Muscle Strain

Most episodes of low back pain are caused by damage to the soft tissues supporting the lower spine, including muscles, tendons, and ligaments.

The lower spine, also called the lumbar spine, depends on these soft tissues to help hold the body upright and support weight from the upper body. If put under too much stress, the low back muscles or soft tissues can become injured and painful.

While a pulled back muscle or strain may seem like a minor injury, the resulting pain and muscle spasms can be surprisingly severe.

Types of Lower Back Strain

There are two common types of soft tissue injuries in the low back: 

• Muscle strain occurs when fibers in a muscle begin to tear from being overstretched or overused (commonly called a pulled muscle).

• Lumbar sprain occurs when ligaments are overstretched or torn. Ligaments are tough, fibrous tissues that connect bones together.

A specific diagnosis of ligament sprain or muscle strain is usually not needed, as both have almost identical symptoms and receive the same treatment. This article refers mainly to lower back muscle strains, but applies to sprains or other soft tissues injuries as well.

Inflammation and Muscle Spasm

When soft tissues in the low back are stretched or torn, the surrounding area will typically become inflamed. Inflammation or local swelling, is part of the body’s natural response to injury, in which blood is rushed to an injured tissue in order to restore it. Inflamed muscles may spasm, feel tender to the touch, or cramp , and contract tightly, causing intense pain.

The Course of Lower Back Muscle Strain 

The hip, pelvis, buttock, and hamstring muscles assist low back muscles in supporting the lumbar spine. When these muscles are injured, pain or tightness may be felt across the low back and into the hips or buttocks.

Symptoms are typically limited in duration and follow a pattern: 

• Pain is most intense for the initial few hours and days. It is normal to experience increased pain with certain movements or positions, such as bending forward, backward, or standing upright. 

• Ongoing moderate pain and stiffness is usually felt for 1 to 2 weeks while muscles heal. Pain when holding certain movements (such as anything that jars the spine) or positions (such as standing for a long period), stiffness, and local tenderness are typical.

Compared to many other kinds of back injuries, a pulled muscle is usually straightforward to diagnose and easy to treat, and symptoms usually resolve within 4 to 6 weeks. Some severe muscle injuries, such as a complete muscle tear, can take months to heal. 

Lower Back Muscle Strain Symptoms

The pain from a pulled back muscle can range from merely irritating to intense and debilitating. Most cases of low back muscle strain start to abate within a couple of hours or days and do not lead to long-term problems. If pain has continued for more than a week or two, or if it is severe enough to disrupt daily activities, seeking medical attention is warranted. 

Common Symptoms of a Pulled Back Muscle

Symptoms to expect from a pulled lower back muscle—or any type of lower back strain—typically include:

• Dull, achy low back pain. Strained muscles usually feel sore, tight, or achy. Pain that feels hot, tingling, or electric is more likely caused by an irritated nerve root, not a pulled muscle. 

• Intensified pain with movement. Low back strain typically worsens with specific movements that activate the affected muscles. For example, there may be a flare-up of pain when getting up from a seated position, when bending forward, or when first getting out of bed in the morning.

• Pain that is localized in the low back. Pain is usually concentrated in the lower back. It may also be felt in the buttocks and/or hips, as these muscles help support the low back. Rarely does pain travel down the legs and into the calves and feet, as in cases of sciatica.

• Stiffness, difficulty walking or standing. Typical movements may be limited when a low back muscle is strained, making it difficult to bend, shift positions, or walk or stand for extended periods. 

• Local tenderness and inflammation. A muscle strain may become inflamed and feel tender to the touch. Muscle spasms and cramps can cause intense pain and temporarily limit mobility, as the affected area in the lower back may be swollen for a few days. 

• Pain relief when resting. Briefly resting the low back muscles allows them to relax, alleviating tension and spasms. Reclining in a supported position, such as sitting in a recliner with legs elevated or lying in bed or on the floor with the knees slightly elevated, may temporarily reduce pain. Pain will likely intensify when getting up to move again.

A common underlying component of the intense pain associated with a lower back muscle strain is from muscle spasms. The acute contraction of muscle fibers in the lower back, which are intertwined within and around an extensive network of nerves, can cause intense pain. This pain is often described as surprisingly severe.

Pain from a muscle strain or pulled muscle usually comes on suddenly and can be linked to a specific event or activity. The severe pain tends to resolve within one to two weeks. 

It is not uncommon to feel a lower level of pain with intermittent pain flare-ups for up to 4 to 6 weeks after the initial injury.

Causes and Diagnosis of Lower Back Strain

Muscle strain can happen suddenly because of an injury or can develop over time due to overuse and repetitive motions. A one-time injury that damages a muscle, tendon, or ligament is considered an acute muscle strain. These injuries usually occur after sudden, jarring impacts or during activities that include heavy lifting or excess pressure placed on the spine. 

Chronic strains, on the other hand, are caused by repetitive movements that gradually overstretch or tear a muscle. Chronic muscle strain is more common in athletes or people with physically demanding jobs.

Many lower back strains occur during everyday activities, such as while exercising or at work. 

Common causes of—and risk factors for—low back muscle strain include: 

• Heavy lifting. Strain from heavy lifting, twisting the spine, lifting from the ground, or an item overhead are common causes of low back strain. Safe lifting practices include tactics such as keeping the item close to the chest and avoiding twisting the upper body while lifting. 

• Sudden impact. The impact from jarring motions can place heavy, immediate stress on the low back muscles. For example, high-impact sports such as football and lacrosse place excessive pressure on joints and muscles. The sudden impact from a car accident or a fall is another common contributor to back muscle injury. Deconditioned, stiff muscles are more prone to this type of injury. 

• Repetitive motions. Stressful, repeated motions can cause muscles to tighten or tear.  Sports such as rowing, golf, or baseball may cause chronic strain due to repeated, forceful motions. Chronic strain may gradually become painful over time, or pain can suddenly worsen if a muscle is already sore and then put under intense stress.

• Poor posture, weak abdominal or back muscles. When low back and core abdominal muscles are weak, the lower back becomes more susceptible to injury. Slouching forward puts added strain on the low back muscles and on the spine. Similarly, tight hamstring muscles place added strain on the lower back over time.

• Taking on a new activity. Starting a new sport or activity may lead to a muscle strain by putting sudden, unfamiliar stress on a muscle or group of muscles. 

The above list is not comprehensive—rather, it highlights some of the more common situations that lead to a pulled back muscle. 

Several additional factors increase the risk of muscle strain, such as smoking (or any type of nicotine intake), stiffness or limited range of motion in the back, and obesity.

Diagnosing Low Back Muscle Strain

Collecting a medical history and conducting a physical exam are usually sufficient to diagnose muscle strain in the lower back.

• A medical history includes information about current symptoms, as well as when and how symptoms began, such as whether pain began after an injury, came on suddenly, or has gotten progressively worse. A medical history also includes information about typical exercise levels, sleep habits, and past medical issues. 

• A physical exam tests for range-of-motion and flexibility in the low back, as well as in the hip, pelvic, or hamstring muscles. Feeling along the lower back (called palpation) can detect spinal abnormalities that may be the source of pain. Nerve root irritation may also be tested by using a leg raise test, which can rule out injuries such as a herniated disc or spinal stenosis. 

While an imaging test such as an x-ray or MRI scan is rarely needed for a muscle injury, one may be used to check for other possible pain sources, such as a fracture or herniated disc, if those conditions are suspected. In patients with a history of malignancy or trauma, imaging tests are usually needed prior to conservative exercises.

Pulled Back Muscle Treatment

Treatment for low back muscle strain is typically simple and only needed for a short time. A long term exercise program, or ergonomic or sports modifications, may be recommended as well. 

Aggressive physiotherapy and manipulation should be avoided at the onset of treatment. It is best to restore health in a very gradual and dedicated process, watching for worsening symptoms versus improvement. 

Ultimately, the severity of a muscle injury will determine what kind of treatment is necessary.

Initial Treatments for Low Back Muscle Strain 

Most cases of a pulled back muscle are treated using standard self-care or non-invasive treatments. Some typical first-step treatments for a pulled low back muscle include: 

• Anti-inflammatory medicines (NSAIDs) such as ibuprofen, aspirin, and naproxen reduce inflammation, which often contributes to pain. Anti-inflammatory medicines are available over-the-counter or with a prescription. 

• Over-the-counter pain medicines, such as acetaminophen, minimize pain by interfering with the way the brain interprets pain signals.

• Muscle relaxants may be prescribed on a short-term basis to reduce muscle spasm. Most muscle relaxants do not affect muscles directly, but rather dampen pain receptors in the central nervous system.

• Ice packs reduce inflammation that can occur shortly after a muscle is injured. Typical recommendations include applying a cold or ice pack for 10 - 20 minutes at regular intervals throughout the day, and using a towel or other barrier between the ice and the skin to prevent an ice burn. 

• Heat packs increase circulation, which improves healing and relieves tension in strained muscles. As a general rule, heat therapy is usually recommended starting about 48 hours after the injury occurs. A layer should be kept between the heat pack and skin to avoid a burn. Applying heat before changing positions or starting an activity can help ease pain related to movement. For example, using a heating pad on the low back for 10 minutes before getting out of bed in the morning can alleviate stiffness. 

• Massage therapy increases circulation and relaxes muscles, improving range-of-motion and decreasing pain. Massage therapy also releases endorphins, which lessen pain signals in the nervous system.

• Walking and staying active during the day is important to keep the spinal structures functional and healthy. Even short, frequent walks can be helpful—walking for 3 to 5 minutes several times a day can help relieve low back stiffness, and in the process reduce discomfort and pain. 

• Activity modification, such as avoiding strenuous activity or heavy lifting when low back pain is intense, can help prevent worsening a muscle injury and low back pain. In some cases a short rest period may be advised; it is best to limit rest to one or two days, as underusing muscles causes deconditioning and stiffness over time.

A low back strain may signal that the back muscles are deconditioned and unable to effectively support the spine and the weight of the upper body. Keeping the low back muscles active through stretching and strengthening exercises can help reduce overall pain levels and prevent future flare-ups from occurring.

Exercises for Lower Back Muscle Strain

Muscles in the low back, abdomen, buttocks, and hips are all necessary for supporting and stabilizing the spine. Keeping these muscles active and strong can help avoid low back injury, and can minimize pain if the spine does become injured.

A complete back exercise program consists of stretching and strengthening the low back, abdominal, and lower body muscles, and also includes regular aerobic conditioning. Specific exercises should be prescribed based on individual needs. The program that works best will largely depend on factors such as fitness level, specific back pain diagnosis, and personal preferences.