Best Treatment for Muscle Strain Pain in the Back
For muscle strain pain in the back, the best treatment is to start with superficial heat therapy combined with NSAIDs, while staying active and avoiding bed rest. 1, 2
First-Line Treatment Options
Medication Management
- NSAIDs are recommended as first-line pharmacological therapy:
Heat Therapy
- Apply heat wrap therapy or a heated blanket to the affected area
- Heat therapy has been shown to be moderately superior to placebo for short-term pain relief 1
- Heat therapy is even superior to oral acetaminophen or ibuprofen for short-term pain relief in some studies 1
- Minor skin irritation is the main adverse effect to watch for 1
Activity Modification
- Avoid bed rest, which can prolong recovery 2, 5
- Stay active and continue ordinary activities within pain limits 5
- Return to normal activities as soon as tolerable 5
Second-Line Treatments
Physical Therapy
- If no improvement after 1-2 weeks, consider referral for active physical therapy interventions 5
- Focus on active interventions rather than passive modalities 2
- McKenzie exercises may be particularly helpful for pain radiating below the knee 5
- Land-based physical therapy is preferred over aquatic therapy 2
Muscle Relaxants
- Consider adding muscle relaxants to NSAIDs if significant muscle spasm is present 2
- Use for short duration only, as they can cause drowsiness and may not be more effective than NSAIDs alone 5
Treatments to Avoid
Ineffective or Not Recommended Interventions
- Traction has not been shown to be more effective than placebo or sham treatments 1
- Transcutaneous electrical nerve stimulation (TENS) shows inconsistent results and is not clearly effective 1
- Ultrasonography has shown inconsistent results in small trials 1
- Shortwave diathermy has not demonstrated effectiveness 1
- Bed rest should be avoided as it can delay recovery 2, 5
- Opioids including tramadol are not recommended for acute back pain without severe symptoms 2
When to Consider Further Evaluation
- If no improvement after 4-6 weeks of conservative treatment 6
- Presence of red flags such as:
- Age younger than 5 years
- Systemic symptoms
- Nighttime pain
- Bowel/bladder dysfunction
- Neurological symptoms 7
Prognosis
- Reassure patients that 90% of episodes resolve within 6 weeks regardless of treatment 5
- Minor flare-ups may occur in the subsequent year 5
- Long-term outcome after muscle strain injury is usually excellent with few complications 8
Common Pitfalls to Avoid
- Overuse of imaging for acute back pain without red flags
- Prolonged inactivity or bed rest
- Overreliance on passive treatments instead of active rehabilitation
- Premature referral for surgical evaluation
- Prolonged use of NSAIDs without considering potential side effects
Remember that muscle strain pain typically responds well to conservative measures, and most cases resolve spontaneously with appropriate self-care strategies and time.