What exactly causes back spasms, the athlete's curse, and what can be done to treat and prevent them?
Few active individuals are able to escape completely from the pangs of back spasms, which are among the most common of all athletic injuries. Although they are nothing more than involuntary, intermittent, and sometimes prolonged contractions of the muscles of the back, back spasms can be quite painful and debilitating, and they can knock the 'weekend warrior' or the elite athlete completely out of action for weeks at a time.
Usually, spasms prey on the muscles in the lower back, rather than the upper regions of the torso. The origins of back spasms are diverse, but it is clear that they are often a response to an injury or inflammation of the spinal region. In many cases, the muscles of the back themselves are injured or inflamed, but the spine itself, including the thin cartilaginous discs between the spinal vertebrae and the ligaments which connect the vertebrae, may also be the source of the difficulty. Some back-spasm experts believe that spasms are a reaction by which the body attempts to immobilise the spine and thus prevent further injury.
Naturally, the injuries that produce back spasms might be caused by 'overuse' (chronic muscular exertion without adequate recovery) or by a single, traumatic incident. In the case of overuse, repeated rotational movements of the spine, such as the swinging motions required for baseball, cricket, tennis, squash, handball, racquetball, or golf, may eventually lead to an injury or inflammation of the vertebrae, spinal discs, ligaments of the spine, or spinal muscles themselves, particularly in individuals whose lower back muscles are functionally weak.
Radical training changes as well
Sudden injuries which lead to spasms might result from a blow to the back, a fall on the back upon a hard surface (such as a basketball floor), a quick, forceful twisting of the spine during sporting activity, or a sudden change in direction while running. Radical changes in training also seem to increase the risk of back injury and spasms. For example, an increased frequency of back spasms has been noted in sprint runners who suddenly add uphill running, stadium-step running, or running against resistance to their training regimens. Anecdotally, it appears that back spasm may result from prolonged sitting or standing, especially if poor posture is utilised. If the spine is allowed to 'sag' forward near the hips during prolonged standing, increased strain is placed on the lower back muscles. Similarly, if one slouches while sitting, increased force is placed on the spine in a front-to-back direction, requiring the muscles of the low back to work extra hard to maintain spinal stability.
Scientific investigations have noted that back spasms are linked with prolonged and/or excessive flexion of the back ('Multifidus EMG and Tension-Relaxation Recovery after Prolonged Static Lumbar Flexion,' Spine, Vol. 26(7), pp. 715-723, April 2001). Research reveals that in vulnerable individuals just 20 minutes of significant anterior flexion of the back can produce spasms which are not resolved after as much as seven hours of complete rest of the back muscles (ibid).
Such findings are important for individuals who have trouble with back spasms. First, they indicate that a significant injury is not really required for back spasms to occur - prolonged or hyper-flexion of the back can do the trick. Many athletes are already aware of this, since acute spasms frequently occur during training or competition in response to exaggerated back flexions or situations in which the back must be held in a flexed position for an unusually long time.
The link between flexion of the back and spasms suggests that athletes who have poorly balanced core strength, ie, greater strength in the abs, compared with their lower back muscles, are more prone to lower back spasms. Superior strength in the abs tends to put the back in a chronically flexed position, which consequently places unusual strain on the lower back muscles, which are forced to try to pull the spine back into its normal configuration at the same time as they are stretched out because of the abnormal flexion. Such stress no doubt raises the risk of lower back-muscle 'burn-out' and spasms.
What are the symptoms?
The main symptoms of back spasms include severe pain emanating from the back in the absence of motion, significant discomfort in the back upon movement of the legs or arms, and/or pain associated with rotation of the spine. Such symptoms are usually accompanied by a sensation of a lack of mobility of the spine. The discomfort and feeling of immobility may last from a few seconds up to several minutes, go away, and then return again after a brief respite. Spasms which appear suddenly during activity may disappear when a resting position is assumed; anecdotally, lying down seems to be more relieving than sitting. Subsequent movement, however, may cause the spasms to return.
An occasional spasm in your back - without any other indication of back pain - may be a warning signal that you have a muscular imbalance or that you have a 'below-the-radar-screen' injury to your back. In either case, you should exercise great care with your back, attempting to avoid situations in which the back is placed under great strain, and you should also begin to carry out strengthening exercises for your back (see below). Naturally, if your back spasms occur relatively often, you should pay a visit to your health-care professional. If the symptoms of back spasm are of sudden onset, which is often the case, he/she will want to know if a traumatic incident caused the initiation of symptoms. He/she should also ask questions about your training practices, including whether you embarked on a new mode of training prior to the development of back trouble.
'One of the first things is to apply ice to the injury site. Keep the ice on the site for 12 minutes at a time, with 20-minute recoveries between applications'
The knowledgable health-care professional will want to palpate your injured area and perhaps even manipulate your spine, legs, and/or arms to determine the external forces and body positions which produce symptoms. You might be required to perform certain movements and describe symptoms that occur during such motions. In addition, x-rays or other imaging techniques, such as 'CATscans', bone scans, or magnetic-resonance-imaging procedures (MRIs), might be necessary to identify or rule out injury to the spinal vertebrae or the cartilaginous discs between vertebrae.
If you have been unfortunate enough to injure your back, one of the first things you should do is apply ice to the injury site. You should keep the ice on the site of injury for about 12 minutes at a time, with 20-minute 'recoveries' between applications. Ideally, you or a helpful friend can perform 'ice massage' on your affected area, using the nub of ice from a styrofoam cup (which has been left in the freezer for enough time to freeze its water) to gently work coldness into the hurting area; reveal the icy nub within the cup by peeling away its topmost styrofoam. Massage for about 12 minutes, take a 20-minute break, and repeat. At least six 12-minute massages per day should be performed to ease pain, inflammation, and swelling. Some athletes have gained considerable relief from using a special 'PROSERIES' ice-pack system for their backs; this system wraps neatly around the back and can be used during activity, providing both cooling and compression of the low back (for more information, contact Fitter International Inc. in Canada at 403-243-6830 or at firstname.lastname@example.org).
Nonsteroidal anti-inflammatory drugs (such as ibuprofen or a COX-2 inhibitor) may be prescribed by your doctor to control the inflammation at the spasm site and reduce pain. Note, though, that COX-2 inhibitors may not represent appropriate treatment if the back spasms are the result of ligament damage to the back. Recent research suggests that the use of COX-2 inhibitors might be linked with retarded healing in injured ligaments ('A Cyclooxygenase-2 Inhibitor Impairs Ligament Healing in the Rat,' The American Journal of Sports Medicine, Vol. 29(6), pp. 801-805, 2001).
Your doctor might also prescribe muscle relaxants, which may ease the hyper-contracted state of the back muscles involved in the spasms. Such easing can decrease pain and increase mobility in the back, which are good things, of course - as long as an individual does not attempt to return too quickly to normal activity. Quick returns might further injure the problem area.
Recently, a novel treatment has been developed for alleviating lower back pain and spasms: the administration of Botulinum toxin! This may sound a bit bizarre, but bear in mind that there is a strong rationale for the use of such a sometimes-deadly substance. As you are undoubtedly aware, botulism is a rare but extremely serious paralytic illness caused by a nerve toxin produced by the bacterium Clostridium botulinum. Scientists have reasoned that injections of small quantities of this toxin into areas of the back struck by spasms might induce a bit of controlled paralysis in those areas. This could be desirable if it stopped spasms by letting muscles become more flaccid.
Here's a recent study
Recently, researchers at the Walter Reed Army Medical Center in Washington, DC (USA) tested the efficacy of botulinum toxin A in the treatment of lower back difficulties (there are seven types of botulism toxin designated by the letters A through G; types A, B, E, and F cause illness in humans). 15 of 31 patients received 200 units of botulinum toxin A (40 units per site at five lumbar paravertebral levels on the side of the back with maximum discomfort), while 16 received normal-saline injections. After both three and eight weeks, patients receiving the toxin reported significantly better pain relief, compared with the control group, and there were no significant side effects. Injections of botulinum toxin A truly relieved pain and improved lower back function, compared with control ('Botulinum toxin A and Chronic Low Back Pain: A Randomised, Double-Blind Study,' Neurology, Vol. 56(10), pp. 1290-1293, May 22, 2001).
'Back spams can sometimes be linked with a chronically maintained body position - for example, if you spend large amounts of time with your back in a rigid, slightly flexed position'
Ordinarily, the duration of back spasms depends on the severity of the injury, the amount of inflammation at the site of injury, and of course the success of the rehabilitation programme. Always bear in mind that you should be symptom-free before you return to full participation in your sport. This means that you should be able to perform all the skills and basic movements of your activity with no significant pain before you decide to return. Obviously, a too-early return to activity can lead to re-injury and an intensification of back spasms. Nonetheless, a successful return can sometimes be accomplished in a couple of days. However, in instances where inflammation is great, with possible involvement of lower back ligaments or intervertebral discs, weeks may pass before safe return to activity is advised.
In some cases, back spasms can be linked with a chronically maintained body position; for example, if you spend large amounts of time sitting with your back in a rigid, slightly flexed position, you are probably at increased risk for spasms. In such cases, the risk of spasm occurrence can probably be lowered by frequent changes in body position and periodic stretching of the back muscles. More importantly for the athlete, it is also believed that back spasms can be prevented by strengthening the muscles of the back, by improving and balancing core strength and coordination, and by increasing the flexibility of the back and lower extremities (if the low back is tight and inflexible, 'microtears' of lower back muscles probably occur more readily in response to sudden movement). Exercises for increasing the strength and functional flexibility of the low back are described below.
Basic exercises to prevent back spasms
Basic, traditional, back-spasm-preventing and back-strengthening exercises include the following (make sure you warm up
by walking, jogging, or cycling easily for 10 minutes or so before you begin the drills):
(1) Knee Raises (for lower back flexibility). Lie on your back with your legs extended, and then bring your left knee toward your chest and grasp it. Pull the left knee as close to your chest as pain permits, and hold for about 10 to 15 seconds, letting your hamstrings, bum, and lower back muscles 'unkink'. Then, return to the starting position and perform the same sequence with your right leg. Return to the starting position to complete one rep; complete 10 reps overall.
(2) Back Rounders (for lower back flexibility). Lie on your back with your legs extended and your arms at your sides. Draw both of your knees toward your chest. Then, grasp your knees underneath your thighs and raise your head from the floor. In a relaxed and smooth manner, bring your head and knees as close together as pain and flexibility permit, and hold this position for five to 10 seconds. Return to the starting position, relax, and repeat for a total of 10 times.
(3) The Pelvic Press (for strengthening the low back). To carry out this exercise, simply lie on your back with your arms at your sides - or with your hands behind your head. Then, tighten the muscles of the stomach and buttocks, pressing the small of your back to the floor. Hold the small of your back on the floor for about 12 seconds, return to the starting position, and relax for a few seconds. Perform this cycle 12 times, rest for a moment, and then follow up with 12 more 'presses'.
(4) The Double-Knee Lift (for better coordination and flexibility, as well as improved core strength). Lie on your back with your knees bent and the soles of your feet on the ground. Then, tighten your stomach muscles and bring your knees slowly and smoothly toward your chest. Next, extend your legs into a straightened position while keeping your heels several inches off the floor. Hold this position for three to five seconds (or for as long as pain permits). Return to the starting position by bringing your knees back toward your chest and then lowering your feet to the floor, and relax for a few seconds. Perform two sets of eight reps of this exercise, stopping the exertion if any pain arises.
(5) Opposite Arm and Leg Lifts (for strength and flexibility). Lie face down on the floor with your legs straight and your arms fully extended, so that they are lying on the floor on either side of your head. Then, raise your right arm and left leg as high off the floor as possible, and hold the position for about 12 seconds. Lower your right arm and left leg back to the floor and relax for a few seconds. Then, raise your left arm and right leg as high off the floor as you can, holding for 12 seconds. Complete one rep by relaxing for a few seconds, and carry out a total of two sets of 10 reps, with a short break between sets.
(6) lower back Extensions (to enhance lower back strength). Lie on your stomach, with your arms by your sides and your hands extended toward your feet, with palms touching the floor. Contract the muscles at the back of your neck, so that you are gazing forward and upward. That's the basic position! A rep is simply a contraction of your lower back muscles, lifting your torso off the ground, followed by a slow easing of your trunk back to the floor. Complete two sets of 12 reps, with a short intervening break.
(7) Hip Circles and Twists (two movements to improve core strength during actions involving rotation of the spine). With your hands on your hips and your feet spread apart somewhat wider than your shoulders, make circles with your hips in a clockwise direction for 12 repetitions. Repeat the circles in a counter-clockwise direction for 12 reps. Then, extend (straighten) your arms so that they are extending straight out on either side of your body (they should be parallel with the floor), and twist your torso and hips to the left, shifting your weight onto your left foot. Then twist your torso to the right while shifting your weight to the right foot. Complete 12 reps on each side, making sure that movement is produced by your core muscles, not by violent thrusts from your shoulders and arms.
(8) Warrior at the Wall (for lower back strength and flexibility, as well as bum strength). Stand tall but relaxed with your feet at hip width; your arms should be hanging at your sides, with palms turned toward your legs. Look straight ahead, facing a blank wall which is about three feet away. As you exhale, bend forward from your hips and extend your arms forward until your fingertips are touching the wall. Adjust yourself so that your legs are perpendicular to the floor and your arms and upper body are absolutely parallel with the ground. As you inhale, raise your left leg backward and up until it is parallel with the ground. Hold your left leg up for about eight breaths, and then repeat with the opposite leg. Repeat several times with each leg.
More advanced exercises for the low back and core
Once you have completed the basic routine above a couple of times per week for a few weeks (or once you can breeze through the above exertions with no problems), you are ready to move on to more challenging drills for your back and core muscles. The following exercises will have a pronounced impact on your strength, stability, and coordination:
(1) The Bridges of Kenya (for achieving stunning core strength). Lie face down on the ground or floor and stretch out in a prone position. Then, lift up your body so that you are balanced only on your forearms and toes. Your elbows are on the ground and should be directly below your shoulders. Your forearms and hands are pointed straight ahead, resting on the ground. Your toes (and feet) are about shoulder-width apart, and your toes are the only part of your lower body which are touching the ground. Your whole body is supported only by your forearms and toes.
A. Now, a key, key point: 'tuck' your pelvis. This basically means rotating your pelvic girdle by pushing the lower part of your pelvic area toward the ground while the upper part of the pelvis rotates away from the ground. Your hip area doesn't actually come any closer to the ground (your whole body should be in a fairly straight line from your toes up to your shoulders). When you 'tuck', you are just rotating your pelvis, not moving it up or down. If you were standing, you would be directing the lower part of your pelvis forward and pulling the top part of your pelvic girdle backward. It's important to complete this exercise as directed, because it is crucial for improving what I call your core strength - the strength of the muscles surrounding the pelvic girdle, which promote powerful, economical, injury-free sporting activity.
B. Hold this basic position (body supported only on forearms and toes, pelvis tucked) for 15 seconds, and then lift your right arm off the ground, straighten it, and point it straight ahead, holding it in the air for 10 seconds (at this point, your body is supported only by your left forearm and the toes of your two feet). After 10 seconds, return to the starting position.
C. Then, lift your left arm off the ground and point it straight ahead, holding it in the air for 10 seconds. Return to the starting position.
D. Now lift your right leg up in the air and hold it there for 10 seconds (your body will now be supported by your two forearms and the toes on your left foot). Return to the starting position.
E. Lift your left leg in the air for 10 seconds, and then return to the starting position.
F. Here's a move you'll always remember: from the starting position, lift your right arm and left leg in the air SIMULTANEOUSLY. Hold them up for 10 seconds, and then return to the starting position.
G. Then, lift your left arm and right leg SIMULTANEOUSLY, and hold them in the air for 10 seconds. Return to the starting position.
Take a one to two-minute break, and then repeat steps A-G once more.
H. Once you've completed the second set, stay in the basic position for one additional minute. Please remember to keep your pelvis tucked and your body in a straight line.
I. Now, flip over on your back and lift yourself up so that your body is supported only by your forearms and your HEELS! Again, your body should be linear, your pelvis should be tucked, and your elbows should be approximately below your shoulders. Stay in this basic position, and then lift your right leg off the ground for 10 seconds.
J. Return your right heel to the ground, and lift your left leg in the air for 10 seconds (you are balanced only on your forearms and right heel). Then, return it to the ground and hold the basic position for 30 seconds.
K. Flip over on your right side and support your whole body with only your right forearm and the OUTSIDE OF YOUR RIGHT FOOT. Your body should be a straight line, inclined upward from the foot to the shoulder - and off the ground (don't let your leg touch the ground). Your left foot should simply be lying on the right foot. Then, lift your left leg straight up (abducting the hip) for 10 seconds, before returning to this basic position.
L. Flip over to your left side, and repeat step K, but with your body weight supported by your left forearm and the outside of your left foot (you will raise your right leg in the air). Hold your right leg in the air for 10 seconds, and you're done with the core routine!
More functional exercises
Although the Bridges of Kenya is an extremely effective exercise, note that it - like the exertions in the basic back-spasm-prevention programme outlined above - is not as functional as one might hope. That is, 'Bridges' does not utilise a standing posture, which is the body position used in most sports, and it does not call for strength and coordination during active movement, which is what is required during most sporting activities. The following exercises, with their emphasis on movement and coordination, are considerably more functional:
(2) Picking up Litter (for coordination and lower back strength). As you jog along easily, suddenly stop on your left foot (with your left foot out ahead of your body), perform a squatting motion with your left leg (ie, flex the left leg at the knee), and simultaneously swing your right hand downward, scooping up an imaginary piece of litter from the ground. Straighten your left leg so that you once again achieve an erect posture, and then three steps (right, left, right), stopping on the third - right - step and repeating the overall motion (flex right leg at knee, scoop up 'litter' with left hand). Continue in this manner for one minute, rest for 15 seconds, and repeat. This exercise is great for improving balance and agility, as well as lower back flexibility and coordination.
(3) Half Standing Forward Bends (for greater lower back strength and coordination). Stand tall but relaxed with your feet at hip width; your arms should be hanging at your sides, with palms turned toward your legs. Look straight ahead. As you exhale, step forward about 36 to 42 inches (about the length of your leg) with your right foot. Then, place your hands on the tops of your hips and make sure the front of your pelvis is 'squared'. Release your hands and let your arms hang. As you inhale, raise your arms forward and then straight overhead. As you exhale again, bend forward from the hips, 'soften up' your right knee, and let your head and arms hang down. Your head should be directly above (but a little to the left of) your right foot, and your arms should pass alongside your ears, with your hands attempting to make contact with the ground just a little in front of your toes. If your head is not very close to your right knee, flex your right knee a little more. As you inhale, 'roll' up slowly, 'stacking' the bones of your spine on each other, and then raise your arms overhead, reaching for an imaginary object well above you. Step back with your right foot to the beginning position, while letting your arms move back to your sides. Rest for a moment, and then repeat four more times, before completing five forward bends with your left leg forward.
(4) Cross-body Leg Swings (for greater lower back mobility). Leaning slightly forward with your hands on a wall and your weight on your left leg, swing your right leg to the left in front of your body, pointing your toes upward as your foot reaches its farthest point of motion. Then swing the right leg back to the right as far as comfortably possible, again pointing your toes up as your foot reaches it final point of movement. Repeat this overall motion 10 times before performing 10 reps with your left leg. Rest for a few seconds, and then repeat.
(5) If you are a golfer, tennis player, baseball/cricket athlete, or squash /handball/racquetball competitor, your sport involves considerable twisting motions which can damage lower back muscles and induce spasms. To strengthen your lower back during tortuous twists, utilise devices like the 'NRG Ball' (think of a medicine ball on a stick) or a 'Bodyblade' (a flexible rod) to provide resistance as you carry out the normal swinging motions associated with your sport (Fitter International Inc., mentioned above, carries both products). As a cheap alternative, you may also hold a free weight or medicine ball in front of you, and alternatively twist from side to side in movements mimicking those of your sport, using your abdominal and lower back muscles to produce motion, rather than freely swinging your shoulders and arms back and forth.
(6) The Rotational Hamstring Stretch (for improving flexibility in the lower back, bum, and hamstring areas):
(A) Stand on your right foot with your left leg elevated to nearly hip height in front of you, with your left heel resting on top of a bench or table. Your right foot should be turned outward approximately 45 degrees from straight ahead. Then, lean forward slightly to induce stretching on the left hamstring. At this point, rotate your left foot, ankle, knee, and hip inward and outward 15 times to each side.
(B) Repeat the above action with your support (right) foot rotated inward approximately 10 degrees.
(C) Finally, repeat both of the above actions with the opposite leg.
If you carry out this advanced routine two to three times a week for several weeks, you will notice a remarkable improvement in your lower back and core strength, coordination, and sport-specific flexibility, and you should be at lower risk of back spasms. Best of all, your upgraded strength and control should help you perform at a higher level in your chosen sport.