A Closer Look at Upper Back Spasms: Causes and Treatment

The major muscles of the upper back support the spinal cord and help maintain good posture. Spasms, or involuntary contractions of muscles, can cause pain and interrupt daily activities (2).

Common causes of back muscle spasms include:

• Overuse of the muscle through prolonged stress incurred by repetition of an athletic move or exercise. This is especially common in running or lifting (3).
• Acute injury from trauma due to a car accident, fall, or a similar situation that impacts the back or spine.
• Poor posture over a sustained period of time. This is a common culprit for back spasms in patients who sit at a desk for hours on end while working, or those who lean forward while looking at a screen (4). Poor posture places excessive pressure on the back muscles and can also weaken muscles in the legs and hips.
• Herniated spinal disc, when a spinal disc dislocates or ruptures. A herniated disc compresses local nerves, causing pain, numbness, or weakness in the surrounding area. A herniated disc can also cause upper back muscles to tighten.          

Spinal cord conditions like scoliosis and neurological diseases like polio and ALS can also cause upper back spasms (5).

Muscle spasms vary in frequency and severity depending on the cause and patient. Back pain due to spasms is diagnosed using several scales that allow a patient to report their level of muscle tightness.

The Modified Ashworth Scale developed in 1987 is most commonly used today. The 4-point scale ranges from a 0, for which muscle tone doesn’t increase (or flex) at all, to a 4, for which muscle is rigid in flexion or extension (6).

The wide range of potential causes of upper back spasms translates into a similarly wide range of treatments for the condition, depending on the severity and nature of the pain.

Stretching and Physical Therapy

This often takes place under the supervision of a physical therapist. Physical therapy programs can involve the use of foam rollers and other techniques like manual trigger point therapy in order to improve circulation in the back muscles, which reduces the frequency of spasms (7).

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Over-the-counter (OTC) NSAID medications such as Tylenol (acetaminophen), Aleve (naproxen), and Advil (ibuprofen) can help reduce the frequency of upper back muscle spasms and resultant pain and stiffness. 

Guaifenesin

Guaifenesin is an OTC expectorant that’s typically used to treat colds and allergies. Studies have connected guaifenesin with the reduced muscle spasms, pain, and tension in the muscles. However, more research is needed to confirm the efficacy of guaifenesin in treating muscle spasms (8).

Muscle Relaxants 

These medications help prevent muscles from firing by acting locally on the muscle itself or on the central nervous system to prevent the brain from firing signals to muscles. Baclofen, clonidine, and benzodiazepines are a few of the common muscle relaxants used to treat stiffness and spasms. Relaxants are taken orally, injected, or pumped directly into the spinal fluid (9).

Local Injections 

Anesthetic injections of lidocaine and bupivacaine temporarily block nerve signals that cause back muscles to contract. In particularly severe cases in which longer-lasting treatment is required, botulinum toxin (botox) can also be used for muscle spasms. Botox acts directly on the nerve endings in muscles, inhibiting their ability to fire (10).

Ultrasound Therapy 

Ultrasound treatments can be used for myofascial pain syndrome, or pain in the trigger points of a muscle due to repeated contractions. Studies have shown that ultrasound treatments can reduce the pain and frequency of muscle spasms associated with myofascial pain syndrome (11). 

Electrotherapy

Transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) use controlled electricity application to stimulate nerve endings. Research published in the Journal of Back and Musculoskeletal Rehabilitation suggests that both of these methods relieve pain associated with nonspecific neck discomfort. More research is needed to better understand the exact benefits of electrotherapy for muscle spasms, but this is a treatment option worth considering with your doctor for persistent spasms (12).

Ice and Heat Therapy

For more minor spasms that result from overuse or soreness, heat and ice therapy can be effective. Cold treatment works by temporarily inhibiting the nerve receptors and limiting blood flow in muscles to limit the frequency at which they fire. Heat therapy works in the opposite manner, promoting blood flow to help muscles relax and contract less frequently.

Physical therapy or stretching can lead to soreness and pain, especially if you’re performing uncomfortable movements that involve tight or sore muscles. Medications may carry more significant side effects.

Potential Side Effects of OTC Medication

Expectorants like guaifenesin can cause stomach problems like nausea and indigestion. NSAIDs can also cause heartburn and stomach pain. Patients who have reduced kidney function or a history of kidney issues should consult with their doctor before using NSAIDs to treat back spasms.

Potential Side Effects of Muscle Relaxants

Prescription muscle relaxants like carisoprodol and cyclobenzaprine are known for causing side effects like fatigue, nausea, and drowsiness. Additionally, some classes of muscle relaxants have a high potential for abuse. Muscle relaxants are not a long-term solution for back spasms and are typically only prescribed for a few weeks at a time.

Potential Side Effects of Electrotherapy Treatment

Skin irritation where electrodes are placed is the most common side effect of electrotherapy. Certain electrotherapy patients have developed eczematous lesions due to this skin irritation (13).

Scientific understanding of the underlying causes of upper back spasms is limited, so there’s no conclusive “best” treatment for these spasms. For mild cases related to normal overuse or soreness after training, conservative treatments like gentle stretching or the use of a foam roller and moist heat may be sufficient to reduce or treat spasms.

For more serious cases, localized injections or oral ingestion of muscle relaxants or anti-inflammatory medications can be effective. Only a certified medical professional can provide you with medical advice on your back muscle spasms. If you’ve tried home remedies like stretching and OTC medication like NSAIDs without pain relief, consult your doctor to discuss other options for alleviating painful upper back spasms.