​Can we at least agree that a muscle spasm creates a shortening of the muscle as it performs its action? When you have a true calf cramp your foot starts to plantar flex (point down). When your hamstring spasms, your knee bends. When your toe flexors cramp, your toes curl. And so on. (There can be many causes of these muscle spasms including musculoskeletal, nutritional, and others.)

So, if your low back muscles were in true spasm, they (primarily extensors which extend - or backward bend - your low back) should pull you into backward bend. Why don’t they? Because while you feel muscular symptoms, it’s rarely (I want to say never) a true muscle spasm. Instead, it’s pain referred from the nearby low back joints. These muscular symptoms can be horrendous, but they are driven by the joint; and once you start to get the joint moving correctly again, the muscular symptoms calm down.

Many patients with low back problems actually lean forward or are stuck forward due to the joint derangement, which further disproves the common theory that muscle spasm is the problem and is what needs to be treated. -- Laura

Regularly sitting for prolonged periods, especially slouched, can lead to orthopedic problems. But the problems arise almost always from joints, not muscles. I continually hear people (health professionals, notably) declare that sitting’s “shortened” position of the hip flexors can cause painful, tight hip flexors. Granted this doesn’t affect all sitters (nothing does), but if large amounts of time in shortened states can lead to painfully tight muscles, then where is the observable pattern? Why aren’t more biceps affected secondary to prolonged elbow bending? Where’s the complaint of painful anterior neck muscles as our heads are so often forward?
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Though I make my case verbally, people won’t budge. It’s likely the only way to prove my point would be to demonstrate an evaluation and treatment of someone with this given “diagnosis.”  In the absence of that, I put forth that, one, we have ways of clinically determining if this is occurring, which, importantly, involves ruling out joints and nerves. Two, if we consider joint mechanics, deranged upper-mid lumbar segments and hip joints can send referred/radicular pain to the hip flexor area. Deranged elbows usually refer pain to the medial, lateral, or posterior elbow. And neck derangements typically send pain posteriorly and laterally – rarely anteriorly. The deranged joint pattern is observable. --Laura

If you lie propped up on your elbow for some time, it’s likely when you go to first move it, it’s stiff. Same with sitting on a crossed hip or ankle. As you start to move, the joint rapidly loosens and there’s no lasting impact. Do this enough, though, and it can become harder for a joint to consistently rebound to its correct alignment. And as the joint further deforms, this stiffness may become pain.
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While this applies to extremity joints, these days it seems more prevalent in the spine. If your day entails primarily kneeling, it can become increasingly stiff and painful to straighten your knee(s). More commonly, though, if your day is spent protruding your neck looking at a computer or rounding your back driving in a car’s bucket seat, your spine may enter the stiffness-pain paradigm.

For many joints, it can be hard to notice stiffness/motion loss. Detecting stiffness, however, is often important in the prevention of pain, especially with previously painful joints. I therefore teach my patients how to self-test their affected joint each day. If stiffness is spotted, their corrective exercise should be performed to restore full joint motion and prevent unwanted escalation into pain. --Laura