Q and A on Disabling Low Back Pain Due To Muscle Spasm or Tense Back Muscles or Facet Joint Pain

Most common causes of disabling lower back pain are tense lower back muscles, muscle spasm, lower back injury, facet joint illness and disk diseases. Lower back injury causes trauma of tendon, ligament and muscles. Other causes are failed back syndrome, fracture of vertebral body, and metastasis of backbones.

Back muscles become tenses or results in spasm secondary to overuse of back muscle, lifting heavy objects, and improper posture for prolonged period of time while sitting or standing. Tense muscles are in continuous state of contractions and later become painful. Back muscle spasm is also caused by facet joint disease or disk injuries. Tense and spasmodic muscles causes increased pressure within muscle mass, decreased blood flow and increased expression of neuropeptide substance P in dorsal root ganglion resulting in severe pain.¹

Muscle spasm or tense back muscle causing pain is diagnosed by history of low back pain and the clinical examinations. Clinical examination most useful to diagnose tense muscle or muscle spasm is palpation but scientific data suggests palpation can detect increased muscle tension in a limited proportion of cases.² Lab study like electromyogram is often used to diagnose tense muscles and muscle spasm, though results of study may not conclude clinical manifestation of muscle spasm or tense muscle.

Muscle spasm in extremities may be occasionally observed during phase of contraction. Spasmodic muscles of extremities if superficial can be felt with hand during examination. Contraction or spasm of deeply situated muscles like back muscles are often not seen or felt in majority of cases during the phase of muscle contractions.²

Lab study like electromyography is often used to diagnose tense muscles and muscle spasm. Electromyography can evaluate abnormalities of nerves and muscles, though it may not diagnose physiological contraction. Research studies like ultrasound and MRI of selective muscles group during contraction phase are compared with similar studies of normal muscles. These studies are not done as a routine investigation.

Fibromyalgia is a generalized muscle pain and has multiple painful areas spread over the body. Fibromyalgia is caused by central stimulation and disinhibition, while lower back pain is caused by localized physiological alterations within the affected segment possibly due to peripheral sensitization. Scientific paper published in 2011 by Blumenstiel K., suggest fibromyalgia is caused by central physiological changes and chronic low back pain is caused by peripheral sensitization.³ Solitary lower back may not have been caused by fibromyalgia.

Muscle spasm is treated with rest, anti-inflammatory medications and muscle relaxants. Treatment may include massage therapy and physical therapy for long-term pain relief. Prognosis and outcome of treatment is better, if treated early. Early treatment also prevents progression to chronicity of low back pain.⁴

Stretching and muscle strengthening exercises are often taught in physical therapy sessions. You should continue these exercises. As an alternative treatment you should join yoga classes under supervision. Yoga therapy may be beneficial if you continue as a daily exercise. Study performed in Spain and published in 2012 involving 100 patients suffering with back pain suggest regular exercise of lower back muscles can prevent long-term chronicity.⁵

Low back pain caused by tense muscles and muscle spasms do respond to manual therapy.⁶ Manual therapy such as chiropractic manipulations, massage therapy and physical therapy are useful to treat musculoskeletal pain.

Lower back pain is sometimes diagnosed as musculoskeletal pain when radiological test results are normal. Diagnosis of musculoskeletal pain suggests pain is originating from muscles, joint or bones.

Facet joint pain is often diagnosed as musculoskeletal pain. Back pain caused by facet joint disease is difficult to establish with conventional clinical examination and radiological studies unless facet joint is hypertrophied. Pain caused by facet joint is often diagnosed as musculoskeletal pain, which is a non-specific diagnosis.

Yes. Facet joint disease is one of the common causes of low back pain. About 15 to 45% of low back pain is often caused by facet joint disease.⁷

Facet joint pain is best diagnosed by facet joint diagnostic injection. Diagnostic injection is performed in surgical center under aseptic precautions. Facet nerve or facet joint is injected with local anesthesia. Satisfactory pain relief for few hours to days confirms the pain is caused by facet joint disease.

Facet joint pain is treated with anti-inflammatory medications, physical therapy, cortisone injections, facet nerve ablation, and spinal fusion surgery.

Mild facet joint inflammation will respond to anti-inflammatory pain medications and you could get prolonged pain relief. Facet joint hypertrophy or chronic facet joint disease may not respond to only anti-inflammatory medications but may give long term pain relief if treated simultaneously with physical therapy.

If physical therapy and antiinflammatory medications have failed to resolve your low back pain then you should consider cortisone injection of facet joint or radiofrequency ablation of facet nerve. Cortisone injection between one and three may give you pain relief of 50% or more lasting 3 to 6 months. If pain after cortisone injection is over 50%, but lasts for only less than 3 months, then you should consider radiofrequency ablation of facet nerve.

Facet nerve ablation is achieved by heating nerve to 900 C by using radiofrequency heat. Outcome of the study performed on 68 patients treated with radiofrequency ablation of facet nerve suggest 89% patient had significant pain relief lasting 6 months and 50% of patient had pain relief lasting 1 year.⁸ Around 75% of patients were willing to repeat the same procedure again.⁸ Procedure is safe since radiofrequency needles are placed under guidance of X-ray image intensifier and following placement of needle the nerve is tested by sensory and motor nerve stimulation.

Facet joint disease can cause facet joint hypertrophy, which may result in spinal stenosis. Surgery is indicated when facet joint hypertrophy causes spinal stenosis or foraminal stenosis. Untreated spinal or foraminal stenosis can cause irreversible nerve damage. Surgery is performed to prevent irreversible nerve damage and stabilize the facet joint. Surgery is also indicated when intractable pain is not responding to any of the conservative treatment.

Also Read:

• Low Back Pain Due to Lumbar Disc Bulge
• Lower Back Muscle Spasms: Causes, Symptoms, Treatment
• Lumbar Disc Herniation Causing Low Back Pain
• What Causes Back Muscle Spasms or Sprain & What is its Treatment, Prevention
• Facet Joint or Zygapophysial Joint Pain Causing Back Pain
• Back Pain Caused by Spinal Stenosis
• Disability Benefits For Back Pain

Also Watch:

• 3D Video On How Lumbar Facet Joint Injection is Performed

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