A pulled back muscle is painful, but most people recover fully within about two weeks with the right care at home. The key is managing inflammation in the first couple of days, then gradually returning to normal movement rather than staying in bed. Here’s exactly what to do, step by step.
The First 48 to 72 Hours
Stop whatever activity caused the injury and avoid heavy lifting, twisting, or exercise for the first few days. This doesn’t mean you should stay in bed. 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. Staying immobile for too long actually makes stiffness and pain worse.
Apply ice to the painful area for the first 48 to 72 hours. Cold slows cell activity, constricts blood vessels, and numbs the area, all of which reduce swelling and pain. Use an ice pack wrapped in a cloth for no more than 20 minutes at a time, four to eight times a day. After two or three days, switch to heat. Heat raises your pain threshold and relaxes tight muscles, which becomes more useful once the initial swelling has calmed down.
Over-the-counter anti-inflammatory pain relievers like ibuprofen or naproxen help with both pain and inflammation. Acetaminophen works for pain but won’t reduce swelling. There’s no special dosage for back pain specifically. Follow the label directions and don’t exceed the recommended amount.
How to Sleep With a Pulled Back Muscle
Sleep can be the hardest part of the first few days. Small adjustments to your position make a real difference in how much pressure your spine absorbs overnight.
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 if you tend to shift positions during the night. If you sleep on your back, place a pillow under your knees. This relaxes the lower back muscles and preserves the natural curve of your spine. You can add a small rolled towel under your waist for extra support.
When to Start Moving Again
Gentle movement should begin within a day or two, even if you’re still sore. Walking at a comfortable pace is a good starting point. Avoid heavy lifting or twisting for the first six weeks, but don’t treat your back like it’s fragile. The goal is to stay active within the limits of your pain.
Once you can move without sharp pain, gentle stretches help restore flexibility and prevent the muscles from tightening up further. Three stretches recommended by the Mayo Clinic work well in early recovery:
- 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. Repeat with both knees together. Do 2 to 3 repetitions, morning and evening.
- 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.
- Lower back rotational stretch: Lie on your back with knees bent. Keeping your shoulders flat on the floor, slowly roll both bent knees to one side. Hold for 5 to 10 seconds, then switch sides.
None of these should cause sharp pain. A mild stretch sensation is fine, but if any movement makes things worse, back off and try again in a day or two.
Typical Recovery Timeline
Most people with a pulled back muscle see significant improvement within about two weeks. Full recovery, meaning you can return to all normal activities without pain, typically falls within that same window if you manage the injury properly. Some strains take longer, particularly if you reinjure the area or return to heavy activity too soon. Lingering stiffness for a few weeks beyond that is normal and usually resolves with continued gentle stretching and activity.
Signs That Something More Serious Is Wrong
A standard muscle strain hurts, but it doesn’t cause neurological symptoms. Get emergency medical care if your back pain comes with any of the following:
- Loss of bowel or bladder control
- Sudden numbness in your pelvic region, inner thighs, groin, or one or both legs
- Difficulty standing or walking
- Pain that wraps from your lower back around to your abdomen
- Fever, redness, or swelling around the spine
These can signal nerve compression, spinal infection, or a condition called cauda equina syndrome, where the bundle of nerves at the base of the spine becomes compressed. This is rare but requires immediate treatment. You should also seek medical attention if your back pain came from a traumatic injury like a car accident, developed suddenly and severely, or hasn’t improved after 12 weeks.