Lower Back Pain When Lying Down: What You Need To Know

We all look forward to lying down or relaxing at night after a long, busy day. This allows us to rest and will enable the body to recover. Unfortunately, lower back pain when lying down can make it difficult to relax, and it may interrupt your ability to perform daily activities or even sleep well. Poor sleep can intensify pain symptoms and contribute to several other problems such as weight gain, diabetes, and heart disease.

If you have been experiencing lower back pain when lying down, don’t ignore it. There are preventative measures you can take to help resolve it. This article explains all you need to know about managing lower back pain when lying down.

What causes lower back pain when lying down?

Strain or sprain

Lumbar strains are among the most common causes of low back pain when lying down. This issue occurs when the back muscles are overstretched or forced into an awkward position. Lumbar sprains describe overstretching or tearing of the spinal ligaments; these structures are tough bands of tissue holding the bones together.

Strains and sprains are two different injuries but are difficult to tell apart due to similar symptoms. As a result, the outlook and treatment for these two conditions are similar despite involving two different structures.

Unlike other spinal conditions that also cause problems down the legs, lumbar strains and sprains are usually only felt in the back. Common symptoms include muscle spasms, pain around the lower back/pelvis, stiffness, and difficulty moving.

In most cases, people develop lumbar strain or sprain when performing tasks that impact their back, such as lifting heavy objects or sudden forceful movements. The recommended way to treat lumbar strain or sprain is physical therapy. Light and gentle movements are proven strategies for restoring movement and resolving lower back pain.

Ankylosing spondylitis (AS)

Ankylosing spondylitis is a rare form of arthritis that can cause lower back pain when lying down. It causes chronic inflammation affecting the neck and back. If the condition is severe, the spine's bones can fuse (known as ankylosis), causing it to become stiff and rigid.

The initial symptoms of ankylosing spondylitis are pain and stiffness in the low back region. Most people are diagnosed before the age of 30¹.

The symptoms can also travel to other parts of the body, including the neck, shoulders, and hips. Since ankylosing spondylitis can affect the whole body, you may also develop fatigue, fever, or inflammatory changes.

Treatment for ankylosing spondylitis focuses on reducing stiffness, pain, and inflammation and involves medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). However, exercise is also critical in treating the problem since not staying active may worsen the pain. 

Spinal osteoarthritis

Spinal osteoarthritis occurs when the cartilage between the discs and vertebrae of the spine begins to break down. The deterioration is often a gradual process and causes the gaps between vertebrae to narrow. Bone spurs (osteophytes) develop and, as the bones rub against each other, the joints connecting the spine's vertebrae become inflamed, leading to more advanced joint degeneration.

Osteoarthritis typically develops over time and can be triggered by different factors, such as being overweight or repetitive spine trauma. A family history of spinal osteoarthritis is also a risk factor.

The symptoms of spine osteoarthritis include stiffness, loss of flexibility, and pain around the spine. Treatments for this condition include physical therapy, heat and cold therapy, massage, and medications such as opioid analgesics and NSAIDs.

Spinal tumor

Pain from a spinal tumor may intensify when lying down due to the increased pressure on the affected area. A spinal tumor is a mass of abnormal cells surrounding or in the spinal column. These tumors can weaken or compress the structures in the back, which leads to back pain. These conditions can also eventually lead to spinal instability, compression of nerves, or spinal fractures.

Tumors are classified as intramedullary (growing within the spinal cord) or extramedullary (growing on the membrane around the spinal cord or the nerves coming out of it).

Tumors can develop in the spine or spread from other areas like the prostate, lungs, or breasts. However, this condition is rare compared to the other causes of lower back pain listed here.

Sciatica

Sciatica may be behind your lower back pain when lying. Structures in the lower back can pinch the sciatic nerve during certain sleep positions and lead to shooting pain down the legs.

Sciatica is a pain resulting from irritation or injury to the sciatic nerve. The sciatic nerve consists of three nerve roots from the sacrum (tailbone) and two from the lumbar (lower back) region. It is the thickest and longest nerve in the body – almost the width of a finger – which explains why it is so easily irritated or pinched.

A person with sciatica may experience mild to severe pain along the course of the nerve at any point from the lower back, hips, buttocks, and down the legs. Additionally, it can cause muscle weakness in the foot and leg and unpleasant tingling from pins and needles down the whole leg.  Some people describe sciatica pain as sharp, shooting, stabbing, electric, or burning.

The risk factors for this problem include lack of core strength, being overweight, poor general health,  previous spinal injuries, diabetes, being inactive, and smoking. Physical therapy and exercise can also help manage this condition.

How to treat lower back pain when lying down

You can use some basic remedies to effectively treat mild or acute low back pain when lying down; these include:

Change your sleeping position

You may not have to change to an entirely new sleeping position, but simply make some adjustments to how you sleep in that position.

For example, back sleepers can place a pillow under the knees while lying comfortably flat on their back to ensure the spine stays neutral. Sleeping on the back distributes weight evenly and provides better support, reducing stress on the joints.

Stomach sleepers should place a pillow below their lower abdomen and pelvis. This method is recommended to improve pain from certain spinal conditions and allow you to continue sleeping comfortably on your stomach if that is your preference.

Sleeping in the fetal position can also help relieve lower back pain when lying down. Here, you lie on your side and tuck your knees slightly to your chest so that your body is curled into position.

Another recommended position is sleeping on your side. Whether left or right, allow your shoulders and the rest of the body to lie comfortably on the mattress. Place a body pillow between the knees and a small one (or rolled-up towel) between the mattress and waist for support.

Finding the correct alignment and position could be your pathway to relieving lower back pain when lying down. Regardless of your preference about sleep position, there are ways to make small changes that can lead to major improvements.

Heat or ice therapy

You can treat lower back pain when lying down by using heat or ice therapy. The heat from a hot water bottle, warm bath, chemical or adhesive heat wraps, or electric heating pad can improve blood flow and relax tense muscles. When blood flows freely, the muscles get the oxygen and nutrients they need for recovery.

Ice packs can also help if inflammation is the main reason for your lower back pain when sleeping. Although, be aware that they can cause the muscles around the spine to stiffen up. Additionally, you should protect your skin from long exposures to ice or heat to prevent tissue damage. Some people have also reported benefits from alternating heat and cold treatment.

How to help prevent lower back pain when lying down

Exercise

One way of preventing lower back pain is getting up and moving. Prolonged rest can lead to deconditioning and muscle weakness, whereas being physically active helps strengthen the body. Additional benefits of exercise include weight management, keeping the joints lubricated, and general wellbeing.

While there are many different types of beneficial exercise, below are just some examples for managing lower back pain:

Bridges

This exercise works on the gluteus maximus, one of the largest muscles in the body that is responsible for hip movement and core stability. Lower back pain may occur if this muscle is weak or not functioning correctly.

You can start the bridge lying on your back, knees bent and feet flat onto the ground. Keeping the upper back and arms resting against the ground, push your feet through the floor and lift your bottom off the ground.

Drawing-in maneuver

This exercise specifically works on the transversus abdominis, an important muscle that supports the spine and abdomen. The drawing-in maneuver involves lying on the floor with the feet flat on the ground and hip-width apart. Following this, gently draw the belly button towards the spine.

Partial curls

This exercise strengthens the core muscles, such as the transversus abdominis and rectus abdominis. These two abdominal muscles support the spine, maintain proper postural alignment, and contribute to the body's overall stability.

The exercise involves lying on the ground with feet flat and knees bent. Brace the abdominals by pulling your belly button in towards the spine and lift the shoulders off the floor slightly to contract the muscles.

Improve your diet

You can prevent lower back pain when lying down by maintaining good eating habits, mainly by consuming anti-inflammatory foods. This allows you to maintain a healthy weight to avoid putting unnecessary stress on the body.

Your diet should contain a balance between fresh fruits and vegetables, dairy products, lean meats, and whole grains. However, try to seek the assistance of a qualified dietitian or nutritionist to cater to your individual needs.

Reduce stress

Stress can impact back health without you even realizing it. Research² has shown that being stressed is associated with lower back pain. How it’s related is not definitively known, but it could be related to compensating body movements (e.g., regularly shrugging your shoulders) and increased pain sensitivity.

Activities that help reduce stress can also help prevent lower back pain. Examples include meditation, deep breathing, yoga, guided imagery, and tai chi.

Quit smoking

Smoking increases the risk of certain cancers and heart disease, but people don't realize it also affects the back. Smoking worsens back pain due to several factors, such as increased inflammation and reduced blood flow to healthy joints. When blood vessels are narrow, fewer nutrients and oxygen reach the spine, increasing susceptibility to injury.

Maintain proper posture

Sitting for 7-8 hours a day can cause stress and strain on the back. Consider maintaining a proper posture by working at an ergonomically correct workstation, whether at home or the office. Good posture helps maintain the natural curves of the back and ensures it remains comfortable. Additionally, break up long periods of sitting in front of a computer with stretching exercises.

When should you see a doctor for your lower back pain?

You can try home remedies to lower back pain when lying down. But if the pain constantly wakes you from sleep or prevents you from sleeping, it is time you seek medical help.  Sometimes low back pain may also present as stiffness or reduced movement, and it’s important to report these symptoms to your doctor or health professional.

There are circumstances where you should seek medical help if you experience specific symptoms, including:

  • Signs of an infection such as swelling, redness, or fever

  • Numbness, weakness, or tingling in the lower body

  • Pain that continues to worsen over a few days 

  • Symptoms radiating to other body parts, such as the buttocks and legs

The doctor can treat you or refer you to a specialist if symptoms are severe or other treatments are not working.

The lowdown

Experiencing lower back pain when lying down can be pretty frustrating since the pain disrupts your ability to get the sleep your body needs to recover. So, you should seek medical advice if lower back pain constantly wakes you up at night or concerning symptoms develop. A healthcare professional can help relieve your pain to ensure you get restful sleep.


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