Can back issues cause tremors?

Can Back Issues Cause Tremors?

Back issues themselves do not typically cause tremors, but tremors can occur as part of functional neurological disorders (FND) that may develop in response to pain or injury, including back problems.

Types of Tremors and Their Causes

• Tremors are involuntary rhythmic oscillations of a body part produced by reciprocally innervated antagonist muscles and vary in frequency and amplitude 1
• Functional tremor is characterized by variability in frequency and amplitude, and most importantly, its distractibility (stopping when attention is redirected) 2
• Parkinsonian tremor is primarily a resting tremor (4-6 Hz) that may have postural components but lacks the distractibility seen in functional tremor 2
• Cerebellar tremor becomes more pronounced during goal-directed movements and is associated with dysarthria and ataxic gait 2, 3

Relationship Between Back Issues and Tremors

• Back problems themselves are not direct causes of tremors in medical literature, but they can lead to:

  • Development of functional neurological symptoms, including tremors, as a response to pain or injury 4
  • Maladaptive movement patterns that may manifest as tremor-like symptoms 4
  • Secondary problems from using assistive devices for back pain (e.g., crutches causing joint pain and muscle deconditioning) 4

• Functional tremors may develop in patients with chronic pain conditions, including back pain, as part of a broader functional neurological disorder 2

Distinguishing Features of Functional Tremors

• Functional tremors typically show:

  • Distractibility - tremor decreases or stops when attention is directed elsewhere 2
  • Entrainment - tremor changes frequency to match a voluntary rhythm performed by another body part 4
  • Variability in amplitude and frequency 2
  • Improvement with relaxation techniques 4

• Intervention strategies for functional tremor include:

  • Superimposing alternative, voluntary rhythms on top of the existing tremor 4
  • Using the unaffected limb to dictate a new rhythm 4
  • Assisting the person to relax muscles to prevent cocontraction 4
  • Using gross rather than fine movements that require more concentration 4

Other Causes of Tremors to Consider

• Neurological disorders such as Parkinson's disease (4-6 Hz resting tremor) 4, 1
• Essential tremor (4-8 Hz postural and kinetic tremor) 1, 5
• Medication side effects, particularly from certain psychiatric medications 4
• Metabolic disorders, including hypocalcemia which can induce or worsen movement disorders 4
• Cerebellar pathology from multiple sclerosis, stroke, or trauma 3
• Wilson's disease presenting with characteristic tremor 3

Management Approaches

• For functional tremors related to back issues:

  • Address the underlying back problem appropriately 4
  • Avoid reinforcing abnormal movement patterns by minimizing attention to the tremor 2
  • Implement rehabilitation strategies that focus on redirecting attention away from symptoms 2
  • Teach patients how self-directed attention can make symptoms worse 2

• Consider avoiding aids and equipment in the acute phase as they may:

  • Prevent future improvement by interrupting normal automatic movement patterns 4
  • Cause maladaptive ways of functioning 4
  • Lead to secondary problems such as joint pain and muscle deconditioning 4

• If tremors persist or worsen, consider evaluation for other neurological conditions that may require specific treatments 4, 6

Important Cautions

• Tremors that don't respond to distraction techniques or show features of neurological disease (such as rigidity, bradykinesia, or other neurological signs) warrant further investigation 4, 2
• New-onset tremors, especially in older adults, should not be assumed to be functional without appropriate neurological evaluation 4
• Certain conditions like hypocalcemia can cause tremors and abnormal involuntary movements that may be mistaken for functional tremors 4