Are You Experiencing
Back Muscle Pain?

Back muscle pain can be debilitating. Both muscle pain and muscle spasms can lead to severe back pain and limited function. What is the cause of the pain and what can you do to relieve your symptoms?




Back Muscle Anatomy

The spine is supported by a numerous muscles all designed to help support and move the spine. Deep muscles, such as the multifidi, are short and help provide spine stabilization. Longer and more superficial muscles, such as the erector spinae group help provide movement of the spine. Any one of the muscle groups can be injured with movements and activities.


Back Muscles


Causes of Back Muscle Pain

Of course, the cause of muscle pain that most often comes to mind is a muscle strain. Strains of the muscle generally occur with a specific movement. For example, you bend over to help lift a piece of furniture and feel a “pull” in your back.

Despite what may feel like a muscle strain, most back muscle pain is not due to an injury to the muscle itself. In fact, the muscles are often reacting to an underlying problem. As an example, when you sprain your ankle, the body reacts with swelling to both bring healing cells to the region and minimize movement in order to allow healing to occur. In the same way, muscle spasms occur around the spine to increase local blood flow and to minimize movement in order to allow healing to occur. Unfortunately these muscle spasms themselves can be as painful as the underlying problem.

In addition, the pain you are feeling may not be in the muscle itself. Rather, what you may be experiencing is referred pain. For example, a person having a heart attack may not feel any chest pain at all. Instead they may feel arm or jaw pain. This is an example of referred pain. The same can be true for symptoms of the back that may feel like they are from the muscles but in reality are originating from another source. The kidneys and lungs are common sources of back muscle pain.

In addition to organs, the joints of the spine can refer pain to the muscles. It is very common for the joint of the lower cervical (neck) spine to refer pain to the middle back. The symptoms feel just as if you have strained a muscle around your shoulder blade but in fact, the cause of the pain is from the lower cervical spine.



Signs and Symptoms

The most common symptom for pain that is caused by the muscle itself is pain with movement of that specific muscle. If the muscle is strained, movement of the muscle will hurt and resting the muscle will immediately make it feel better.

For muscle pain that is the result of referred pain, symptoms are not as clear cut. Symptoms that are aggravated with specific postures or positions may indicate an underlying spine condition. For example, if pain occurs with sitting, driving, or bending to touch your toes, the root cause may be a bulging disc. If the symptoms are elevated with standing and walking and relieved with sitting, you may have either spinal stenosis or degenerative disc disease.

Finally, if you are experiencing severe back pain at night or pain that does not appear to be related to any posture or position, the pain may be referred from an organ such as the kidneys or lungs. If you are experiencing these types of symptoms, see a doctor immediately to diagnose the cause of your pain.


Typical Treatment

Treatment for back muscle pain will be based on the underlying cause. Of course, if the symptoms are referred from an organ such as a kidney, the treatment plan will be determined by your doctor for treating the underlying kidney condition.

If the cause is from a muscle strain or an underlying spine condition, begin by utilizing ice therapy. Ice your lower back for 10 minutes at a time, a minimum of three times a day. Do not use heat! Far too often I have patients come to see me who have been using heat, only to have their symptoms get worse or last longer. If you are experiencing any pain, avoid heat and only use ice.

At a minimum, if there are specific positions or movement that aggravate your symptoms, stop or at least limit these activities or positions. And, if there are positions that generally feel better, try to maximize being in these positions.


Low Back Double Knee to Chest Stretch



Exercise and Stretching

Of special note, do not think that bed rest is the best form of allowing your back to heal. Prolonged positions of lying in bed, sitting, or standing will aggravate your condition. Try to change positions frequently but definitely do not spend a day on the couch or in bed thinking it will allow your back to heal.

Stretching and exercise can also be an important aspect to back pain treatment. The key is to avoid activities that aggravate symptoms and do as much activity as your pain allows.

Most back pain follow a pattern of symptoms. Paying attention to when the pain is worse and when it is better will be of primary importance in determining the best stretches.

For example, if pain occurs with sitting and bending, walking is encouraged and performing extension exercises will help relieve your pain.

If, however, pain occurs with standing and walking, do more sitting and perform these flexion exercises to minimize pain. The key is to listen to your body. Avoid the positions and activities that aggravates your pain and maximize the positions and activities that minimize your pain.


Massage

As a physical therapist I am also frequently asked if massage can be helpful in reducing back muscle pain. The simple answer is, if it feels good, massage is fine but generally not a cure to back pain. However, realize that often aggressive massage that looks to kneed out muscle spasms may actually make the pain worse. It is better to start with light massage first to make sure it is tolerated well and then increase the intensity of the massage over time.


Medication and Supplements

Taking over the counter medication is also a treatment option (consult your doctor regarding medication). If possible, chose anti-inflammatory medication as pain related to joint and muscles have an inflammatory component. In addition, if you chose to take anti-inflammatory medication, in order for it to be effective in reducing the inflammation, it must be taken on a consisted basis. Muscle relaxants can also be helpful but you will need to consult your doctor for a prescription of this type of medication.

In addition to medication, supplements may be helpful in reducing back muscle pain. Research indicates that taking 1200 mg of Omega-3 (fish oil) is an effective alternative to NSAIDS in the treatment of back pain. Being that fish oil does not have the side effects associated with NSAIDS (namely stomach upset), fish oil may be more appropriate choice for many.


When to See a Doctor

Most back muscle pain will resolve within a few weeks. However, here are some indications that may signal that it’s time to see a doctor:

• Nighttime pain that interrupts sleep and does not vary based on position.
• Symptoms of numbness or weakness in the legs.
• Changes to bowel or bladder function.
• Numbness or symptoms in the groin region
• Back pain that worsens or does not improve within a few weeks.


Summary

• Back muscle pain can have a number of causes including muscle strain, underlying spinal conditions, and referred pain from organs.

• Do not use bed rest to treat your low back pain.

• Utilize ice therapy (no heat), minimize aggravating activities, and use over the counter medications to help relieve muscle pain.

• Light exercising and stretching is encouraged.
• Seek medical attention if you have severe back pain at night, your pain worsens, or the pain lasts for more than a couple of weeks.


Back muscle pain more often is related to underlying spinal conditions. Implement simple treatment recommendations and seek the help of a qualified medical professional to determine the best long term plan.




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References

Phys Med Rehabil Clin N Am. 2010 Nov;21(4):679-709. Functional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators. Vora AJ, Doerr KD, Wolfer LR.

Clin Sports Med. 2008 Jul;27(3):449-62, ix. Neuromuscular consequences of low back pain and core dysfunction. Hammill RR, Beazell JR, Hart JM

Eur Spine J. 2006 May;15(5):668-76. Epub 2005 Jul 27. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Panjabi MM.

Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.Maroon JC, Bost JW.


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