5d • General discussion
Get Ready! It is Here...
Back Spasm Season: What I See Every Year and How to Handle It
The holiday season is here—and unfortunately, I’ve come to call it “Back Spasm Season.” After treating patients for over 20 years, I’ve noticed that nearly 40% of them experience an acute low-back spasm at some point during this time of year.
My first 2 SI patients of the AM today were doing great and both back spasm after the holiday week!
Why Does It Happen?
Most episodes aren’t caused by a dramatic injury, I find. Instead, they’re triggered by everyday stressors such as:
- Increased emotional stress around the holidays
- Vacuuming, sweeping, or mopping
- Long car rides
- Prolonged standing
- Plane flights
When these patients come in, I often find acute SI joint, sacral torsion/ shear —all commonly associated with protective muscle guarding.
What’s Really Going On?
In many people (including myself over the years), the nervous system becomes dysregulated, the body goes into a protective spasm, and the surrounding muscles clamp down. This protective response can shift the SI joint or sacrum and create the pain patients feel.
Trying to “push through it” or continuing your usual workout routine often makes the situation worse.
How I Manage It in the Clinic
The way you explain and manage the episode with a patient can completely change the outcome.
First, I reassure them that back spasms are common and usually not dangerous when serious red flags are absent. I always screen for:
- Progressive weakness or myopathy
- Bowel or bladder changes
- Saddle anesthesia
- Recent trauma
- Symptoms that could indicate cauda equina syndrome or other medical emergencies
If none of these are present, I explain that their body is in a protective spasm and needs time to settle.
What Patients Should Expect
A typical back spasm takes 1–3 weeks to calm down in my experience. During that time, the goal is to:
- Reduce threat to the nervous system
- Allow the protective spasm to ease
- Avoid exercise that can prolong the episode
- Gradually reintroduce movement once symptoms relieve totally
After that initial calming period, I guide patients back into my exercise progression so they rebuild stability in a safe and effective way.
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Get Ready! It is Here...
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