Paravertebral muscle contracture

Specialty: Musculoskeletal.

• protective muscle spasm
• paraspinal muscle rigidity
• spastic muscular lumbago

Why it occurs

• Reflex protective response to an underlying disc or joint injury (herniated disc, facet osteoarthritis)
• Acute postural muscle overload or sudden flexion-extension movement with rotation
• Whiplash after traffic collision
• Chronic psychosomatic stress with muscle somatization
• Structural alterations of the spine (hyperlordosis, decompensated scoliosis)
• Foraminal stenosis or narrow canal with root irritation

Initial workup

Plain x-ray of the affected spinal segment (AP and lateral, usually showing rectification of the physiological curves due to muscle spasm) | MRI if the spasm is associated with progressive neurological radiculopathy | Systematic clinical palpation of the interscapular and lumbar muscles.

Standard management

• Diazepam — 2-5 mg orally every 8 hours or at night; powerful benzodiazepine with systemic muscle relaxant effect for periods no longer than 7 days
• Cyclobenzaprine — 10 mg every 12 hours orally
• Aceclofenac — 100 mg every 12 hours orally; anti-inflammatory
• Methocarbamol (500 mg every 6-8 hours orally).