What is the treatment for a pulled muscle in the back?

Treatment for Pulled Muscle in the Back

For a pulled muscle in the back, the most effective initial treatment is superficial heat therapy, which provides superior short-term pain relief compared to other interventions including acetaminophen and ibuprofen. 1

Initial Self-Care Approach

• Apply heat wrap therapy or a heated blanket to the affected area for short-term pain relief and improved back function 1
• Heat therapy works by increasing blood flow, metabolism, and elasticity of connective tissues, which helps reduce pain 2
• Rest the injured area initially, but avoid prolonged inactivity as this may delay recovery 3
• Over-the-counter acetaminophen can be used for pain relief, as it is FDA-approved for backache and muscular aches 4
• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used for pain relief, though heat therapy has been shown to be moderately superior to oral acetaminophen or ibuprofen for short-term pain relief 1

Treatment Timeline

Acute Phase (First 1-3 Days)

• Apply heat therapy for 15-20 minutes several times daily 1
• Mild compression with an elastic bandage may help reduce swelling 3
• Avoid activities that aggravate the pain 3
• Use acetaminophen or NSAIDs for pain management 1, 4

Recovery Phase (After Initial Pain Subsides)

• Begin gentle stretching exercises to restore flexibility 3
• Gradually introduce strengthening exercises targeting the affected muscle groups 3
• Continue heat therapy before exercise to improve tissue elasticity 2
• Return to normal activities gradually as pain permits 1

Non-Pharmacologic Interventions

• Superficial heat therapy: Consistently shown in higher-quality trials to be moderately superior to placebo for short-term pain relief and improved function 1
• Exercise therapy: Should be initiated as pain and swelling subside to restore flexibility and strength 3
• Massage therapy: Soft tissue manipulation can be effective for pain relief in chronic back pain 1
• Spinal manipulation: May provide small to moderate short-term benefits for acute low back pain when administered by properly trained providers 1

Pharmacologic Options

• Acetaminophen: FDA-approved for temporary relief of minor backache and muscular aches 4
• NSAIDs: Effective for pain relief but carry risks of gastrointestinal, cardiovascular, and renal adverse effects 1
• Muscle relaxants: May be an option for short-term relief of acute back pain but are associated with central nervous system side effects, primarily sedation 1

When to Consider Additional Treatment

• If pain persists beyond 2-4 weeks despite self-care measures 1
• If there is severe, disabling pain not controlled with acetaminophen and NSAIDs 1
• If there are signs of neurological involvement (numbness, weakness, radiating pain) 1

Common Pitfalls to Avoid

• Prolonged bed rest: Can lead to muscle deconditioning and delayed recovery 1
• Cold therapy for muscle strains: While commonly recommended, evidence suggests heat therapy provides better pain relief for muscle injuries 2
• Traction: Not proven effective for low back pain and may cause aggravation of symptoms 1
• Transcutaneous electrical nerve stimulation (TENS): Has not been proven effective for chronic low back pain 1
• Shortwave diathermy and ultrasonography: Insufficient evidence to recommend these interventions 1

Long-Term Management

• Regular exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening are associated with the best outcomes for preventing recurrence 1
• Heavy resistance training has been shown to improve symptoms and optimize muscle function even years after a strain injury 5
• Avoiding excessive fatigue and performing adequate warm-up before intense exercise may help prevent future muscle strain injuries 3