I've Pulled My Back – What Should I Do Now?

When your back suddenly "goes", it can be frightening, painful and disorienting. 

This blog post gently guides you through understanding a muscular back strain commonly called a “pulled back”.

***Pulled back and Muscle Strain mean the same thing, but if you're searching the internet for good information, a back strain is a more accurate description to find good information.***

This blog will help you to decide if you have pulled your back or if you need emergency care.

It will show you how you can start helping yourself, setting goals and progressing through your recovery straight away. 

I've tried to simplify the process of confirming what's happening to you by walking you through:

1. The tell-tale signs of a back strain, (via the consultation questions)

2. Confirming it with some simple movements you can do at home gently.

3. Explaining what a back strain/pulled back actually is and how long it takes to heal.

4. Then showing you the solution with Movement, Mindfulness and Massage.

5. I've added in a nice extra of reflective exercises to help those with an acute injury from becoming chronic, and those who have a chronic pain to start rewiring patterns that might not be serving them, through no fault of theirs.

Let’s start at the beginning… consultation

Let's take a case history together. You might be wondering, why bother with this step?

Asking these critical questions of ourselves at the beginning is important.

Most of the time these answers tell us almost immediately what's happening. But we can also confirm by performing special orthopedic tests of the joint.

Once we know what the problem is, we are over halfway to forming the solution. Which means a thoughtful, informed and realistic action plan to move you forwards towards recovery.

1. let's get this consultation started

Grab a pen and paper and write down your answers to the following questions,

If they match mine, it's very likely you've pulled your back...

I've got five questions for you:

pain diagrams from the muscles of your back

The 3 most important muscles of the lower back and their respected pain patterns in pink on the right of them.

Now let's keep this consultation going:

2. the confirmation...

test your movement with me

If you have answered yes to all the above questions you are on the right track to confirming you have pulled your back, or in my language, you have a back strain. 

Think back to how you were moving when you initiated the pain in the first place:

• Were you at the gym deadlifting? 

• Were you moving house and twisting as you passed boxes out of the van?

• Were you holding your child for a long time on your hip or bouncing them in the air?

We are going to test it out now. 

Your back can do three movements that we can test quite easily.

• A forward bend

• A side bend to both the left and right (think of the movement “I’m a little tee-pot”)

• And rotation turning through your waist to look behind you.

Carefully and slowly do these three movements one at a time, slowly and gently. 

As you do each movement carefully listen to your body. 

If one of those movements makes your pain suddenly sharper and more specific - then you've injured the muscle that’s responsible for that movement. Makes sense right!

If you have increasing sharpness on one or more of those movements

Then you have overstretched several muscles at once. 

Please don't panic... We can still work with that together.

It is the same process.

Below are the muscles responsible for forward bending, side bending and rotation. Have a look below:

3. Know what's actually happening...

So what is a muscle strain?

For some people it is helpful to be able to visualise what has happened.

If you find this helpful, please read on to the description of what a muscle strain is.

Otherwise, skip straight ahead to the solution.

A muscle strain is a tearing of muscle fibers when a muscle tissue and its tendon have been overloaded too quickly.

As we have discussed in the case of the lower back this happens when lifting and twisting normally heavy and awkward loads. 

A muscle strain is categorised into 3 options:

Grade 1 (click to expand)

• A few fibers have torn, but the majority of the muscle remains healthy

• People experience mild pain that settles quite quickly

• The healing time is pretty quick 1-3 weeks

• The rehabilitation is quite simple

Grade 2 (click to expand)

• More fibers have torn, the pain is sharper & bruising is more likely to be present

• There will be increasing protection and pain around the area

• You will have lost some strength in the movement

• But a small amount of the movement is still possible

• The healing time is slightly longer between 4-12 weeks

• You'll have to spend more time mobilising the tissues in rehabilitation and not rushing to stretch or strengthen them before you have full range of movement back.

Grade 3 (click to expand)

• These are really rare in lower backs & more common around the arm & leg muscles

• This is where there is a total rupture of the muscle

• That much force going through the structure of the back is likely to cause damage to other tissues such as the spine and other symptoms.

• Surgery is needed to reattach the muscles

• The healing time is between 3-6 months

  
  

• Grade 3 tears are exceptionally rare in the muscles of the back without other symptoms being present

• Grade 3 tears of any muscle mean you can no longer do any of the movement that muscle once did, you can’t weight bear at all

• Grade 3 tears need to go to A&E immediately

Red flags that need emergency care in the lower back:

Red flags that need emergency care in the lower back: (click to expand)

• Unrelenting pain even at night

• Pain that never changes and remains constant no matter what you do

  • Constant pain levels

  • Constant pain location 

  • Constant sensation 

• Numbness or tingling in the base of the pelvis where you would feel a bike seat if cycling

• Changes in or total loss of bowel and bladder control

• Pain that radiates down both legs at once, at the same time

Red flags in the lower back are rare, but are also obvious when they happen.

They need emergency care straight away for a situation called “cauda equina”.

Please go straight to A&E if you even suspect these symptoms. 

If you can confidently say that you have not experienced any of the above, please keep reading to find out how to manage your back, moving forwards.

3. Knowing that pain isn't just physical

How do my beliefs affect my healing?

This is a sensitive topic. 

Let me first start by saying, you are not mad.

There are lots of factors that cause pain to persist... (Click to expand)

• The severity of the initial injury

• How much of the nervous system was involved

• Were you going through significant life events just before, during or after the injury?

• How much support do you have at home, work and from friends and family?

• How much are you able to express yourself and feel safe in that expression?

• How old or young are you?

• How well do you sleep or your ability to relax your body?

• Your experience or lack of experience of working with injury/pain

• Your beliefs - often cultural about whether this is the end of your 

  • Tennis playing days

  • Ability to play with your kids

  • Your career, “I’ll never be able to keep laying the bricks I once did in a day”

  • “My back is now broken, backs do not recover from a herniated disc….”.”

3. Knowing that pain isn't just physical

cultural & social beliefs about pain

It was crazy to me when I was learning, how inaccurate my own medical knowledge really was. I started asking lecturers if my Mum’s sayings were in fact true.  9 times out of 10 they were not. 

Our society is littered with poor medical advice in popular culture that we might have taken on subconsciously (click to expand...)

Ever wondered how that poor person being hit over the head with a frying pan (to knock them out) is, in the film, where it's used as a plot device?

9/10 times, in real life they are NOT fine and just a little bit giggly.

Coming to an injury with a balanced perspective is really hard. (click to expand...)

Being overly pessimistic matters just as much as being toxically positive. 

3. Knowing that pain isn't just physical

clearing up beliefs that trip people up:

Your back will never be permanently broken... (yes you read that right)

• Muscle tissues heal quickly & exceptionally well, when given the right environment.

• Movement won't hurt you & helps the healing process when done thoughtfully 

• Manual treatment helps the healing process desensitising nerves

• A therapist helps you see the wood from the trees, with real information & guidance

• If pain returns months after an injury, it is coming from a different source.

  
  

• The physical tissues will have knitted back together...

• But your body may have found a work around & is putting more strain through different tissues.

• Or your body is still acting out the stress component of the injury through your nervous system

• Or other social or psychological factors are still present holding you in that pattern.

A good rehab plan combined with soft tissue therapies tries to avoid compensations by nourishing the tissues & building back their strength, whilst empowering and holding space for you.

4. the solution - the journey through & out

4. the solution - the journey through & out

Treatment Planning 

Download the treatment guide at the end of this blog. 

Acute Phase (0–5 Days)

• Rest gently and keep doing daily movements within your comfort zone -without pain.

• Use warmth (hot water bottle, warm bath) to reduce spasm in and around the area.

• Gentle breath-led positioning, mobilising your back, hips and spine through your breath (e.g., knees bent, feet on the floor).

  
  

Subacute Phase (5–21 Days)

• Start gentle massage, myofascial release, or side-lying treatments with a trusted therapist 

• Introduce pelvic tilts and mobilisations

• Start slowly with supported stretching and breathwork in the area. 

• Use movement to build trust again in your body and mind. 

• Do not push into pain whether in movements or daily activities

  
  

Chronic Recovery (6 months +)

• Myofascial release to help scar tissue that's pulling tissues around the scar

• Sports massage with trigger point therapy and stretching to open the area for strengthening exercises to succeed.

• Strengthen with bodyweight movements, bridge progressions.

• Explore postural confidence and proprioception.

• Address lifestyle patterns (e.g., prolonged sitting, bracing habits).

• Address mindset and subconscious blocks with the reflection questions posed below. 

5. ON going growth out of chronic pain...

An invitation to Reflect

Just like our conversation on how our beliefs affect us. If you are struggling with long term chronic pain, a useful exercise when you are ready and only when you are ready is to explore your attitudes and beliefs, honestly with yourself. 

Taking a gentle tone of compassionate curiosity with yourself is key. Remember there is no right answer here, the exercise is about starting to understand what is holding you back perhaps on a subconscious level. 

I will let you in on a secret: one of my biggest stumbling blocks that I really had to dig into and slowly excavate was my habit of being strong and supporting everyone around me. 

The problem I faced was I loved supporting others and offering the rock-like quality of stability. The thing is though, it blocked me for a long time in my own healing. I found it incredibly difficult to express the depth to which I had been rattled in my core. I found it so difficult to allow myself to truly feel the whole of that depth. The reason: at the depth of my injury I could not function to help others anymore, and that felt horrible.

“I’d always been that person”. 

Now my story is extreme. Not everyone is going to need to go through the places I have gone through, they might not want to either. It was necessary for me, and perhaps reflects my personality.

But the good news is that, not only when I felt it all, was there so much support for me waiting in the wings from loved ones. My real fear of never coming back together after what I thought was a breakdown, didn’t come to pass. In the moment of peak dysfunction and pain. What I thought was a total regression, I found new strength to come back together in a softer and fuller way than I had ever thought possible. 

Truly there is so much wisdom in this process, and here is an invitation to look inwards when you are ready:

• Have you had back pain before? 

• If so, what helped you recover?

• What activities do you fear?

• How do life, work, or emotional stressors contribute to your tension?

• Who supports you right now?

• Do you believe healing is possible?

• What do you truly need right now?

• What do you truly need in 1-6 months from now?

• Is there something in this moment, you realise has never been met in your life?

• Can you start to find a way to honour your needs a little more each day?

the signs to watch out for...

Red & Yellow Flags

Red Flags: A quick recap of emergency symptoms that need urgent medical care 

• Red: Sudden incontinence, severe weakness, unrelenting never changing pain—seek urgent care.

Yellow Flags: A quick recap of social symptoms that can block our own healing. 

• Yellow: Belief that your back is “broken,” anxiety about movement, loss of hope.

  
  

A healing machine...

your body is programmed to heal

Muscles heal. Your body is already working to repair itself even now.

Your nervous system may be on high alert but with the right approach, it can recalibrate. Focus on small daily wins: breathing, gentle movement, rest and connection.

This is not about pushing through it is about tuning in.

A powerful question to ask yourself at the start:

Your answer is your starting point. Focus on that goal as the star you're aligning to.

Let us begin your journey back to ease. With one breath, one step and one moment at a time.

If you are struggling with chronic pain right now and you need to work through some questions this blog has brought up, my inbox is always open to you. 

Please reach out. I know how challenging it can be to go at it alone. 

Much love, 

Carmen