What is the treatment for a back muscle strain?

Treatment for Back Muscle Strain

For a pulled back muscle (muscle strain), the most effective treatment is a combination of rest, heat therapy, over-the-counter pain medications, and gradual return to activity, avoiding bed rest which can worsen outcomes. 1

Immediate Management (First 24-48 Hours)

• Stay active: Continue ordinary activities within pain limits rather than strict bed rest 2
• Apply heat: Use heating pads or heated blankets for short-term relief, particularly effective for acute muscle pain 1
• Pain medication options:
  • First-line: Acetaminophen (1000mg three to four times daily, not exceeding 4g/day) or NSAIDs like ibuprofen if no contraindications 1
  • Second-line: Muscle relaxants like cyclobenzaprine may be considered for short periods (up to 2-3 weeks) for relief of muscle spasm 3

Days 2-7 Treatment Plan

• Continue heat therapy: Apply for 15-20 minutes several times daily
• Begin gentle stretching: As pain allows, start gentle stretching exercises to prevent stiffness
• Maintain activity: Continue normal daily activities as much as pain permits 1
• Medication management: Continue with acetaminophen or NSAIDs as needed; use muscle relaxants only at night if sleep is disturbed by muscle spasms 3

Week 2 and Beyond

• Begin structured exercise: Start a supervised exercise program after the acute phase (2-6 weeks) 1
• Focus on strengthening: Exercises that incorporate individual tailoring, supervision, stretching, and strengthening are associated with best outcomes 4
• Gradually increase activity: Return to normal activities progressively, avoiding sudden increases in intensity
• Consider physical therapy: If not improving after 1-2 weeks, referral for goal-directed manual physical therapy is recommended 2

Important Considerations

• Avoid excessive rest: Prolonged bed rest can delay recovery and lead to deconditioning 2
• Return to work early: This is associated with less disability 2
• Reassurance: 90% of back pain episodes resolve within 6 weeks regardless of treatment 2
• Warning signs: Seek immediate medical attention if experiencing:
  • Severe or progressive neurological deficits
  • Unexplained weight loss or fever
  • History of cancer, significant trauma, or osteoporosis
  • Pain that worsens despite treatment 1

Ineffective Treatments to Avoid

• Transcutaneous electrical nerve stimulation (TENS): Not proven effective for back pain 4
• Traction: Not shown to be effective for back pain with or without sciatica 4
• Bed rest: Can worsen outcomes and delay recovery 2
• Routine imaging: Not recommended for nonspecific back pain as it doesn't improve outcomes 1

Prevention of Recurrence

• Proper technique: For those who lift weights or engage in physical activity, focus on proper form and technique 5
• Core strengthening: Regular exercises to strengthen core muscles can help prevent recurrence
• Warm-up: Adequate warm-up before intense exercise may help prevent muscle strain injury 6
• Address imbalances: Correct mobility and muscular imbalances, particularly important for athletes 5

The long-term outcome after muscle strain injury is usually excellent with appropriate management, and following these evidence-based recommendations will help ensure optimal recovery and minimize the risk of recurrence 6.