Most pulled back muscles heal on their own within two to three weeks with the right combination of rest, movement, and pain management. The key is finding the balance between protecting the injured muscle and staying active enough to prevent stiffness. Here’s how to manage your recovery from the first day through full healing.
Ice, Heat, and Early Pain Relief
In the first few days after pulling a back muscle, both ice and heat can help. Apply an ice pack for 10 to 15 minutes every two to three hours to reduce swelling and numb the area. A heating pad on a low or medium setting for 15 to 20 minutes every two to three hours relaxes tight muscles and increases blood flow. Some people alternate between the two, while others find one works better. Always place a cloth between ice or heat and your skin.
For pain relief, anti-inflammatory medications like ibuprofen or naproxen tend to work better than acetaminophen for back pain. A large review of the evidence found that acetaminophen performed no better than a placebo for back pain, with recovery taking about 17 days regardless of whether people took it or not. Anti-inflammatories address both pain and swelling, making them the stronger choice for a muscle strain. Follow the dosing instructions on the label and take them with food to protect your stomach.
Stay Moving, but Scale Back
One of the biggest mistakes people make with a pulled back muscle is staying in bed too long. Prolonged bed rest actually slows recovery by weakening the muscles that support your spine. The current medical consensus is clear: avoid bed rest beyond the first day or two.
Stop your normal physical activity for only the first few days. Walk around the house, do light chores, and keep your body moving at a comfortable level. You don’t need to push through sharp pain, but gentle movement prevents the surrounding muscles from tightening up and making things worse. After two to three weeks, you can begin easing back into regular exercise.
Sleeping Without Making It Worse
Nighttime is often the hardest part of recovering from a back strain. The wrong sleeping position can leave you stiffer and more sore by morning. Strategic pillow placement makes a real difference.
If you sleep on your side, draw your knees up slightly toward your chest and place a pillow between your legs. This keeps your spine, pelvis, and hips aligned and takes pressure off the injured area. A full-length body pillow works well here. If you sleep on your back, put a pillow under your knees to help relax the lower back muscles and maintain the natural curve of your spine. A small rolled towel under your waist can add extra support. Stomach sleeping puts the most strain on a sore back, but if that’s the only way you can fall asleep, slide a pillow under your hips and lower stomach to reduce the pull on your spine.
Gentle Stretches for Early Recovery
Once the initial sharp pain subsides (usually after a few days), gentle stretching helps restore flexibility and reduce muscle tightness. Do these slowly and stop if anything causes a spike in pain.
- Single knee to chest: Lie on your back with both knees bent. Grasp the back of one thigh and pull your knee toward your chest. Hold for 30 seconds, then switch legs. If it feels comfortable, bring both knees up at once. Repeat twice daily.
- Lower back rotation: Lie on your back with knees bent and feet flat. Keeping your shoulders on the floor, slowly roll both bent knees to one side. Hold for 5 to 10 seconds, return to center, and repeat on the other side. Do 2 to 3 repetitions per side.
- Hamstring stretch: Lie on your back with knees bent. Raise one leg so your knee is over your hip, interlace your fingers behind the thigh, and slowly straighten the knee until you feel a stretch in the back of your leg. Hold for 5 seconds. Repeat 10 times on each side.
- Hip flexor stretch: Lie on your back near the edge of a bed and let one leg dangle off the side. You’ll feel a stretch in the front of your hip and lower back. Hold for 10 to 30 seconds. Repeat twice daily.
These stretches target the muscles surrounding the injured area. Tight hamstrings and hip flexors both pull on the lower back, so loosening them reduces strain on the healing muscle.
Rebuilding Strength to Prevent Reinjury
Your spine is supported by three groups of muscles: the extensors along your back and glutes, the flexors in your abdomen and hip area, and the obliques along your sides. A pulled muscle often signals that one or more of these groups isn’t strong enough to handle the demands you’re placing on it. Building core stability is the best way to prevent the same injury from happening again.
Once you’re past the initial two to three weeks of recovery, add these exercises. Start with 5 repetitions a day and gradually work up to 30 over several weeks.
- Pelvic tilts: Lie on your back with knees bent. Tighten your belly muscles to press your lower back into the floor, hold for 5 seconds, then arch slightly in the opposite direction and hold for 5 seconds. This builds the small stabilizing muscles along your spine.
- Bridges: From the same starting position, tighten your core and glutes, then raise your hips until your body forms a straight line from knees to shoulders. Hold long enough to take three deep breaths, then lower back down.
Consistency matters more than intensity. Fifteen minutes a day of these exercises builds the kind of endurance your back muscles need to handle everyday lifting, bending, and twisting without giving out.
Signs the Problem Is More Serious
A straightforward muscle pull improves noticeably within the first week and resolves within a few weeks. Certain symptoms, however, point to nerve damage or spinal cord compression rather than a simple strain.
Seek immediate medical attention if your back pain comes with any of the following: sudden weakness in one or both legs, loss of bladder or bowel control, or numbness in the groin or buttocks (sometimes called saddle anesthesia). These symptoms together can indicate cauda equina syndrome, a condition where nerves at the base of the spine are severely compressed. This is a medical emergency that typically requires surgery to prevent permanent damage. Numbness or tingling radiating down one leg, persistent pain that worsens rather than improves over several days, or pain accompanied by fever or unexplained weight loss also warrant a visit to your doctor.