Index of Herbs

Concern guide

Herbs for Back and Muscle Pain

Herbs that may ease an aching back and sore muscles, from capsicum plasters to willow bark, with what the research shows.

6 herbs reviewed

Updated October 7, 2026

Back pain is one of the most common health complaints: about 80 percent of adults have low back pain at some point, and stiff, strained muscles after lifting, gardening or a hard workout are familiar to nearly everyone. Most back pain is described as nonspecific, meaning it comes from the muscles, ligaments and joints of the back rather than from a serious disease, and it usually improves within a few weeks. Pain that lasts beyond about three months is called chronic and often benefits from a longer-term plan.

Staying active is one of the most helpful things you can do. The NHS advises carrying on with daily activities as far as you can, doing gentle exercises and stretches, using heat or cold packs, and avoiding long spells in bed. For new back pain, the American College of Physicians recommends starting with options such as superficial heat, massage, acupuncture or spinal manipulation, and for chronic pain, exercise, yoga, tai chi or mindfulness-based approaches, with anti-inflammatory painkillers if medicine is wanted. Herbs, many of them creams and plasters applied to the skin, can sit alongside these steps, and a Cochrane review found that several reduced back pain more than placebo.

The herbs below are ordered by strength of evidence for back and muscle pain, then by how commonly they are used. Ratings run from good clinical evidence to long traditional use, and for back pain the best-supported herbs currently sit at promising, with the most research behind topical capsicum. Most trials are small and short, test specific standardized products, and focus on low back pain, so results may not apply to every cream or capsule on the shelf. The full monographs cover doses, side effects, and interactions.

02 The shortlist

The herbs, from best studied to time-honored

How to read the ratings

  • Good clinical evidence
  • Promising clinical evidence
  • Early or mixed evidence
  • Long traditional use

Ratings show how much research backs each herb for this particular concern. Every herb links to its full monograph, with preparations, safety notes, and sources.

  1. 01 Cayenne

    Promising clinical evidence

    Capsicum annuum

    Capsicum plasters and creams, made from hot peppers, have the most research among herbs for back pain. A Cochrane review found they probably relieve chronic low back pain better than placebo, based on three trials with 755 people, and EMA accepts standardized capsicum preparations as a well-established use for muscle pain such as low back pain in adults. The warmth and sting are part of how it works. Use it only on intact skin, for no more than three weeks at a stretch, never under a heating pad, and keep it away from the eyes.

    Read the cayenne monograph →

  2. 02 White Willow

    Promising clinical evidence

    Salix alba

    Willow bark is the traditional source of salicin, a chemical cousin of aspirin, and its clearest evidence is for low back pain. EMA accepts willow bark dry extracts as a well-established short-term treatment for low back pain, and a Cochrane review found moderate-quality evidence that extracts providing 120 or 240 mg of salicin a day ease short-term pain better than placebo. Trials are still small and short. It is for adults only, for up to four weeks; avoid it with aspirin or NSAID allergy, stomach ulcers or blood thinners.

    Read the white willow monograph →

  3. 03 Devil’s Claw

    Early or mixed evidence

    Harpagophytum procumbens

    Devil’s claw root is a popular European remedy for an aching back. A Cochrane review found that extracts standardized to 50 or 100 mg of harpagoside a day may relieve short-term low back pain better than placebo and reduce the need for rescue painkillers, based on two trials rated low quality, so larger trials would help. It works gradually rather than as a quick painkiller. Avoid it with stomach ulcers, in pregnancy and under 18, and check first if you have gallstones, high blood pressure or diabetes, or take warfarin.

    Read the devil’s claw monograph →

  4. 04 Comfrey

    Early or mixed evidence

    Symphytum officinale

    Comfrey root ointment is a traditional European rub for sprains, bruises and sore muscles. In a five-day trial of 120 people with acute upper or lower back pain, a specific comfrey root extract ointment eased pain on movement much more than placebo, which a Cochrane review rated as low-quality evidence because it is a single trial. Comfrey must never be swallowed, since its alkaloids can cause serious liver damage; use a licensed ointment on unbroken skin for short courses only, and not in pregnancy, breastfeeding or children.

    Read the comfrey monograph →

  5. 05 Peppermint

    Long traditional use

    Mentha × piperita

    Peppermint oil rubs feel cooling because menthol activates the body’s cold sensors, which many people find takes the edge off aching muscles. EMA accepts skin preparations containing 5 to 20% peppermint oil as a traditional remedy for localized muscle pain, though trials for back pain itself are still lacking. Apply it to intact skin away from the eyes, and avoid layering it with other menthol products. Never use peppermint oil on or near the face of a baby or young child, as menthol can trigger breathing problems.

    Read the peppermint monograph →

  6. 06 Rosemary

    Long traditional use

    Salvia rosmarinus

    Rosemary is best known in the kitchen, but in Europe rosemary oil ointments and rosemary leaf baths are accepted as traditional remedies for minor muscle and joint aches, and many people find a warm, scented bath soothing after a long, strained day. This rests on long use rather than clinical trials, so it is best enjoyed as a comfort measure. Rosemary oil is for adults only, must never be swallowed, and is best avoided with a history of seizures, in pregnancy, and on broken skin.

    Read the rosemary monograph →

03 Caution

Using these herbs safely

Most back pain is not caused by anything serious and eases within a few weeks, but some symptoms need medical care quickly. Call 911 or go to an emergency department if back pain comes with numbness or tingling around the genitals, buttocks or inner thighs (the saddle area), new difficulty passing urine or loss of bladder or bowel control, or new weakness or numbness in the legs. These can mean cauda equina syndrome, a compression of the nerves at the base of the spine that needs emergency treatment to prevent permanent damage. Back pain after a serious fall or accident, or with chest pain, also needs urgent care. See a doctor promptly if back pain comes with fever or feeling unwell, a history of cancer, unexplained weight loss, pain that wakes you at night or is worse lying down, steroid use or injecting drugs, or severe pain that is getting quickly worse.

Willow bark contains salicylates, so it should not be combined with aspirin, NSAIDs such as ibuprofen or naproxen, or salicylate rubs such as wintergreen oil, and it adds to bleeding risk with anticoagulants such as warfarin and antiplatelet drugs such as clopidogrel. It should never stand in for aspirin prescribed to protect the heart. Devil’s claw may also affect warfarin, since one patient developed bleeding into the skin, and it can irritate the stomach, especially alongside NSAIDs or steroids; its effects on blood pressure and blood sugar are unpredictable, so people taking medicines for either should monitor their readings. On the skin, layering capsaicin with menthol, camphor or methyl salicylate rubs, or putting a heating pad over a plaster, raises the risk of burns. If you take prescription painkillers, muscle relaxants or blood thinners, a quick check with a pharmacist before adding a herb is worthwhile.

A few herbs carry specific warnings. Willow bark must not be used by anyone allergic to aspirin or other NSAIDs, or with aspirin-triggered asthma, active stomach ulcers, clotting disorders, or severe liver or kidney disease, and it must never be given to children or teenagers, because salicylates are linked to Reye’s syndrome, a rare but serious illness affecting the brain and liver. Comfrey is for external use only: never swallow it in any form, and use licensed ointments only on unbroken skin for short courses, because its pyrrolizidine alkaloids can cause serious liver damage. Capsaicin burns on contact with the eyes, mouth and genitals, so wash your hands well after applying it and never use it on broken skin. Peppermint and rosemary oils must never be swallowed, and rosemary oil is best avoided with a history of seizures. Devil’s claw should be avoided with stomach or duodenal ulcers, and anyone with gallstones should check with a doctor first.

Pregnancy and breastfeeding: back pain in pregnancy is common and worth discussing with a midwife or doctor. EMA does not recommend devil’s claw, medicinal peppermint oil or rosemary preparations, willow bark is generally avoided and must not be used in the third trimester, comfrey should not be used, and strong capsicum products over large areas are best discussed with a clinician first. Children: capsicum, willow bark, devil’s claw and rosemary oil medicines are for adults only, comfrey should not be used, peppermint oil products must never be used under age 2 or near a young child’s face, and back pain in a child deserves a medical assessment. Product quality matters: choose licensed creams and plasters with a stated capsaicinoid content, willow extracts that state their salicin dose, and devil’s claw that states its harpagoside content, and never make homemade pastes from kitchen cayenne, which can blister the skin.

04 Questions

Frequently Asked Questions

The best-supported options are applied to the skin or taken for a short time. Capsicum plasters and creams made from cayenne peppers probably relieve chronic low back pain better than placebo, according to a Cochrane review, and willow bark extracts are accepted in Europe as a well-established short-term treatment for low back pain. Devil’s claw has smaller, lower-quality trials. Staying active, heat and gentle exercise remain the foundations of recovery, and herbs work best alongside them.

It is best not to. Willow bark contains salicin, which the body turns into salicylates related to aspirin, so combining it with aspirin, ibuprofen, naproxen or other NSAIDs adds to the risk of stomach irritation and bleeding. Never use it in place of aspirin prescribed for heart protection, and avoid it entirely if you are allergic to aspirin or NSAIDs, have aspirin-sensitive asthma, or are under 18. If you take a blood thinner, ask your doctor first.

Follow the label of a licensed product, applying a small amount of cream or a plaster to clean, intact skin over the painful area. Expect warmth or stinging at first; that is how capsicum works, by overstimulating and then quieting pain nerves in the skin. EMA advises adults only and no more than three weeks of continuous use, followed by a break of at least two weeks. Wash your hands after applying it, keep it away from the eyes and broken skin, and never put a heating pad over it.

Call 911 if back pain comes with numbness around the genitals, buttocks or inner thighs, new difficulty passing urine or loss of bladder or bowel control, or new weakness or numbness in the legs, because these can signal cauda equina syndrome. Seek prompt care for back pain with fever, a history of cancer, unexplained weight loss, pain after a serious fall or accident, or pain that wakes you at night. Herbs such as devil’s claw are for everyday aches, not for these situations.

Several herbal rubs are traditional in Europe for aching muscles. Peppermint oil preparations feel cooling, rosemary oil ointments and baths feel warming, and comfrey root ointment is used for sprains, bruises and back pain, with one encouraging trial in acute back pain. Use licensed products on unbroken skin, avoid layering several rubs together, and keep them away from the eyes. Never swallow essential oils or comfrey, and keep menthol and peppermint oil away from babies’ faces.

05 References

Sources

These references support the claims in this guide. Each herb’s monograph carries its own full source list.

  1. Herbal medicine for low-back pain

    Cochrane Database of Systematic Reviews (PubMed 25536022), 2014

    Fourteen trials: moderate-quality evidence for capsicum cream or plaster and white willow bark, low-quality evidence for devil’s claw and a comfrey ointment, and no significant adverse events.

  2. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

    Annals of Internal Medicine (PubMed 28192789), 2017

    Supports starting with heat, massage, acupuncture or spinal manipulation for new back pain and exercise-based approaches for chronic pain, noting that most acute back pain improves over time.

  3. Back pain

    NHS, 2026

    Source for the advice to stay active and avoid long periods in bed, and for emergency signs including saddle numbness, bladder or bowel changes, and leg weakness or numbness.

  4. Low back pain - acute

    MedlinePlus, National Library of Medicine (NIH), 2026

    Lists red flags needing prompt care, including a history of cancer, fever, a severe blow or fall, loss of bladder or bowel control, pain that wakes you at night, and unexplained weight loss.

  5. Capsici fructus (capsicum)

    European Medicines Agency, 2015

    Well-established use of capsicum skin preparations for muscle pain such as low back pain, for adults only and no more than three weeks of continuous use.

  6. Salicis cortex (willow bark)

    European Medicines Agency, 2017

    Well-established use of willow bark dry extract for short-term low back pain in adults, with contraindications including salicylate or NSAID allergy, children and adolescents, and late pregnancy.

  7. Efficacy and safety of comfrey root extract ointment in the treatment of acute upper or lower back pain: results of a double-blind, randomised, placebo controlled, multicentre trial

    British Journal of Sports Medicine (PubMed 19460762), 2010

    The 120-person, five-day trial in which a comfrey root extract ointment reduced back pain on movement more than placebo.

  8. Low-Back Pain and Complementary Health Approaches: What You Need To Know

    National Center for Complementary and Integrative Health (NIH), 2020

    Notes that about 80 percent of adults have low back pain at some point and that topical cayenne may help relieve it.

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