What is the recommended treatment for acute low back strain?

From the Guidelines

The recommended treatment for acute low back strain includes a combination of rest, activity modification, and pain management, with spinal manipulation being a beneficial nonpharmacologic therapy for short-term benefits. Initially, relative rest for 24-48 hours is advised, avoiding activities that worsen pain while maintaining gentle movement as tolerated. Over-the-counter pain medications such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) can help manage pain and inflammation 1. Apply ice for the first 48-72 hours (15-20 minutes every 2-3 hours) followed by heat therapy. Gentle stretching and strengthening exercises should be gradually introduced as pain allows.

Key Considerations

• Spinal manipulation administered by providers with appropriate training is associated with small to moderate short-term benefits for acute low back pain (duration <4 weeks) 1.
• Supervised exercise therapy and home exercise regimens are not effective for acute low back pain, and the optimal time to start exercise therapy after the onset of symptoms is unclear 1.
• Other nonpharmacologic treatments, such as acupuncture, massage therapy, yoga, cognitive-behavioral therapy, or progressive relaxation, may be considered for chronic or subacute low back pain, but their effectiveness for acute low back strain is limited 1.

Red Flag Symptoms

If pain is severe or persists beyond 4-6 weeks, or if you experience red flag symptoms like leg weakness, numbness, or bowel/bladder changes, seek medical attention promptly. This approach works because it addresses both the inflammatory response and muscle tension while promoting healing through controlled movement and preventing deconditioning that can prolong recovery.

From the FDA Drug Label

Cyclobenzaprine hydrochloride tablets are indicated as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions Improvement is manifested by relief of muscle spasm and its associated signs and symptoms, namely, pain, tenderness, limitation of motion, and restriction in activities of daily living

The recommended treatment for acute low back strain is cyclobenzaprine hydrochloride tablets as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions, such as low back strain. The treatment should be used only for short periods (up to two or three weeks) 2. Key points to consider:

• Rest and physical therapy are essential components of the treatment
• Cyclobenzaprine hydrochloride tablets should be used for a limited duration due to the lack of evidence for prolonged use
• The treatment aims to provide relief from muscle spasm and its associated symptoms, including pain, tenderness, limitation of motion, and restriction in activities of daily living 2

From the Research

Treatment Options for Acute Low Back Strain

The recommended treatment for acute low back strain includes:

• Staying active and continuing ordinary activity within the limits permitted by pain 3
• Avoiding bed rest and returning to work early, which is associated with less disability 3
• Considering McKenzie exercises, which are helpful for pain radiating below the knee 3
• Recommending acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) if medication is necessary 3
• Using diflunisal, which has been shown to be effective in treating mild to moderate pain caused by acute low back strain 4
• Considering ketorolac, which has been found to provide comparable efficacy to acetaminophen-codeine with a superior adverse event profile 5

Non-Pharmacological Interventions

Non-pharmacological interventions that may be beneficial for acute low back strain include:

• Fitness programmes and advice to stay active, which can reduce pain and improve function 6
• Maintaining physical activity and avoiding rest, which can reduce pain and maintain function in acute low back strain 6
• Manual therapy, which can reduce pain and maintain function in acute low back strain 6
• Behavioural treatment, which can prevent acute low back strain from becoming chronic 6

When to Seek Further Medical Attention

Further medical attention may be necessary if:

• There are "red flags" present, such as a history of trauma, fever, incontinence, unexplained weight loss, or intense localized pain 7
• There is no improvement after 6 weeks, in which case imaging may be considered 3
• There is suspicion of spinal fracture or compression, in which case a plain lumbosacral spine x-ray may be considered 3