What is the treatment for back strain?

Treatment for Back Strain

For back strain, the most effective first-line treatment is a combination of superficial heat therapy and NSAIDs, along with encouragement to stay active rather than rest. 1, 2

Initial Management

• Heat therapy: Apply heat wrap or heating pad for 30 minutes to the affected area

  • Moderate-quality evidence shows heat therapy provides moderate pain relief and improved function compared to placebo 1
  • Heat is more effective than acetaminophen or ibuprofen alone for short-term pain relief 1

• Medications:

  • NSAIDs: First-line pharmacologic option with moderate-quality evidence 2
  • Muscle relaxants: Consider cyclobenzaprine for up to 2-3 weeks if muscle spasm is prominent 3
    • FDA-approved specifically for "relief of muscle spasm associated with acute, painful musculoskeletal conditions" 3
  • Acetaminophen: Alternative for those who cannot take NSAIDs 2

• Activity modification:

  • Encourage staying active rather than bed rest 4
  • Japanese workers who received advice to stay active had lower risk of recurrent back strain compared to those advised to rest (adjusted OR: 3.65) 4

Physical Interventions

• Exercise therapy: Should be initiated as pain and swelling subside 5

  • Focus on restoring flexibility and strength 5
  • Motor control exercises that restore coordination and strength of spine-supporting muscles may be beneficial 1

• Avoid:

  • Traction: Not more effective than placebo or sham treatment 1
  • Transcutaneous electrical nerve stimulation (TENS): Not proven effective for acute back pain 1
  • Ultrasound: Inconsistent results in trials, with larger studies showing no benefit 1
  • Strain-Counterstrain therapy: Not more effective than exercise alone 6

Risk Stratification

Use the STarT Back tool to categorize patients into risk levels 2:

1. Low risk: Self-management with appropriate pain relief and education
2. Medium risk: Refer to physiotherapy with patient-centered management plan
3. High risk: Refer for comprehensive biopsychosocial assessment and physiotherapy

Duration of Treatment

• Cyclobenzaprine should only be used for short periods (up to 2-3 weeks) 3
• Most back strains resolve within 4 weeks with appropriate management 1
• If symptoms persist beyond 6 weeks despite appropriate management, consider additional imaging or specialist referral 2

Prevention

• Adequate warm-up before intense exercise
• Avoid excessive fatigue
• Focus on core strengthening exercises 5

Important Caveats

• No significant difference between heat and cold therapy was found in one study, suggesting either could be used based on patient preference 7
• For patients with cardiovascular disease or renal impairment, use NSAIDs with caution 2
• The long-term outcome after muscle strain injury is usually excellent with few complications 5