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Treatment of Acute Low Back Pain

What to do for muscular back injuries


Updated June 26, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

An acute back strain is different from chronic back pain. An acute injury is when back pain and muscle spasm come on suddenly following an injury. Often associated with a lifting or twisting maneuver, these injuries can cause significant pain and concern that there is a serious problem. The good news is that these injuries almost always resolve with some simple treatments. However, people who experience these episodes of acute onset back pain should make sure they take steps to prevent this problem from happening again.


When a back injury occurs, stress should be avoided. Often, back injuries occur at work or during athletic activities. These activities should be limited, and further strain to the back should be avoided.

In the past, some doctors recommended "bed rest," lying completely still for up to a few days. These days are gone, and experts agree that rest should consist of limited activity, but not immobilization. Gentle movement should be encouraged, and low-impact exercise can be helpful.


Acute onset back pain can be frightening. Until this has happened to you, it is hard to understand how significant and debilitating the symptoms can be. Being unable to find any position of comfort is particularly concerning to many people. The good news is, your symptoms will improve with time. Many studies have shown that after an acute low back strain, the treatment really doesn't matter, as symptoms will resolve with the passing of time.

While seeking medical attention is appropriate any time you have a serious concern, there are no special tests that should be performed for the diagnosis of an acute back strain. X-rays and MRIs are not necessary, and can often be misleading if performed for the wrong reason.


Medications are often helpful for the early stages of treating an acute episode of low back pain. Anti-inflammatory medications are the most commonly used, but there are also other options. Pain medications can be very helpful, although some pain medications have a risk of dependency, and must be used carefully.

Other medications used for acute low back pain include muscle relaxing medications, anti-depressants, steroid medications, and sleep aids. As with any new medication, you should discuss with your physician which medication might best help with your condition.


Exercise therapy has been shown to be very helpful in the treatment of chronic low back pain, but it has limited benefit in the treatment of acute low back pain. Most experts agree that if you're going to exercise when you have sudden onset back pain, it should be low-impact cardiovascular exercise.

Exercise is most helpful in that it helps to improve mood and increase pain tolerance. People who don't exercise are more likely to experience pain at a higher level than people who perform regular fitness activity.


Manual therapy or manipulation are commonly used treatments usually provided by osteopathic doctors or chiropractors. There is good evidence to support the use of these treatments in the setting of acute back pain. They are effective in decreasing pain and improving activity levels.

The use of manipulation as a "maintenance treatment" to prevent back injury has not been shown to be helpful, but many patients find excellent relief with manipulation when they do encounter problems of back pain.


There is no evidence to support the use of any of the common injections for the treatment of acute low back pain. While injections can be very helpful for a number of different spine problems, acute muscular low back pain has not been one of those.

Many types of injections are used, however, including:

None of these injections have been shown to be helpful for acute low back pain.

Alternative Treatments

The use of a number of alternative treatments is common with acute low back pain. These include some of the treatments mentioned above, as well as massage, acupuncture, and magnets. Some of these treatments provide individual patients with significant relief, but there is little data to routinely support the use of these as a standard treatment for acute low back pain. That said, these are very safe treatments, with few reported side effects, that may be worthwhile when used in conjunction with standard treatment.

Preventing Recurrence of Back Pain

Knowing what to do for treatment of a back strain is the first step, but the most important issue is stopping it from happening again. As mentioned above, acute onset back pain almost always resolves with time. However, preventing these uncomfortable episodes is the best medicine.

Helpful steps to prevent back pain include:

  • Regular exercise
  • Maintaining good strength and posture of the spine
  • Keeping body weight normal
  • Avoid smoking


Shen FH, et al. "Nonsurgical Management of Acute and Chronic Low Back Pain" J. Am. Acad. Orthop. Surg., August 2006; 14: 477 - 487.

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