can learn pain and set expectations to have pain which results in a self-fulfilling prophecy. This can get a bit in the weeds but here is how I usually explain it.

With sensitization we can have a decreased tolerance for activation of the area (peripheral say at our back) and a decreased threshold for activation for the output of pain (central at our brain).

In order to unlearn pain - we have to confront our thoughts about the issue and instill new learned behaviors of minimizing fear avoidance behavior related to movement. In essence, we must do the things we are fearful of doing because we expect the outcome of pain. This sounds like you are already doing that by continuing to train with tolerable symptoms. I think the next step is learning more about pain and it’s meaning. Check out this video by Moseley called Tame the Beast - Tame the Beast.

Happy to discuss more.

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Thanks for the response. All this information has been extremely helpful and fascinating to me. It’s definitely been an easier road for me this time around thanks to you all.

Chris

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Thanks for sharing your experience with muscle relaxers and their relation to your ears. The muscle relaxer may be causing your symptoms. It’s definitely worth talking to your doctor about alternatives. A friendly reminder, don’t obtain medication illegally; ensure you’re getting it from a reputable source. If you’re looking to buy Pyrazolam, buy pyrazolam pellets from a reputable website.