Spine, Neck & Back

Low Back Pain / Lumbar Strain

Low back pain is the second most common reason Americans visit a doctor, surpassed only by upper respiratory illness. At any given time, roughly 31 million Americans experience low back pain, and the vast majority of acute episodes resolve within 6 weeks without surgical intervention. At Maryland Orthopedic Specialists, we specialize in evidence-based non-operative management of both acute and chronic low back pain. We provide accurate diagnosis, reassurance, and targeted treatment to help patients recover quickly and reduce the risk of recurrence.

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What is low back pain / lumbar strain?

Low back pain encompasses a broad spectrum of conditions affecting the lumbosacral region (L1–S1). In clinical practice, the most common presentation is acute lumbar strain — pain arising from overloaded or injured paraspinal muscles, thoracolumbar fascia, or posterior spinal ligaments.

Low back pain encompasses a broad spectrum of conditions affecting the lumbosacral region (L1–S1). In clinical practice, the most common presentation is acute lumbar strain: pain arising from overloaded or injured paraspinal muscles, thoracolumbar fascia, or posterior spinal ligaments. This is often called a "muscle pull" or "pulled back."

Acute vs. chronic:

Acute low back pain: Duration less than 4 weeks; typically resolves spontaneously
Subacute low back pain: Duration 4–12 weeks; may require structured intervention
Chronic low back pain: Duration greater than 12 weeks; requires a more comprehensive evaluation and multi-modal management plan

Structures involved in lumbar strain:

Paraspinal muscles (erector spinae, multifidus) subjected to sudden overload, eccentric contraction, or sustained awkward posture
Thoracolumbar fascia tears
Posterior spinal ligaments (supraspinous, interspinous, posterior longitudinal)

Lumbar strain accounts for approximately 70–80% of acute low back pain presentations. The remainder involve specific identifiable pathology such as disc herniation, stenosis, facet arthropathy, spondylolisthesis, or, rarely, serious systemic disease.

Symptoms — do you recognize these?

Acute onset of low back pain, often following a specific lifting, twisting, or bending incident — or in some cases, awakening after a restless night or without a clear precipitant
Deep, aching, or spasming pain in the lower back and paraspinal muscles
Stiffness with difficulty standing upright or changing positions
Pain that may radiate into the buttocks and upper thighs (referred, non-dermatomal — not true sciatica)
Protective muscle guarding with reduced lumbar range of motion
True radiating leg pain below the knee following a dermatomal distribution (suggests nerve root involvement)
Neurological deficits (weakness, numbness, reflex changes)
Bilateral leg symptoms or bowel/bladder changes
Bowel or bladder dysfunction (possible cauda equina syndrome — surgical emergency)
Progressive lower extremity weakness or numbness
Fever, chills, or unexplained night sweats with back pain (infection, malignancy)
History of cancer with new back pain
Recent significant trauma (vertebral fracture concern, particularly in osteoporotic patients)
Unintentional weight loss
Back pain in age <18 or >50 years with no prior history

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations. Red flag symptoms require prompt evaluation.

How we diagnose it

Clinical evaluation remains the cornerstone of low back pain diagnosis. A detailed history identifies mechanism of injury, duration, pain character, aggravating and relieving factors, and neurological symptoms. Physical examination assesses range of motion, palpation of paraspinal musculature for spasm and tenderness, and a neurological screening exam (motor strength, sensation, reflexes).

Imaging is typically NOT indicated for uncomplicated acute low back pain in the first 4–6 weeks. Clinical guidelines (AHRQ, ACP, AAOS) consistently show that early MRI or X-rays for non-specific low back pain without red flags do not improve outcomes and may harm patients by identifying incidental degenerative findings that lead to unnecessary concern or procedures.

When imaging IS indicated:

Presence of any red flag listed above
Failure to improve after 4–6 weeks of appropriate conservative treatment
Neurological deficit identified on examination
Consideration for injection or procedural treatment

Plain radiographs can assess alignment, fracture, and severe disc height loss. MRI is the study of choice when neurological involvement, infection, malignancy, or structural pathology is suspected.

Treatment options

Acute low back pain almost always resolves on its own. Treatment focuses on staying active, managing pain, and preventing recurrence.

Stay Active

Bed rest delays recovery. Patients are encouraged to continue normal activities as tolerated. Walking, gentle stretching, and light activity speed healing more than rest.

Medications

NSAIDs (ibuprofen, naproxen) are first-line for pain and inflammation. Acetaminophen provides additional relief for patients who cannot take NSAIDs. A short course of muscle relaxants helps with acute spasm that limits daily activity.

Physical Therapy

For pain that persists beyond 2 to 4 weeks, PT addresses movement patterns, core stability, and ergonomics to prevent recurrence. Most patients graduate from PT with a home exercise program to maintain results.

Injections

For persistent, localized pain that hasn’t responded to conservative care, targeted injections (trigger point, facet, or SI joint) identify and treat the specific pain generator.

Recovery & rehabilitation

90% of patients with acute lumbar strain recover within 6 weeks. The majority of these patients need only reassurance, activity guidance, and simple analgesics. Subacute and chronic presentations benefit from more intensive PT, lifestyle modification, and occasionally injection therapy. Recurrence is common. It is reported in up to 70% of patients within 12 months after an initial episode. Building and maintaining lumbar core strength, maintaining a healthy weight, and practicing proper body mechanics are the most effective strategies for reducing recurrence risk.

Frequently Asked Questions

Should I get an MRI for my back pain?

For most people with new-onset acute low back pain, an MRI within the first 4–6 weeks is not needed and may not help. Guidelines recommend imaging only when red flags are present or symptoms fail to improve. Your MOS physician will advise if imaging is appropriate.

Why does low back pain come back?

Recurrence is common because the factors that make the spine vulnerable (disc degeneration, muscle weakness, body weight, posture habits) persist. Active rehabilitation and core conditioning are the best preventive strategies.

Is pain with movement a sign of serious injury?

In most cases, no. Pain with lumbar range of motion is typical of muscle strain and facet irritation, not structural injury. Neurological symptoms (numbness, weakness, bowel/bladder changes) are more concerning and warrant prompt evaluation.

Are muscle relaxants safe?

Short-term use under physician supervision is generally safe. They cause drowsiness, so driving should be avoided. Long-term use is not recommended.

When should I see a doctor instead of waiting?

See us promptly if you have: any leg weakness or numbness, bowel or bladder changes, fever, unexplained weight loss, history of cancer, or if your pain is not improving after 2–3 weeks of home management.

Meet the specialists

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Related conditions

Degenerative Disc Disease (Lumbar)Sciatica Facet Joint Arthropathy

Medically reviewed by Christopher S. Raffo, MD

Last reviewed May 1, 2026

References

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. "Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians." Annals of Internal Medicine 2017;166(7):514–530. https://doi.org/10.7326/M16-2367
Deyo RA, Mirza SK. "Herniated lumbar intervertebral disk." New England Journal of Medicine 2016;374(18):1763–1772. https://doi.org/10.1056/NEJMcp1512658
Chou R, Qaseem A, Snow V, et al. "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society." Annals of Internal Medicine 2007;147(7):478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006
Pengel LH, Herbert RD, Maher CG, Refshauge KM. "Acute low back pain: systematic review of its prognosis." BMJ 2003;327(7410):323. https://doi.org/10.1136/bmj.327.7410.323
van Tulder MW, Scholten RJ, Koes BW, Deyo RA. "Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group." Spine 2000;25(19):2501–2513. https://doi.org/10.1097/00007632-200010010-00013
OrthoInfo / AAOS. "Low Back Pain." https://orthoinfo.aaos.org/en/diseases--conditions/low-back-pain/