Production was handled by Tedeschi herself and her husband Derek Trucks, with George Drakoulias co-producing all tracks except "Butterfly". Upon its debut, Back to the River received favorable reviews from music critics. The album peaked at number one on the Billboard Top Blues Albums.
The album has received positive reception from critics. In a review for AllMusic, Steve Leggett praised Tedeschi's improved songwriting and called her singing "a wonderful instrument, strong and hushed by turns." The album was nominated for the 2010 Grammy Award for Best Contemporary Blues Album, her fifth Grammy nomination to date, but lost to her husband's Already Free.