Most pulled muscles in the lower back heal on their own within two to six weeks with the right combination of rest, movement, and pain management. The key is knowing what to do in the first few days, when to start moving again, and how to rebuild strength so it doesn’t happen again.
What Happens When You Pull a Lower Back Muscle
A pulled muscle in the lower back, sometimes called a lumbar strain, means you’ve overstretched or torn small fibers in the muscles or tendons that support your spine. This usually happens during a sudden twist, heavy lift, or awkward movement. The area becomes inflamed, the surrounding muscles tighten to protect the injured spot, and you feel anything from a dull ache to sharp, gripping pain that makes it hard to stand up straight.
The good news is that muscle tissue has a strong blood supply, which means it heals relatively well. Your job is to manage the pain, avoid making it worse, and gradually return to normal activity.
The First 48 to 72 Hours
In the immediate aftermath, your priority is calming the inflammation and pain. Cold therapy helps reduce swelling and temporarily numbs the area. Apply an ice pack wrapped in a thin towel to your lower back for 10 to 12 minutes at a time, twice a day. Move it slowly across the sore area rather than leaving it in one fixed spot.
After the first two or three days, switching to heat often feels better and can be more effective. Heat raises the temperature of the tissue near the skin’s surface, which relaxes tight muscles and increases blood flow to speed healing. A heating pad, warm towel, or disposable heat wrap worn against the skin can provide steady warmth for several hours. One clinical trial found that a heated blanket reduced acute back pain scores by about 32 points on a 100-point scale immediately after use, a meaningful drop.
That said, some people find heat helpful from the start. If ice doesn’t feel right to you, it’s fine to try warmth earlier. The evidence comparing ice and heat for back pain specifically is actually inconclusive, so go with what gives you the most relief.
Keep Moving (Seriously)
One of the biggest mistakes people make with a pulled back muscle is staying in bed too long. It feels logical, but prolonged rest actually slows recovery. Your muscles stiffen, weaken, and the pain can linger longer. Health providers no longer recommend bed rest for back strains.
Stop your normal physical activity for only the first few days. After that, begin light movement. Walking is the simplest starting point. Even five or ten minutes at a slow, comfortable pace helps keep blood flowing to the injured area and prevents your muscles from seizing up further. Riding an upright stationary bike or swimming are also good early options because they’re low-impact and don’t load your spine the way running or lifting would.
The goal isn’t to push through pain. It’s to stay gently active rather than immobile. If a movement causes a sharp increase in pain, back off. But mild discomfort during light activity is normal and doesn’t mean you’re causing more damage.
Over-the-Counter Pain Relief
Anti-inflammatory medications like ibuprofen and naproxen are considered first-line treatments for acute lower back pain. They reduce both pain and the inflammation driving it, which makes them particularly well-suited for a muscle strain. Take them with food to protect your stomach.
Acetaminophen (Tylenol) is another option, especially if you have stomach issues, kidney problems, or heart conditions that make anti-inflammatories risky. It manages pain effectively but doesn’t reduce inflammation the way ibuprofen does.
If your muscles are spasming, meaning they’re clenching involuntarily and won’t release, your doctor may suggest a short course of a muscle relaxant. These can help break the pain-spasm cycle, though they tend to cause drowsiness and are best used at bedtime. Opioid painkillers offer limited benefit over these simpler approaches for typical back strains and carry real risks, so they’re generally reserved for cases where nothing else works.
Sleeping Without Making It Worse
Nighttime is often when a pulled back muscle feels worst, because you’re not moving and the muscles stiffen. How you position yourself matters.
If you sleep on your back, place a pillow under your knees. This relaxes the muscles along your lower spine and helps maintain its natural curve. A small rolled towel tucked under your waist can add extra support if you feel a gap between your back and the mattress.
If you’re a side sleeper, draw your knees up slightly toward your chest and place a pillow between your legs. This keeps your spine, pelvis, and hips aligned so your lower back isn’t twisting through the night. A full-length body pillow works well if you tend to shift positions.
Gentle Stretches for Recovery
Once the sharpest pain has subsided, usually after a few days to a week, gentle stretching helps restore flexibility and reduces stiffness. Move slowly and stop if any stretch causes sharp pain. These should feel like a mild pull, not a wince.
- Knee-to-chest stretch: Lie on your back with knees bent and feet flat. 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 up together. Repeat each variation 2 to 3 times.
- Lower back rotation: Lie on your back with knees bent and feet flat. Keeping your shoulders firmly on the floor, slowly roll both bent knees to one side. Hold for 5 to 10 seconds, return to center, then roll to the other side. Repeat 2 to 3 times per side.
- 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. Repeat 3 to 5 times, twice a day.
- Bridge: Lie on your back with knees bent and feet flat. Tighten your abdominal and glute muscles, then lift your hips until your body forms a straight line from knees to shoulders. Hold long enough to take three deep breaths, then lower slowly.
These stretches come from Mayo Clinic’s back exercise program and target the muscles most involved in lumbar support. Start with the gentler ones (knee-to-chest and rotation) before progressing to the cat stretch and bridge.
Building Strength to Prevent Recurrence
Once you’ve recovered, the work isn’t quite done. People who pull a back muscle once are more likely to do it again, and the most effective prevention is strengthening the deep core muscles that stabilize your spine. These aren’t the “six-pack” muscles on the surface. The ones that matter most sit deeper: a muscle called the transversus abdominis, which wraps around your torso like a corset, and small muscles along each vertebra called the multifidus. Together, they co-contract to brace your spine during movement.
Weakness or poor coordination in these deep stabilizers is a well-documented cause of recurring lower back problems. Exercises that specifically target them, like planks, dead bugs, bird-dogs, and the bridge exercise described above, are more effective for spinal stability than general fitness routines. Even 10 to 15 minutes of targeted core work a few times per week makes a measurable difference. If you’re unsure where to start, a physical therapist can assess which muscles are underperforming and build a program around your specific weaknesses.
Signs Something More Serious Is Going On
The vast majority of pulled back muscles are painful but harmless. However, certain symptoms alongside back pain signal a medical emergency. Get immediate care if you experience any of the following:
- Loss of bladder or bowel control: New incontinence paired with back pain can indicate compression of the nerves at the base of your spinal cord, a condition called cauda equina syndrome.
- Numbness in the groin or inner thighs: This “saddle anesthesia” pattern, where you lose sensation in the areas that would contact a saddle, points to the same type of nerve compression.
- Rapidly worsening weakness in your legs: Progressive neurological deficits, especially in both legs, require urgent evaluation.
These scenarios are rare, but they require surgical intervention within hours to prevent permanent damage. A typical muscle pull doesn’t cause numbness, weakness, or changes in bladder function. If yours does, that’s a different situation entirely.