Most pulled lower back muscles heal fully within about two weeks with the right combination of rest, movement, and self-care. The key is managing pain and inflammation in the first few days, then gradually returning to normal activity rather than staying in bed. Here’s how to move through each phase of recovery.
The First 72 Hours: Ice and Rest
Right after you strain your back, your priority is reducing inflammation. Apply ice to the painful area for 10 to 15 minutes at a time, waiting at least two hours between sessions. Stick with ice for the first 72 hours. After that three-day window, switch to heat if you’re still in pain. Heat promotes blood flow, loosens stiff muscles, and supports longer-term healing. Apply a heating pad or warm towel for 15 to 20 minutes per session.
For pain relief, acetaminophen is a good first choice because it carries fewer side effects than other options. Keep the total dose under 3,000 mg in a 24-hour period. If that’s not enough, over-the-counter anti-inflammatories like ibuprofen or naproxen can help with both pain and swelling.
Keep Moving (Within Reason)
It’s tempting to stay in bed, but extended rest actually slows recovery. Clinical trials consistently show that returning to normal activities early, with some rest as needed, produces better outcomes than staying home for days on end. If you need to lie down, limit it to a few hours at a stretch and no more than a day or two total. An extended period of bed rest isn’t helpful for a moderate back strain at any stage of healing.
This doesn’t mean pushing through sharp pain. It means gentle walking, standing, and going about light daily tasks as soon as you can tolerate them. The goal is to keep blood flowing to the injured tissue and prevent the surrounding muscles from stiffening up.
Exercises That Speed Recovery
Once the initial sharp pain starts to fade, usually after the first few days, gentle stretches and strengthening exercises can shorten your recovery time. Start with five repetitions a day and gradually work up to 30 as you feel stronger.
- Knee-to-chest stretch: Lie on your back with knees bent and feet flat on the floor. Pull one knee toward your chest with both hands, tighten your abdominal muscles, and press your spine into the floor. Hold for five seconds, then switch legs.
- Cat stretch: Start on your hands and knees. Slowly arch your back upward, pulling your belly toward the ceiling while dropping your head. Then let your back sag toward the floor as you lift your head. Return to the starting position and repeat.
- Bridge: Lie on your back with knees bent and feet flat. Keep your head and shoulders relaxed on the floor. Tighten your abdominal and glute muscles, then raise your hips until your body forms a straight line from knees to shoulders. Hold briefly, lower, and repeat.
- Pelvic tilt: From the same position on your back, flatten your lower back against the floor by pulling your bellybutton downward. Hold for five seconds, relax, and repeat.
If you’re coming back from a significant strain, talking to a physical therapist before starting exercises is worthwhile. They can confirm which movements are safe for your specific injury and correct your form.
Ice is also useful after stretching or exercise sessions to calm the muscles you just worked.
Sleeping With a Pulled Back
Nights are often the hardest part of a back strain. The wrong sleeping position can leave you stiffer and more painful in the morning. Two positions help the most.
If you sleep on your side, draw your knees up slightly toward your chest and place a pillow between your legs. This aligns your spine, pelvis, and hips, taking pressure off your lower back. A full-length body pillow works well if you tend to shift around.
If you sleep on your back, place a pillow under your knees. This relaxes the lower back muscles and maintains the natural curve of your spine. A small rolled towel under your waist can provide additional support. In either position, make sure your neck pillow keeps your head aligned with your chest and back rather than propping it forward.
Preventing Re-Injury
Lower back strains tend to recur if you go back to the same habits that caused the first one. The most common culprit is lifting incorrectly. When you pick something up, bend at the hips and knees, not at the waist. Keep the object close to your body and avoid twisting as you lift. If something feels too heavy, it probably is.
Continuing the stretching and core-strengthening exercises from your recovery period is one of the best long-term protections. Strong abdominal and back muscles act as a brace for your spine, absorbing forces that would otherwise strain the smaller muscles around your vertebrae.
Red Flags That Need Immediate Attention
Most back strains are painful but straightforward. Rarely, what feels like a muscle pull can involve nerve compression, particularly a condition called cauda equina syndrome, where the bundle of nerves at the base of the spine gets squeezed. This is a medical emergency. Get evaluated immediately if you notice any of the following alongside your back pain: inability to feel the urge to urinate or difficulty controlling your bladder, numbness or tingling spreading into your legs or groin, sudden sexual dysfunction, or progressive leg weakness. These symptoms indicate something beyond a simple muscle strain.