Muscle Spasms

WHEN TO SEE YOUR DOCTOR

* Pain and stiffness don't ease up within the first three days.

* If a back or neck spasm is accompanied by tingling, numbness or weakness, see your doctor immediately.

What Your Symptom Is Telling You

You swoop down to pick up a piece of paper off the floor. You cradle the phone with your chin while chatting. You hoist your groceries out of your trunk. Suddenly, you're ambushed by a tightness that painfully twists your body like a corkscrew.

When a muscle goes into spasm, all the fibers within the core of a muscle contract simultaneously. This most commonly occurs when you suddenly move or overextend a tensed-up muscle that hasn't been properly prepared for the movement.

Quickly bending over after sitting, for example, can overstretch your back muscles and injure the area. In response, the surrounding muscle fibers instantly tighten, forming a kind of protective splint that guards the back against further irritation. This triggers a back-stabbing cycle: Contracted fibers squeeze off blood flow to the muscle, creating irritation and more pain. The additional pain triggers even tighter contractions. You're caught in a painful vise without a chance of the muscle relaxing on its own.

Unlike an ordinary muscle cramp that also involves a sudden contraction, a spasm does not usually release with movement. If your back locks in spasm, you can't move.

The prime targets for spasms are the muscles in the neck and back, according to Irene von Estorff, M.D., assistant professor of rehabilitation medicine at the New York Hospital-Cornell Medical College in New York City. These areas are often tight, tense and more vulnerable to becoming overstressed by the least little thing, she says. A cool breeze, for example, might blow over neck muscles already tensed from working at a computer or playing tennis. These muscles suddenly clench against the chill. Now you have the classic "crick" and probably won't be able to turn your head to see out your car's side window.

A sudden spasm in your back or neck that's accompanied by numbness, tingling or weakness, could mean a ruptured disk or nerve injury.

Symptom Relief

Spasms have a way of holding on stubbornly. To release that grip, try any of these techniques.

Get off your feet. "Lying down will take the strain off already stressed tissues," says Karlis Ullis, M.D., assistant clinical professor in sports medicine at the University of California, Los Angeles, UCLA School of Medicine. If the spasm is in your back, gently bring your knees up to your chin and hold them there for a minute or more (as long as there is no pain). "This should help release some of the shortened connective tissue and muscle fibers," says Dr. Ullis. (For other techniques that deal specifically with back pain, see Lower Back Pain on page 323, Midback Pain on page 344 and Upper Back Pain on page 563.)

Try a gentle ice massage. "Rubbing an ice cube directly over the sore area in slow circles can numb the area in about five minutes flat," says Dr. von Estorff. (If you can't reach the area yourself, ask a friend or family member to lend a hand.) What's more, at first the ice narrows the blood vessels, then they open up superwide. This allows a rush of healing blood to flow in, helping to release the clenched fibers. "Just be sure to keep the ice moving so you don't freeze and injure surface tissues," says Dr. von Estorff. Repeat the rub once an hour.

Swallow a pain reliever. Aspirin or another nonsteroidal anti-inflammatory such as ibuprofen are "the best pain relievers you can get without a prescription," says Robert Nirschl, M.D., assistant professor of orthopedic surgery at Georgetown University School of Medicine in Washington, D.C. Acetaminophen may bring less effective relief because it's not an anti-inflammatory, he says.

Limber gently; don't jerk. After icing, moving slowly and gently will help restore normal circulation and ease fibers back into their customary patterns of contraction and relaxation, according to Dr. von Estorff. Don't stretch too aggressively, however. "Stretching could make the spasm worse," she says.

After icing your sore shoulder, for example, simply move it through its full range of motion. Do this by gently raising your shoulders up to your ears, rolling them forward, then back, and also moving your arm diagonally across your chest. "This actually reprograms the fibers in the shoulders, telling them where to go so they don't clench up again," says Dr. Ullis. (For other techniques dealing specifically with shoulder pain, see page 452.)

Get it warm. If the spasm still has you in its grip after three days, you can try treating the area with heat, says Dr. von Estorff. Once the acute pain and swelling subside, heat will nudge blood flow to the sore site, she explains. Simply wrap a hot, wet towel around the area, cover it with plastic wrap and then wrap it with a dry towel to seal in the heat. Apply these hot packs five times a day for no more than 20 minutes at a time.

Break up the knot. Once the pain and swelling have subsided somewhat, you may be left with a tough little knot of muscle that is still in spasm. Try pressing your thumb, finger or even the tip of a broomhandle directly into a stubborn spasm, says Dr. von Estorff. This may help move the built-up fluid, relax the muscle and separate fibers, she says. If direct pressure doesn't do the trick, you may need to see a doctor who specializes in musculoskeletal pain.

See also Muscle Cramps; Muscle Pain