Back Muscle Pain: 7 Essential Facts

Back muscles are vital for posture, movement, and support of the spine and upper limbs. They play a central role in stability and flexibility. Understanding these muscles and how to care for them is crucial for maintaining a healthy spine and avoiding discomfort.

Back muscle-related pain is one of the most frequent reasons for primary care and specialist visits. It often overlaps with other causes of spine pain, including discogenic issues, facet joint problems, and nerve compression syndromes. Importantly, spine imaging often reveals disc bulges and degenerative changes even in people with no symptoms. Therefore, back muscle pain remains a top diagnostic consideration in evaluating spine pain, especially when imaging findings don’t explain a patient’s symptoms.

Anatomy and Function of Back Muscles

Superficial Back Muscles

These muscles control movements of the upper limbs and scapula. They are the most external group of back muscles and are generally innervated by branches of the brachial plexus (except trapezius).

Trapezius: Elevates, retracts, depresses, and rotates the scapula. Innervated by spinal accessory nerve (CN XI).
Latissimus Dorsi: Extends, adducts, and medially rotates the arm. Innervated by thoracodorsal nerve.
Levator Scapulae: Elevates scapula; assists in downward rotation. Innervated by dorsal scapular nerve.
Rhomboid Major & Minor: Retract and stabilize the scapula. Innervated by dorsal scapular nerve.

Intermediate Back Muscles

These assist with respiratory mechanics and lie deep to the superficial muscles.

Serratus Posterior Superior: Elevates the ribs; aids inspiration.
Serratus Posterior Inferior: Depresses the ribs; aids forced expiration.

Deep (Intrinsic) Back Muscles

These muscles maintain posture and control vertebral motion. They are innervated by the dorsal rami of spinal nerves and are organized into three layers:

Superficial Layer of Intrinsic Muscles

Splenius Capitis: Extends, rotates, and laterally flexes the head.
Splenius Cervicis: Extends and rotates the cervical spine.

Intermediate Layer – Erector Spinae Group

The erector spinae runs longitudinally along the spine and is the main extensor of the vertebral column.

Iliocostalis (lumborum, thoracis, cervicis): Extends and laterally flexes the spine.
Longissimus (thoracis, cervicis, capitis): Extends spine and head, rotates head.
Spinalis (thoracis, cervicis, capitis): Extends the vertebral column.

Deep Layer – Transversospinalis Group

Semispinalis: Extends the head and thoracic and cervical regions; rotates them contralaterally.
Multifidus: Provides stability to the vertebrae; crucial in preventing back injury.
Rotatores: Stabilizes and assists with local rotation and extension of the vertebral column.

Common Causes of Back Muscle Pain

Back muscle pain can stem from several mechanical and postural factors. Learn more about pinched nerves and disc herniation that may overlap with muscle symptoms.

Strain: Injury to muscle or tendon due to overstretching or overuse.
Sprain: Involves ligaments and results from excessive joint movement or trauma.
Poor posture: Sitting or standing with improper alignment strains back muscles over time.
Repetitive use: Prolonged lifting, bending, or twisting can fatigue the musculature.
Injury or trauma: Sudden falls, accidents, or sports injuries may tear or inflame muscle fibers.

Symptoms of Back Muscle Pain

Symptoms often vary based on the muscle group involved but generally include:

Dull, aching or throbbing pain that may intensify with movement.
Localized tenderness or muscle tightness.
Pain that may radiate slightly to the hips or shoulders but usually does not follow a nerve distribution.
Restricted range of motion and stiffness.
Pain typically worsens with specific movements, prolonged sitting or standing.

When to See a Physician

Seek medical evaluation if you experience:

Persistent pain lasting more than 7–10 days.
Pain radiating down legs or associated with numbness or weakness.
Fever, weight loss, or history of cancer.
Loss of bladder or bowel control.

Home Care and Prevention

Apply cold packs initially, then switch to heat therapy after 48 hours.
Gentle stretching and light exercise (e.g., walking, swimming).
Use lumbar support or ergonomic furniture to maintain posture.
Over-the-counter NSAIDs may help with pain and inflammation.

Treatment Options

Physical Therapy: Strengthening and mobilization techniques.
Trigger Point Injections: For muscle knots causing persistent pain.
Manual Therapy: Myofascial release or chiropractic manipulation.
Advanced Interventional Procedures: Includes facet joint blocks or epidurals for overlapping spinal issues.

Medications

Medications are commonly used to manage back muscle pain, but must be used with care due to potential side effects.

Category	Common Names	Potential Side Effects	Safe Duration
NSAIDs	Ibuprofen, Naproxen	GI upset, kidney injury, ulcers	Short-term (≤2 weeks unless monitored)
Muscle Relaxants	Cyclobenzaprine, Tizanidine	Drowsiness, dry mouth, dizziness	Short-term (≤2 weeks)
Topical Analgesics	Diclofenac gel, Lidocaine patches	Skin irritation, local rash	As directed, long-term use is safer
Acetaminophen	Tylenol	Liver toxicity at high doses	Safe within 3000 mg/day

Botulinum Toxin Injections (Neurotoxin Therapy)

Botulinum toxin (Botox) may be considered for chronic myofascial pain that hasn’t responded to other treatments.

Disclaimer: Neurotoxin therapy is FDA-approved for certain conditions, but its use in back muscle pain is off-label. Insurance may cover it in specific cases.

FAQ: Is Botox safe and effective for back muscle pain?

Yes, it is sometimes used for myofascial pain. It temporarily relaxes overactive muscles. Side effects are generally mild when administered by a professional.

Emerging Therapy: ReActiv8 Neurostimulation Device

The ReActiv8 device is an implantable neurostimulator designed to restore multifidus muscle function via nerve stimulation. It is FDA approved under a Humanitarian Device Exemption.

Controversy: High cost, surgical implantation, and limited long-term data make this therapy debated among spine experts.

Take Control of Your Spine Health
Ready to get relief from back muscle pain?
Book Now

For more information on evidence-based treatments, see the NIAMS Back Pain Resource.