Witch’s Blow

The “witch’s blow” is an acute traumatic event that causes a very painful contracture to the lumbar muscles (acute low back pain), preventing you from moving your back and in the most severe forms forces you to keep it bent in a completely unnatural way, at about 45 °, for a few days.

Typically, the disorder arises following the execution of abrupt movements of the back and trunk, which irritate the nerve endings present at the level of the lumbar vertebrae, resulting in contracture of the paravertebral muscles. Those who have suffered from it, describe the effects of this phenomenon equating it to the sensation you get when you receive a “beating” in the lower-central part of the back (lumbar area of the spine).

Although characterized by striking symptoms and associated with considerable physical discomfort, the witch’s blow tends to resolve itself within a week. To promote recovery and not suffer excessively, it is important to ensure the necessary rest to the back and make use of symptomatic therapies that can soothe pain and relieve contracture, such as non-steroidal anti-inflammatories and analgesic drugs.

The period of almost total disability associated with the acute phase of the witch’s blow, in addition to leading to understandable practical problems in everyday life, can be poorly tolerated on the psychological level. Having patience and waiting for the back to recover full functionality before returning to usual occupations, without forcing or wanting to accelerate the remission times, is essential to prevent low back pain from lasting longer than necessary or that the witch’s blow recurs after a short time, at the first careless movement, but it is also important to start moving again as soon as the pain allows it. Movement is key to recovery.

Why it manifests itself and how it evolves

At the base of a witch’s blow there is often no functional cause, but it is only the consequence of an abrupt or poorly executed movement. Other times, however, especially when the episodes of back pain are often repeated, you could have a protrusion or even a hernia, in any case, although the pain it involves is very intense, the event does not cause specific injuries to the paravertebral muscles or to the nerve or articular structures involved.

When the doctor examines the back, all he finds is an abnormal contracture, not necessarily commensurate with the extent of the sudden movement performed and completely reversible once the acute phase has passed. The single episode of the witch’s blow, therefore, is challenging to endure, but it does not have to worry too much and can be managed without further diagnostic investigations.

The speech is slightly different when the disorder recurs several times over a few months, in conjunction with a particular activity or in different situations. In this case, it is advisable to contact an orthopedist experienced in pathologies of the spine to examine the situation with instrumental investigations (radiography, CT, MRI, etc.). and check for the possible presence of vertebral pathologies (osteoarthritis) or intervertebral discs (herniated discs, sometimes improperly called “herniated disc”) or other specific disorders that can promote inflammation or contracture of the lumbar muscles.

Although the witch’s blow can occur at any time of life, people over 35-40 years old are most often affected, an age after which muscles and joints begin to age, becoming less toned and elastic and resulting, therefore, more “susceptible” and less able to respond promptly to sudden stresses.

The most frequent causes

To cause the blow of the witch are all the situations and movements that put abruptly under stress the lumbar region of the back, triggering a sudden and abnormal contraction of the muscles that support and surround the spine.

The most frequent causes of the disorder are listed in the following table.

In the case of rapid bends of the spine, in general, the witch’s blow takes over in the phase of straightening the back, while in the case of twists, the risk is more if you are holding heavy objects or you have a backpack in shoulder.

In most cases, the stabbing pain typical of the witch’s blow arises when these sudden movements are made “cold” or when the lumbar muscles least expect it, as happens immediately after waking up, after a fairly prolonged rest period or after maintaining the same position for several hours (a day at the office, a long car journey, etc.).

The probability of experiencing the disorder is even higher for those who tend to be sedentary, have constitutively inelastic muscles and little toned and / or not trained to respond to stresses, for those with excessive body weight and during the last months of pregnancy, due to the weight of the fetus that requires additional work on the back muscles, also exasperating the curvature of the lumbar area of the spine.

Even the cold can favor the onset of the witch’s blow, facilitating its unleashing even in correspondence with movements that in better environmental conditions probably would not have created particular discomfort. In this case, to aggravate the effects of careless movements is the greater basic contraction of the lumbar muscles, which is established in response to exposure to low temperatures, and their consequent less readiness to react to impromptu motor demands.

The effect of cold on the functionality of the back and the consequent risks should be taken into account especially those who carry out heavy work, or that very much occupy the lumbar area, in environments characterized by low temperatures (ie outdoors between November and February), those who enter and exit cold rooms and rooms with air conditioning set to “glacial” temperatures and those who practice sports winter or other types of physical activity in the mountains or in parks and gardens even when the thermometer drops below 10 ° C.

How to prevent the witch’s blow

The witch’s blow cannot be completely prevented, because in everyday life there may always be situations that accidentally force you to make improper back movements, too fast or associated with intense effort, which the lumbar muscles cannot support.

However, by adopting some practical measures and keeping your back as trained and toned as possible, the likelihood of acute episodes of severe low back pain and transient muscle blockage can be substantially reduced.

Among the attentions to be respected in everyday life, at any age and especially after the “doors” or if you know you have a somewhat “delicate” back, it should be remembered above all to:

– avoid sitting too long, but provide periodic breaks to walk a few minutes and do exercises to stretch the back muscles

– use rigid seats, with anatomical / ergonomic shape or shaped cushions to support the lumbar area and avoid assuming an inadequate posture

– prefer chairs / armchairs not too low and with armrests to support the forearms, relieving tension from the muscles of the shoulders and neck and make less effort to get up

– do not lift and carry significant weights (over 5-6 kg) and do not twist your torso too quickly (especially if you have weights in your hand)

– to pick up objects from the ground, do not bend down, but bend your legs or ask for help (this advice also applies to grandparents who want to pick up their grandchildren)

– when you have to restore the upright position after bending, always do it slowly, possibly leaning on a piece of furniture and making force on the arms

– do not try to push or pull furniture or crates that are too heavy, cars etc.

– when getting out of bed, first lean on your side, so as not to overload the back and abdominal muscles, then lift sideways, making force on the arms (this is especially true in the last months of pregnancy)

– choose a good quality anatomical mattress and equip yourself with shaped pillows to support the cervical / lumbar area and the space between the legs (if you sleep on your side), to avoid incorrect postures and consequent muscle tension / contractures during the night

– follow a healthy diet, also with a view to keeping body weight under control so as not to impose a constant extra load on the muscles of the lumbar region of the back

– If obesity or overweight conditions are present, plan with the help of your doctor or a nutritionist a balanced low-calorie diet to lose weight.

With regard to physical activity, the main recommendations are to:

– practice physical exercise regularly, choosing the sport that best suits your age, physical characteristics, level of athletic preparation and general state of health, without exceeding the duration and intensity of training

– start training very gradually if you have never practiced sports or have abandoned it for some time, being supported, at least in a first phase, by an experienced instructor

– prefer sports that do not impose excessive stress on the back muscles and that do not involve significant risks of sudden back movements, falls or accidental trauma

– do not practice physical activity in unfavorable environmental conditions, such as intense cold and humidity, and always have technical clothing appropriate to the climate (both to protect yourself from the cold and to avoid sweating excessively)

– In winter, prefer indoor activities, favoring swimming, exercise bike and gentle gymnastics, on land or in water, pilates etc.

– perform, after learning the correct exercise technique and never “cold”, stretching exercises, an excellent ally of the well-being of the back as it helps to loosen and prevent tension and contractures

– undergo, in the presence of mild back pain and before starting any type of training, a physiotherapy evaluation and identify together with the physiotherapist and / or sports doctor the activities and exercises that can bring the maximum benefits without involving risks

– perform cycles of physiotherapy and spa treatments (mud therapy), which can be very useful to prevent new episodes of witch stroke in people who tend to suffer from it repeatedly.

Cures and remedies for the witch’s blow

In the hours immediately following the witch’s blow moving is almost impossible, both because of the intense pain, which is exasperated by any slightest further stress on the back muscles, and because of the severe and temporarily disabling contracture. This critical situation must not be forced in any way so as not to increase the irritation of the vertebral nerves and not to damage the contracted muscle fibers.

The only thing to do in the first 24-48 hours from the onset of pain is to remain completely at rest, in bed, in the position that is most tolerable and that, in general, corresponds to that in which you have been stuck. During this time, the symptoms generally begin to gradually improve and this allows you to start moving again, cautiously and very gradually, in the following period.

On the other hand, immobilization should not be prolonged too long (a couple of days at most) because, after the initial acute phase, the muscles can recover their functionality better if you start using them again in a physiological way.

From the onset and for a few days, to promote the attenuation of muscle contracture (on which much of the pain depends) it is useful to take muscle relaxant drugs that act specifically at this level, after seeking the doctor’s advice regarding dosages and treatment times.

To alleviate acute pain, treatment for 3-4 days with analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) is appropriate. NSAIDs can be taken by mouth (with food) or applied topically in the form of gels or gradual release patches, as indicated in the package insert and/or by your doctor.

After the first 48 hours, a physical approach based on heat can also be used to counteract muscle contracture and pain. Thermal therapy can be implemented in a simple and practical way thanks to the availability of adhesive self-heating bands, to be applied on the area of the back affected by the witch’s blow. The band, invisible under clothing, should be left in place for up to 8 hours and provides prolonged and significant relief, which should not, however, lead to a reduction in caution in movements.

Clinical studies on the effectiveness of self-heated bands have shown that the heat thus administered is able to relieve muscle pain, without causing any side effects. Heat therapy can be used as long as you feel the need, but generally 3-7 days are enough to reverse the symptoms. If this is not the case, it is advisable to consult your doctor for a second evaluation.

Massage and manipulations are not recommended during the acute phase of back pain and as long as the painful symptoms due to the witch’s blow are present, while they can be useful once the acute episode has been completely overcome, in order to stretch and keep the back muscles more elastic and prevent, thus, further contractures, but you must always contact qualified physiotherapists.