Pain in the neck (and back)


I have seen no shortage of patients with back problems, and a good 4 out of every 5 have clear spasms in the long muscles on either side of their spine (paraspinal muscles).  After going through the spiel a few dozen times and feeling disappointed that the robust library of patient information doesn’t spell out the issue quite this way, I decided to finally create a summary of my most common advice to patients with muscle spasms.  And hey: why not share it here?  Everyone gets a stiff or sore neck or back at some point.

I had thought for a while that I could summarize it into three steps but it wasn’t until I wrote it down that I realized the basic steps are really four-fold (hydration is absolutely necessary in my opinion, and sometimes I still forget to remind patients of that… no longer!).  I would gladly welcome feedback or advice from physical therapists or sports medicine professionals out there.  [=-)


Muscle spasms are a very common cause for back and neck pain and can be severe, even debilitating. The good news is that it is a problem that can be fixed. Effective control of muscle spasms can best be achieved by understanding and taking a four-fold approach:

A. The definitive cure for a muscle spasm is to relax the muscle or relieve the contraction by lengthening it. This is best achieved with targeted stretching. Massage can also be helpful. However, a muscle that is actively contracting and won’t relax has other problems and trying to move or stretch it can actually worsen the problem unless the other issues are addressed. Consider the following:

B. When a muscle contracts without relaxing, eventually some of the muscle cells will be damaged, releasing its cellular breakdown products and causing inflammation within the muscle. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Naprosyn, Aleve) which can be obtained over the counter help to reduce this inflammation so that the muscle can move more easily and with less pain. Please remember that NSAIDs can be tough on the stomach lining and also the kidneys so take them in moderation and always with food.

C. Muscle relaxation is actually an active process that requires energy. Consider rigor mortis, where muscles contract progressively in the absence of available energy. In the human body, energy requires oxygen, and oxygen availability to any given part of your body requires blood flow. Coldness in any area of your body indicates a decrease in blood flow. Heat application to a muscle group helps draw oxygen-rich blood to the area which aids in relaxation.

D. Finally, also critical for clearing muscle breakdown products that cause inflammation and pain from an area in pain from spasms is drinking plenty of water.

In summary, a basic formula to relieving pain from muscle spasms includes doing the following at least twice a day (along with avoidance of the activity that brought the problem on) for 5-7 days:

1. Take a dose of an NSAID, dosed appropriately for your age and body size, and always with food.

2. Apply heat to the muscle group experiencing spasms for 15-30 minutes.

3. AFTER completing steps 1 and 2, perform targeted stretching exercises for the muscle group experiencing spasms.

4. Drink two to three 8oz glasses of water within the first hour after this process, and at least two more glasses of water over the course of your waking hours. Make sure you are urinating out approximately the same amount that you drink in a given day.

Seeking the help of a medical professional may be useful to guide the dosing of your NSAID, and you may also warrant consultation with a physical therapist to assist with proper stretching and body mechanism to prevent the problem from coming back.

Depending on your specific circumstances, you may need additional medication to help relax your muscles or to control severe pain if it hampers your ability to function normally. This would require consultation with your medical provider to provide prescriptions for what seems most appropriate for you.