There are many causes for muscle spasms the ones most often seen in physical therapy are those that arise from trauma, guarding, poor blood circulation in physical exertion, overuse and overloading.

Muscle spasms from Trauma and Guarding

When a body or an extremity gets hit with a noxious stimulus either a fall, a hit, or sometimes even surgery the body tends to want to protect itself from another traumatic event (guarding). It does this by over-stimulating the muscles, causing that particular part of the body to tighten and stiffen to protect itself from being hit again. Some of you may have experienced this from a fall or a surgery, where you feel pain for days on end even though the apparent injury site is healing. The pain is often agonising and the body is slow to recover because the muscles (and your psyche) need to be coaxed to relax again. This process is not as easy as it sounds: there definitely is a neural component, a mechanical component and a psychological component to muscle pain. Your physical therapist is armed with all the tools needed to calm your muscles down: manual therapy to decrease tensile stiffness, joint mobilisations to improve joint mobility and regain range of motion, exercises and stretches to gradually return you back to function, and most of all, reassurance that you will get through this. It is a delicate balance one that most experienced physical therapists can appreciate.

Muscle spasms from overuse and overloading

Most muscle spasms and knots are due to overuse of muscle in lifting or carrying a load. Oftentimes, injury happens when the muscle is too weak or too fatigued to perform a task. Imagine a line of men trying to pull a weight that is too heavy for them. Eventually, they will start to complain, then try to overexert, then scream, then worse: falter and fall apart. This is much like what happens in a strained muscle. In truth, fatigue is ideal for muscle building (i.e. hypertrophy) but excessive forces that a muscle cannot bear are usually damaging and need more time to recover.

Oftentimes in our Portland physical therapy clinics we see patients who have spasms because of muscle weakness. Sedentary habits have led their muscles to atrophy and when a given a load too heavy to handle, the muscles react with a spasm and the result is pain. In order to stop the cycle of weakness-strain-spasm, the weak muscles have to get stronger, and body mechanics trained to be more solid and unified to handle the load.

Common Injuries

  • lower back muscle injuries
  • upper back muscle injuries
  • leg muscle injuries

Prevention is the key to most skeletal muscle spasm episodes. Since they are often associated with dehydration and electrolyte disturbances, it is important to keep the body well hydrated. If the fluid loss is due to an illness with fever or vomiting and diarrhea, controlling the symptoms will help limit fluid loss and prevent spasms. Similarly, for those who work or exercise in a hot environment, drinking enough fluids to keep hydrated is very important. It is often helpful to hydrate prior to activities in warm environments.

Muscles should also be prepared for the activity that they are expected to do. Just as athletes stretch and warm up before the game, non-athletes should warm up before heavy labor, including jobs like raking, mowing, and shovelling snow. Should a large skeletal muscle go into spasm (often referred to as a charley horse), the initial treatment is to gently stretch the muscle back to length to break the spasm cycle and resolve the acute situation. For example, first aid for a hamstring spasm (where the muscles in the back of the thigh are affected) includes straightening the knee joint and flexing the hip, which stretches the muscles and helps resolve their spasm.

Further treatment will depend upon the underlying cause of the muscle spasms. For muscles that have been damaged or strained, medications may be required for short-term pain relief, including anti-inflammatories (ibuprofen [Advil, Motrin]), narcotics, and muscle relaxants. The treatment of smooth muscle spasm, such as bowel spasm, depends upon diagnosing and treating the underlying cause. Nocturnal leg cramps are difficult to control and treat. Historically, quinine has been prescribed to help with the muscle spasms, but this drug can have side effects including abnormal bleeding problems. Other medications, including B-complex vitamins, gabapentin, and diltiazem, may be helpful.

Many possible treatments are available for the dystonias. The decision as to which medication to use depends upon the individual situation. It may take trial and error to find the right medication in the right dose to control symptoms.

  • Anti-Parkinsonism drugs, like trihexyphenidyl HCl (Artane) and benztropine mesylate (Cogentin), decrease acetylcholine levels.
  • Muscle relaxants like diazepam (Valium) and baclofen (Lioresal) affect GABA receptors.
  • Levodopa (Sinemet) and reserpine (Harmonyl) affect dopamine levels.
  • Carbamazepine (Tegretol), a seizure-control drug, may be useful in some patients.
  • Botulinum toxin type A (Botox) may be injected into a specific muscle to paralyze it and relieve the muscle spasm of dystonia, such as for blepharospasms.

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