I’ve pulled a muscle in my back (again!)—here’s what to do next according to a physio, osteopath and chiropractor

Around a month ago, I ran a 5K and followed it with a full-body dumbbell workout. Halfway through a set of renegade rows, I felt something go in my back. It didn't hurt too much immediately, but it flared up the next day and stayed stiff and sore for weeks.

So I put the question to three experts—a physical therapist, osteopath and chiropractor: How do you treat your eternally injury-prone back? It turns out their answers are more aligned than I expected.

Below is what to do the moment you feel your back go, what to do over the subsequent days and weeks, and what to do to stop the injury recurring.

Hopefully it'll help you—and me—learn from past mistakes to stay injury-free for good.

What to do immediately after your back goes?

The first thing you should do when you feel your back go is stop.

“As soon as you feel any pain, stop what you're doing,” says physical therapist Dr John Gallucci Jr., CEO of JAG Physical Therapy. In my case: abort the renegade rows.

Then head for the freezer. “Apply ice to the area to reduce inflammation. Stay gently mobile within a pain-free range in order to avoid muscle stiffness or guarding,” he adds, referring to the body’s natural protective response.

Muscle guarding occurs when muscles tense up and go into spasm to limit movement around an injury. While this can be helpful to prevent pain initially, prolonged guarding due to lack of movement can cause longer-term weakness and pain.

Dr Haley Ray, director of chiropractic at NextPain Care, recommends applying ice to the affected area “two to three times a day for 15-20 minutes at a time over the first 48 hours to reduce acute inflammation.” Allow enough time between sessions for the area to return to normal body temperature, she adds.

Osteopath Matthew Martin from London-based clinic Active Backs agrees that the first thing you should do is stop. “If you're in a group workout, with added social pressure, you might be reluctant but that's a good way to take yourself from quite injured to very injured,” he says, speaking from personal experience.

Apply ice and use anti-inflammatories but not heat. “If the area is hot and irritated, you don’t want to add heat. If it’s stiff, locked up and tight, then that’s when ice can help,” he says.

Martin also urges caution when reintroducing movement. “People often misconstrue that they should get active straight away, but there is nothing wrong with resting on the sofa for a day or so,” he says.

“Lower back injuries are hardly ever one thing in isolation and often any damage won’t show up until a week after the initial injury so find a comfortable position and wait to see how the injury unmasks over the next 12-48 hours.”

What to do to alleviate pain?

After the acute 48 hours phase, all three practitioners recommend reintroducing very gentle stretching and light movement, while listening to your body for cues.

“If you feel low back pain when moving or changing positions then it’s likely a simple mechanical issue,” says Martin. “If you feel back pain along with fizzing, numbness or tingling down your leg or legs then you might have suffered radiculopathy—a disc injury.”

Also known as a pinched nerve, radiculopathy can be caused by a herniated or protruding spinal disc, when the soft, jelly-like cushion between each vertebra protrudes against a nerve root.

“If the pain is more than a three out of 10 and gets worse the more you do an activity, then stop doing it. If three out of 10 or less and the pain improves as you move then you”re doing something good,” says Martin.

“It’s all about timing and dosage. The only difference between medicine and poison is dosage. Getting the dosage correct can help guide the healing. If you overdo it you can reinflame things.”

Physiotherapist Gallucci Jr. similarly suggests slowly reintroducing low-impact movement, along with core and postural strengthening exercises as tolerated.

“While you should take it easy initially, avoid prolonged rest and monitor your symptoms. If the pain persists or worsens, or you're unable to complete your activities of daily living, check in with your doctor,” says Gallucci Jr.

Chiropractor Ray concurs. “If the pain is still persistent after a couple of days of icing and rest, seeing a healthcare professional is important to rule out any other possible injuries,” she says.

Once the initial acute pain has eased—and assuming the all clear from your doctor—“an effective method for at-home low back pain treatment is the McKenzie Method,” says Ray.

This involves a graduated series of exercises to mobilize the lower back muscles depending on your level of pain and stiffness. For example, lying on your front, propped up on your elbows or hands to gently extend the spine, or lying on your back and hugging your knees into your chest, or flexing forward from a seated position.

“These exercises target the extensor muscles of the lower back, which can help reduce pain, promote healing and reduce the risk of future injury,” says Ray.

How to reduce the chance of reinjury

After around a week of light movement and gentle stretching, all three experts recommend reintroducing targeted strength work. Ray says adding in core- and back-strengthening exercises will help “get the best, long-term results of healing and future prevention.”

Martin encourages you to scrutinize your strength, range of motion and coordination. “Injury is often caused by a deficit in one or some of those three,” he says. It’s also useful to think back to what caused the injury.

“If caused by a squat, you want to look at your hip range of motion,” Martin says. “Is there some other deficiency in your body that caused an abnormal stress to impact your back? Did something predispose you to injury?”

This is where a clinician or coach can identify any chinks in your armour. “Ask a coach to check your squat form,” Martin continues. “Injuries are often due to overload because a movement pattern is bad, which can cause abnormal stress to build up or because you overdid the load or intensity.”

Like doubling up a 5K run with a full-body resistance workout, for instance. “Maybe you crested above the volume of work your hips and back could manage that day,” he says.

Along with practicing proper lifting and body mechanics, while maintaining flexibility and good posture during daily activities, Gallucci Jr. insists that core stabilization is crucial to future-proofing your back from reinjury.

“A strong and stable core sets the foundation for safe and efficient movement, especially when recovering from or trying to prevent injury,” he says.

What’s the difference between a physiotherapist, osteopath and chiropractor?

It’s a question many people ask and worth considering when planning your recovery. While there is some crossover in how each practitioner might treat a bad back, there are also a few differences in approach and treatment.

Approach

Physiotherapists tend to address more localized issues, helping restore movement or function after injury or before or after surgery. They will focus on rehabilitation and improving strength and mobility long-term.

Osteopaths tend to treat the body as a whole, interconnected unit. For example, I've previously seen an osteo to address weakness in my knees, and my clinician—the aforementioned Matthew Martin—spent the majority of our sessions addressing imbalances in my hips, ankles and spinal alignment.

By contrast, a chiropractor’s primary focus is on the spine, believing misalignment impacts overall health and nervous system function.

Treatment

Physios emphasize long-term exercise prescription to alleviate muscle or joint pain or imbalances, along with hands-on manual therapy.

An osteo might focus more on gentle hands-on stretching, massage and joint manipulation, but less on exercise guidance to correct imbalances.

A chiro will likely use precise hands-on adjustments and manipulations to correct spinal misalignment for more immediate, short-term symptom relief.

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