Do Infants Suffer Back Spasms?

Background

October 2017: A 17yo female volleyball middle blocker reported to the athletic training facility with complaints of thoracic and lumbar pain after suffering a contact injury the day before impacting her back and vertebrae directly against the floor. Evaluation revealed a positive stork and quadrant test with pain upon palpation over the spineous process and right transverse processes of T8-T11 as well as muscle guarding of the erector spinae in the region, particularly on the right. The patient also exhibits hypertrophy through the right thoracic erectors prior to and after the initial onset of the injury. The patient was referred for imaging to further rule out fracture with negative results. The following day, the patient reported to the athletic training facility during practice with back spasms that were unresponsive to treatment and progressed to a violent level and was referred to urgent care for treatment. She was able to return to practice three days later with the help of prescription muscle relaxers and pain medication and began a therapeutic exercise program based on the rehabilitation philosophy I have outlined previously with an emphasis on breathing, trunk stability and control, and basic movement patterns like the hip hinge. Her symptoms were largely resolved with intermittent complaints of mild pain in her back throughout the volleyball season with inconsistent visits to the athletic training facility due to her schedule.

Current Issue

February 2018: The patient, not participating in a winter sport, was inconsistent with strength and conditioning work to facilitate her rehabilitative progression. Toward the end of the first quarter of a home basketball game I saw her walking to the athletic training facility at which time I followed to find her suffering from mild back spasms once again. After a quick re-evaluation I determent that the patient was at no risk of further injury and had no reason to suspect further complication. Lacking TENS or E-Stim in my clinical setting, and having recently become rather interested in Dynamic Neuromuscular Stabilization (DNS), I decided to utilize a supine 3 month old position in an attempt to reciprocally inhibit the spinal erectors by encouraging diaphragmatic breathing, unloaded reflexive spinal stabilization, and promoting proper trunk and core posture via the neuromuscular system through a developmental (ontogenetic) posture. After a minute or two of this, facilitating diaphragmatic breathing with the patient via pressure manually applied to the lateral abdomin, the patient’s back spasm reduced and then disappeared all together. After a short rest interval of roughly one minute, this intervention was repeated for another minute and the patient was able to stand up, return to the stands, and continue watching the basketball game. During the fourth quarter the patient returned to the athletic training facility with a mild return of the back spasms at which point the same intervention was repeated for roughly three more minutes and the patient was advised to leave and rest, reporting no symptoms during followup the next day. While this may not have been the ideal long lasting outcome that might have allowed the patient to return to full funciton directly after treatment, it is an example of how, with a robust enough understanding of treatment techniques, the function and systems of the body and how dysfunction occurs, and a bit of creativity, patient care in any setting can be quick and quite successful. My continued exploration of the neuromuscular system and techniques such as DNS have allowed me to grow my patient care in the four short months between these two incidents of back spams in the same patient.