What is a lumbar strain?

A lumbar strain is an injury to the muscles or tendons of the lower back, while a lumbar sprain involves the ligaments that hold the spinal bones together. Both happen when soft tissue is stretched too far or torn, often during the sudden jolt of a rear-end collision or when lifting, twisting, or carrying a heavy load at work. Unlike a disc or nerve injury, a strain or sprain affects the supporting soft tissue around the spine rather than the spinal cord or nerve roots. It is sometimes called a pulled muscle or a soft-tissue back injury, and it is the leading reason people develop acute lower back pain after a crash.

Lumbar strain symptoms

Symptoms usually begin within hours to a day or two of the injury and tend to stay centered in the lower back rather than shooting down the leg. The muscles often tighten and spasm to protect the area.

• Dull, aching, or sharp pain across the lower back
• Muscle spasms or a sensation of the back "locking up"
• Stiffness that is worse in the morning or after sitting
• Pain that worsens with bending, lifting, twisting, or standing for long periods
• Tenderness when the lower back muscles are pressed
• Difficulty standing fully upright or moving normally

How a lumbar strain is diagnosed

Diagnosis usually starts with a physical exam in which the provider checks your range of motion, presses along the muscles to locate tenderness, and tests reflexes and leg strength to rule out nerve involvement. Because a strain affects soft tissue, it does not always show on a standard X-ray; X-rays are mainly used to rule out a fracture after a significant accident. If pain radiates into the leg, causes numbness, or does not improve as expected, an MRI may be ordered to look for a herniated disc or nerve compression. For most uncomplicated strains, imaging is not needed right away.

Lumbar strain treatment

Most lumbar strains and sprains are treated without surgery. The goal is to calm the spasm and inflammation early, then gradually restore strength and flexibility so the back is less likely to be re-injured. Prolonged bed rest is generally discouraged; gentle movement usually helps tissue heal.

• Physical therapy to relieve spasm and rebuild core and back strength
• Chiropractic care to restore mobility and address joint restriction
• Pain management including anti-inflammatory measures and targeted injections when appropriate
• Activity modification and guidance on safe lifting and posture
• Heat, ice, and manual therapy to ease tightness
• A graded return-to-activity or return-to-work plan

Recovery & when to see a doctor

Many lumbar strains improve over a few weeks with appropriate care, though recovery varies from person to person and more severe sprains can take longer. You should be evaluated promptly if your back pain followed a car accident or workplace injury, if it is not improving, or if you develop pain, numbness, tingling, or weakness traveling down the leg. Seek emergency care immediately for loss of bladder or bowel control or numbness in the groin area, which can signal a more serious problem. An early evaluation helps confirm the diagnosis and keeps a simple strain from turning into a longer-lasting issue.

Related care at Injury Recovery MD

• back injury care
• No-Fault injury care
• Workers’ Comp injury care

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Lumbar Strain and Sprain FAQ

What is the difference between a lumbar strain and a lumbar sprain?

A strain injures the muscles or tendons of the lower back, while a sprain injures the ligaments connecting the spinal bones. The symptoms and treatment are similar, and the two often occur together.

Do I need an MRI for a pulled lower back muscle?

Usually not. A physical exam is often enough for a straightforward strain. An MRI is typically reserved for pain that travels down the leg, causes numbness or weakness, or does not improve as expected.

Is my lower back treatment covered if it came from a car accident or work injury?

In New York, care for injuries from an auto accident is generally billed to No-Fault insurance, and on-the-job injuries are billed to Workers’ Comp. For eligible visits, that typically means $0 out of pocket. Our team verifies your coverage before you begin.

Should I rest in bed until my back feels better?

Extended bed rest is usually discouraged. Gentle movement and a guided return to activity tend to help the soft tissue heal, while too much rest can leave the back stiff and weak.