Morning Back Pain

There are many options when it comes to morning back pain.

Causes of Back Pain

Back pain in the morning is a common complaint, but back pain every morning is a cause for seeking treatment. The pain may affect the entire back, or it may just be lower back pain every morning. First of all, it is important to understand how the back is constructed. It contains bones, joints, nerves, and muscles, and this complex structure may make it difficult to find the source of the pain. While serious injuries or disease can be the underlying problem, more often it is minor strains, sprains, and irritated nerves that are at the root of the back pain. Bending in an awkward position, lifting, pulling, carrying, or pushing heavy objects, slouching, twisting, overstretching, sitting for too long of a time, or a repetitive strain overusing muscles can all lead to back pain. For some patients, waking up in the morning brings back pain, and they may not know why. Patients most at risk for back pain include the overweight, smokers, pregnant women, those who practice long term use of certain medications (ex. corticosteroids), patients with depression, and those who are under stress. Particular medical conditions known to trigger back pain are prolapsed or slipped disc, sciatica, joint pain from arthritis, shoulder pain from a frozen shoulder, headaches, stiffness, and back or neck pain from whiplash, spinal fracture, infection, or cancer.¹

Morning Back Pain Issues

Having back pain in the morning may seem minor, especially as the symptoms subside towards the evening, but it is frustrating when the pain recurs each day. Quality of sleep reduces, and this impacts daily activities. Some serious conditions that lead to low back pain include osteoarthritis, rheumatoid arthritis, fibromyalgia, osteoporosis, spinal stenosis, and ankylosing spondylitis. The most common causes of morning back pain are “muscle imbalances and poor conditioning of these muscles”. As a result, there can be joint, disc, and vertebrae issues. For example, “a muscle imbalance in the lumbar area will cause a disc problem which may cause a nerve problem” that leads to spasms and stiffness.² There are several misunderstandings with regard to morning back pain, the first of which being that “morning low back pain is just in the morning”. The pain is actually present throughout the day, but it is just worse in the morning. The inflammation, damage, and wear are still happening all day. The body’s natural painkillers create some numbness, but eventually fatigue catches up and the pain flares up again. Another misconception is that “back pain is normal, comes with age and is manageable”. Lifestyle, activity, genes, diet, injury, and disease all factor in when it comes to back pain. Age is a factor, but it isn’t the only one, and not everyone has chronic back pain. Some may feel that occasional exercise and enough rest is the cure for morning back pain, but “too much rest and improper exercise can contribute to further injury”. Temporary measures do not resolve the problem. Those who suffer from back pain may feel that the room’s environment, pillow, or bed are the problems. While they do affect quality of sleep and comfort, and they are important, they can only manage or reduce skeletal or muscular pain, which also need to be addressed. “Rest, ice head and medication” are not the only solution, either. They just reduce the severity of symptoms. Exercise is important, too, but only if it is done correctly.³

Traditional Treatments

To treat lower back pain in the morning, or back pain in general, patients may try various pillow adjustments for proper alignment, constantly readjusting the body while sleeping, seeking the best mattress, padding, or pillow, adjusting the climate or clothing while sleeping, or even looking into over-the-counter medications or muscle relaxants.⁴ It is necessary to find the proper sleeping position. For example, the “fetal position” is healthy, so long as it is done properly. The legs should not be too straight or too bent, and the lower back should not be overly arched or rounded. In addition, the shoulders shouldn’t be overly hunched so that the head is bent too far forward or back. Putting a pillow between the knees helps. If a patient sleeps on the back, putting a pillow beneath the knees is helpful, and the head should not be elevated too much. Sleeping on the stomach is typically not recommended, but if a patient does that anyway, putting a towel or very thin pillow under the groin or stomach will help to push the lower back into proper alignment.⁵ Many feather pillows do not provide enough neck support. For some patients (side and back sleepers), a cervical pillow is helpful. A medium-firm mattress may also be beneficial, and it is important to replace the mattress every 10 years. When getting out of bed, the best method is “to roll onto your side and use your arm to push up from the side-lying position”, then “scoot to the very edge of the bed and get up using your legs”.⁶ More serious back pain does need to be addressed by a healthcare professional, though, such as a fractured spine, or “incontinence and/or true numbness around the groin and buttocks”. Spinal cord compression and injury are very serious, but rare, conditions. Other “red flags” include unexplained chills or fever, weight loss, steroid use, drug abuse, autoimmune disease, symptoms that spread to both legs, a dragging foot, or severe upper back pain.⁷

Chiropractic and Massage for Morning Back Pain

Chiropractors can help patients with low back pain in the morning, or with musculoskeletal issues overall. Like physical therapists, they can help patients with flexibility, such as in the trunk and hips. When lying on the back at night, the hips “do not have adequate extension range of motion” and “the tightness in the hips will tug or pull on the lower back” causing pain. Or if the hips are flexible, the spine may not be. Over time, the stiffness leads to back pain. Swimming, elliptical training, and walking are good exercises for back pain to build healthy joints. Cycling can lead to an awkward position for the spine and running may be too much impact. The low-impact forms of aerobic exercise help the blood flow to the spinal tissues. Exercise balls can be useful in improving flexibility. It is important to stay well-hydrated. Some patients may benefit from supplements or dietary changes.⁸ Manual therapies that are used by chiropractors are “generally effective for the treatment of lower back pain”, and for radiculopathy and neck pain. Treatment methods include spinal manipulation, manual manipulation, and mobilization to increase range-of-motion.⁹ Morning lower back pain and muscle issues can also be treated with massage therapy. For lower back pain, the massage therapist should concentrate on the “quadratus lumborum (QL) and the gluteus medius” for 60 minutes. The QL needs to be massaged and stretched simultaneously. QL irritation is typically caused by leaning over and lifting or sitting in a slumped position. The QL is massaged while the patient lies on their side. The gluteus medius, a buttocks muscle, compensates when the QL (which “connects the last rib to the pelvis”) is dysfunctional. The gluteus medius can be worked on also by massaging and stretching at the same time, as the patient lies on the stomach.¹⁰