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 — providing accurate diagnosis, reassurance, and targeted treatment to help patients recover quickly and reduce the risk of recurrence.
Ready to get started?
Schedule an appointment with a specialist experienced in treating low back pain / lumbar strain.
In-network with most major insurance plans. Same-day appointments available for acute injuries.
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.
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.
Frequently Asked Questions
Should I get an MRI for my back pain?
Why does low back pain come back?
Is pain with movement a sign of serious injury?
Are muscle relaxants safe?
When should I see a doctor instead of waiting?
Meet the specialists
John J. Christoforetti, MD
Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery
Meet Dr. Christoforetti →
Related conditions
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/