Lower back pain when waking up isn't unusual. It's the most common form of musculoskeletal pain¹ adults experience. 84% of individuals² will experience it in their lifetime and, in 23% of them², it will be chronic.
In many cases, mild back pain and stiffness in the morning arise in response to strenuous activity the day before and sleeping in the same position. However, if this is a recurring pattern and beginning to impact your day, further investigations are necessary. If you ask yourself, "why is my lower back pain worse in the morning?", below are several common explanations.
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There are many different reasons why you may be experiencing lower back pain when you get up in the morning. However, the most common causes are environmental factors or physical issues.
Morning back pain, for many people, isn't a sign of a larger spinal problem but rather due to one or more common environmental causes, including:
Sleeping on an old, worn-out cratered mattress can aggravate your back. You'll experience better spinal support by sleeping on a firm or medium-firm bed.
One 2009 study³ shows that simply changing out your old mattress after 9.5 years can help to:
Reduce back discomfort
Improve the quality of sleep
Reduce stress symptoms
Poor sleep posture
When you sleep in an unsupportive position, it increases spinal pressure, leading to back pain. One common position that causes this is sleeping prone or lying on your stomach.
However, everyone will have their own preferred sleep position. Experimenting with varying sleep postures can reduce strain on your hips, neck, and lower back.
But, this doesn't mean you have to alter your normal sleeping position completely. Instead, you can try supporting your body better by placing a couple of pillows at strategic points while you sleep in your most comfortable position.
If you sleep on your back, try placing a pillow under your knees. This helps better align your spine to reduce pain.
If you sleep on your side, place a pillow between your legs, which can better align your spine and hips.
If you sleep on your stomach, place a pillow under your lower abdomen, which helps reduce excessive lower back curvature.
If using pillows doesn't improve your symptoms, you may want to start investigating the possible causes of your morning back pain.
Your ergonomics, such as bad posture while working or exercising, can expose your back to repetitive stress. A build-up of continuous strain can cause additional symptoms and pain, even leading up to nighttime.
If you've tried fixing potential environmental factors that may contribute to morning back pain with little success, your symptoms could be due to a medical condition. You should make an appointment with your doctor for a diagnosis and possible treatment.
There are a number of medical conditions that can cause lower back pain when waking up, including:
Degenerative disc disease generally occurs without any big triggering event. It is often a result of natural wear and tear and aging. Over time, the discs between your vertebrae begin to lose their ability to cushion and keep the spine flexible. This can lead to extreme discomfort and pain that worsens in the morning. In some cases⁴, disc degeneration doesn't cause any discomfort. The pressure inside your disc is greater upon waking up.
Your doctor may prescribe pain medication, physical therapy, or steroid injections to relieve your pain.
A herniated disc
Herniated discs occur when the material inside it begins to protrude. This is comparable to the oozing of jelly from a donut. The leaking insides of a herniated disc can compress structures around it, including nerves and the spinal cord. The pain you experience with a herniated disc can be worse in the morning due to the long periods of inactivity and poor positioning while you sleep.
Back pain is very common during pregnancy, especially in the later months⁵. However, some women can also have back pain in their early months.
During pregnancy, the increased weight in the stomach can strain your supportive lower back muscles. Repetitive stress and strain can carry over through the night and into the morning. Over time, muscle tightness and stiffness occur due to extra weight from the pregnant belly.
Some women can find relief through a range of strategies, including exercise, wearing a pregnancy belt, hydrotherapy, heat packs (away from the belly), and seeking physical therapy.
Some methods you can try to relieve your lower back pain in the morning include:
Stretch before getting out of bed. While you lie on your back, stretch your arms up over your head as far as possible. At the same time, stretch your feet out in the other direction. Now, draw your knees towards your chest and hold to stretch your lower back. You can also rock gently from side to side if it feels helpful for relieving your discomfort.
Then, sit up with your feet planted on the floor shoulder-width apart and stretch your arms to the ceiling and to the sides for an all-over stretch.
Exercising during the day is important for easing back pain. One of the best exercises you can do is walking⁶, which can help you to develop a resilient back. This can be achieved by aiming for 5,000-10,000 steps a day. If this is too much, try swimming to ease the stress on your back.
It's also important you take frequent breaks, particularly if you work in an occupation which involves lots of sitting (e.g., office work, driving, etc.). Every 30 minutes, stand up and stretch. You may want to consider a standing desk that will help keep your spine mobile at work.
3. Over-the-counter medications
Sometimes, moderate-to-severe back pain will require immediate relief. Talk with your doctor about possibly taking painkillers like ibuprofen or nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs also help reduce the inflammation that can contribute to your pain and discomfort.
TENS machines are a non-medicated option to help relieve lower back pain. These machines use electrical currents to block the pain signals to and from the brain to the affected area. Clinical reviews⁷ show TENS can help with severe chronic musculoskeletal pain, but individuals may need to build up a tolerance to the electrical currents over time. Consult with your doctor to see whether using a TENS machine may be beneficial for your back pain.
If you're suffering from morning back pain that doesn't get better with self-care measures, you'll want to speak with your doctor. It's essential that you seek medical treatment promptly if you're experiencing severe pain that makes your day-to-day movement and activities difficult.
You should also see your doctor right away if your back pain occurs alongside any one or more of these symptoms:
Weakness or loss of feeling in your legs or arms
Bladder or bowel problems
Shortness of breath
Severe and persistent night pain
Sudden fever accompanying lower back pain
Your doctor will likely review your symptoms and medical history and perform a physical exam. They may also suggest imaging tests, such as CT scans, X-rays, or MRIs, to help diagnose the underlying cause of your morning back pain.
Waking up with lower back pain is usually due to excessive strain on your body during the day or from bad sleeping habits. But, it can also be a sign of a specific medical condition, including degenerative disc disease or a herniated disc. If self-care measures (e.g., changing your mattress, adjusting your sleep posture, etc.) do not assist, it may be worthwhile consulting your doctor. Additionally, see your doctor if you're experiencing severe back pain that limits movement or affects your ability to perform essential day-to-day activities.
Non-specific low back pain (2012)
Back pain during pregnancy | The American College of Obstetricians and Gynecologists
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