What is the recommended treatment for a patient diagnosed with musculoskeletal strain?

Treatment for Musculoskeletal Strain

Topical NSAIDs with or without menthol gel should be used as first-line therapy for musculoskeletal strain to reduce pain, improve function, and enhance treatment satisfaction. 1

First-Line Treatment Approach

Topical Treatments

• Apply topical NSAIDs to the affected area of the right-sided back and hip 3-4 times daily 1, 2
• Consider adding menthol gel (such as Biofreeze) for additional pain relief 1, 2
• Topical treatments minimize systemic exposure while providing localized pain relief 2

Rest and Activity Modification

• Implement relative rest for the affected area while maintaining activity in unaffected areas
• Avoid activities that exacerbate pain, particularly heavy lifting which triggered the injury 3
• Gradually return to normal activities as pain subsides

Physical Interventions

• Apply ice to the affected area for 15-20 minutes every 2-3 hours during the first 24-48 hours to reduce inflammation 3
• Use compression (such as an elastic bandage) to provide support and reduce swelling 3
• Consider appropriate bracing if the strain affects joint stability 2

Second-Line Treatment Options

If first-line treatment is insufficient after 3-5 days:

Oral Medications

• Oral NSAIDs: Consider naproxen or other non-selective NSAIDs if topical treatments are inadequate 1

  • Use the lowest effective dose for the shortest possible duration 2
  • Monitor for gastrointestinal side effects

• Acetaminophen: Alternative option if NSAIDs are contraindicated or poorly tolerated 1

  • Use up to 3,000 mg/day in divided doses 2

• Muscle Relaxants: Consider cyclobenzaprine for short-term use (up to 2-3 weeks) if muscle spasm is prominent 4

  • Be aware of potential side effects including drowsiness and dry mouth 4

Non-Pharmacological Interventions

• Physical Therapy: Initiate as pain and swelling subside 3

  • Focus on restoring flexibility and strength to the affected muscles 2
  • Include core strengthening exercises to support the back 2

• Transcutaneous Electrical Nerve Stimulation (TENS): May help reduce pain in some patients 1

• Acupressure: Consider for pain reduction and improved physical function 1

Important Considerations and Cautions

Avoid Opioids

• Opioids (including tramadol) should be avoided for treatment of musculoskeletal strain 1
• The risks of opioid use outweigh potential benefits for this condition

Duration of Treatment

• NSAIDs should be used for the shortest possible time to minimize adverse effects 1
• Muscle relaxants should only be used for short periods (2-3 weeks maximum) 4

Special Populations

• In patients with cardiovascular disease, use a stepped care approach starting with acetaminophen or non-acetylated salicylates before considering NSAIDs 1
• For patients with gastrointestinal risk factors, consider adding a proton pump inhibitor if oral NSAIDs are necessary 2

Follow-up and Progression

• Evaluate response to initial treatment after 4-7 days 2
• If symptoms persist beyond 2-3 weeks despite appropriate treatment, reassess the diagnosis and consider additional imaging or specialist referral 3
• Gradually increase activity as symptoms improve, with focus on preventing recurrence through proper body mechanics and strengthening exercises 2

Prevention of Recurrence

• Implement proper warm-up before physical activity, especially before heavy lifting 3
• Strengthen core and back muscles to provide better support during activities 2
• Improve workplace ergonomics to reduce strain during lifting and other activities 1
• Maintain flexibility through regular stretching 3

The evidence strongly supports a conservative approach focusing on topical anti-inflammatory medications first, followed by oral medications only if needed, while incorporating appropriate physical therapy and activity modification to promote healing and prevent recurrence.