Conditions · Carrollwood · Tampa Bay
Muscle Spasm of the Back and Neck
What a spasm actually is, the warning signs that belong to a physician or an emergency department, and what the research shows once those are cleared.
A back or a neck that locks up can stop you mid-motion and leave you with no idea what just happened. That is usually the 11pm search that lands people on a page like this one: braced against a counter, trying to work out whether tonight is an emergency room night. This page is the translation. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, so if you are holding an X-ray or an MRI report with words on it that nobody has read with you, that conversation is part of the examination here. Bring yours.
Muscle Spasm Overview
What the words on your report mean
Muscle is not passive tissue that waits to be told what to do. The muscles running alongside your spine, the ones a report calls paraspinal, hold your trunk upright thousands of times a day without a conscious thought from you, and they respond to what the joints, discs and nerves underneath them are doing. A spasm is that system contracting hard and refusing to let go. It is a state that muscle goes into. It is not a disease you have caught, and the word alone does not say why, because it describes what the muscle is doing without saying what it is responding to. Sorting out the why is what an examination is for. Here are the words you are likely to run into, in plain language.
Muscle spasm, guarding, splinting
A spasm is an involuntary contraction of muscle that does not release on command. In the back and the neck it usually arrives as a band or a wall of muscle that has gone hard and tender, holding a region still. Guarding and splinting are the clinical words for the same thing described by its function: the muscles around the involved area tighten and limit motion through it, the way a splint limits motion at a wrist. That is worth knowing when you are lying awake wondering what your body is doing. What the muscle is responding to is the question an examination answers: which joints and nerves are involved, what the muscle is holding, and whether anything on the warning-sign list further down this page is in play.
Also written as: muscle spasm, paraspinal spasm, paravertebral spasm, muscular guarding, protective muscle splinting, hypertonicity (higher than usual resting muscle tension), muscle tightness.
“My back went out”, a locked back, a seized neck
These are the everyday names for the same event, and they are useful descriptions of what it felt like. What people are describing is a region that stopped moving, usually within seconds, often with a sensation of catching, and a set of positions that are now available and a set that are not. The low back version has people frozen at an angle, unable to straighten. The neck version has people turning the whole body to look at something instead of turning the head. What the phrase does not tell you is which structure started it, which is why the examination looks past the muscle that hurts to the joints, the discs, the nerves and the region above and below.
Also called: back went out, threw my back out, locked back, back seized up, crick in the neck, stiff neck, sleeping wrong.
Muscle strain, and how it differs from spasm
A strain is an injury to muscle fibers or to the tendon that anchors muscle to bone, meaning the tissue itself has been overloaded. A spasm is a contraction that will not release. The two words describe different things, and they get used as if they meant the same thing, so it is worth knowing which one you were told. A strain can be accompanied by spasm in the muscle around it, and spasm also turns up with joint and disc problems and after a crash. The distinction matters because it changes what is examined and what a plan looks like.
Also written as: muscle strain, muscular strain, pulled muscle, lumbar strain, cervical strain, myofascial strain, strain-sprain (a chart phrase covering both muscle and ligament).
Torticollis and wry neck
Torticollis means a neck held turned or tilted to one side, from words meaning twisted neck. Wry neck is the everyday version of the same term. The presentation people describe is waking up with the head parked to one side and a wall of muscle that will not let it come back to center. The word names the position of the head. It does not name a cause, and there are several possible ones, including some that belong to a physician rather than to this office, which is why an examination for a neck that has locked to one side includes screening the warning signs listed below.
Also written as: acute torticollis, acute wry neck, cervical dystonia (a separate neurological condition with a similar posture), stiff neck, head tilt.
Trigger points and myofascial pain: the knot
A trigger point is a tender spot inside a taut band of muscle, the ropey strand you can feel roll under a thumb. Myofascial pain is the clinical name for pain arising from muscle and fascia, the sheet of connective tissue wrapped around and between muscles. A trigger point and a spasm are not the same finding. A spasm involves a region of muscle holding a contraction; a trigger point is a discrete tender spot within a band, and pressing on it can reproduce the ache a person has been describing somewhere nearby. The two can be present in the same back or the same neck, and the examination checks for both by hand, because they are treated differently.
Also written as: myofascial trigger point, muscle knot, myofascial pain syndrome, taut band, tender point, rhomboid or trapezius knot when the report names the muscle.
Cramp, charley horse, twitch
A cramp is a sudden, hard contraction, usually in a limb, and a charley horse is the everyday name for one in the calf or thigh. A fasciculation is a twitch, a flicker of muscle visible under the skin that does not move the joint. None of these are the same event as a back or neck spasm that holds a region still, though people reach for all of these words when they call. Which one you mean, and how long it lasts, changes what gets examined.
Also written as: muscle cramp, charley horse, muscle twitch, fasciculation, muscle jump.
“Paraspinal muscle spasm” on a report or a chart note
This phrase shows up in emergency department notes, urgent care summaries and radiology reports, and it is often the only clinical language a person is handed. What it records is real: the muscles alongside the spine were contracted and tender when someone examined you, or a report described a straightened curve and attributed it to muscle contraction. That is a finding worth having in writing, and it is where the question starts rather than where it ends. Bring the report in and we will read it with you.
Also written as: paravertebral spasm, muscular spasm noted, loss of normal cervical lordosis (a straightened neck curve), straightening of the lumbar curve, guarding noted on examination.
A finding is not a diagnosis
People in spasm often arrive holding paper. An urgent care X-ray, an MRI from a previous episode, a report with disc and wear words scattered through it. So it is worth being precise about what a report of that kind settles, because it settles less than it appears to.
In a research review of 33 studies covering 3,110 people who had no symptoms at the time of their scans, disc bulges were reported in about 30% of people at age 20 and about 84% of people at age 80.1 In that review, findings like these were reported more often in the older age groups, and it runs both ways: a finding named on your report is not automatically the cause of your pain, and your pain is not less real because the same words appear on other people’s reports.
Two things about that review matter here. What it counted was disc and wear findings on scans, so it says nothing about how often spasm turns up and it is not evidence about your muscle. And it counted findings in people who happened to have no symptoms on the day of the scan, which tells you how often a word appears on a report. It does not tell you whether the word on yours has anything to do with what you are feeling. That question depends on where the finding sits, which structures it could affect, whether that matches what you actually feel, and what your examination shows in the positions that hurt. The report is the starting point. The examination connects it to you.
1. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. PubMed
What a review found about the months after low back pain begins
The first question almost everyone asks is how long this lasts. The research on the weeks and months after an episode of back pain was done in people enrolled for non-specific low back pain, meaning back pain that had not been traced to a particular structure, rather than in people enrolled for spasm. In a pooled review of 11 studies of people who went to a primary care doctor for non-specific low back pain that had lasted less than three months, 33% had recovered by the three-month mark, and 65% still reported pain a year after it started. In that review, what counted as recovery varied between studies, from 57% to 71% still reporting pain at 12 months depending on how strictly recovery was defined, and the reviewers noted that current guidelines assume a favorable prognosis mainly on the basis of return to function, while what this review pooled was something different, whether people still report pain.2
The details behind those numbers change what they mean. Everyone counted in those cohorts had already sought care from a primary care doctor, so this is the course of a treated group rather than an untreated one. Still reporting pain at twelve months is what the review pooled, so it counts people rather than describing how any one of their years went. The cohorts were enrolled for non-specific low back pain of less than three months, not for muscle spasm, and the review covers the low back rather than the neck. And the spread between 57% and 71% is not a rounding detail. It is one reason the headline number moves, and it tells you that part of what any recovery figure reports is the definition the researchers chose. The same review also found the figure varied by where the studies were done, 41% for the Australian studies against 69% for the European and US ones.
What that leaves is a group finding, not a forecast for the person reading it. It is also the argument for care that is monitored rather than assumed. Your response over the first few visits is information, and a plan that is not moving you is a plan that should change.
2. Itz CJ, et al. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2013;17(1):5-15. PubMed
Symptoms, and the warning signs we screen for
Spasm has a recognizable shape. A region goes tight and stays tight. Motion in one or two directions is available and the rest is not. Positions matter more than they usually do, so people find one chair in the house that works and stop using the others. The muscle is often tender to touch across a band rather than at a single point. Movement that stretches the involved muscle catches, and people learn to move around it, which is why a person with a low back spasm turns the whole body to reach a seatbelt and a person with a neck spasm turns the shoulders to check a blind spot.
Where it sits also tells the doctor something. Spasm across the low back and into the buttock keeps company with the structures covered on our low back pain page. Spasm along the side of the neck and into the top of the shoulder keeps company with the structures on our neck pain page. Spasm that arrives with pain, numbness or weakness traveling down an arm or a leg is a different examination than spasm that stays local, because it raises the question of a nerve being involved.
Then there is the shorter list. Some of what brings on a locked back or a locked neck sits outside the muscles, joints and discs of the spine. The emergency list below names those, and they belong in an emergency department tonight rather than in an appointment book.
Common, and examined here
- A back or neck that locked up and will not let you straighten or turn
- A band of muscle that has stayed tight and tender after a lift, a long drive, or a night of poor sleep
- Waking with the head held to one side and a neck that will not come back to center
- A knot between the shoulder blades or along the top of the shoulder
- Spasm that keeps coming back to the same spot every few months
- Spasm alongside pain that travels into an arm or a leg
- A report or a chart note that says paraspinal muscle spasm and has never been explained to you
- A back or a neck that locked up after a crash or a fall and has not been examined yet
Emergency, not an appointment
- Back or neck pain with a fever
- Back or neck pain with weight loss you cannot account for
- Spasm after a crash, a fall, or a blow to the head or spine with new numbness, weakness, or a change in alertness
- Weakness in an arm or a leg that is getting worse
- New loss of bowel or bladder control, or numbness in the groin or inner thighs
- Back pain with chest pain, breathlessness, or pain in the abdomen
These can signal an infection, a fracture, pressure on the bundle of nerves at the bottom of the spinal canal, which is called cauda equina syndrome, or a problem in the chest or the abdomen that is felt in the back. Call 911 or go to the emergency department now. Screening for these is part of what the examination here does.
How we approach a muscle spasm
The examination comes first: your history, a physical and neurological examination, screening for the warning signs above, and any imaging report you are carrying read with you rather than at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for exactly that conversation. The question the visit answers is the one you came in with: what is the muscle responding to, and does anything on your report explain the person in the room?
For a spasm the examination reaches past the muscle that hurts. The joints above and below the tight region are checked for how they move and whether moving them reproduces what you feel. Nerve function is tested when symptoms travel into an arm or a leg: strength, reflexes and sensation. The muscles themselves are checked by hand for the taut bands and the discrete tender spots that come with them, and the region is examined in the positions that hurt rather than only on a table, because a spasm that has organized itself around sitting behaves differently standing.
When conservative care fits, it is built from what that examination found. Adjustment of the joints found restricted, delivered by hand or with an instrument depending on your examination, your build and what you are comfortable with. Hands-on soft tissue work across the muscles that are holding. Dry needling when the examination finds trigger points or myofascial pain, meaning tender spots in taut bands of muscle and pain arising from muscle and its fascia. Dry needling uses a thin solid filament needle placed into the tender band. Nothing is injected and nothing is drawn out, which is what dry refers to. Dr. Bobby Koser, DC, chiropractic physician, is certified in dry needling by the Florida Department of Health. Alongside all of it, guidance on what to do between visits: what motion to keep, what to load, what to change about the seat, the desk or the pillow. Care is monitored, and if you are not responding, the plan changes.
Some presentations point out of this office rather than into a plan here. The warning signs listed above. Weakness that is progressing. A history of cancer, of recent infection, of long-term steroid use, or of osteoporosis with a new episode of pain. Pain that does not change with position or with rest. A picture that does not add up. When that is what the examination finds, we say so, refer you to the right physician, and send your records with you. Making sure you are in the right room is part of the job here.
Hurt in a car accident? Florida’s PIP law gives you 14 days from the crash to begin care and keep your no-fault medical benefits. If that window is open, start at our auto accident page and we will get you examined.
What the research shows
Three reviews are summarized below: one on staying active, one on heat and cold, one on dry needling. Each studied the population it names, and none of them enrolled people for muscle spasm. The trials underneath them are mostly randomized, meaning people agreed to let chance assign them to one approach or the other so the two could be compared fairly.
On staying active versus resting in bed. In a Cochrane review of ten randomized trials, the two trials pooled for acute low back pain, 401 people in all, suggested small improvements in pain and in function for advice to stay active over advice to rest in bed, and the reviewers rated that evidence moderate quality.3 Their own wording was that people may experience small benefits. In the same review, people with sciatica, leg pain from an irritated nerve in the low back, had little or no difference between the two approaches. The review also reported low-quality evidence from three further trials, 931 people, of little or no difference between exercises, advice to rest in bed and advice to stay active in acute low back pain. That review was published in 2010, the stay-active effect comes from two of its ten trials rather than from all of them, and the reviewers closed by writing that further research is very likely to have an important impact on the estimate of effect.
On heat, and on cold. In a Cochrane review of nine trials involving 1,117 adults with low back pain, the reviewers found moderate evidence, from a small number of those trials, that heat wrap therapy gave a small short-term reduction in pain and disability in people with a mix of recent and longer-running low back pain, what the review calls acute and sub-acute.4 The reviewers also wrote that adding exercise to the heat wrap further reduced pain and improved function, a conclusion resting on one trial of 100 participants in which the addition reduced pain after seven days. The pain half of that finding rests on two of the nine trials, 258 participants, measured at five days against an oral placebo, meaning a dummy pill; the reviewers put no trial count on the disability half beyond a small number of trials. In the same review, the evidence on cold came to three studies the reviewers rated poor quality, and they wrote that no conclusions can be drawn about using cold for low back pain. They also wrote that the evidence comparing heat against cold is conflicting, so the review does not say which of the two is better. The reviewers’ own summary of the whole picture was that the evidence base to support the common practice of superficial heat and cold for low back pain is limited. That review was published in 2006, and the finding above is about heat wrap therapy specifically rather than about heat in general, not a heating pad and not a hot shower.
On dry needling for trigger points. In a meta-analysis, meaning a study that pools the results of earlier trials, 11 randomized trials covering 802 patients who had low back pain along with myofascial trigger points, tender knots in muscle, were combined. Moderate evidence showed that dry needling of those trigger points, especially alongside other treatment, could be recommended to relieve the intensity of low back pain at the end of the treatment period.5 That is where the benefit was measured, at the end of the course of care rather than at a later check. In that same analysis, dry needling also came out ahead of the treatments it was compared with on day-to-day function. In the same review, the authors wrote that dry needling’s clinical superiority for day-to-day function, and its effects at later follow-up, remain unclear. Those trials enrolled people with low back pain in whom trigger points had been confirmed, and they covered the low back rather than the neck or the mid back.
What any of this means for the person reading it is a question the examination works on, because what these reviews report are group findings in the populations each of them enrolled.
3. Dahm KT, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;2010(6):CD007612. PubMed
4. French SD, et al. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006;2006(1):CD004750. PubMed
5. Liu L, et al. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99(1):144-152.e2. PubMed
Common questions about muscle spasm
What is a muscle spasm?
A muscle spasm is an involuntary contraction of muscle that does not release on command. In the back and the neck it usually presents as a band or a region of muscle that has gone hard and tender and is holding that area still, which clinicians also call guarding or splinting. It is a state muscle goes into rather than a disease, and the word describes what the muscle is doing without saying why it is doing it. Working out what the muscle is responding to, and whether any of the emergency warning signs are in play, is what an examination does.
Why did my back or neck lock up?
People describe an episode arriving in every kind of moment. Some describe a lift at an odd angle, a long drive, a night on a bad pillow, hours at a desk, or a return to activity after time away. Some describe a crash or a fall. Some cannot point to a moment at all. Your history and your examination are where an episode gets worked through, and imaging is read alongside them rather than on its own. What the examination describes is where you are now: which joints are moving and which are not, whether nerve function is affected, and which muscles are holding.
How long does a muscle spasm last?
The research does not answer that question about spasm directly. The nearest evidence is about low back pain. In a pooled review of 11 studies of people who went to a primary care doctor for non-specific low back pain, meaning back pain that had not been traced to a particular structure, lasting less than three months, 33% had recovered by the three-month mark and 65% still reported pain a year after it started, with the figure moving between 57% and 71% still reporting pain at 12 months depending on how strictly each study defined recovery. Those cohorts were enrolled for non-specific low back pain rather than for muscle spasm, everyone in them had already sought care, and what they give you is a group finding rather than a timeline for one person. It is the reason care here is monitored: your response over the first visits is information, and a plan that is not moving you should change.
Should I stay in bed when my back or neck locks up?
The research on staying active versus resting in bed was done in people with acute low back pain and with sciatica, leg pain from an irritated nerve in the low back, rather than in people with muscle spasm. In a 2010 Cochrane review of ten randomized trials, the two trials pooled for acute low back pain, 401 people in all, suggested small improvements in pain and in function for advice to stay active over advice to rest in bed, and the reviewers rated that evidence moderate quality and wrote that people may experience small benefits. In the same review, people with sciatica had little or no difference between the two approaches, and the reviewers closed by writing that further research is very likely to have an important impact on the estimate of effect. The review also reported low-quality evidence from three further trials, 931 people, of little or no difference between exercises, advice to rest in bed and advice to stay active in acute low back pain. What you should be doing in the first days of your own episode is worth asking the doctor who has examined you.
Is heat or ice better for a spasm?
The evidence on this is limited, and it covers low back pain rather than spasm. In a 2006 Cochrane review of nine trials involving 1,117 adults with low back pain, the reviewers found moderate evidence, from a small number of those trials, that heat wrap therapy gave a small short-term reduction in pain and disability in people with a mix of recent and longer-running low back pain, a finding whose pain half rests on two of the nine trials, 258 participants, measured at five days against a dummy pill. The reviewers also wrote that adding exercise to the heat wrap further reduced pain and improved function, a conclusion resting on one trial of 100 participants in which the addition reduced pain after seven days. In the same review, the evidence on cold came to three studies the reviewers rated poor quality, and they wrote that no conclusions can be drawn about using cold for low back pain. They also wrote that the evidence comparing heat against cold is conflicting, so the review does not say which of the two is better. Their own summary was that the evidence base to support the common practice of superficial heat and cold for low back pain is limited. That finding is about heat wrap therapy specifically rather than about heat in general, not a heating pad and not a hot shower.
What is dry needling?
Dry needling is the placement of a thin solid filament needle into a trigger point or a taut band of muscle. Nothing is injected and nothing is drawn out, which is what the word dry refers to. It treats trigger points and myofascial pain, meaning tender spots in taut bands of muscle and pain arising from muscle and its fascia, the connective tissue wrapped around muscle. In a meta-analysis pooling 11 randomized trials and 802 patients who had low back pain along with myofascial trigger points, moderate evidence showed that dry needling of those trigger points, especially alongside other treatment, could be recommended to relieve the intensity of low back pain at the end of the treatment period. In that same analysis, dry needling also came out ahead of the treatments it was compared with on day-to-day function, while the authors wrote that its clinical superiority for day-to-day function, and its effects at later follow-up, remain unclear. Whether it belongs in your plan depends on whether the examination finds trigger points and where. Dr. Bobby Koser, DC, chiropractic physician, is certified in dry needling by the Florida Department of Health.
My report says disc bulge and my back is in spasm. Is the bulge the reason?
Not necessarily, and this is worth taking seriously in both directions. In a research review of 33 studies covering 3,110 people who had no symptoms at the time of their scans, disc bulges were reported in about 30% of people at age 20 and about 84% of people at age 80, so a bulge named on a report is not automatically the cause of pain, and pain is not less real because the same word appears on other people’s reports. That review also looked at discs rather than at muscle, so it says nothing about your spasm either way. Whether the finding on your report explains what you feel depends on where it sits and whether that matches your symptoms, and that is what an examination works out.
When is a spasm an emergency?
Back or neck pain with a fever, with weight loss you cannot account for, or with chest pain, breathlessness or abdominal pain. Weakness in an arm or a leg that is getting worse. New loss of bowel or bladder control or numbness in the groin or inner thighs. Spasm after a crash, a fall, or a blow to the head or spine with new numbness, weakness, or a change in alertness. These can signal an infection, a fracture, pressure on the bundle of nerves at the bottom of the spinal canal, called cauda equina syndrome, or a problem in the chest or abdomen felt in the back. Call 911 or go to the emergency department now rather than booking an appointment.
Top 3 Finalist: Best Chiropractor
Creative Loafing Best of the Bay 2025 · Readers Pick
Quoted in National Press
See the coverage →
This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
A locked back is worth an examination.
A complete examination with Dr. Bobby Koser, DC, any report you are carrying reviewed with you, and your findings explained the same day.