From the Guidelines
Paraspinal tenderness should be initially managed with conservative treatment, including rest, ice, heat therapy, and over-the-counter pain medications, as this approach is associated with improved outcomes and reduced risk of complications, as suggested by the American College of Physicians and the American Pain Society 1.
Causes and Symptoms
Paraspinal tenderness refers to pain or discomfort when pressure is applied to the muscles alongside the spine. This condition commonly results from muscle strain, poor posture, overuse injuries, or underlying spinal conditions. Symptoms may include localized pain, stiffness, and limited range of motion.
Diagnostic Approach
A focused history and physical examination are essential to determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement. The patient's history should include the location of pain, frequency of symptoms, and duration of pain, as well as any history of previous symptoms, treatment, and response to treatment.
Treatment Recommendations
For mild to moderate paraspinal tenderness, the following treatment options are recommended:
- Rest from aggravating activities
- Application of ice for 15-20 minutes every 2-3 hours during the first 48-72 hours, followed by heat therapy
- Over-the-counter pain medications such as ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours)
- Gentle stretching exercises and proper posture maintenance
Indications for Medical Evaluation
If symptoms persist beyond 1-2 weeks, worsen, or are accompanied by radiating pain, numbness, weakness, or bowel/bladder changes, medical evaluation is necessary as these may indicate more serious conditions like herniated discs or nerve compression. Physical therapy focusing on core strengthening and proper body mechanics may be recommended for persistent cases.
Key Considerations
Paraspinal tenderness occurs because muscle inflammation triggers pain receptors in the affected area, and addressing both the symptoms and underlying causes is essential for effective treatment. Clinicians should be aware of the potential for underlying conditions such as cancer, infection, or cauda equina syndrome, and should consider risk factors for these conditions when evaluating patients with paraspinal tenderness 1.
From the Research
Paraspinal Tenderness
- Paraspinal tenderness can be associated with various conditions, including myositis ossificans, which is a rare condition that can occur after minor injury or procedures such as acupuncture 2.
- The diagnosis of paraspinal tenderness can be challenging, and it is essential to rule out other possible causes, such as neoplasms or infections 2.
- Treatment for paraspinal tenderness depends on the underlying cause, and it may include conservative management with rest and analgesics, or more invasive procedures such as surgery 2.
Relationship with Low Back Pain
- Paraspinal muscle pathophysiology is associated with low back pain and spine degenerative disorders, and altered muscle structure and function can contribute to the development of low back pain 3.
- Exercise-induced delayed-onset muscle soreness (DOMS) can also affect paraspinal muscles, leading to reduced functional capacities and increased pain sensitivity 4.
- The relationship between paraspinal muscle function and low back pain is complex, and further research is needed to understand the mechanisms that regulate spine and paraspinal muscle health 3.
Treatment Options
- Cyclobenzaprine, a muscle relaxant, has been shown to be effective in treating acute neck or back pain with muscle spasm, and it can be used alone or in combination with ibuprofen 5.
- Acetaminophen, a commonly used analgesic, has limited efficacy in treating chronic pain conditions, including low back pain, and its use should be reassessed 6.
- Other treatment options, such as exercise and physical therapy, may also be effective in managing paraspinal tenderness and low back pain, but more research is needed to determine their efficacy 4.