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

Why Do I Have This Disabling Low Back 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.

What Causes Muscle Spasm And Pain In The Low Back?

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

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

How Is Muscle Spasm Or Tense Back Muscle Diagnosed?

Muscle spasm or tense back muscle causing pain is diagnosed by history of low back pain and 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.

Can Anyone See Or Feel Muscle Spasm?

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

Is There Any Lab Study Or Test, Which Can Confirm Presence Of Tense Back Muscles Or Spasm Of Back Muscles?

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.

Is My Disabling Lower Back Pain Due To Fibromyalgia?

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.

How Is The Back Pain Caused By Muscle Spasm Treated?

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

What Should I Do To Prevent My Low Back Pain From Becoming Chronic?

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

Is Massage Therapy Useful In Treating Low Back Pain?

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.

What Is 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.

Is Facet Joint Pain A Musculoskeletal Pain?

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.

How Common Is Facet Joint Pain And Can It Cause Low Back Pain?

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

How Can I Find Out If My Back Pain Is Facet Joint Pain?

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.

How Is Facet Joint Pain Treated?

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

Which Treatments Are Useful For Long-Term Back Pain Relief?

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.

What Should I Do If Back Pain Relief Is Inadequate Following Physical Therapy And Anti-Inflammatory Pain Medications?

If physical therapy and anti inflammatory meds 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.

What Is Radiofrequency Ablation And Is It Harmless Treatment?

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.

When Will Surgery Be Necessary?

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.

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References:

  1. Increased intramuscular pressure in lumbar paraspinal muscles and low back pain: model development and expression of substance P in the dorsal root ganglion.

    Kobayashi Y, Sekiguchi M, Konno S, Kikuchi S., Spine (Phila Pa 1976). 2010 Jul 1;35(15):1423-8. doi: 10.1097/BRS.0b013e3181c645bb.

    Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.

  2. Lower back pain and neck pain: is it possible to identify the painful side by palpation only?

    Maigne JY, Cornelis P, Chatellier G., Ann Phys Rehabil Med. 2012 Mar;55(2):103-11. doi: 10.1016/j.rehab.2012.01.001.

    Service de médecine physique, Hôtel-Dieu de Paris, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 04, France.

  3. Quantitative sensory testing profiles in chronic back pain are distinct from those in fibromyalgia.

    Blumenstiel K, Gerhardt A, Rolke R, Bieber C, Tesarz J, Friederich HC, Eich W, Treede RD., Clin J Pain. 2011 Oct;27(8):682-90. doi: 10.1097/AJP.0b013e3182177654.

    Department of General Internal Medicine and Psychosomatics, Medical Hospital, Ruprecht Karls University Heidelberg, Germany.

  4. Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable.

    McCarberg BH, Ruoff GE, Tenzer-Iglesias P, Weil AJ., Pain Med. 2011 Nov;12 Suppl 4:S119-27. doi: 10.1111/j.1526-4637.2011.

    Kaiser Permanente, 732 North Broadway, Escondido, CA 92025, USA

  5. An occupational, internet-based intervention to prevent chronicity in subacute lower back pain: a randomised controlled trial.

    del Pozo-Cruz B, Parraca JA, del Pozo-Cruz J, Adsuar JC, Hill J, Gusi N., J Rehabil Med. 2012 Jun 7;44(7):581-7. doi: 10.2340/16501977-0988.

    Faculty of Sport Sciences, University of Extremadura, Caceres, Spain.

  6. Non-thrust manual therapy reduces erector spinae short-latency stretch reflex asymmetries in patients with chronic low back pain.

    Goss DA Jr, Thomas JS, Walkowski S, Clark SC, Licciardone JC, Yue GH, Clark BC., J Electromyogr Kinesiol. 2012 Oct;22(5):663-9. doi: 10.1016/j.jelekin.2012.01.004.

    Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH 45701, USA.

  7. Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints.

    [Article in Croatian]

    Grgić V., Lijec Vjesn. 2011 Sep-Oct;133(9-10):330-6.

  8. Identifying patients with chronic low back pain likely to benefit from lumbar facet radiofrequency denervation: a prospective study.

    Tomé-Bermejo F, Barriga-Martín A, Martín JL., J Spinal Disord Tech. 2011 Apr;24(2):69-75. doi: 10.1097/BSD.0b013e3181dc9969.

    Spine Unit, Department of Orthopaedic Surgery and Traumatology, Virgen de la Salud Hospital, Toledo, Spain.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: October 7, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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