Lower back pain is an extremely common condition, which can have a variety of causes and can also lead to pain in the hips. It is one of the most common reasons why people seek medical advice.
In some cases, your back and hips might hurt more when you are lying down. Why is that, and what can you do about it?
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Low back pain refers to any pain that you feel in the lower part of your back, and can sometimes spread into your hips. In addition, it could manifest as your back feeling stiff, causing you difficulty in standing straight, or suffering decreased movement in your back. For example, you may not be able to bend over as far as previously and may have difficulty getting in and out of chairs.
Back pain that gets worse when lying down can be a major problem, making it hard for you to sleep. In some cases, you may only feel pain when lying down. Your back pain might also get worse in the morning, i.e., after you have been lying still all night.
In most cases, back pain gets better when you lie down. Lying down reduces the strain on your spine and the pressure on discs. However, if it feels worse when lying down, some specific conditions might be suspected.
Back pain that gets worse when lying down should be taken more seriously than back pain which gets worse in other positions. Back pain that gets worse when sitting is often a herniated disc, as sitting puts more pressure on the spine and discs. Herniated discs are relatively simple to treat and generally get better quickly.
Some things which can cause pain when lying down:
Ankylosing spondylitis (AS) is a form of arthritis that primarily affects the spine. Inflammation and swelling develop between the vertebrae, causing severe, chronic pain. Because swelling tends to get worse with immobility or inactivity, AS is often worst when you first get up in the morning or if you lie still for too long.
AS can run in families and typically develops in adolescence or early adulthood but may be triggered by an infection or other environmental factors. Risk factors are family history and frequent gastrointestinal infections. There is no cure for AS, but there are treatments to manage the pain.
Sciatica happens when a herniated disk, bone spur, or alteration of the spine compresses part of the nerve that runs from your lower back to one leg. A diagnostic feature is that the pain radiates down the back of one leg.
It’s common for sciatica to get worse in certain positions, such as sitting, because of increased pressure on the affected nerve, though it can sometimes get worse when lying down. You might be able to get relief from pain by changing your position or by using pillows to position yourself into a sleeping position that doesn't aggravate your sciatica.
Mild sciatica usually goes away over time, but if it lasts longer than a week or is worsening, you should see your doctor.
Most mothers experience back pain¹ as pregnancy progresses due to the extra weight and hormonal changes that affect body joints to prepare the body for childbirth. There is a theory that pain that gets worse at night may result from the uterus pressing on the vena cava (a large vein found below your diaphragm) when lying down, which causes venous congestion and hypoxia.
Many pregnant people don't bother getting medical attention as back pain is considered "normal" during pregnancy, and treatment options are limited. However, low-intensity exercise and stretches, as well as massage and acupuncture, can help. Typically, back pain in pregnancy goes away after your child is born.
Infections of the spinal canal or adjacent soft tissues are more likely to cause pain that worsens when lying down due to pressure put on the spine. Spinal infections are serious but, fortunately, very rare.
You should not immediately assume that back pain that gets worse when lying down is a spinal infection, but it is a good reason to get yourself checked, just in case.
Risk factors include diabetes, HIV infection, organ transplantation, or recent back surgery. Rarely, an infection can be caused by a urological or dental procedure or from IV drug use, as the bacteria which might be present in the bloodstream following these situations can spread to the back.
If you have a fever, bowel/bladder dysfunction, or weakness of your arms and/or legs, you should seek emergency medical care.
Spinal tumors² may be benign or malignant (cancerous), and they generally affect either the covering of the spinal cord or the spinal cord itself. Most tumors grow outside of the dura, which is a layer of thin tissue covering the spine. Cancers elsewhere in the body can spread (or metastasize) to the bones of the back, particularly lung, breast, and prostate cancer.
It is very rare for low back pain to be the result of cancer, and when it is, the pain generally worsens with both activity and when lying down. A tumor might be expected if you also have other concerning symptoms such as back stiffness, loss of bowel or bladder function, loss of sensation, or weakness in the legs, arms, or chest.
Most back pain is due to a simple problem such as a muscle sprain or spasm. Back pain may increase when lying down simply because the pressure is put on the injury.
Back pain after a fall may worsen when lying down for similar reasons or merely because of nasty bruising that responds to pressure. This kind of back pain typically resolves quickly with time, over-the-counter painkillers, and stretching.
You should still check with your doctor if you have back pain at night to make sure it is not a more serious problem.
If you have a fever or loss of bowel and/or bladder function, back pain is an emergency regardless of when it occurs.
In most cases, back pain is temporarily relieved by lying down. In some cases, however, this can cause it to get worse. This is usually because of pressure on an injury, but it can be a red flag for more serious conditions.
It's a good idea to check with your doctor if you have back pain that gets worse when lying down, especially if it hasn't resolved after a week. In most cases, your back pain will not be due to something serious, but it's always a good idea to check with your medical professional if you develop back pain. If you are pregnant, your doctor can make suggestions to help relieve your back pain until the baby is born.