An over-the-counter NSAID like ibuprofen (Advil, Motrin) or naproxen (Aleve) is the best first choice for a pulled back muscle. These drugs reduce both pain and the inflammation driving it, and they outperform acetaminophen (Tylenol) for back pain specifically. Most pulled back muscles recover in about 17 days, but the right combination of medication, topical treatment, and movement can make that stretch far more manageable.
Why NSAIDs Work Better Than Acetaminophen
When you strain a muscle in your back, the damaged fibers trigger an inflammatory response: swelling, heat, and pain. NSAIDs target that inflammation directly, which is why they’re considered more potent for back pain relief. Ibuprofen and naproxen are both available without a prescription and work through the same mechanism, though naproxen lasts longer per dose (roughly 8 to 12 hours versus 4 to 6 for ibuprofen).
Acetaminophen, by contrast, interferes with pain signaling but does nothing to reduce inflammation. A large research review in the BMJ pooled data from more than 1,800 participants and found no evidence that acetaminophen relieved back pain, reduced disability, or improved quality of life compared to a placebo. A key study within that review, published in The Lancet, showed that recovery time was identical at about 17 days whether people took acetaminophen or a sugar pill. If you’re choosing one thing off the shelf, an NSAID is the stronger option.
That said, some people can’t tolerate NSAIDs due to stomach issues, kidney concerns, or blood-thinning medications. If that applies to you, acetaminophen is still a reasonable fallback for taking the edge off, just don’t exceed 4,000 milligrams in 24 hours.
When a Muscle Relaxant Helps
If your back is locking up with spasms and an NSAID alone isn’t cutting it, a prescription muscle relaxant can be a useful addition. These are moderately effective for short-term relief compared to placebo. Common options include cyclobenzaprine (Flexeril), methocarbamol (Robaxin), and tizanidine (Zanaflex). Your doctor will likely prescribe a two-week course at most, since these medications cause drowsiness and are not meant for long-term use.
Muscle relaxants work best as a complement to an NSAID, not a replacement. They calm the spasm while the NSAID addresses the underlying inflammation. The drowsiness is real, so plan to take them at night or when you don’t need to drive or focus. Many people find that a few days of nighttime use is enough to break the spasm cycle.
Topical Options for Targeted Relief
Topical NSAIDs let you deliver anti-inflammatory medication directly to the sore area. Diclofenac gel (sold over the counter as Voltaren) is the most studied option. You apply it to the skin over the painful area, and it absorbs into the tissue beneath. For a back strain, this can provide localized relief with less systemic exposure than oral NSAIDs, meaning fewer stomach-related side effects.
Diclofenac also comes in patch form for acute pain, applied to the most painful spot once or twice daily depending on the product. The patches can be more convenient for the back since reaching around to rub in gel isn’t always easy when you’re in spasm. Menthol-based creams like Biofreeze or Icy Hot work through a different mechanism: they create a cooling or warming sensation that temporarily overrides pain signals. They won’t reduce inflammation, but they can offer quick comfort between NSAID doses.
Ice, Heat, and Movement
For the first 48 to 72 hours, ice is your best non-medication tool. Apply a cold pack wrapped in a thin cloth for 15 to 20 minutes at a time, several times a day. Cold constricts blood vessels and limits the swelling that contributes to pain and stiffness.
After those first few days, switch to heat. A heating pad, warm bath, or heat wrap relaxes the tight muscles around the injury and increases blood flow, which helps the tissue heal. Many people alternate between the two depending on what feels better, and that’s fine.
One of the most important things to know: bed rest makes a pulled back muscle worse, not better. Gentle movement, even just short walks around the house, keeps blood flowing to the injured muscle and prevents the surrounding muscles from stiffening up. You don’t need to push through sharp pain, but staying completely still for days will extend your recovery. Light stretching of the hamstrings and hips can also relieve tension on the lower back.
What About Magnesium Supplements
Magnesium is widely marketed for muscle relaxation and cramp relief, and it does play a role in normal muscle function. Magnesium glycinate is the form most commonly recommended because it’s easier on the stomach. The daily recommended intake is 400 to 420 mg for adult men and 310 to 320 mg for adult women.
However, there’s an important caveat: magnesium hasn’t been proven in human studies to help with muscle relaxation or spasm relief. If you’re deficient in magnesium, supplementing could theoretically help, but it’s not a reliable treatment for an acute muscle strain. It won’t hurt to take it, but don’t count on it as a substitute for an NSAID or muscle relaxant when you’re in real pain.
A Practical Treatment Timeline
For the first three to five days, focus on managing inflammation aggressively. Take an NSAID on a regular schedule (not just when pain spikes), apply ice, and keep moving gently. If spasms are severe, this is the window where a prescription muscle relaxant makes the biggest difference.
From days five through ten, you should notice the sharpest pain fading. Switch from ice to heat, continue your NSAID as needed, and gradually increase your activity. Walking for 10 to 15 minutes a few times a day is a reasonable goal. Light stretching, particularly for the hamstrings and hip flexors, takes pressure off the lower back.
By weeks two and three, most people are close to full recovery. You can taper off medication and start returning to normal activity. If pain hasn’t improved meaningfully by week three or four, that’s a sign something beyond a simple muscle strain may be going on.
Signs That Need Immediate Attention
A pulled back muscle is painful but not dangerous. Certain symptoms alongside back pain, however, signal something more serious. Loss of bladder or bowel control, numbness in the groin or inner thighs (called saddle anesthesia), or progressive weakness in both legs are red flags for a condition called cauda equina syndrome, where nerves at the base of the spine are being compressed. This is a medical emergency that requires treatment within hours to prevent permanent damage. If you experience any of these, go to the emergency room immediately.