According to songwriter Bruce Springsteen, the song came about from going through a rhyming dictionary in search of appropriate words. The first line of the song, "Madman drummers, bummers, and Indians in the summers with a teenage diplomat" is autobiographical—"Madman drummers" is a reference to drummer Vini Lopez, known as "Mad Man"; "Indians in the summer" refers to the name of Springsteen's old Little League team; "teenage diplomat" refers to himself.

Manfred Mann's Earth Band released a version of the song in 1976. Their recording of the song changes the lyrics. The most prominent change is in the chorus, where Springsteen's "cut loose like a deuce" is replaced with "revved up like a deuce." This is commonly misheard as "wrapped up like a douche". The lyric is actually a reference to a 1932 Ford "deuce coupe." Springsteen was fond of classic cars in his youth, hence the line "cut loose like a deuce, another runner in the night."

Springsteen himself has joked about the controversy, claiming that it was not until Manfred Mann rewrote the song to be about a feminine hygiene product that it became popular.