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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35011
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I've had upper back muscle spasms for the last one month and

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Hi, i've had upper back muscle spasms for the last one month and that stabbing pain hasn't gone. it becomes unbearable at time, and then i need to use hot bag therapy I've been on pain killers for a month and taken TENS treatment for 5 days. The pain doesn't fully go away, but keeps coming back. moreover, i am getting more spasms in the back. What can i do?

Hello Amween ,
I am Dr. Arun and will be helping you today.

Did the upper back muscle spasm occur because of accident / injury / fall / unaccustomed activity?
Is there specific area of pain or pain is generalized in upper back?

Dr. Arun

Customer: replied 4 years ago.

Dear Arun - yes the pain is on a specific spot. The physiotherapist before starting TENS had said that when he touched it on the spot where i feel the pain, he asked me tu rown my head to one side, and he could feel the spasm. I was taking a medicine called arcoxia. There was no injusry as such, but i was swimming wearing a life jacket, due to which my head was out side the pool constantly for one hour. So i think it was a major strain. Is it normal forthe spasms to reoccur even after a month? Also, just a few days later, i was lying down sideways with hgh pillows, and got a spasm in my lower back as well. the pain is almost gone, but it hurts when i sit.

Hello Amween,

It is not abnormal for spasm to persist for a month. Especially if there are minor triggering events or complete cure had not been achieved. This is called as myofascial pain syndromes. Muscles of the neck and shoulder girdle, namely; trapezius, scalene, sternocleidomastoid, levator scapulae etc can develop myofascial trigger points. These are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenrative disc disease in neck causing pinched nerves. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. The treatment is following;

1) passive stretching of the affected muscle after application of sprayed vapocoolant.

2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 4 years ago.

Hi I am going for an MRI next week. Does it help to find out the root cause? Also, I never had this kind of a pain before and just now it has come in such a bad way since a month. Will it be able to disappear fully? Also, is it a good idea to take an injection, so that the pain goes and i do the stretching for it to heal?

Amween, MRI would help to determine any concomitant issue. This is a completely treatable issue. Injection can definitely help which can be followed by the stretching.

Following investigations would be required for upper and lower backache;

1) X-ray of the lower back

2) MRI of the spine

3) Nerve conduction velocity (NCV) study

4) Electromyography (EMG)

Following measures would be helpful for low backache;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or brace

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

You can consult following specialists (apart from your GP);

a) Orthopedist

b) MD in Physical medicine and rehabilitation

It is privilege assisting you.

Dr. Arun
Customer: replied 4 years ago.

Thanks Doctor - also, is it better to take the injection now or shall i wat for an MRI which is next wek. Just that when the pain comes back, it' horrible, so wonder if now would be a good ime to take the injection? i do not want to prolong the pain :(

You are most welcome.

You should for MRI, than decide about the injection. Meanwhile Ibuprofen, local analgesic cream and relative rest would help.
Customer: replied 4 years ago.

Alright - will get in touch with you once i get the MRI.


You may consider rating the answer right now. You can come for follow up questions even after rating.

Best wishes and kindest regards
Dr. Arun Phophalia and 2 other Health Specialists are ready to help you
Customer: replied 4 years ago.

hi Dr. Arun. The MRI turned out to be fine....and my pain is a bit less. Should i still go for the injection? are tehre any side effects of it? Also, what ind of an injection is recommended for muscle spasms? I'm really trying to keep the injection as a last option.

Hello Amween,

If pain is severe, than only injection is usually needed. There are no significant side effects of the injection. You may try meanwhile;

Physical therapy
Mild massage
Deep electrotherapy; therapeutic ultrasound.
Customer: replied 4 years ago.

i see okay -sicne it is not severe and is there about 40%, then i won't take the injection. btw - can you recommend some exercises for my case, at this point? both upper back and lower back? last week i remember that i was in teh Air conditioner for two days. that was what caused my muscles to tighten again. Im taking a lot of precautions for that.

I mentioned the link and some exercises in my first answer for lower back. This is a good link for upper back exercises;

Ideally therapeutic exercises should be advised after personal exam and should be supervised by a medical personal initially.
Customer: replied 4 years ago.

thank you so much. Will ask if anymore questions. btw- i didn't tell you before, i also have a coccyx was bad 2 months ago, but has improved bcause i've avoided sitting. but i still can't sit for long hours. can you give any tips?

You are very welcome.

Warm sitz bath will help you three times a day. Anti-inflammatory analgesics like Motrin / Advil / Aleve are also beneficial with the narcotic analgesics. One has to sit on sorbo rubber ring for a while, so pressure on the tail bone does not occur while sitting. This will heal the inflammation to the tail bone and relieve the pain. The comprehensive treatment entails: 1) kegel exercise 2) steroid injections, 3) Botulinum toxin injections 4) sitting only on sorbo rubber ring (available over the counter at pharmacy) 5) deep therapy modalities like electrical stimulation, interferential, short wave diathermy or ultrasound.
Customer: replied 4 years ago.

Dear Dr.Arun -i there any idea about how long i should take physio therapy? i mean, when do i know it is enough?

Till you feel 90% better, physiotherapy should be continued.
Customer: replied 4 years ago.

ok thansk doctor - i am keeping on getting the stiffness back again, so i'll continue physio till it get's better. however, when is a good time to start exercise?

When you are better by say 50%, exercises can be started.

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