Management of Lower Torso Muscle Pain
For acute lower torso muscle pain, initiate treatment with topical NSAIDs with or without menthol as first-line therapy, combined with supervised exercise therapy focusing on muscle strengthening and flexibility. 1
Initial Treatment Approach
First-Line Pharmacologic Options
- Topical NSAIDs with or without menthol gel provide the strongest evidence for pain reduction, improved physical function, and treatment satisfaction with minimal systemic adverse effects 1
- Topical 1% menthol cream applied twice daily to affected areas demonstrates substantial pain relief with minimal toxicity 2
- Lidocaine topical preparations can temporarily relieve minor pain as an adjunctive option 3
First-Line Non-Pharmacologic Options
- Supervised exercise programs should include muscle strengthening, flexibility training, and stretching, with proper attention to load magnitude, repetitions, sets, and progression following ACSM guidelines 1
- Massage therapy provides pain relief through soft tissue manipulation, with reported adverse events limited to mild muscle soreness 1
- Heat therapy applied within 1 hour after activity reduces pain within 24 hours and beyond, with hot packs showing the most significant effect 4
Second-Line Treatment Options
Oral Medications
- Oral NSAIDs reduce pain and improve physical function with moderate-certainty evidence 1
- Oral acetaminophen provides pain reduction as an alternative when NSAIDs are contraindicated 1
- Cyclobenzaprine (muscle relaxant) serves as an adjunct to rest and physical therapy for acute, painful musculoskeletal conditions, used only for short periods (2-3 weeks) 5
Additional Non-Pharmacologic Interventions
- Acupressure at specific points reduces pain and improves physical function 1
- Transcutaneous electrical nerve stimulation (TENS) reduces pain, though evidence quality is low 1
- Spinal manipulation combined with other therapies shows benefit for pain relief and improved function 1
- Low-level laser therapy (LLLT) slightly improves pain compared to sham laser 1
Therapies with Insufficient or Negative Evidence
- Ultrasound shows no difference compared to sham treatment for pain or function 1
- Traction demonstrates no clear differences compared to other active treatments 1
- Lumbar support alone shows no benefit over exercise alone 1
- Kinesio taping shows no differences compared to sham taping 1
Critical Precautions
Avoid These Interventions
- Opioids (including tramadol) should NOT be used for acute musculoskeletal pain due to addiction risks, constipation, and lack of superior efficacy compared to non-opioid options 1, 2
- Long-term NSAID use carries gastrointestinal and cardiovascular risks; reserve for short-term acute flares only 2
Important Considerations
- Cold therapy (cold water immersion) applied within 1 hour after exercise reduces pain within 24 hours but has no obvious effect beyond 24 hours 4
- Initial treatment should include rest, ice, compression, and NSAIDs, followed by physical therapy to restore flexibility and strength as pain subsides 6
- Exercise programs must be adequately reported with specific parameters including frequency, intensity, time, type, volume, and progression to maximize effectiveness 1
Underlying Factors to Address
- Metabolic causes including depleted iron stores, hypothyroidism, or Vitamin D deficiency may perpetuate chronic muscle pain and require correction 7
- Structural factors such as scoliosis, joint hypomobility, or joint laxity should be identified and managed 7
- Sleep disturbances and fatigue commonly accompany chronic muscle pain and warrant attention 1, 7
Duration and Progression
- Acute muscle pain typically resolves with short-term treatment (2-3 weeks), and specific therapy for longer periods is seldom warranted 5, 6
- Physical therapy should be initiated as pain and swelling subside to restore flexibility and strength 6
- Long-term outcomes after muscle strain injury are usually excellent with few complications when properly managed 6