How to Treat Lower Back Spasms, According to Physical Therapists

Although a lower back spasm — which occurs when muscles suddenly tighten up — can be alarming and painful, it’s typically harmless and temporary. Lower back spasms are also incredibly common: Up to 80% of Americans experience lower back pain at some point, and that usually includes back spasms. 

Luckily, these involuntary muscle contractions can be successfully treated with lifestyle changes, PT-recommended exercises, and medication to help relieve the pain, tightness, weakness, and difficulty with movement they can cause. 

“A lot of people think lower back spasms are a sign of danger, but they’re just another way your body talks to you and gives you feedback — in this case, it’s trying to tell you that you’ve probably overtaxed the area or moved in a way that your body isn’t used to,” says Samantha Stewart, PT, DPT, a physical therapist at Hinge Health. 

While moving may be the last thing you think will help release you from the pain of a lower back muscle spasm, the reality is it’s the best prescription for pain relief, says Dr. Stewart. “Gentle movement is what helps your body relax and, over time, allows you to return to normal activity.” That’s why our healthcare team likes to say, “Movement is medicine.” 

Read on to learn more about what causes lower back muscle spasms and how to prevent and treat them — especially with stretches and exercises from our Hinge Health physical therapists.

What Causes Lower Back Spasms?

Lower back spasms happen for all kinds of reasons, including: 

• Not changing positions throughout the day. If you haven’t changed positions much throughout the day, like when you’re working at a desk or sitting on the couch, this can reduce mobility in the back. “It’s similar to going into an athletic activity without a warm-up,” says Dr. Stewart. 

• Muscle weakness. “There are a lot of small muscles in the lower back that — when functioning properly — essentially give you a built-in back brace,” says Dr. Stewart. But if these muscles aren’t strong enough to help stabilize your lower back, they can spasm while trying to provide the extra support you need.

• Doing too much, too soon. If you overuse your lower back muscles and fatigue them – or go beyond your movement sweet spot, where the body doesn’t feel prepared for certain movements — the muscles can tighten up as they try to create more support. “Even if your muscles are strong, you can still overuse them,” says Dr. Stewart. “It can happen when you do something that’s out of your normal routine, like a full day of yard work. Your back may not be used to all the twisting and lifting you’re suddenly doing.”

• Muscle strain. Muscle strain (aka a pulled muscle) occurs when a muscle is overstretched, causing some of the fibers to tear. Pain, weakness, swelling, and spasms are all common symptoms of muscle strains in the lower back. 

• Age-related spine changes. “Everything in our back changes over time; it’s a normal part of aging,” says Dr. Stewart. As a result, spasms can occur in conjunction with other back issues, like herniated discs, back arthritis, or spinal stenosis. 

• Nerve problems. Muscle spasms are frequently associated with nerve inflammation or compression issues, such as sciatica. It occurs when your sciatic nerve, which runs from your lower back down the back of your hip and leg, becomes irritated or inflamed. 

• Stress. When you’re stressed, you’re more likely to unknowingly contract or tighten your muscles, and muscle tension can lead to spasms. “You’re more likely to be fatigued and less aware of your body mechanics when you have more on your plate,” says Dr. Stewart. “That can contribute to altered movement patterns that your body may not tolerate well.”

• Spondylolisthesis. Spondylolisthesis is a spinal condition in which a vertebra shifts its position. It may happen anywhere along the spine but is most common in the lower back. If the affected vertebra irritates nearby nerves, it can lead to back pain or spasms. 

Symptoms of Lower Back Spasms 

Lower back spasms occur in varying degrees, from mildly painful events that happen from time to time to chronic sources of debilitating pain. 

Symptoms typically include:

• Sudden, tight, and intense back pain

• Limited mobility

• Weakness

• Instability

When your lower back spasms, your muscles are trying to create a bracing mechanism. “They’re tightening to give you a little extra protection because the area is irritated,” says Dr. Stewart. “People tend to get this after significant activity or movement that they’re not used to.”

The primary symptom is a cramping sensation. “It’s not something that creeps up on you,” says Dr. Stewart. “All of a sudden, you’re not able to move well and you don’t feel stable.” Frequently, she notes, “People will say, ‘My back is locked up.’” 

Spasms typically last from seconds to 15 minutes or longer and may recur multiple times before going away. After a spasm, the affected muscles may feel sore and tender. 

If you notice spasms frequently, or they last for minutes at a time, talk to your doctor. Some underlying conditions, such as fibromyalgia or type 2 diabetes, can also trigger muscle spasms.

Treatment Options for Lower Back Spasms

Muscle spasms often quickly resolve on their own. But there are several things you can do to make the experience far less unpleasant. 

• Alternate ice and heat. “Generally, people who have spasms prefer using heat, which helps relax the spasm,” says Dr. Stewart. “But ice is helpful too as it reduces inflammation and decreases pain, so there’s a benefit to both.” Try alternating hot and cold packs for 20 minutes at a time, with a 20-minute break in between.

• Over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for pain associated with lower back spasms. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Physical therapy. A physical therapist will educate you on how to handle a lower back muscle spasm with specific exercises that help loosen up the area and relax the muscles. “A physical therapist can guide you on how to breathe through a stretch and when to lean into a move a little bit more to get the most improvement from it,” says Dr. Stewart. “If you’re bracing and fighting the movements because you’re nervous, that will just perpetuate your symptoms.” You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Self-massage. Massage the affected area with your hands, a foam roller, or even a tennis ball. “With a spasm, the muscle is locked up a bit and that direct pressure can help trigger some release,” says Dr. Stewart. 

• Balanced diet. Dietary deficiencies, such as low calcium, magnesium, or potassium and not drinking enough water, may raise your risk of muscle spasms. “Having good hydration and balanced electrolytes can put you at a place where you’re less likely to have issues with muscle spasms,” says Dr. Stewart.