double knee to chest stretch is beneficial for low back muscle spasm

Self-care and medical approaches to tight spasmed muscles in the low back

Self-care for the client/patient with low back muscle spasm:

Double knee to chest self-care stretch for the low back muscles. Permission: Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis (2015).

Double knee to chest self-care stretch for the low back muscles. Permission: Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis – A Clinical Orthopedic Approach (2015).

Self-care is an extremely important part of the treatment regimen for the client/patient with low back muscle spasm, especially if the condition is chronic. Moist heat followed by stretching should be recommended. One excellent self-care stretch is double knee to chest stretch. Another beneficial self-care stretch is what is termed in yoga as child’s pose or restorative pose. If the problem is severe and/or chronic, two to three (or more) sessions of moist heat/stretching should be done each day. It is also advisable to recommend that the client/patient minimize or avoid postures or activities that exacerbate the problem.

Medical approach to low back muscle spasm:

The medical approach for low back muscle spasm is usually pharmacologic. Over the counter anti-inflammatory or analgesic (pain killer) medications are usually recommended. Stronger prescription anti-inflammatory (steroidal/prednisone), analgesic, or muscle relaxant medications are recommended for more severe cases. Trigger point and cortisone injections are also possible. Referral to a physical therapist is also commonly recommended.

Manual therapy case study for low back muscle spasms:

Frederique is a 36-year-old kindergarten teacher who has been experiencing pain and tightness in her left low back for the past two days. On a pain scale of 0-10, she reports her pain and tightness as a 9 first thing in the morning. It reduces to a 4-5 after taking a hot shower and moving around, but quickly increases back to an 8 by early afternoon. She has no referral pain into her lower extremities.

Verbal history reveals that Frederique was recently bending down to help one of her pupils and when she stood up, she felt a sharp pain in her low back on the left side. Her pain is now dull in nature, but so severe that she cannot work. Postural observation shows her left iliac crest to be high. Active range of motion (ROM) reveals greatly decreased motion and increased pain with flexion and right lateral flexion of her trunk. Upon palpatory examination, Frederique’s left lumbar paraspinal musculature is extremely tight; and palpation of it reproduces the characteristic pain that she has been experiencing. There are no discernable trigger points; rather her entire left low back is tight. Her right lumbar paraspinal musculature and bilateral psoas major muscles are mildly tight. All orthopedic assessment tests for a space-occupying (nerve compression) condition of her lumbar spine are negative.

Given the location of Frederique’s symptoms and the results of the postural and palpatory examination, it is clear that Frederique has a low back muscle spasm, specifically spasm of her left lumbar paraspinal musculature. Given the severity of Frederique’s condition, the therapist recommended three one-hour massages, spaced every other day. The protocol for each session was to begin with heat for five to ten minutes followed by mild pressure soft tissue manipulation into the left side of the low back for approximately 10-15 minutes. To avoid having Frederique prone for too long, the beginning soft tissue manipulation was performed with her on her right side. She was then placed prone with a roll under her abdomen to support her lumbar spine. Gentle stretching to her low back with double knee to chest stretch and very gentle joint mobilization (arthrofascial stretching) compressions for her lumbar spine are then done, followed by moderate depth soft tissue manipulation to the spasmed musculature for another 5-10 minutes. The remaining time was spent on the rest of her back and her thighs.

Frederique was given self-care instructions to take a hot shower and then gently perform double knee to chest stretch as often as possible (a minimum of three times each day). She was also told that she could ice her low back after the stretching to diminish/numb the pain if desired. She was asked to avoid prolonged sitting and standing as much as possible. It was recommended that she lie down to rest with a pillow under her knees as much as possible, but to get up and gently walk around her home for 5-10 minutes every hour so that she would not stiffen as a result of being sedentary.

At the end of the three sessions, Frederique’s low back tightness and pain had decreased approximately 70%, and she was able to return to work. Care was continued at twice per week for another week, at which time she felt 100% better. Given how stressful her job is for her low back, Frederique decided to return for massage once a month.