Most pulled back muscles heal on their own within about two weeks with a combination of short-term rest, ice and heat, over-the-counter pain relief, and gentle movement. The key is balancing enough rest to let the muscle recover with enough activity to prevent stiffness and deconditioning. Here’s how to manage each phase.
Make Sure It’s a Muscle Strain
A pulled muscle in the back typically causes pain that stays localized to one area. It feels sore, achy, or tight, and it gets worse when you move. You may also notice stiffness or muscle spasms around the injury. The important distinction is that the pain doesn’t travel. It stays put.
A herniated disc, by contrast, often sends sharp, shooting pain down your leg (sciatica) or into your arms, depending on where the problem is. Numbness, tingling, or weakness in your limbs points toward a nerve issue rather than a simple strain. If your pain gets worse when you sit, cough, or sneeze, and it comes with any of those nerve-related symptoms, you’re likely dealing with something beyond a pulled muscle.
Seek emergency care if you develop loss of bladder or bowel control, numbness in your groin or inner thighs, or progressive weakness in both legs. These are signs of a rare but serious condition called cauda equina syndrome that requires immediate treatment.
Ice First, Then Switch to Heat
For the first two days, apply a cold pack to the injured area for no more than 20 minutes at a time, four to eight times per day. Wrap the ice pack in a thin towel to protect your skin. Cold reduces swelling and numbs the sharpest pain during the acute phase.
Once those first couple of days pass, switch to heat. A heating pad, warm towel, or warm bath helps relax tight muscles, increase blood flow, and ease stiffness. You can use heat for 15 to 20 minutes at a time as needed. Some people find alternating between ice and heat works well after the initial phase, so experiment to see what gives you the most relief.
Choosing the Right Pain Reliever
Anti-inflammatory medications like ibuprofen (Advil, Motrin) and naproxen (Aleve) tend to work better for back pain than acetaminophen (Tylenol). A research review of over 1,800 participants published in BMJ found no evidence that acetaminophen relieved back pain, reduced disability, or improved quality of life compared to a placebo. A large Australian study within that review found that recovery time was the same, about 17 days, whether people took acetaminophen or a sugar pill.
That said, NSAIDs like ibuprofen are harder on the stomach. If you have digestive concerns, you can try both acetaminophen and an NSAID together. They work through different mechanisms, so combining them doesn’t appear to increase side effects while many people find the combination more effective than either alone. Give any pain reliever three to five days to see if it’s helping.
Move Early, but Gently
One of the biggest mistakes with a pulled back muscle is staying in bed too long. Limit lying down to a few hours at a stretch, and no more than a day or two total. Clinical trials consistently show that an early return to normal activities, with some rest as needed, leads to better outcomes than extended bed rest. Too much time lying down causes muscles to lose conditioning, can lead to constipation, and even raises the risk of blood clots in your legs and pelvis.
This doesn’t mean pushing through sharp pain. It means walking around the house, doing light daily tasks, and avoiding the couch-for-a-week approach. The goal is to keep your muscles engaged without aggravating the injury.
Stretches for Early Recovery
Once the worst of the acute pain settles (usually after a day or two), gentle stretching can speed recovery and prevent stiffness. The Mayo Clinic recommends starting with just a few repetitions and increasing as the exercises get easier. Aim for the routine twice a day, morning and evening.
- 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. Finish by pulling both knees to your chest at the same time.
- 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 and belly sag toward the floor as you lift your head. Return to the starting position and repeat.
- Lower back rotational stretch: Lie on your back with knees bent and feet flat. Keep your shoulders firmly on the floor and slowly roll both bent knees to one side. Hold for 5 to 10 seconds, return to center, then roll to the other side. Repeat two to three times per side.
These stretches target the muscles that support your lower back without putting significant load on the injured area. If any stretch causes sharp or worsening pain, stop and try again in a day or two.
Sleeping With a Pulled Back Muscle
Nighttime is often the hardest part of dealing with a back strain. Small adjustments to your sleeping position can make 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 your lower back. A full-length body pillow works well for this.
If you sleep on your back, place a pillow under your knees. This relaxes the muscles along your spine and preserves your lower back’s natural curve. A small rolled towel under your waist can add extra support. Stomach sleepers should place a pillow under their hips and lower abdomen to reduce strain.
Recovery Timeline
Most people with a back strain feel significantly better within two weeks and make a full recovery with basic self-care. If your symptoms haven’t improved after two weeks, or they’re getting worse instead of better, that’s a signal to get evaluated. Additional treatment like physical therapy may be needed, or the diagnosis may need to be reconsidered.
Preventing the Next One
A pulled back muscle often comes down to weak core muscles, poor lifting mechanics, or both. Once you’ve recovered, building a simple daily routine of back and core exercises can significantly reduce your risk of re-injury.
For lifting, the fundamentals matter more than anything fancy. Stand as close as possible to the object. Spread your feet about shoulder-width apart. Keep your back straight and squat down using your knees and hips. Never twist your back while bending, lifting, or carrying. Set objects down by squatting again rather than bending at the waist. And if something looks too heavy or awkward, get help. A large percentage of back strains happen because someone decided to muscle through a lift they shouldn’t have attempted alone.
The same stretches that help during recovery, like the knee-to-chest, cat stretch, and rotational stretch, work as preventive maintenance. Doing them for 15 minutes a day, once in the morning and once in the evening, keeps the muscles around your spine flexible and resilient.