Back pain from a pulled muscle or spasm can feel intense, but it doesn’t have to side-line you for long. In this guide, Reuben, our senior physiotherapist, explains the difference between muscle strains and spasms, how to tell what’s really going on, and when physiotherapy can help. You’ll learn practical steps to ease pain, support healing, and avoid making things worse.
What to do if you have a muscle spasm or strain?
Physiotherapy for pulled muscles and spasms
When to see a physiotherapist?
Back pain is incredibly common, and often, it's caused by something as simple yet painful as a pulled muscle. Whether it occurs during exercise or lifting something unexpectedly heavy, a pulled back muscle can be frustrating and sometimes feel scary.
But how do you discern if your back pain is a muscle strain? And, more importantly, how can you find relief?
Back pain has many names—“pulled muscle,” “muscle strain,” “muscle spasm,” and just plain “back pain.” However, when used on the internet or with friends/family, these terms generally just describe discomfort in the lower back area.
A true pulled or strained muscle occurs when muscle fibres overstretch or tear. Imagine a football player forcefully kicking a ball or sprinting at full speed, suddenly straining their hamstring. Typically, muscle tears happen when the muscle is placed under high loads, causing immediate pain. Often, noticeable bruising appears afterwards, due to bleeding within the muscle from the injury [1].
Muscle tears range from grade 1 (minor, involving only a few fibres) to grade 4 (complete muscle rupture). In the lower back, grade 1 tears are most common, while grades 2–4 are very rare and usually involve intense sports/gym activity [1].
In my 11 years as a physiotherapist, bruising accompanying acute lower back injuries is extremely uncommon unless there’s direct trauma (perhaps a fall or being tackled, for example). However, a suspected grade 1 strain can still cause severe pain in the lower back (even 10/10), primarily due to protective muscle spasms [3].
It can be important to distinguish between muscle spasms and muscle strains:
If your back pain doesn’t follow heavy lifting or strenuous activity or persists beyond typical healing timeframes (most healing occurs within 12 weeks), you might be experiencing a muscle spasm rather than a strain [7].
Muscle spasms can be intensely painful, lasting days, weeks, or even months, and often flare up during periods of stress, poor sleep, anxiety, or unfamiliar movement [3]. In these times, your nervous system becomes hyper-sensitive, so even minor challenges can feel threatening and trigger protective muscle tension (and sometimes inflammation) that becomes painful, even without tissue damage [4].
Psychological factors (stress, fear of movement, unhelpful beliefs) and social pressures (workload, lack of support) can amplify your brain’s “threat radar,” increasing sensitivity and slowing recovery [5].
Interestingly, the inverse can also occur—people sometimes sustain significant injuries yet feel little or no pain because their brain does not register them as threatening. You may have seen an unexplained bruise on your body, or heard of someone discovering a broken bone only when an unrelated X-ray was taken. For a fascinating deep dive into this mind–body paradox, watch:
Most back injuries involve both physical and psychological drivers. A skilled physiotherapist will use targeted questions and simple tests to identify which factors are at play—and help you develop a clear, comprehensive plan to manage them.
It’s often helpful to ask yourself:
Understanding whether the load was high enough to challenge or exceed what your body is prepared to handle can help differentiate between a sudden strain and a protective muscle spasm (they can also occur together to complicate things further!).
If it’s likely a muscle spasm, the best approach is to stay calm, gently move, and reassure your body that there’s no significant damage.
Research shows that providing reassurance, staying active, and gradually returning to regular routines—rather than resting excessively—can significantly reduce recovery time and prevent persistent pain [2, 8–10]. Activities like gentle movement, deep breathing exercises, relaxation techniques, and maintaining regular daily activities can help. If you’re uncertain or are struggling to manage, it would be beneficial to consult a health professional.
If you suspect you’ve pulled a back muscle, you have options: you can stay calm, carry on, and allow natural healing to improve your symptoms. Or, if you’re concerned and feel professional help would be beneficial, continue reading below to find out how physiotherapy can empower you to take control of your recovery.
The good news is you don’t need to endure pain or recover alone. Physiotherapy offers a safe, effective, non-invasive way to treat back pain and support your recovery.
Most acute back pain improves significantly within 6–12 weeks with education, reassurance, and gradual return to normal activities [5, 11]. Early self-management—such as gentle movement, maintaining daily routines, and addressing unhelpful beliefs—supports natural healing and prevents persistent pain [5, 8].
You should seek professional advice promptly if you experience any of the following:
A physiotherapist can provide focused assessment, targeted treatment, and tailored education to address your pain’s physical and psychosocial drivers. Early assessment can help you recover more quickly and confidently if in doubt.
At our Burswood clinic, our experienced physiotherapists provide expert care to relieve your pain and help you move comfortably again. Whether your issue is recent or ongoing, we’re dedicated to guiding you through recovery every step of the way.
Book your initial consultation today in 60 sec and let’s get you back to feeling your best.